Citation Nr: 18129262 Decision Date: 08/24/18 Archive Date: 08/24/18 DOCKET NO. 15-12 449 DATE: August 24, 2018 ORDER Entitlement to a disability rating greater than 30 percent prior to April 7, 2017, and greater than 50 percent thereafter, for posttraumatic stress disorder (PTSD) is denied. FINDINGS OF FACT 1. The record evidence shows that, prior to April 7, 2017, the Veteran’s service-connected PTSD is manifested by, at worst, complaints of anxiety, suspiciousness, nightmares, irritability, panic attacks less than once a week, and social isolation. 2. The record evidence shows that, effective April 7, 2017, the Veteran’s service-connected PTSD is manifested by, at worst, complaints of flashbacks, sleep disturbance, difficulty getting along with and irritability towards co-workers, short-term and long-term memory impairment, and increased depressive symptoms. CONCLUSION OF LAW The criteria for entitlement to a disability rating greater than 30 percent prior to April 7, 2017, and greater than 50 percent thereafter, for PTSD have not been met. 38 U.S.C. §§ 1155, 5107 (West 2012); 38 C.F.R. §§ 4.1, 4.2, 4.130, Diagnostic Code (DC) 9411 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran had active service from October 1981 to October 1985 in the U.S. Air Force. She also had additional U.S. Air Force National Guard service. In a September 2017 rating decision, the Agency of Original Jurisdiction (AOJ) assigned a higher 50 percent rating effective April 7, 2017, for the Veteran’s service-connected PTSD. Thus, the claim on appeal is characterized as stated above. A videoconference Board hearing was held in May 2018 before the undersigned Veterans Law Judge and a copy of the hearing transcript has been added to the record. The Board finds that the preponderance of the evidence is against granting the Veteran’s claim of entitlement to a disability rating greater than 30 percent prior to April 7, 2017, and greater than 50 percent thereafter, for PTSD. The Veteran essentially contends that her service-connected PTSD is more disabling than currently evaluated throughout both time periods at issue in this appeal. The record evidence does not support her assertions. It shows instead that, prior to April 7, 2017, the Veteran’s service-connected PTSD is manifested by, at worst, complaints of anxiety, suspiciousness, nightmares, irritability, panic attacks less than once a week, and social isolation. For example, on VA outpatient treatment in August 2012, the Veteran complained that she was sleeping 2-3 hours more than usual. She was getting more exercise playing golf. She also experienced an anxiety attack in the previous week. Mental status examination of the Veteran showed she was well groomed, normal speech and thought process, full orientation, intact memory, and good insight and judgment. The diagnoses included PTSD. On VA PTSD Disability Benefits Questionnaire (DBQ) in December 2012, the Veteran’s PTSD symptoms were anxiety, suspiciousness, mild memory loss, and an inability to establish and maintain effective relationships. The VA examiner reviewed the Veteran’s electronic claims file, including her service treatment records and post-service VA treatment records. “[The] Veteran has never been married but dates on an occasional basis and has friends.” She had been employed full-time as a teacher for 22 years. She had been treated since 2008 for trauma due to in-service sexual harassment “and believes it has been helpful.” The Veteran’s Global Assessment of Functioning (GAF) score was 70, indicating some mild symptoms or some difficulty in social, occupational, or school functioning but generally functioning pretty well with some meaningful interpersonal relationships. The Axis I diagnosis was PTSD. On VA outpatient treatment in January 2013, a history of anxiety and insomnia was noted. The Veteran discussed her prior paranoid delusions of being watched or followed. She denied experiencing any paranoia or suspiciousness “for the past several months.” Mental status examination of the Veteran showed she was fully oriented, casually dressed, plainly groomed, intense, no longer delusional or paranoid, no hallucinations, “rarely irritable and worries less,” good energy, concentration, and memory, maintained interests in family, schooling, job, and hobbies, no suicidal or homicidal ideation or plan, and adequate judgment and insight. The Veteran’s GAF score was 67, indicating mild symptoms. The impressions included PTSD. In June 2013, the Veteran’s complaints included anxiety and nightmares. Her hobbies including knitting on weeknights and golfing on weekends. Mental status examination of the Veteran showed full orientation, normal speech, no hallucinations or perceptual disturbances, normal and coherent thought processes and association, no unusual thought content, intact memory, good insight and judgment, and no suicidal or homicidal ideation. In October 2013, the Veteran’s complaints included anxiety and paranoia. She reported getting better sleep although she still woke up at night. Mental status examination of the Veteran showed appropriate grooming, full orientation, normal speech, no perceptual disturbances, normal and coherent thought processes, no unusual thought content, no suicidal or homicidal ideation, good insight and judgment, and intact memory. The VA clinician stated that the Veteran “appears to have significant difficulties in the following areas: social, occupational, and family.” The diagnosis was PTSD. On VA PTSD DBQ in November 2013, the Veteran’s complaints included