Citation Nr: 18159274 Decision Date: 12/18/18 Archive Date: 12/18/18 DOCKET NO. 13-23 961 DATE: December 18, 2018 ORDER Entitlement to service connection for a heart disability is granted. Entitlement to an initial rating of 100 percent for posttraumatic stress disorder with major depressive disorder and moderate alcohol use (hereinafter “PTSD”) is granted. Entitlement to a total rating based on individual unemployability due to service connected disability (TDIU) is dismissed as moot. FINDINGS OF FACT 1. The Veteran had active service at the Korat Royal Thai Air Force Base (RTAFB) in the Vietnam era. 2. The Veteran’s duties at the Korat RTAFB during the Vietnam era took him near the base perimeter, and herbicide agent exposure is accepted on a facts-found basis. 3. The Veteran has a current diagnosis of coronary artery disease that is presumed to be related to herbicide exposure sustained in service. 4. For the entire period on appeal, the occupational and social impairment resulting from the Veteran’s PTSD has more nearly approximated total. 5. As of the date of this decision, for the entire period on appeal, the Veteran has a schedular rating of 100 percent. CONCLUSIONS OF LAW 1. The criteria for service connection for a heart disability have been met. 38 U.S.C. §§ 1110, 1112, 1113, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2018). 2. The criteria for an initial rating of 100 percent for PTSD have been met or approximated for the entire period on appeal. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.7, 4.130, Diagnostic Code 9411 (2018). 3. The Veteran’s claim for entitlement to a TDIU is moot. Vettese v. Brown, 7 Vet. App. 31 (1994); Holland v. Brown, 6 Vet. App. 443 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from February 1966 to February 1969. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from August 2010 and November 2017 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO). In connection with this appeal, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge in March 2018 and accepted that hearing in lieu of an in-person hearing before a member of the Board. A transcript of that hearing has been associated with the claims file. 1. Service Connection – Heart Disability The Veteran has asserted that he has a heart disability that is etiologically related to his active service. Specifically, the Veteran has asserted that his heart disability is due to herbicide agent exposure. In this case, the Veteran did not have service in the Republic of Vietnam, rather he has asserted that he served at Camp Friendship Korat Royal Thai Air Force Base (RTAFB), and Camp Vayama. He claims that he was exposed to herbicide agents during his service in Thailand. VA concedes herbicide agent exposure for United States Air Force Veterans who served in Thailand during the Vietnam era at certain RTFABs, to include Korat RTAFB, if they served as security policemen, security patrol dog handlers, members of the security police squadron, or otherwise near the air base perimeter as shown by evidence of daily work duties, performance evaluation reports, or other credible evidence Per his military personnel record, the Veteran’s military occupational specialty (MOS) was a Lineman. As the Veteran did not work with Air Force security, the Board must determine, based on evidence of daily work duties, performance evaluation reports, or other credible evidence whether the Veteran’s regular duties placed him on or near the perimeter of the base. In a March 2010 memorandum, VA was unable to document or verify that the Veteran was exposed to herbicide agents during his service in Thailand. In written correspondence and sworn testimony before the Board, the Veteran has asserted his duties at Korat RTAFB caused him to regularly be at the perimeters of the base. Moreover, the Veteran has asserted that he worked outside of the base and in the jungle between bases, where herbicide agents were sprayed to control vegetation near the communication lines. Further, the Veteran has submitted photos taken during his service in Thailand that show a lack of vegetation near and around the pole lines, and to show that his duties required him to go to the base perimeters as well as off base. He asserts the lack of vegetation shown in his submitted photographs was as due to herbicide agent use in those areas. In support of his claim, the Veteran has submitted several lay statements from his fellow servicemembers. In those statements it is asserted that the duties as a “pole lineman” required activity at the perimeter of the base, both on and off base, and sometimes in the jungle. Notably, in May 2016 lay statements, Mr. G.B. and Mr. D.P. asserted that the Veteran would have been on the same perimeters as Military Police, as well as deeper into the roads, byways, and clearings to service the lines of communications at both Camp Vayama and Korat RTAFB. Further, in a November 2017 lay statement, Mr. C.M. stated that he served with the