Citation Nr: 18113545 Decision Date: 06/22/18 Archive Date: 06/22/18 DOCKET NO. 15-06 009 DATE: June 22, 2018 ORDER An evaluation greater than 30 percent for service-connected adjustment disorder with anxious mood (also claimed as posttraumatic stress disorder (PTSD)) is denied. FINDING OF FACT The Veteran’s service-connected adjustment disorder (also claimed as PTSD) is productive of occupational and social impairment with no more than occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. CONCLUSION OF LAW The criteria for an evaluation greater than 30 percent for adjustment disorder with anxious mood (also claimed as PTSD) have not been satisfied. 38 U.S.C. §§ 1155, 5107 (2014); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1-4.7, 4.14, 4.27, 4.31, 4.130 Diagnostic Code 9411 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January to April 1997, and from February 2000 to August 2011. Personnel records show he deployed to Afghanistan in 2002, 2004, 2009 and to Iraq in 2003; and that he was awarded the Combat Infantryman Badge. Increased Rating The Veteran seeks entitlement to a higher evaluation for his service-connected adjustment disorder with anxious mood. Disability ratings are assigned in accordance with the VA’s Schedule for Rating Disabilities and are intended to represent the average impairment of earning capacity resulting from disability. See 38 U.S.C. § 1155; 38 C.F.R. § 3.321(a), 4.1. Separate diagnostic codes identify the various disabilities. See 38 U.S.C. Part 4. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. “Staged” ratings are appropriate for any rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119 (1999). In this case, the Veteran appealed the August 2013 rating decision in which the agency of original jurisdiction denied an evaluation greater than 30 percent for the service-connected adjustment disorder with anxious mood (also claimed as PTSD). The Veteran’s adjustment disorder with anxious mood is evaluated under 38 C.F.R. § 4.130, Diagnostic Code 9413, as an unspecified anxiety disorder. Unspecified anxiety disorder is to be rated under the general rating formula for mental disorders under 38 C.F.R. § 4.130, which affords a 30 percent evaluation for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). A 50 percent evaluation is warranted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). A 70 percent rating is provided where there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as suicidal ideation; obsessed rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships. 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. See 38 C.F.R. § 4.130, Diagnostic Code 9413. In the present case, service connection for adjustment disorder with anxious mood was granted in a January 2013 rating decision and evaluated as 30 percent disabling, effective in August 2011. In June 2013, the Veteran claimed an increase in the evaluation assigned. He also asked that PTSD be added to his service-connected psychiatric condition. In an August 2013 rating decision, the AOJ continued the 30 percent evaluation, but changed the description of the disability to reflect the inclusion of PTSD. The Veteran appealed the August 2013 rating decision in a notice of disagreement received in February 2014. The Board notes that the present case was certified to the Board in June 2015, and that he perfected his appeal to the Board in February 2015. Hence, while his case was pending before the AOJ prior to 2014, it was not pending before the Board until 2015. Therefore, the change in regulations that requires the use of the American Psychiatric Association’s DIAGNOSTIC AND STATISTICAL MANUAL FOR MENTAL DISORDERS, 5th Edition (DSM-5) applies to this case. See 79 Fed. Reg. 45093 (Aug. 4, 2014). What this means is that the Board will not discuss Global Assessment of Functioning (GAF) scores, where they may have been assigned, in keeping with DSM-5. Moreover, the Board observes that the schedular criteria used in evaluating the Veteran’s psychiatric symptoms have not changed during the appeal period. In addition, the December 2014 VA examination for mental disorders confirmed the diagnosis of adjustment disorder under DSM-5. 1. Entitlement to an evaluation greater than 30 percent for adjustment disorder with anxious mood (also claimed as PTSD). After review of the relevant medical evidence, the Board finds the Veteran’s service connected adjustment disorder with anxious mood does not meet the criteria for an evaluation greater than 30 percent. VA treatment records and VA examination reports show that the Veteran is treated for his service-connected psychiatric disorder with talk therapy, group therapy, and prescribed medications to include prazosin, sertraline, hydroxyzine, lorazepam, bupropion, and cyproheptadine to generally good effect. These records show complaints of nightmares and difficulty sleeping, suspiciousness, anxiety including panic attacks occurring more than once per week, avoidance, intrusive memories, flashbacks occurring 3 to 4 times per week, survivor guilt, depression, hypervigilance and exaggerated startle response, irritability and angry outbursts, and poor concentration. Health care providers and VA examiners have observed chronic sleep impairment, anxiety, depression, and mild memory loss. These symptoms are contemplated by the 30 percent evaluation currently awarded. See VA Treatment Records, generally, and February 2012 VA Examination for PTSD; and December 2014 VA Examination for Mental Disorders. The Board observes that panic attacks occurring more than once a week is a symptom contemplated under the criteria for a 50 percent evaluation. Yet, these records demonstrate overwhelmingly that the Veteran does not evidence other symptoms required for a 50 percent, or higher, evaluations. These records reflect no findings of flattened affect, an inability to understanding complex commands, impaired judgment or abstract thinking. Memory loss was described as mild. Moreover, the Veteran has consistently been found to present with good hygiene, normal speech, grossly intact memory and cognition, and linear, logical and goal-directed thought processes. He has not been found to exhibit impaired abstract thinking or impulse control; and delusions, hallucinations, psychoses, and suicidal or homicidal ideations have neither been reported nor observed. The Veteran has not been found to be a danger to himself or others; or to exhibit obsessional rituals, near-continuous panic or depression, spatial disorientation, or to be unable to perform the activities of daily living. As to disturbances of mood and motivation, the evidence shows that the Veteran occasionally had trouble with the prescribed medications, impacting his sleep, irritability, anxiety, mood and motivation. However, the records also demonstrate that health care providers found combinations and levels of prescription medications that ultimately worked to restore sleep and mood. See VA Treatment Records, generally, and February 2012 VA Examination for PTSD; February 2012 VA Examination for Traumatic Brain Injury, p. 10; and December 2014 VA Examination for Mental Disorders. Concerning occupational and social impairment, the Veteran has not reported, nor does the record show, that he is unemployed or unemployable, or that he is significantly socially impaired. Rather, he has been employed or in school throughout the period under appeal, including a period being employed while going to school part-time to earn his bachelor of arts in business. VA treatment records reflect he is still employed as of 2018. In addition, VA records reflect the Veteran consistently reported his social support at adequate or better, and that health care providers have assessed his social support at above poor, despite challenges including divorce and child custody issues. In 2018, VA treatment records dated in 2018 show he is living with his daughter and that he has a girlfriend. See VA Treatment Records, generally, and February 2012 VA Examination for PTSD; and December 2014 VA Examination for Mental Disorders. Accordingly, the weight of the evidence shows that an evaluation no greater than 30 percent is warranted for adjustment disorder with anxious mood (also claimed as PTSD) at any time during the period under appeal. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Bakke, Counsel