Citation Nr: 20048044 Decision Date: 07/17/20 Archive Date: 07/17/20 DOCKET NO. 16-15 789A DATE: July 17, 2020 ORDER A rating in excess of 50 percent prior to November 30, 2017, for posttraumatic stress disorder (PTSD) is denied. FINDINGS OF FACT 1. The Veteran served on active duty from March 1966 to February 1969; he has been 100 percent disabled since August 2016. 2. PTSD has been manifested by subjective complaints of anxiety, irritability, depression, poor motivation, and poor sleep; objective findings have not revealed impairment with deficiencies in most areas. CONCLUSION OF LAW The criteria for a rating in excess of 50 percent for PTSD prior to November 30, 2017, have not been met. 38 U.S.C. §§ 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.15, 3.321(b)(1), 4.3, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9411 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board remanded this appeal in October 2018 for additional development. It has now been returned to the Board for further appellate action. There has been substantial compliance with the remand directives, and there is no bar to proceeding with the appeal. Stegall v. West, 11 Vet. App. 268, 271. 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. All psychiatric disabilities are evaluated under a General Rating Formula for Mental Disorders (“General Rating Formula”). Under the General Rating Formula, a 50 percent rating is warranted under the General Rating Formula for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect, circumstantial, circumlocutory, or stereotyped speech, panic attacks occurring more than once a week, difficulty in understanding complex commands, impairment of short-term memory (i.e. retention of only highly learned material or forgetting to complete tasks), impaired judgment, impaired abstract thinking, disturbances of motivation and mood, and difficulty in establishing effective work and social relationships. A 70 percent rating is warranted under the General Rating Formula for occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, 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 an 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), and an inability to establish and maintain effective relationships. A 100 percent rating is warranted under the General Rating Formula for 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 the ability to maintain minimal personal hygiene), disorientation to time or place, and memory loss for names of close relatives, own occupation, or own name. The symptoms listed under the rating criteria are meant to be examples of symptoms that would warrant the rating, but they are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Initially, the Veteran has been in receipt of a 50 percent rating for PTSD since February 26, 1999. He filed a claim for an increased rating based on worsening symptoms which was received by VA on April 7, 2015. As such, the relevant appeal period is from that until November 30, 2017, when a 100 percent rating was eventually granted, and the Board has limited its consideration accordingly. Turning to the evidence, in a May 2015 VA examination, the Veteran reported symptoms of anxiety, chronic sleep impairment, mild memory loss, disturbances of mood and motivation, difficulty in establishing and maintaining effective work and social relationships, and difficulty in adapting to stressful circumstances, including work or a worklike setting. He reported that he had been married to his current wife for 35 years and that they had two adult children. He stated that he and his wife resided in the same home but had a strained relationship. He also stated that he had some relationships with other veterans through various veterans’ organizations. He denied any legal or behavioral issues, and stated that he only drank alcohol occasionally as well as marijuana for sciatica pain. The examiner noted that the Veteran was on time, casually dressed, and adequate groomed. He was alert and oriented to person, place and time, and was pleasant and cooperative. There was no evidence of a formal thought disorder and his mood was euthymic with a congruent affect. He admitted to past, infrequent thoughts of suicidal ideation, without plan and denied any current ideation, intent or plan. He was found to not be a risk by the examiner, and was found capable of managing his financial affairs. The examiner found that PTSD manifested as occupational and social impairment with reduced reliability and productivity. The examiner also noted that PTSD symptoms had remained relatively stable over time with only an increase in anxiety which the Veteran primarily attributed to suffering a stroke in 2000 and chronic marital problems. He reported mild flashbacks infrequently. He also noted that he visited with a few military friends. He denied any problems recalling past events, with the exception of some short-term memory issues since his stroke. The Veteran mostly noted an increase in anxiety which he attributed to moments of tension with his wife and sleep disturbances but he denied any loss of interest. The examiner noted that PTSD was moderate to severe in that it negatively affected his social and occupational functioning but that it remained largely stable. At a subsequent April 2016 VA examination, the