Veteran at Korat RTAFB. Mr. C.M. stated that their duties took them to “every part of the Army and Air Force Bases,” and that the linemen were “every place the Military Police were and also further into the jungle.” In considering the Veteran’s MOS of Lineman, his active service at the Korat RTAFB during the Vietnam War era, his statements of performing his duties on communication lines on and near the perimeter of the base, and the corroborating statements of the Veteran’s fellow servicemembers; the Board finds that evidence is, at the very least, in relative equipoise as to whether the Veteran served at Korat RTAFB near the perimeter of the base. Therefore, the Board will resolve all doubt in favor of the Veteran in finding that he worked near the Korat RTAFB perimeter. Accordingly, his exposure to herbicide agents in Thailand is conceded on a factual basis. A review of the record shows that the Veteran was diagnosed with coronary artery disease in 1992. Coronary artery disease is considered as a form of ischemic heart disease for purposes of presumptive service connection due to exposure to herbicides. 38 C.F.R. § 3.309(e) (2018). In sum, the Veteran is presumed to have been exposed to herbicides while serving in Thailand, and he has a current diagnosis of heart disease. Therefore, the Board finds that the preponderance of the evidence is for the claim and entitlement to service connection for a heart disability is warranted. 38 U.S.C. § 5107 (b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Increased Rating – PTSD The Veteran has asserted that he should have a higher rating for his PTSD as his symptoms are worse than those contemplated by the currently assigned ratings. In sworn testimony before the Board in March 2018, the Veteran stated that his PTSD symptoms were as follows: quick to criticize others; inability to work regularly; struggling with activities of daily living, including flossing his teeth; chronic sleep disturbances; memory loss; anger; alcohol abuse; avoidance of social situations; and isolation. Notably, the Veteran testified to an incident when he “got 8,000 pennies and dumped them” through a mail slot during a dispute with City Hall. He reported his symptoms had continually worsened since the 1970s. Moreover, the Veteran testified that due to his PTSD symptoms, that if he “had a car here with a bottle of gin in it,” he would leave the Board hearing to go drink. Of record is a July 2018 private psychological evaluation by Dr. Q.A-S. At that time, the Veteran presented with chronic moderate to severe depression and further PTSD symptoms. His affect was labile. The Veteran was noted to minimize difficulties and avoided discussing emotions and experiences to any depth. He was noted to have chronic difficulty articulating his emotional state and experiences. He reported severe and frequent ruminations about his military experiences, flashbacks that interfered with his daily functioning and caused significant distress, severe mood symptoms, drinking to avoid his feelings, considerable psychomotor slowing, and considerable financial and interpersonal difficulties. Dr. Q.A-S. noted that the Veteran’s PTSD symptomatology have continued without any significant improvement since at least 2014. The Veteran was noted to have obsessions, procrastinations, fears of getting things incorrect, a possible obsessive-compulsive disorder, and chronic hypervigilance. Dr. Q.A-S. noted that the Veteran fixated on correctness, and that to the Veteran doing things correctly represented safety. He was fixated on the belief that had things been done correctly in Thailand, his fellow servicemember would not have been electrocuted. He had a continued need for rigid rules and vigilance. The Veteran acknowledged an ongoing difficulty with alcohol dependence, and reported that his alcohol use was “pretty bad,” and that he drank daily. He reported he would wake at night to drink due to experiencing withdrawal symptoms. His withdrawal symptoms included tremors, sweatiness, feelings of panic, and other physiological alcohol withdrawal symptoms. He reported that he drank one bottle of wine, or six individually packed six-ounce bottles of wine, or six to eight gin drinks a day. Upon mental status examination, the Veteran presented as alert and oriented to time, place, and person. His speech was notable for being slowed, with lengthy pauses and response delay. He presented with an odd cadence to his speech. His over all manner of relating was good. He reported he still enjoyed photography. He stated he spent most of his time alone. He reported his only hobbies were “fucking and gambling,” but that he could no longer do either. He stated he had not been sexually active in many years, and that his wife slept in a separate room. He stated he could not financially support gambling, nor did he have any motivation to gamble. The examiner noted that the Veteran’s “sudden profane outburst regarding these interests demonstrate[d] difficulties