Citation Nr: 21000233 Decision Date: 01/04/21 Archive Date: 01/04/21 DOCKET NO. 16-33 891 DATE: January 4, 2021 ORDER Entitlement to a disability rating in excess of 10 percent prior to November 22, 2019 and in excess of 20 percent thereafter for bilateral hearing loss is denied. Prior to March 23, 2016, entitlement to a disability rating in excess of 30 percent for posttraumatic stress disorder (PTSD) is denied. From March 23, 2016 to December 1, 2019, entitlement to a disability rating of 50 percent, but no higher, for PTSD is granted. From December 2, 2019, entitlement to a disability rating in excess of 50 percent for PTSD is denied. FINDINGS OF FACT 1. The Veteran’s bilateral hearing loss manifested at worst by Level III hearing in the right ear and Level IV hearing in the left ear prior to November 22, 2019 and by Level V hearing in the right ear and Level VI hearing in the left ear thereafter. 2. Prior to March 23, 2016, the Veteran’s PTSD resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. 3. From March 23, 2016, the Veteran’s PTSD resulted in occupational and social impairment with reduced reliability and productivity. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 10 percent prior to November 22, 2019 and in excess of 20 percent thereafter for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5103, 5103A; 38 C.F.R. §§ 4.85, 4.86, Diagnostic Code (DC) 6100. 2. Prior to March 23, 2016, the criteria for a disability rating in excess of 30 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. § 4.130, Diagnostic Code 9411. 3. From March 23, 2016 to December 1, 2019, the criteria for a disability rating of 50 percent, but no higher, for PTSD have been met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. §§ 4.3, 4.130, Diagnostic Code 9411. 4. From December 2, 2019, the criteria for a disability rating in excess of 50 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. § 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the Army from April 1970 to December 1971. These matters come before the Board of Veteran’s Appeals (Board) on appeal from a March 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO), which granted service connection for bilateral hearing loss and assigned a 10 percent evaluation effective May 3, 2013, and PTSD and assigned a 30 percent evaluation effective May 3, 2013. In March 2019, the Veteran presented testimony at a travel board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is on record. In August 2019, the Board remanded the matters for VA examinations to determine the current severity of his service-connected bilateral hearing loss and PTSD. During the pendency of the appeal, in an August 2020 rating decision, the agency of original jurisdiction (AOJ) increased the disability rating for bilateral hearing loss to 20 percent effective November 22, 2019, and PTSD to 50 percent effective December 2, 2019. Since the AOJ did not assign the maximum disability rating possible for the entire appeal period, the appeal for higher disability evaluations and earlier effective dates remain before the Board. AB v. Brown, 6 Vet. App. 35 (1993). Increased Ratings Disability ratings are determined by the application of the VA’s Schedule for Rating Disabilities (Rating 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.  Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficient to identify the disease and the resulting disability and above all, coordination of the rating with impairment of function will be expected in all cases.  38 C.F.R. § 4.21. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. Where there is a question as to which of two ratings should be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned.  38 C.F.R. § 4.7. 1. Entitlement to a disability rating in excess of 10 percent prior to November 22, 2019 and in excess of 20 percent thereafter for bilateral hearing loss is denied. The Veteran seeks an increased rating for his service-connected bilateral hearing loss. The Board finds an increased rating is not warranted for either period on appeal. The severity of a hearing loss disability is determined by comparisons of audiometric test results with specific criteria set forth at 38 C.F.R. § 4.85. Evaluations of bilateral defective hearing range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of controlled speech discrimination tests together with the average hearing threshold level as measured by pure tone audiometry tests in the frequencies of 1,000, 2,000, 3,000, and 4,000 Hertz (cycles per second).  The Rating Schedule allows for such audiometric test results to be translated into a numeric designation ranging from Level I to Level XI in order to evaluate the degree of disability from bilateral service-connected defective hearing. Significantly, an examination for hearing impairment must be conducted by a state-licensed audiologist and must include a controlled speech discrimination test (Maryland CNC) and a pure tone audiometry test.  Examinations must be conducted without the use of hearing aids.  38 C.F.R. § 4.85.  Exceptional patterns of hearing impairment are addressed in 38 C.F.R. § 4.86. When the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral.  Each ear will be evaluated separately.  38 C.F.R. § 4.86(a).   When the pure tone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. That numeral will then be elevated to the next higher Roman numeral.  Each ear will be evaluated separately.  