Citation Nr: 19111069 Decision Date: 02/12/19 Archive Date: 02/12/19 DOCKET NO. 17-26 586 DATE: February 12, 2019 ORDER An initial rating in excess of 30 percent for other specified trauma/stressor related disorder is denied. An initial compensable rating for internal hemorrhoids, previously rated as tubular adenoma, is denied. FINDINGS OF FACT 1. The Veteran had active service from September 1983 to August 1986 and March 1988 to October 2014. 2. For the entire period on appeal, the Veteran’s psychiatric disorder has been manifested by feelings of anxiety and suspicion of others. 3. For the entire period on appeal, the Veteran’s internal hemorrhoids, previously rated as tubular adenoma, have been manifested by inactive disease and mild or moderate internal hemorrhoids. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 30 percent for other specified trauma/stressor related disorder have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 4.1, 4.130, 4.3, 4.7, Diagnostic Code (DC) 9411 (2018). 2. The criteria for a compensable rating for internal hemorrhoids, previously rated as tubular adenoma, have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 4.1, 4.130, 4.3, 4.7, DC 7336 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Other Specified Trauma/Stressor Related Disorder Under DC 9411 and the General Rating Formula for Mental Disorders, a 30 percent rating 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, and mild memory loss (such as forgetting names, directions, recent events). A 50 percent rating is assigned for occupational and social impairment with reduced reliability and productivity due to such symptoms as a flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships. Careful review of the evidence shows that the Veteran’s symptomatology approximates symptoms associated with a 30 percent rating for the entire period on appeal. Specifically, in a June 2014 VA examination, the Veteran reported being anxious at work and exhibiting a panic attack after standing up to a female superior. However, his long and short-term memory were rated as good, judgment and insight were intact, and impulse control appeared good. In a July 2015 post-service clinical record, the examiner rated the Veteran’s mood as anxious and his affect restricted. However, thought processes were normal and judgment was good. In a May 2017 VA treatment record, he was determined to be at risk for suicide; however, in August of that year, the examiner noted no evidence of suicidal ideation. In a June 2017 post-service clinical record, the Veteran reported feeling anxious and feeling a need to be perfect. Upon examination, the physician determined that his insight and judgment were good and observed no evidence of psychotic phenomena. In June 2018, the Veteran underwent a VA psychiatric examination. He reported resigning from his job in January 2018 after experiencing stressors due to mistrust between him and management. Although he was unable to find another job, he attributed this to negative reviews from previous positions and not due to a mental impairment. Upon examination, he was anxious but experiencing good judgment and capacity for insight. Although he was noted to have occasional suicidal ideation, he denied a current plan or intent due to family commitments and religious beliefs. Most recently, in a July 2018 mental health consultation, the Veteran reported struggling with anxiety and trust while employed. He contended that since becoming unemployed, his anxiety had decreased. Upon examination, no hallucinations or suicidal ideation were reported. Further, memory was intact and judgment and insight were good. Throughout the record, the Veteran mentioned an incident that occurred while he was on active duty in 2001. Though he stated that could not mention specific details, he classified the incident as an unsubstantiated accusation of sexual harassment. Although the allegation was dismissed, he maintained that this incident has made him fearful to trust others, including his wife, as he was suspicious of being “trapped.” Further, he reflected that he avoided being alone with females unless a witness was present. During his June 2014 examination, he requested that the door be open during his interview, as his examiner was female. Taken together, the medical evidence does not support a rating in excess of 30 percent. The evidence shows that his psychiatric disorder resulted in anxious mood, increased suspiciousness, and occasional panic attacks. However, his lack of suicidal or homicidal ideation, coherent speech, organized thought processes, and fair concentration reflect that he experiences symptoms like or similar to those associated with a rating of 30 percent but no more. Hemorrhoids The Veteran is rated under DC 7336 for internal hemorrhoids, previously rated as tubular adenoma. Under DC 7336, a higher rating will be warranted when the objective medical evidence shows the following: • large or thrombotic hemorrhoids, irreducible, with excessive redundant tissue, evidencing frequent recurrences (10%); or • hemorrhoids with persistent bleeding and secondary anemia, or with fissures (20%). As the Veteran was originally rated under DC 7343 for malignant neoplasms of the digestive system, the Board will first consider whether a higher rating is warranted under that diagnostic code. The evidence shows that the Veteran underwent a therapeutic procedure in February 2013 to remove polyps from his colon. In a June 2014 VA examination, the examiner noted the polyp removal and characterized it as malignant. There was no active malignancy identified at that time. More recently, he underwent a colonoscopy in April 2015. Although internal hemorrhoids were present, no evidence of malignancy was found. Therefore, a higher rating under DC 7343 for malignant neoplasms of the digestive system does not apply. As to the now-diagnosed hemorrhoids, post-service clinical records noted an absence of rectal bleeding, excessive redundant tissue, secondary anemia, or fissures. Further, in an August 2017 examination for employment, he marked that he was not suffering from hemorrhoids. Accordingly, the medical evidence does not support a compensable rating for hemorrhoids as they have not been shown to be large, or thrombotic, frequent recurring, or having symptoms consistent with persistent bleeding and secondary anemia or fissures. The Board has considered multiple statements offered by the Veteran regarding the current severity of all the disabilities at issue in this appeal. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, he is not competent to identify a specific level of disability of these disorders according to the appropriate diagnostic codes. Such competent evidence concerning the nature and extent of the Veteran’s disabilities have been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings directly address the criteria under which his disabilities are evaluated. Moreover, as the clinicians have the requisite medical expertise to render medical opinions regarding the degrees of impairment caused by the disabilities and had sufficient facts and data on which to base the conclusions, the Board affords the medical opinions great probative value. As such, these records are more probative than the subjective evidence of complaints of increased symptomatology provided by the Veteran and the appeals are denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Ragofsky, Legal Clerk