with impulse control and appropriate social behavior.” The Veteran reported feeling numb, low motivation, and general disinterest. He could not finish things and had poor concentration. He had profound lack of motivation and vegetative symptoms. His wife was responsible for all the financial management for the family. He had very poor sleep, considerable recurring nightmares, and brief suicidal ideation. He regularly overreacted. He denied any history or present homicidal ideation. The Veteran had severe, unremitting, and crushing guilt. He continued to ruminate and fixate over the deceased Thailand soldier. He felt an intense level of responsibility towards that soldier’s family. The Veteran reported his depression had worsened due to attending nine funerals in nine weeks. He reported that on a daily basis, he thought about the situations over his lifetime that had been traumatic and heartbreaking. He felt that those experiences continued to add up and impact him. Dr. Q.A-S. noted that the Veteran was preoccupied with his experiences in the Army and that “even the most minor stimuli tend to spark intrusive and overwhelming recollections.” Further evaluation showed the Veteran to have severe PTSD symptoms. He endorsed avoidance in thinking or talking about stressful military experiences; hypervigilance; being easily startled; moderately severe experiences with repeated and disturbing memories of his military experiences; nightmares; intense and very realistic flashbacks; loss of interest in others; feeling distant and cut off from people; emotional numbing; irritability; feeling overwhelmed by his emotions; negative thought or feelings that became chain reactions; suspiciousness; distrust of others; being highly alert; chronic irritability; being hypercritical of others; and highly avoidant of conflict. No signs of psychosis or delusion were found. He had clear and linear thought processes. He denied any hallucinations. His symptomatology did not rise to outright paranoia. Dr. Q.A.-S. diagnosed the Veteran with PTSD, severe; major depression, severe, recurrent, without psychotic features; and alcohol dependence. Dr. Q.A.-S. opined that the Veteran was “100% disabled,” and that he had total occupational and social impairment, noting that the Veteran was “grossly impaired, especially in the social domain, unable to tolerate interpersonal contact of any level.” All the Veteran’s relationships were noted to be marginal or nonexistent, including those with his providers and wife. He was unable to tend to his community or daily living support needs. He was unable to pay bills, shop, or cook. Dr. Q.A.-S. opined that with the Veteran’s wife, it would be unlikely that the Veteran “would be able to even remain marginally clean, housed, and fed.” Further, although the wife provided support, they did not engage as a couple. The Veteran was noted to have “persistent grossly inappropriate behavior including irritability and disregard for his basic safety and social needs.” His depression involved “severe vegetative symptoms,” and he disregarded his medical needs entirely. He was noted to be an exceptionally high risk of medical complications from alcohol withdrawals or cardiac disease, which were the result of his own medical self-neglect or alcohol abuse. Those behaviors were noted to be as due to his depression and PTSD. Dr. Q.A.-S. opined that the prognosis for the Veteran was poor, and that he was “putting his life at risk” with his behaviors. He was found to not be medically safe to detox at home, and would have been best served with inpatient admission. Dr. Q.A.-S. determined that the Veteran was “100% disabled by virtue of his psychiatric conditions,” and was totally unemployable. Further, even with “intense close supervision and treatment, [the Veteran’s] disability level [was] unlikely to remit appreciably such that he could sustain even modest levels of employment.” VA Medical Center mental health treatment records during the appellate period, as well as the various VA examination reports indicate, in particular, severe depression; unemployment; interrupted sleep and chronic sleep disturbances; irritability; recurrent distressing dreams; avoidance behaviors; persistent negative emotional state; persistent distorted cognitions about the cause or consequences of the traumatic event; outbursts; impaired impulse control; significant familial and social impairment; marital problems; feelings of alienation; being estranged from his family and friends; frequent thoughts of the traumatic event; feeling sad and guilty; emotional numbing; lack of interest in previously enjoyed activities; exaggerated startle response; emotional numbing; feelings of being overwhelmed; distrust of others; suspiciousness; hypercritical of others; avoidance of conflict; excessive alcohol abuse and dependence; financial issues; hypervigilance; nervousness; interpersonal problems; anxiety; short temper; generalized anger; increased activity during