Citation Nr: 20072849 Decision Date: 11/12/20 Archive Date: 11/12/20 DOCKET NO. 16-59 860 DATE: November 12, 2020 ORDER From July 13, 2015 to April 7, 2017, entitlement to an evaluation of 100 percent for service-connected posttraumatic stress disorder (PTSD) with opioid use disorder (hereinafter psychiatric disorder) is granted. FINDING OF FACT From July 13, 2015 to April 7, 2017, after resolving reasonable doubt in the Veteran’s favor, his service-connected psychiatric disorder more nearly approximates total occupational and social impairment. CONCLUSION OF LAW From July 13, 2015 to April 7, 2017, the criteria for a 100 percent rating for service-connected psychiatric disorder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.130, Diagnostic Code 9413. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 2010 to September 2012. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned at a hearing in April 2017. In January 2019, the claim was remanded. Increased Rating Disability evaluations are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Schedule). The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. Entitlement to an increased rating for psychiatric disorder. In October 2012 the Veteran was granted service connection for adjustment disorder with mixed anxiety and depressed mood and assigned an initial 30 percent rating, effective September 30, 2012. Thereafter, he filed a claim in December 2015 for an increase in his rating and was granted an increase to 50 percent effective July 13, 2015 in an April 2016 rating decision. The Veteran filed a notice of disagreement to this rating and perfected an appeal to such. In a subsequent September 2019 rating decision the RO increased the Veteran’s rating to 100 percent under rating code 9411, effective April 7, 2017. The claim was recharacterized as PTSD with opioid use disorder. The Board therefore notes that for the period from April 7, 2017 benefits for a psychiatric order have been granted in full. The Veteran’s service-connected psychiatric disorder has been rated under the provisions of 38 C.F.R. § 4.130, Diagnostic Code 9413 and 9411. The rating criteria are the same. A 50 percent disability rating is warranted when the Veteran experiences occupational and social impairment with reduced reliability and productivity due to such symptoms 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; and difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent rating requires occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; 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 work-like setting); or inability to establish and maintain effective relationships. Id. A 100 percent rating requires total occupational and social impairment, due to such symptoms 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. Id. The Board observes that the Veteran was incarcerated from October 2015 to January 2016 as a result of outstanding warrants and hold orders. In December 2015, the Veteran reported that he had been battling opioid addiction for three years and it had caused many problems in his life. In a February 2016 VA treatment entry, the Veteran denied anxiety and sleep disturbance. In February 2016 he was diagnosed with PTSD as he reported that he was still having nightmares and intrusive thoughts with panic attacks. In April 2016 the Veteran reported that he was doing well, that he experienced some fatigue and aches during some days, but denied any other side effects. He denied suicidal ideations. See April 2016 Treatment record VAMC Salt Lake City. The Veteran was afforded a VA examination for his psychiatric disorder in March 2016. At that examination the examiner noted prior diagnoses of adjustment disorder with mixed anxiety and depressed mood. The examiner reported that the Veteran did not have more than one mental disorder diagnosed. The examiner noted that the Veteran had occupational and social impairment with occasional decrease in work efficiency and intermittent periods of the inability to perform occupational tasks, although generally functioning satisfactorily with normal routine behavior, self-care and conversation. The Veteran reported having family live nearby, who he felt supported by. The examiner noted that the Veteran was not currently working, but had a job waiting for him and that he planned to attend community college. The examiner made note of the Veteran’s attempt of suicide in 2013, which led to the end of VA supplied pain medication, so he found some on the street. The Veteran struggles with his addiction but he had been clean for 14 months at the time of the examination. The Veteran reported symptoms of depressed mood, anxiety, suspiciousness, panic attacks more than once a week, chronic sleep impairment, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, including work or work like setting, the inability to establish and maintain effective relationships. The Veteran noted that he was capable of managing his financial affairs. In November 2016 the Veteran was admitted to the Substance Abuse Rehabilitative Therapy Program, as he reported he was unable to maintain abstinence in the long term and that continued use of heroin, cocaine, cannabis and alcohol continued despite three residential treatments for substance abuse problems. The Veteran reported that suicidal thoughts brough him to the IPU in October 2016, which is one of the reasons he went to SARRTP for help. In March 2017 Dr. Sarah Hall submitted a statement, that the Veteran reported significant symptoms which were labeled as anxiety in 2013, but it has since become apparent that such were actually chronic PTSD relating to his time in the military. Dr. Hall noted that an in service event caused the Veteran to experience mood changes, anxiety, sleep disturbance and intrusive memories of the event thereafter. He self-medicated with alcohol and also with opioid pain medication prescribed to him. (Continued on the next page)   The Veteran requested a temporary total rating for inpatient PTSD treatment in an application dated April 7, 2017. This application led to the grant of the 100 percent rating. Based on the forgoing it appears that since the Veteran filed his claim for an increased rating, he has struggled with opiod abuse that has been related to his service-connected PTSD. After his incarceration from October 2015 until January 2016, he sought treatment for his drug abuse at SARRTP in November 2016. It does not appear that the Veteran has been able to function outside of a structured environment since his claim for an increased rating and the grant of the 100 percent rating effective April 7, 2017. Accordingly, the Board concludes that a 100 percent rating is warranted. S. HENEKS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Nadia Kamal, 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.