irritability, nightmares, a depressed mood, sleep disturbance, concentration problems, and social isolation. The VA examiner reviewed the Veteran’s electronic claims file, including her service treatment records and post-service VA treatment records. The Veteran stated that “she has been going out more in the community lately…She does reports some continued reclusivity, however, stating she feels very anxious about going out of her apartment anytime between dusk and dawn.” She was employed full-time as a teacher. She reported early morning anxiety which decreased by 9 or 10 am. She denied any workplace problems due to anxiety, depression, or interpersonal conflict with workplace peers. Mental status examination of the Veteran was unchanged from December 2012. The Veteran’s PTSD symptoms were a depressed mood, anxiety, suspiciousness, panic attacks which occurred weekly or less often, and chronic sleep impairment. The VA examiner concluded that the Veteran’s PTSD showed “little to no worsening of symptoms, with the exception of increased nightmares in recent months. At the same time, the Veteran reports decreased social isolation and improvement in depressive symptoms.” She was able to maintain her activities of daily living and had only minimal impairment in social functioning. The Veteran’s GAF score was 65, indicating mild symptoms. The Axis I diagnoses were PTSD and depressive disorder, not otherwise specified, secondary to PTSD. On VA PTSD DBQ in March 2015, the Veteran’s complaints included nightmares, irritability, hypervigilance, sleep disturbance, concentration problems, and social isolation. The VA examiner reviewed the Veteran’s electronic claims file, including her service treatment records and post-service VA treatment records. The Veteran continued to live alone with a cat and had not been in relationship since her most recent VA examination because she was “not interested” in one. She had a positive relationship with her parents and “will visit with them periodically throughout the year, typically staying with them for several days at a time.” The Veteran reported continuing social isolation although she attended a weekly Weight Watcher’s meeting. “Although she notes that she is able to engage successfully with other people as needed, she is often guarded and works to keep people at a distance. She avoids close or intimate relationships.” She still was employed full-time as a teacher and experienced some interpersonal conflict in the workplace with her co-workers. Mental status examination of the Veteran in March 2015 showed full orientation, well groomed, casually dressed, no “mannerisms, tics, or gestures,” intact speech, no suicidal or homicidal ideation, no delusions, linear, logical, and goal-directed thought process, no auditory or visual hallucinations, and intact impulsivity, judgment, and insight. The VA examiner concluded, “The Veteran continues to report mild symptoms of PTSD.” The Veteran reported nightmares 2-3 times a week, intrusive thoughts “especially early in the morning,” suspiciousness, “feeling anxious and edgy,” hypervigilance, “regularly engages in checking behaviors (especially of her finances),” and concentration problems “especially when home alone on the weekends.” The Veteran also reported “continued depressed mood lasting one to three days at a time about two times a month.” Although she reported sleeping too much, she still awoke fatigued. The VA examiner also concluded that the Veteran was able to maintain her activities of daily living. The diagnoses were PTSD and other specified depressive disorder secondary to PTSD. Despite the Veteran’s assertions to the contrary, the record evidence shows that, prior to April 7, 2017, her service-connected PTSD is manifested by, at worst, complaints of anxiety, suspiciousness, nightmares, irritability, panic attacks less than once a week, and social isolation. The Board acknowledges that the Veteran reported ongoing problems with anxiety and depression during this time period. She also reported that her social isolation had decreased, although she continued to isolate herself overnight, and her depression had improved on VA examination in November 2013. The Veteran’s GAF scores obtained prior to April 7, 2017, confirm that the symptomatology attributable to her service-connected PTSD was mildly disabling throughout this time period. These scores are reflected in the symptoms reported by the Veteran and noted by the VA clinicians who evaluated and treated her service-connected PTSD throughout this time period as well. These findings support the 30 percent rating assigned prior to April 7, 2017, under DC 9411 for the Veteran’s service-connected PTSD. See 38 C.F.R. § 4.130, DC 9411 (2017). There also is no indication that the Veteran experienced symptoms of similar frequency, severity, and duration as is required for a disability rating greater than 30 percent prior to April 7, 2017, under DC 9411. Id.; see also Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013). The Veteran’s speech repeatedly was normal, her memory repeatedly was intact, and she reported less than weekly panic attacks throughout this time period. She also was employed full-time, denied any problems at work due to her anxiety and depression, and was able to engage successfully with others (even though she was guarded) throughout this time period. The Veteran further has not identified or submitted any evidence demonstrating her entitlement to a disability rating greater than 30 percent prior April 7, 2017, for her