sleep, including sleep walking; frequent thoughts about the military trauma; arousal; trouble remembering aspects of the trauma; racing thoughts; difficulty with concentration; difficulty with attention; lack of interest in previously enjoyed activities; restlessness; low energy; periods of notable high energy and productivity; feelings of a foreshortened future; impaired thought process or communication; panic attacks; loss of motivation; racing heart or palpitations; feelings of helplessness; inability to rest; bankruptcy; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances, including work or a work like setting; and an inability to establish and maintain effective relationships. Further, a review of the record shows that the Veteran has chronic issues with maintaining regular employment. VA treatment records routinely indicate that the Veteran is unemployed. The Board finds that the Veteran is entitled to an initial 100 percent rating for his PTSD for the entirety of the appeal period. In this regard, the Board finds that the Veteran is considered to have total occupational and social impairment. For the entire appeal period, the Veteran has been shown to have significant symptoms of anxiety, alcohol abuse, unemployment, and an inability to establish and maintain effective relationships. Specifically, the Veteran has consistently experienced issues with work and relationships due to his psychiatric symptomatology, which include being estranged from his wife. The Veteran has experienced significant alcohol abuse. The Veteran’s psychiatric symptomatology has consistently been shown to have major effects in his judgement, his mood, his ability to maintain hygiene, and his ability to interact appropriately in social situations. Further, the Veteran’s symptoms have been relatively consistent throughout the entire period on appeal. Therefore, the Board finds that entitlement to an initial 100 percent rating is warranted for the entire period on appeal. 38 C.F.R. § 4.130, Diagnostic Code 9411. The Board acknowledges that the results of the VA examinations, the symptoms described in the VA examination reports, private psychological evaluation, and the VA Medical Center mental health treatment records do not indicate that the Veteran has experienced all the symptoms associated with a 100 percent rating for PTSD. However, the symptoms enumerated under the schedule for rating mental disorders are not intended to constitute an exhaustive list, but rather are intended serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular disability rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Accordingly, the Board finds that the preponderance of the evidence is for the claim and entitlement to a 100 percent rating is warranted even though all the specific symptoms listed for that rating are not manifested. 38 U.S.C. § 5107 (b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 3. Entitlement to a TDIU The Veteran has asserted that he is unable to work as a result of his service-connected PTSD. As stated previously, the Veteran has been awarded an initial rating of 100 percent from for PTSD. The United States Court of Appeals for Veterans Claims (Court) has recognized that a 100 percent rating under the Schedule for Rating Disabilities means that a Veteran is totally disabled. Holland v. Brown, 6 Vet. App. 443, 446 (1994), citing Swan v. Derwinski, 1 Vet. App. 20, 22 (1990). Generally, if VA has found a veteran to be totally disabled as a result of a particular service-connected disability or a combination of disabilities pursuant to the rating schedule, there is no need, and no authority to otherwise rate that Veteran totally disabled on any other basis. Herlehy v. Principi, 15 Vet. App. 33, 35 (2001). However, a grant of 100 percent disability does not always render the issue of TDIU moot. In Bradley v. Peake, 22 Vet. App. 280 (2008), the Court determined that a separate TDIU rating predicated on one disability may be awarded if that disability is not ratable at the schedular 100 percent level. However, a separate TDIU rating cannot be awarded based on one service-connected disability if the Veteran is already receiving a 100 percent schedular rating for that disorder. Buie v. Shinseki, 24 Vet. App. 242 (2010). In this case, the Veteran has been awarded a 100 percent rating for PTSD, effective the date of entitlement to service connection. As discussed above, the Veteran has also been granted entitlement to service connection for a heart disability. However, there is no indication from the record that the Veteran’s heart disability alone, without consideration of his PTSD symptoms, renders him unable to obtain and maintain employment. As such, the findings in Bradley are not applicable in this case, and the issue of entitlement to a TDIU is moot as the Veteran is in receipt of a schedular 100 percent rating for the entire period on appeal. Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Mariah N. Sim, Associate Counsel