Citation Nr: 18159453 Decision Date: 12/20/18 Archive Date: 12/19/18 DOCKET NO. 16-59 544 DATE: December 20, 2018 ORDER Entitlement to service connection for depressive disorder with alcohol abuse is granted. Entitlement to an initial rating of 100 percent for an acquired psychiatric disorder diagnosed as posttraumatic stress disorder (PTSD), depressive disorder with alcohol abuse is granted. FINDINGS OF FACT 1. The Veteran’s depressive disorder and alcohol abuse are symptoms of his PTSD diagnosis and are related to his in-service experiences. 2. The Veteran’s acquired psychiatric disorder diagnosed as PTSD, depressive disorder with alcohol abuse are productive of total occupational and social impairment. CONCLUSIONS OF LAW 1. The criteria for service connection for depressive disorder with alcohol abuse have been met. 38 U.S.C. §§ 1110, 1111, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for a 100 percent initial rating for an acquired psychiatric disorder diagnosed as PTSD, depressive disorder with alcohol abuse have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.130, Diagnostic Code (DC) 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from July 1989 to May 1993. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2014 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that in his substantive appeal, the Veteran specifically limited his appeal to the issues of entitlement to service connection for depressive disorder with alcohol use disorder and entitlement to a higher initial PTSD rating. As such, the claims of service connection for tinnitus and a compensable rating for his linear and non-linear scar are not before the Board. See 38 C.F.R. § 20.202. Service Connection The Veteran asserts that his depressive disorder symptoms and alcohol abuse disorder are components of his service-connected PTSD and as a result should have been service connected with his PTSD. The Board finds that service connection is warranted for the Veteran’s depressive disorder with alcohol use as these disorders are a component of his service-connected PTSD. At the September 2014 VA examination, the Veteran was diagnosed with PTSD and persistent depressive, alcohol abuse, and cannibis use disorder. The Veteran reports that in-service, he was threatened with a gun and his friend was shot after engaging in altercation with another man. The September 2014 VA examiner concluded that it was possible to differentiate the Veteran’s symptoms for each disorder. The October 2014 VA examiner issued an addendum opinion concluding that the Veteran’s PTSD related symptoms did not interfere with his social and occupational endeavors and that his primary issues were his alcohol and cannabis use disorder. He further opined that the Veteran’s alcohol use disorder was based on biological increased risk because the Veteran’s father was an alcoholic and the depressive disorder was based on the Veteran’s environmental factors because of familial and marital issues. The March 2015 VA examiner opined that the Veteran’s service-connected PTSD symptoms included decreased interest in activities, isolation, sleep issues, irritable behavior resulting in social withdrawal, agitation, anxiety, hostility, abrasive interaction, paranoia, depressive symptoms, fatigue, feelings of worthlessness and suicidal ideation. The March 2015 VA examiner stated that the Veteran did not have more than one mental disorder diagnosed. Following this exam, a June 2016 VA examiner concluded that the variance in diagnoses given is a result of the varying history the Veteran gave to different VA examiners. A September 2018 private examination concluded that the Veteran’s PTSD, depressive disorder, and alcohol abuse disorder are irrevocably intertwined and that the September 2014 VA examiner’s attempt to assign different percentages to different aspects of the Veteran’s symptoms had no clinical meaning. The private physician reasoned that previous VA examiners had no access to the mental health history of the Veteran’s father and thus could not conclude that the Veteran’s current condition is biologically linked to that of his father. The September 2018 private physician also correctly notes that the Veteran had no documented mental disorders prior to service or prior to his traumatic in-service event and that despite his cessation in alcohol and cannabis consumption, his symptoms have persisted and worsened. As such, the private physician concludes that based on the DSM-V, the Veteran’s depressive disorder is clinically described as part of his PTSD and his alcohol abuse disorder is a consequence of his PTSD. Based on the evidence of record, the Bord finds the September 2018 private physician more probative because it is based on a complete record of medical and lay history as reported by the Veteran, considers all the conclusions of the VA examiners and