Citation Nr: 18159492 Decision Date: 12/20/18 Archive Date: 12/19/18 DOCKET NO. 16-57 352 DATE: December 20, 2018 ORDER Entitlement to an initial rating of 70 percent, but not higher, for posttraumatic stress disorder (PTSD) is granted. FINDING OF FACT For the entire period on appeal, the occupational and social impairment from the Veteran’s PTSD has been manifested by deficiencies in most areas. CONCLUSION OF LAW The criteria for an initial rating of 70 percent, but not higher, for PTSD have been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.7, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active naval service from March 1990 to March 1994, to include service in Southwest Asia. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a June 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in San Diego, California. The Board notes that subsequent to the issuance of the September 2016 Statement of the Case, relevant private medical evidence was added to the record without a waiver of review by the Agency or Original Jurisdiction (AOJ). However, because the Veteran’s substantive appeal was received after February 2013, waiver of AOJ review of newly submitted evidence is implied. As such, there is no bar to proceeding with a decision in the appeal. 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 rating. The medical evidence of record reflects that the Veteran endorsed psychiatric symptomatology that included personal relationship issues; bankruptcy and financial stress; significant crying spells; unintentional weight loss; chronic sleep disturbances; guilt; drug and alcohol use; depression; feelings of being overwhelmed; loss of confidence; marital discord; hypervigilance; flashbacks; avoidance of crowds; mistrust of others; insomnia; negative cognitions; low energy; poor concentration; poor appetite; anhedonia; irritability; and hyperarousal. Of record is a May 2015 lay statement submitted by the Veteran. In that statement, he indicated that prior to active service he was very happy and had many friends and activities that fulfilled his life. After service, the Veteran stated he was not truly happy, had trouble getting out of bed, had difficulty sleeping, and felt distant in his interpersonal relationships. He stated he believed his symptomatology worsened every day. He reported he avoided crowds, did not feel safe, felt isolated by his fears and feelings, and was a shell of the man he used to be. He stated he felt empty. Of record is a May 2015 VA treatment record indicating that the Veteran reported he was often unable to work due to stress, insomnia, and flare-ups of his PTSD symptomatology. He stated this occurred approximately once a week with severe symptoms. In June 2015, the Veteran was afforded a VA psychological examination. At that time, the Veteran endorsed the following symptoms: anger at the world; issues at work; restless sleep; insomnia; severe anxiety; agitation; nightmares; hypervigilance; intrusive and upsetting thoughts; guilty feelings; intense or prolonged psychological distress at exposure to internal or external cues; marked psychological reactions to internal or external cues; avoidance behaviors; persistent negative emotional state; markedly diminished interest or participation in significant activities; feelings of detachment or estrangement from others; persistent inability to experience positive emotions; irritability; angry outbursts; exaggerated startle response; problems with concentration; depressed mood; and difficulty in adapting to stressful circumstances. The examiner observed the Veteran to be casually dressed, with good grooming and hygiene. There was no evidence of thought disorder, cognitive deficits, or gross memory impairments. He was cooperative, alert, oriented, and demonstrated appropriate eye contact. He appeared to be mildly dysthymic and anxious, and denied any current suicidal or homicidal ideation, plan, or intent. He was not shown to have any psychotic symptoms. The examiner opined that the Veteran’s PTSD manifested in occupational and social impairment with reduced reliability and productivity. Of record is a November 2016 private psychological evaluation by R.O, MFT. At that evaluation, the Veteran endorsed the following symptoms: sleep disturbances; anxiety; inability to focus; inability to concentrate; memory loss; isolation behaviors; avoidance of crowds or people; depression; mood changes; anger; work issues, resulting in missed work; difficulty managing workload; aggravation of hypertension; recurrent and distressing recollections; nightmares; reexperiencing the traumatic event; intense psychological distress; physiological reactivity on exposure to internal or external cues; avoidance of thoughts, feelings, or conversation related to the trauma; efforts to avoid activities, places, or people related to the trauma; inability to recall important aspects of the trauma; markedly diminished interest or participation in activities; feelings of detachment or estrangement from others; restricted range of affect; sense of foreshortened future; angry outbursts; suspiciousness; near continuous panic or depression that affected the ability to function independently, appropriately, and effectively; chronic sleep impairment; impairment of short term and long term memory; circumstantial, circumlocutory, or stereotyped speech; impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in adapting to stressful circumstances, including work or a work like setting; inability to establish and maintain effective relationships; neglect of personal appearance and hygiene; intermittent inability to perform activities of daily living; and disorientation to time or place. Of record is the November 2016 substantive appeal submitted by the Veteran. In his substantive appeal, the Veteran endorsed the following symptoms: depressed mood; anxiety; suspiciousness; panic attacks more than once a week; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; chronic sleep impairment; impairment of short term and long term memory; flattened affect; circumstantial, circumlocutory or stereotyped speech; impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty adapting to stressful circumstances, including work or a work like setting; inability to establish and maintain effective relationships; intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene; and disorientation to time or place. A review of the record shows that the Veteran receives treatment at the VA Medical Center and from private providers for various disabilities, to include his PTSD. A review of the treatment notes of record does not show that the Veteran has had symptoms of his PTSD that are worse than those reported at his VA examination. The Board finds that the Veteran is entitled to an initial 70 percent rating for PTSD. In this regard, the Board notes that the Veteran’s symptoms have more closely approximated deficiencies in most areas for the entire period on appeal. The Veteran has been shown to have symptoms of anxiety, interpersonal relationship issues; panic attacks; chronic sleep disturbances; crying spells; and significant difficulty at work due to his PTSD symptomatology. Specifically, the Veteran’s psychiatric symptomatology has consistently been shown to have major effects within his relationships, affecting both professional and personal relationships. In this regard, the Veteran was shown to have significant marital discord and having to routinely stop or miss work due to his PTSD symptomatology. Further, the Veteran’s symptoms have been relatively consistent throughout the entire period on appeal. Therefore, the Board finds that entitlement to an initial rating of 70 percent is warranted. 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, the private psychological evaluation report, and the mental health treatment records do not indicate that the Veteran has experienced all of the symptoms associated with a 70 percent rating for PTSD for the entire period on appeal. 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 there is occupational and social impairment with deficiencies in most areas sufficient to warrant a 70 percent rating for the entire period on appeal even though all the specific symptoms listed for that rating are not manifested. Consideration has been given to assigning a higher rating for the appeal period. However, there is no indication from the record that the Veteran’s PTSD results in total social and occupational impairment. The Veteran has not exhibited hallucinations or significant cognitive impairment. The Veteran did not exhibit delusions. He did not present with impairment in speech or thought content. There is no gross impairment in thought processes or communication, and no indication that the Veteran has exhibited grossly inappropriate behavior. There is no indication from the record that the Veteran is a persistent danger to himself, or others. Accordingly, there is no indication from the record that the Veteran’s symptoms were so severe as to cause total occupational and social impairment. Therefore, the Board finds that a rating in excess of 70 percent for PTSD is not warranted. 38 C.F.R. § 4.130, Diagnostic Code 9411. Consideration has been given to assigning staged ratings. However, at no time during the period in question has the disability warranted a higher schedular rating than that assigned. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Mariah N. Sim, Associate Counsel