service-connected PTSD. Thus, the Board finds that the criteria for a disability rating greater than 30 percent prior to April 7, 2017, for PTSD have not been met. The Veteran finally is not entitled to a disability rating greater than 50 percent effective April 7, 2017, for her service-connected PTSD. Contrary to her lay assertions and Board hearing testimony, the record evidence shows that, effective April 7, 2017, her service-connected PTSD is manifested by, at worst, complaints of flashbacks, sleep disturbance, difficulty getting along with and irritability towards co-workers, short-term and long-term memory impairment, and increased depressive symptoms. The Board acknowledges initially that VA PTSD on April 7, 2017, showed that the symptomatology attributable to the Veteran’s service-connected PTSD had worsened and supported the assignment of a higher 50 percent rating under DC 9411 effective on that date. See 38 C.F.R. § 4.130, DC 9411 (2017). For example, at this examination, her complaints included nightmares, flashbacks, panic attacks, hypervigilance, irritability, and sleep disturbance. The VA examiner reviewed the Veteran’s electronic claims file, including her service treatment records and post-service VA treatment records. The Veteran still lived alone “and she has regular contact with her parents, brother, niece, and nephew.” She still was employed full-time as a teacher although she reported “some difficulty getting along with her co-workers, losing focus and missing days of work due to her mental health symptoms.” She had difficulty staying asleep and awoke to nightmares which related directly to her in-service trauma. She experienced weekly anxiety, “especially first thing in the morning and panic attacks monthly…She has less anxiety on the weekend when she can isolate.” She was “overly cautious and does not take risks.” A history of paranoia was noted. “She becomes irritable, especially at work and is snappy towards others but withdraw[s] before anything else happens.” She participated in multiple activities, including knitting, golfing, and walking for exercise. She attended church and had no problems with personal hygiene. Her PTSD symptoms were depressed mood, anxiety, suspiciousness, panic attacks which occur weekly or less often, impairment of short- and long-term memory, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. Mental status examination of the Veteran on April 7, 2017, showed she was adequately groomed and casually dressed, full orientation, logical and organized thought processes, no hallucinations or delusions, and no suicidal or homicidal ideation. The VA examiner concluded that the Veteran’s depressive symptoms were secondary to her service-connected and “have increased in severity.” This examiner also concluded that the Veteran was able to maintain her activities of daily living. The diagnoses were PTSD and unspecified depressive disorder. The Veteran testified at her May 2018 Board hearing that her service-connected PTSD symptoms had worsened when the persons she held responsible for her in-service personal trauma suddenly showed up again in her life. See Board hearing transcript dated May 11, 2018, at pp. 3-4. She experienced daily panic attacks mostly in the mornings, conflict with co-workers, and social isolation. Id., at pp. 4 6. The Board again acknowledges that the symptomatology attributable to the Veteran’s service-connected PTSD worsened effective April 7, 2017, supporting the assignment of a higher 50 percent rating on that date under DC 9411. See 38 C.F.R. § 4.130, DC 9411 (2017). Despite the Veteran’s assertions and hearing testimony to the contrary, however, the record evidence shows that this disability is manifested by, at worst, complaints of flashbacks, sleep disturbance, difficulty getting along with and irritability towards co-workers, short-term and long-term memory impairment, and increased depressive symptoms since that date. The Veteran’s April 7, 2017, VA PTSD DBQ documented her complaints of nightmares, flashbacks, panic attacks, hypervigilance, irritability, and sleep disturbance. Mental status examination of the Veteran was consistent with her reported PTSD symptoms. The VA examiner concluded that the Veteran had experienced increased depressive symptoms but was able to maintain her activities of daily living. The findings regarding the Veteran’s service-connected PTSD symptomatology on VA examination in April 2017 are consistent with her subsequent Board hearing testimony in May 2018. There also is no indication that the Veteran experienced symptoms of similar frequency, severity, and duration as is required for a disability rating greater than 50 percent effective April 7, 2017, under DC 9411. Id.; see also Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013). At this examination, the Veteran reported that she still had regular contact with multiple family members and continued to be employed full-time. She only reported daily anxiety which improved over the course of the morning and monthly panic attacks. She also participated in multiple activities and had no problems with her daily hygiene. The Veteran finally has not identified or submitted any evidence demonstrating her entitlement to a disability rating greater than 50 percent effective April 7, 2017, for her service-connected PTSD. Accordingly, the Board finds that the criteria for a disability rating greater than 50 percent effective April 7, 2017, for PTSD have not been met. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Michael T. Osborne, Counsel