Citation Nr: 20002876 Decision Date: 01/13/20 Archive Date: 01/13/20 DOCKET NO. 18-02 714 DATE: January 13, 2020 ORDER Entitlement to an initial disability rating of 30 percent, but no higher, for service-connected other specified trauma with stressor related disorder (claimed as posttraumatic stress disorder (PTSD) with depression and insomnia), is granted. FINDING OF FACT During the rating period on appeal, the service-connected other specified trauma with stressor related disorder (claimed as posttraumatic stress disorder (PTSD) with depression and insomnia), was manifested by symptoms productive of functional impairment that more nearly approximates occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. CONCLUSION OF LAW During the rating period on appeal, the criteria for an initial disability rating of 30 percent, but no higher, for service-connected other specified trauma with stressor related disorder (claimed as posttraumatic stress disorder (PTSD) with depression and insomnia), have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.3, 4.7, 4.130, Diagnostic Code 9410. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Army from May 2000 to November 2015. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a March 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. Entitlement to an initial disability rating of 30 percent, but no higher, for service-connected other specified trauma with stressor related disorder (claimed as PTSD with depression and insomnia). The record shows that the Veteran was awarded service connection for other specified trauma and stressor related disorder claimed as PTSD with depression and insomnia in a March 2016 rating decision. An initial noncompensable rating was assigned, effective from November 2, 2015. The Veteran contends that he is entitled to at least a 30 percent disability rating based on his symptoms. See January 2018 VA Form 9; November 2019 Appellate Brief. Disability ratings are determined by the application of VA’s Schedule for Rating Disabilities (Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Disability evaluations are determined by assessing the extent to which a veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule. If there is a question as to which evaluation should be applied to the veteran’s disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The primary focus in a claim for increased rating is the present level of disability. Although the overall history of the veteran’s disability shall be considered, the regulations do not give past medical reports precedence over current findings. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Additionally, a staged rating is warranted if the evidence demonstrates distinct periods of time in which a service-connected disability exhibited diverse symptoms meeting the criteria for different ratings throughout the course of the appeal. See Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). In rating mental disorders under the General Rating Formula, the Board must conduct a “holistic analysis” that considers all associated symptoms, regardless of whether they are listed as criteria. 38 C.F.R. § 4.130; Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017). 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). Here, the Veteran’s service-connected other specified trauma and stressor related disorder claimed as PTSD with depression and insomnia is rated under 38 C.F.R. § 4.130, Diagnostic Code 9410 with a noncompensable rating for the period on appeal. A noncompensable rating is assigned when a mental condition has been formally diagnosed, but symptoms are not severe enough to either require continuous medication, or to interfere with occupational and social functioning. See 38 C.F.R. § 4.130, Diagnostic Code 9410. A 10 percent rating is assigned with mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of occasional stress, or symptoms controlled by medication cause occupational and social impairment. Id. A 30 percent rating is assigned when symptoms such 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) cause occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally satisfactorily, with routine behavior, self-care, and conversation normal). Id. 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. Id. 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. Id. 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. Id. As an initial matter, the Veteran’s representative asserted that the Veteran was not provided an initial mental health and PTSD examination. See November 2019 Appellate Brief. However, the Veteran was afforded an Initial PTSD VA examination in February 2016 received by the VA in March 2016. Despite only indicating the Veteran’s symptoms for rating purposes only included anxiety, the VA examiner noted the Veteran’s reports of his symptoms, including recurrent thoughts, irritability, difficulty sleeping, and trouble with memory. See February 2016 VA examination. The VA examiner noted the Veteran’s stressors were related to the Veteran’s fear of hostile military or terrorist activity due to his combat experience while in the military. Id. The VA examiner ultimately diagnosed the Veteran with other specified trauma and stressor related disorder. Id. The VA examiner determined that the Veteran did not report any occupational and social impairment as a result of his mental health diagnosis and determined that the Veteran’s symptoms more closely approximated a noncompensable disability rating. Id. The Veteran’s overall symptomatology more closely approximates the criteria for a 30 percent rating. In May 2017 the Veteran sought treatment for his acquired psychiatric disorder and demonstrated an initial PTSD screening test resulted in a positive finding. See May 2017 VA treatment records. In August 2017, the Veteran was diagnosed with PTSD. See August 2017 VA treatment records. A mental health note provides that the Veteran’s symptoms included irritability or aggression, hypervigilance, difficulty sleeping, intrusive thoughts, nightmares, and avoidance of trauma related stimuli and reminders. Id. Additionally, the mental health note states that the Veteran’s symptoms create distress or functional impairment. Id. Additionally, in support of his claim, the Veteran provided lay statements describing his symptoms related to his service-connected psychiatric disorder. The Board finds that the Veteran is competent to describe the observable symptoms of his service-connected disorder, and his statements are credible and entitled to probative weight. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Caluza v. Brown, 7 Vet. App. 498, 511 (1995). Through the appeal period, the Veteran has asserted that his symptoms include tending to stay away from people and avoiding crowds; difficulties sleeping; irritability and anger; trouble with memory; drinking regularly and frequently; difficulties working with others; and nightmares. See December 2015 VA Form 21-4138; February 2016 VA examination; January 2018 VA Form 9. Additionally, the Veteran provided lay statements from his family that describes the Veteran’s symptoms that included flattened affect; short tempered and easily irritated and angered; anxious in crowds; sleep difficulties; and extreme planning. See December 2015 VA Forms 21-4138. Therefore, the Board finds that the evidence demonstrates that the Veteran’s symptoms more closely approximate occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. The Board further finds that the Veteran’s service-connected acquired psychiatric disorder, to include PTSD, did not result in functional impairment that more closely approximates to the criteria for a 50 percent or higher rating. Though the Veteran provided lay statements that demonstrate some of the criteria for a 50 percent rating such as flattened affect, the Veteran did not demonstrate symptoms consistent with circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty understanding complex commands; impairment of short- and long-term memory; impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty establishing and maintaining effective work and social relationships. Specifically, the Veteran stated that though he has had some issues with work, he is still able to work and reported that he was starting a new job in September 2017. See September 2017 VA treatment records; January 2018 VA Form 9. Though the Veteran provided lay statements indicating difficulty with his memory, the medical evidence of record does not demonstrate that the Veteran’s symptoms demonstrate short- and long-term memory. See August 2017 VA treatment records; February 2016 VA examination. As such, there is no basis for a finding of a higher rating greater than 30 percent. The Board also notes that there is no evidence to distinguish between all of the symptoms of the Veteran’s psychiatric disabilities, and a separate decision as to entitlement to service connection for PTSD is unnecessary. See Howell v. Nicholson, 19 Vet. App. 535, 540 (2006). Thus, in applying the benefit of the doubt doctrine, all of the Veteran’s psychiatric symptoms must, therefore, be attributed to his service-connected other specified trauma and stressor related disorder. See Mittleider v. West, 11 Vet. App. 181, 182 (1998). In sum, the Board finds that, for the Veteran’s service-connected other specified trauma and stressor related disorder, an initial 30 percent rating, but no higher, is warranted through the period on appeal. To the extent that the Veteran seeks a rating in excess of that granted herein, the preponderance of the evidence is against the Veteran’s appeal, the benefit-of-the-doubt rule is not for application, and the appeal must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (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). U. R. POWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. P. Moore, 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.