examiner noted no significant changes in the Veteran’s psychological circumstances since his prior examination in May 2015. He continued to be married to his wife for over 35 years, but that they had agreed to a divorce. He reported being in a new relationship and that he spent a majority of his time with a new girlfriend or another friend. He also reported a good relationship with his adult children. He denied any current treatment for his PTSD, and noted that he was last in treatment in 2007. He also denied any medication or psychotherapy. He denied any suicide attempts and the examiner found that he was not a suicide or homicide risk. He continued to deny any legal or behavioral history. He reported symptoms of anxiety, chronic sleep impairment, mild memory loss, disturbances of mood and motivation, and difficulty in adapting to stressful circumstances. The examiner found that PTSD manifested as occupational and social impairment with reduced reliability and productivity. The examiner noted that compared to his prior VA examination, there was no overall significant change in the severity of PTSD symptoms and that they remain at a moderate level. The examiner noted that the Veteran experienced persistent and generally moderate disruptions in his psychosocial functioning in the form of nightmares and hyperarousal. Depending on exposure to triggers, he was noted to also experience flashbacks and hypervigilance. He was noted to dislike and avoid large gatherings, and being prone to occasional episodes of mild verbal irritability in his household and anger on the road, with isolation. The Veteran was retired and had not worked since 2000 due to a heart disorder. Overall, the examiner found that his ability to enjoy any daily activities continued to be moderately compromised by his PTSD. In July 2016, the Veteran’s friend submitted a buddy statement where she recounted several instances of hypervigilance. Specifically, she noted instances of distress when triggered, suspiciousness, and anger. The Veteran has also reported similar symptoms in submitted correspondence. The Veteran’s VA and private treatment records have also been reviewed. Importantly, there is little treatment for PTSD; however, the available clinical records do not show treatment which suggests more severe symptoms than those outlined in the May 2015 and April 2016 VA examinations. After reviewing the totality of the record for the relevant time period, a rating in excess of 50 percent was not warranted from the period prior to November 30, 2017. In this regard, both examiners found that PTSD manifested as occupational and social impairment with reduced reliability and productivity. Additionally, it was found that his symptoms had not changed or worsened over the course of a year. He also maintained friendships with fellow veterans, friends, and his children. While he did begin the process of a divorce during this time, he was involved in another romantic relationship soon after, illustrating his ability to maintain social relationships. There was no evidence of suicidal ideations with plans, obsessional rituals, illogical speech, near continuous panic or depression, impaired impulse control, spatial disorientation or neglect of personal appearance or hygiene and he was on no medication for psychiatric symptoms. Instead, the Veteran was adequately groomed, cooperative, maintained eye contact, had no issues with participating in several VA evaluations, and had ongoing friendships and relationships. He was found to be alert and oriented to person, place and time. He was also found capable of managing his financial affairs. He denied suicidal or homicidal ideations, hallucinations or delusions. He was not found to have grossly inappropriate behavior, and was found to be extremely low risk of harming himself or others. He also noted that he lived either with his wife, living separate lives, or with his friend and girlfriend, illustrating that he was capable of performing the activities of his daily living independently. While he did note an occasional lapse in short term memory since his stroke, there was no evidence of significant memory impairment. The Board has also considered the Veteran’s lay statements that his disability is worse. While he is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability of this disorder according to the appropriate diagnostic codes. Such competent evidence concerning the nature and extent of the Veteran’s PTSD has 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 (as provided in the examination reports and other clinical evidence) directly address the criteria under which this disability is evaluated. Moreover, as the examiners has the requisite medical expertise to render a medical opinion regarding the degree of impairment caused by the disability and had sufficient facts and data on which to base the conclusion, the Board affords the medical opinions great probative value. As such, these records are more probative than the Veteran’s subjective complaints of increased symptomatology. In sum, after a careful review of the evidence of record, the benefit of the doubt rule is not applicable, and the appeal is 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 M. Yacoub, 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.