Citation Nr: 18107434 Decision Date: 06/04/18 Archive Date: 06/01/18 DOCKET NO. 15-00 176 DATE: June 4, 2018 ORDER A permanent and total disability rating for posttraumatic stress disorder (PTSD) with depressive disorder not otherwise specified is granted. FINDING OF FACT The probative evidence of record supports a finding that the Veteran’s PTSD with depressive disorder not otherwise specified is permanently and totally disabling. CONCLUSION OF LAW The criteria for a permanent and total disability rating for PTSD with depressive disorder not otherwise specified have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 3.340 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had honorable active duty service from December 1991 to December 1995 and from May 2004 to October 2005. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a November 2012 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran presented testimony at a videoconference hearing before the undersigned Veterans Law Judge in April 2018. A transcript is of record. Entitlement to a permanent and total disability rating for PTSD with depressive disorder not otherwise specified Entitlement to a permanent total disability rating requires a Veteran’s disability to be both permanent and total. 38 C.F.R. § 3.340. Pursuant to VA regulations, a total disability may be established in two ways. First, total disability will be considered to exist when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340(a)(1). Second, a total disability may also be assigned where a Veteran’s service-connected disabilities are rated 100 percent disabling under the rating schedule. 38 C.F.R. § 3.340(a)(2). Permanence of total disability will be taken to exist when such impairment is reasonably certain to continue throughout the life of the disabled person. 38 C.F.R. § 3.340(b). Diseases and injuries of long standing which are actually totally incapacitating will be regarded as permanently and totally disabling when the probability of permanent improvement under treatment is remote. Id. The age of the disabled person may be considered in determining permanence. Id. Service connection is in effect for PTSD with depressive disorder not otherwise specified. It was rated as 30 percent disabling effective October 18, 2005; 70 percent disabling effective January 27, 2011; and 100 percent disabling effective April 10, 2012, pursuant to 38 C.F.R. § 4.29 (due to hospital treatment in excess of 21 days), and effective July 1, 2012, pursuant to 38 C.F.R. § 4.130. Entitlement to a total disability rating based on individual unemployability (TDIU) has also been in effect since May 2, 2012. The Veteran asserts that his current and future prognosis shows that obtaining and maintaining permanent employment is close to impossible. He also reports major mood swings; short term memory loss; needing reminders to bathe, take medication and change clothing; problems with anger; and impaired sleep. During a March 2011 VA review examination for PTSD, it was noted that the Veteran had a relative period of stability that was disrupted in January 2011 when the Veteran required an increase in Xanax. The marked increase in symptoms was precipitated by the anniversary of when an improvised explosive device (IED) significantly wounded several of his buddies. It was also noted that the Veteran, an armed nuclear security supervisor, had recently lost his job due to the increase in his PTSD symptoms and the Xanax. The examiner clarified that the need to increase Xanax resulted in the Veteran needing to take the medication in the morning and afternoon such that he was no longer eligible for unescorted access to the nuclear power plant at his job. The increase in PTSD symptoms that began in January 2011 included an increase in social anxiety, frustration, nightmares, sensitivity to clamor, anger and withdrawal, as well as difficulty with concentration and attentiveness and more sleeplessness. The Veteran was admitted to the Canandaigua VA Medical Center (VAMC) domiciliary on April 10, 2012, for his PTSD with depressive disorder not otherwise specified, at which time he reported worsening symptoms and a goal of reducing them so he could function at a better level. He had recently had job problems due to his symptoms and lost his job while in the program. The Veteran was discharged from the program on June 7, 2012. He was subsequently admitted to the PTSD Residential Rehabilitation Program at the Batavia VAMC from July 3, 2012, to July 31, 2012, for PTSD flaring up, depression and rage issues, inability to hold a job, marital issues, and social anxiety. It was noted he had recently lost his job due to going to Canandaigua for treatment. During a September 2012 VA Review PTSD Disability Benefits Questionnaire (DBQ), the examiner reported that the Veteran seemed unlikely to be able to sustain employment at that time due to his irritability, anxiety, depression, anger, and related symptoms, including self-injurious behavior. It was the examiner’s opinion that the Veteran was unemployable due to his PTSD and depressive disorder. The Veteran was admitted to a two-week residential PTSD program at the Batavia VAMC between December 11, 2012, and December 20, 2012. It was noted that despite receiving outpatient therapy, the Veteran’s symptoms had started to worsen, partly because of several anniversaries coming up. During a December 2015 VA Review PTSD DBQ the examiner determined that the Veteran’s diagnosed PTSD and unspecified depressive disorder caused total occupational and social impairment. His occupational history was unchanged from the prior examination. The examiner remarked that the Veteran continued to suffer significant manifestations of his PTSD and his condition was largely unchanged from when he was previously seen, with some exacerbation of avoidance symptoms and anxiety. The Veteran has participated in VA group and individual therapy throughout the appeal period. He was admitted to the PTSD program at the Batavia VAMC domiciliary in February 2018 with the goal of reduce nightmares, anxiety/panic attacks, and emotional numbing, and to improve relationships, especially with his wife. Upon review of the record, the Board finds that the probative evidence of record supports a finding that the Veteran’s service-connected PTSD with depressive disorder not otherwise specified is permanent and total. The Veteran has been admitted to VA facilities on several occasions since April 2012 due to an increase in PTSD symptoms, with the most recent admission being in February 2018; the September 2012 VA examiner indicated that it seemed unlikely the Veteran would be able to sustain employment at that time due to his irritability, anxiety, depression, anger, and related symptoms, including self-injurious behavior, and that the Veteran was unemployable due to his PTSD and depressive disorder; and the December 2015 VA examiner characterized the Veteran’s level of functioning as total occupational and social impairment. During his most recent admission, it was noted that anniversary dates remain the Veteran’s biggest trigger, resulting in intrusive thoughts and memories of his trauma around those times. The Veteran also reported that he had done cognitive processing therapy twice, focusing on two separate traumas, but he still had stuck points around self-blame and failure for his comrades’ deaths; he indicated that he would like to try prolonged exposure therapy to see if it would help with his symptoms. Based on the foregoing, and resolving all doubt in the Veteran’s favor, the Board finds that the most probative evidence of record demonstrates that total impairment from the service-connected psychiatric disability is reasonably certain to continue throughout the Veteran’s life. Thus, a permanent and total disability rating is warranted. See 38 C.F.R. § 3.340. K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Van Wambeke, Counsel