Citation Nr: 19164635 Decision Date: 08/20/19 Archive Date: 08/20/19 DOCKET NO. 18-55 540 DATE: August 20, 2019 ORDER Entitlement to an evaluation higher than 50 percent for posttraumatic stress disorder (PTSD) with alcohol abuse is denied. FINDING OF FACT The severity, frequency, and duration of the Veteran’s symptoms do not more closely approximate occupational and social impairment with deficiencies in most areas. CONCLUSION OF LAW The criteria for a disability rating in excess of 50 percent for PTSD with alcohol abuse have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1987 to June 1991. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a July 2018 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). Additional evidence was received after the case was last adjudicated and then certified to the Board. As that additional evidence is not pertinent to the issue decided herein, the Board may proceed to a decision without prejudice to the Veteran. 38 C.F.R. § 20.1304(c). The Board remanded the issue of entitlement to service connection for sleep apnea in September 2018, for additional development. The RO is still undertaking that development and the claim has not yet returned to the Board for adjudication. Entitlement to an evaluation higher than 50 percent for PTSD with alcohol abuse The Veteran asserts that he is entitled to a higher evaluation for his PTSD with alcohol abuse. The Veteran reported chronic sleep difficulties, hypervigilance, anxiety, dizziness, and nausea. See correspondence received by VA in July 2018. The Veteran’s spouse reported that he has struggled with sleep, paranoid behavior, difficulty communicating with others, increased irritability, being easily angered, and avoidance of others; the cumulative impact of these symptoms negatively impacts their relationship. See statement received by VA in July 2018 (which replicates an October 2012 statement). The Veteran’s representative contends that he is entitled to a 70 percent rating due to the presence of the following symptoms: near continuous panic or depression, impaired impulse, neglect of personal appearance and hygiene, difficulty adapting to stressful circumstances, and inability to establish and maintain effective relationships. See July 2018 notice of disagreement. Under the General Formula for Mental Disorders (General Formula), the Board must conduct a “holistic analysis” that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). The issue in this appeal is whether the Veteran’s associated symptoms caused the level of impairment required for a disability rating of 70 percent or higher. The Board concludes that the Veteran’s symptoms did not cause the level of impairment required for a disability rating of 70 percent or higher. The Veteran’s symptoms more closely approximated the symptoms associated with a 50 percent rating, and resulted in a level of impairment that most closely approximated the level of impairment associated with a 50 percent rating. A 50 percent rating is assigned when symptoms such as 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 cause occupational and social impairment with reduced reliability and productivity. A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; 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 worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned when symptoms such 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; or memory loss for names of close relatives, own occupation or own name cause total occupational and social impairment. The Veteran underwent a VA examination in June 2018. The examiner noted diagnoses of both PTSD and alcohol use disorder with a degree of overlap between the two disorders which makes separation of the symptoms and level of impairment attributable to each disorder unfeasible. The Veteran reported that he is overwhelmingly angry and triggered easily, without any suicidal ideation or attempts. The Veteran’s other symptoms included 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- and long-term memory, circumlocutory or stereotyped speech, impaired judgment, and disturbances of motivation and mood. The examiner noted that the Veteran was generally oriented, with impairment as to location. The Veteran was also casually dressed, but not well-groomed. The Veteran reported that he lives with his wife and adult step child and has no local friends. The Veteran also reported tinkering in the garage and doing yard work to keep busy. The Veteran indicated he has had legal troubles two years prior due to driving under the influence. Upon review of the lay statements provided by the Veteran and his spouse, the examiner remarked that the Veteran’s symptoms of lashing out, road rage, and anger causes negative impact on his social functioning including in relationships with his wife, son, and avoidance of crowds. As to occupational impairment, the Veteran reported working as a computer technician. The Veteran also indicated that he is distracted, causing errors at work. However, he also reported some positivity associated with his work because he is able to work with only computers. The examiner indicated that the Veteran’s overall level of occupational and social impairment with regards to all mental diagnoses was best described as ‘occupational and social impairment with reduced reliability and productivity.’ The VA examination report and the lay statements show that the Veteran’s PTSD with alcohol abuse has manifested with some symptoms that are contemplated by a 30 percent rating, including depressed mood, anxiety, suspiciousness, and chronic sleep impairment. However, his PTSD has manifested, predominantly, with symptoms associated with a 50 percent rating including panic attacks more than once a week, impairment of short- and long-term memory, circumstantial, circumlocutory or stereotyped speech, impaired judgment, and disturbances of motivation and mood. The Veteran had few symptoms associated with a 70 percent rating such as near-continuous panic, some neglect of personal appearance and grooming, and unprovoked irritability. Although the Veteran was generally oriented, he was disoriented as to the location. Some of the Veteran’s symptoms, such as easily startling, avoidance of crowds, and claustrophobia, are not listed with a specific rating. Having reviewed the Veteran’s symptomatology, the Board finds the severity, frequency, and duration of the Veteran’s symptoms more closely approximate the symptoms contemplated by a 50 percent rating, which are less severe, less frequent, and shorter in duration than those contemplated by a 70 percent rating. Notably, although the Veteran reports irritability and anger that was easily provoked, the Veteran did not report that these periods of impaired impulse control resulted in violence. Likewise, although the examiner endorsed near continuous panic or depression, the evidence of records does not show that the Veteran was impaired in his ability to function independently, appropriately, and effectively. Lastly, the Veteran’s report of disorientation to location during the VA examination was not shown to be more severe as the Veteran was able to function satisfactorily at work and in other activities. The Board also finds the level of impairment caused by the Veteran’s symptoms more closely approximates the level associated with a 50 percent rating. As noted by the VA examiner, the Veteran experienced occupational and social impairment with reduced reliability and productivity. Although the Veteran and his spouse reported that the Veteran’s social functioning was negatively impacted by his irritability, anger, avoidance of crowds, and withdrawal, the Veteran was able to maintain some social relationships with his wife and stepchild. Moreover, the Veteran level of occupational impairment was less severe than that of a 70 percent rating. The Board notes that the Veteran reported making some mistakes at work and the examiner endorsed impaired memory. However, the evidence of record does not support any negative consequences due to the Veteran’s psychiatric condition such as work conflicts, counseling, reprimands, reassignments, suspensions, or terminations. The Veteran reported steady work and some positive association with his work. Collectively, the Veteran’s social and occupational impairment does not approximate deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. Thus, the Veteran’s symptoms do not result in the level of impairment envisioned in a 70 percent, or higher, rating Ultimately, while the Veteran experiences some symptoms contemplated by a higher rating, the majority of the Veteran’s symptoms are contemplated by a 50 percent rating. More importantly, his symptomatology manifest in a level of occupational and social impairment that most closely approximates that envisioned by a 50 percent rating. The Veteran had some positive social relationships and was generally shown to be performing adequately at work. Thus, the evidence does not support a level of occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, or total occupational and social impairment. (Continued on the next page)   The Board has considered whether a total rating for compensation based on individual unemployability (TDIU) is a part of the current claim for an increased evaluation. Rice v. Shinseki, 22 Vet. App. 447 (2009). The Veteran has not indicated that that he is unemployable due to his psychiatric disorder and has been employed full-time during the appeal period. Accordingly, TDIU is not raised. In conclusion, the evidence does not support a higher evaluation for PTSD with alcohol abuse disorder in this case. Further, the level of disability has been consistent throughout the appeal and a staged rating is not warranted. See Hart v. Mansfield, 21 Vet. App. 505 (2007). There are no additional expressly or reasonably raised issues. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Vuong, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.