is supported by medical evidence. As such, the Board finds service connection is warranted for the Veteran’s depressive disorder and alcohol use disorder because they are part of his service-connected PTSD. Increased Rating The Veteran asserts that he is entitled to a 100 percent initial rating for his acquired psychiatric disorder diagnosed as PTSD and depressive disorder with alcohol use disorder. DC 9434 provides that psychiatric disorders are evaluated under the general rating formula used to rate psychiatric disabilities other than eating disorders, pursuant to 38 C.F.R. § 4.130. Ratings are assigned according to the manifestations of symptoms and the extent to which they cause occupational and social impairment. See Bankhead v. Shulkin, 29 Vet. App. 10. 18 (2017); see also Vazquez-Claudio v. Shinseki, 713 F.3d 112, 115 (Fed. Cir. 2013). The rating criteria include a non-exhaustive list of symptoms, meaning that VA is not required to find the presence of all, most, or even some of the enumerated symptoms to assign a particular evaluation. Bankhead, 29 Vet. App. at 18 (quoting Vazquez v. Claudio, 713 F.3d at 116-17) (quotations omitted). Thus, a veteran may qualify for a given disability rating by demonstrating that he or she suffers from the particular symptoms associated with that percentage, or others of similar severity frequency, and duration, and that those symptoms caused the level of occupational and social impairment associated with a particular disability evaluation. Bankhead, 29 Vet. App. at 18; Vazquez-Claudio, 713 F. 3d at 116-17 (quotations omitted). In sum, “VA must engage in a holistic analysis in which it assesses the severity, frequency, and duration of the signs and symptoms of the veteran’s service-connected mental disorder; quantifies the level of occupational and social impairment caused by those signs and symptoms; and assigns an evaluation that most nearly approximates that level of occupational and social impairment.” Bankhead, 29 Vet. App. at 22 (internal citations omitted). The Board finds that throughout the appeal period, the Veteran’s acquired psychiatric disorder, diagnosed as PTSD and depressive disorder with alcohol abuse disorder, warrants a 100 percent rating. A 100 percent rating is warranted where there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Throughout the appeal period, the Veteran has displayed persistent active and passive suicidal ideation. In the past year, the Veteran has been hospitalized more than 7 times because he displayed suicidal tendencies and active planning. The Veteran is also a persistent threat to himself and others and displays gross inappropriate behavior and impairment in thought processes. He has numerous arrests stemming from domestic disputes with his family members and friends, was fired from his last job after choking his co-worker, and engaged in violent interactions with the police in an attempt to commit “suicide by police.” The Veteran displays constant anxiety and reports using alcohol as a coping mechanism. He is unable to sleep, experiences stress, flashbacks, and recurrent nightmares. The record also supports a finding that the Veteran is completely isolated from others and experiences social withdrawal as he has little interaction with his mother, siblings, or other family members. To this end, the September 2018 private doctor reports that the Veteran is extremely high risk for completed suicide or homicide and will likely require long term institutionalization because of the difficulty he experiences managing his acquired psychiatric disorder symptoms. This physician further opines that the Veteran is dangerous, volatile, unpredictable, easily triggered into periods of disassociation, and has persistent suicidal ideation resulting in his complete inability to function in occupational and social settings. The Board notes the September 2014, October 2014, and March 2015 VA examiners’ opinions that the Veteran’s symptoms result in less than total occupational and social impairment. However, these statements are entitled to less probative weight because they fail to adequately consider all the symptoms attributable to the Veteran’s service-connected psychiatric disabilities. As such, the Board finds a 100 percent rating is warranted. As the Board grants a 100 percent schedular rating for the Veteran’s service-connected psychiatric disability, the benefit sought by the Veteran has been granted and the Board need not address whether entitlement to a total disability rating due to individual unemployability based on service-connected disabilities (TDIU) is warranted. See October 2018 Submission of Evidence and Appellant’s Brief (requesting the Board grant a 100 percent schedular rating or 70 percent rating and TDIU). TRACIE N. WESNER Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K.Ijitimehin, Associate Counsel