38 C.F.R. § 4.86(b). The Veteran was provided his first VA hearing loss examination in February 2014. Audiometric findings from this examination were as follows: Right Ear Frequency   1000Hz   2000Hz   3000Hz   4000Hz   Pure Tone Threshold   20dB   25dB   35dB   45dB   Left Ear Frequency   1000Hz   2000Hz   3000Hz   4000Hz   Pure Tone Threshold   20dB   25dB   35dB   50dB   The average pure tone threshold was 31.25 decibels for the right ear and 32.5 decibels for the left ear. The speech discrimination scores were 78% in the right ear and 70% in the left ear. Applying Table VI to the February 2014 examination results indicate Level III hearing in the Veteran’s right ear and Level IV hearing in his left ear, which corresponds to a 10 percent rating under Table VII. Table VIa is inapplicable because the record does not reflect an exceptional pattern of hearing impairment, as defined by 38 C.F.R. § 4.86. Thus, according to these results, a 10 percent rating was appropriate as of February 2014. The Veteran next supplied a private hearing loss examination conducted in October 2014. Audiometric findings from this examination were as follows: Right Ear Frequency   1000Hz   2000Hz   3000Hz   4000Hz   Pure Tone Threshold   45dB   50dB   50dB   55dB   Left Ear Frequency   1000Hz   2000Hz   3000Hz   4000Hz   Pure Tone Threshold   40dB   45dB   55dB   55dB   The average pure tone threshold was 50 decibels for the right ear and 49 decibels for the left ear. The speech discrimination scores were 88% in both ears. Applying Table VI to the October 2014 examination results indicate Level II hearing in the Veteran’s right and left ear, which corresponds to a noncompensable rating under Table VII. Table VIa is inapplicable because the record does not reflect an exceptional pattern of hearing impairment, as defined by 38 C.F.R. § 4.86. Thus, according to these results, a disability rating in excess of 10 percent was not warranted as of October 2014. The Veteran was provided a remand ordered examination in November 2019. Audiometric findings of this examination were as follows: Right Ear Frequency   1000Hz   2000Hz   3000Hz   4000Hz   Pure Tone Threshold   40dB   50dB   60dB   65dB   Left Ear Frequency   1000Hz   2000Hz   3000Hz   4000Hz   Pure Tone Threshold   40dB   40dB   55dB   65dB   The average pure tone threshold was 54 decibels for the right ear and 50 decibels for the left ear. The speech discrimination scores were 68% in the right ear and 66% in the left ear. Applying Table VI to the November 2019 examination results indicate Level V hearing in the Veteran’s right ear and Level VI hearing in the left ear, which correspond to a 20 percent disability rating under Table VII. Table VIa is inapplicable because the record does not reflect an exceptional pattern of hearing impairment, as defined by 38 C.F.R. § 4.86. Thus, according to these results, a 20 percent rating became warranted as of November 2019. Based on this evidence, the Veteran’s bilateral hearing loss is appropriately rated as 10 percent disabling prior to November 22, 2019 and 20 percent disabling thereafter. The Board expressly acknowledges its consideration of the lay evidence of record when adjudicating this claim, including the Veteran’s reported difficulty hearing and understanding conversations and instructions, the television, his wife, and the need to pass on certain work assignments because of his hearing loss, as well as his wife’s testimony confirming some of these difficulties.  The Veteran and his wife are competent to report difficulty with his hearing; however, disability ratings for hearing loss are derived from a mechanical application of the rating schedule to the numeric designations resulting from audiometric testing. See Lendenmann v.  Principi, 3 Vet. App. 345 (1992). The rating criteria contemplate speech reception thresholds and ability to hear spoken words on Maryland CNC testing.  The functional impact that the Veteran describes is contemplated by the rating criteria.  Doucette v. Shulkin, 28 Vet. App. 366 (2017).  The Veteran’s main complaint is reduced hearing acuity and clarity, which is what is contemplated in the ratings assigned.  See Rossy v. Shulkin, 29 Vet. App. 142, 145 (2017). 2. Prior to March 23, 2016, entitlement to a disability rating in excess of 30 percent for PTSD is denied. 3. From March 23, 2016 to December 1, 2019, entitlement to a disability rating of 50 percent, but no higher, for PTSD is granted. 4. From December 2, 2019, entitlement to a disability rating in excess of 50 percent for PTSD is denied. The Veteran seeks an increased rating for his service-connected PTSD. The Veteran’s PTSD is currently rated as 30 percent disabling prior to December 2, 2019 and 50 percent disabling from that date. For reasons set forth below, the Board finds that the Veteran’s PTSD is appropriately rated prior to March 23, 2016, but that a 50 percent disability rating is warranted thereafter. The Veteran’s PTSD is evaluated under the General Rating Formula for Mental Disorders, 38 C.F.R § 4.130, Diagnostic Code 9411.  Under Diagnostic Code 9411, ratings are assigned according to the degree of occupational and social impairment resulting from manifestations of the disability at issue.  However, the use of the term “such as” in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating.  Mauerhan v. Principi, 16 Vet. App. 436 (2002). Under the provisions for rating psychiatric disorders, a 30 percent disability rating is assigned when there is evidence of 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, mild memory loss (such as forgetting names, directions, recent events). 38 C.F.R. § 4.130, Diagnostic Code 9411. A 50 percent rating requires evidence of 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; difficulty in establishing and maintaining effective work and social relationships.  Id.  A 70 percent rating is warranted when there is 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; inability to establish and maintain effective relationships.).  Id.  A 100 percent rating is warranted when there is 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; memory loss for names of close relatives, own occupation, or own name.  Id.  When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran’s capacity for adjustment during periods of remission. The rating agency shall assign a rating based on all the evidence of record that bears on occupational and social impairment, rather than solely on the examiner’s assessment of the level of disability at the moment of the examination. When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign a rating solely on the basis of social impairment.  38 C.F.R. § 4.126.  Moreover, it is not sufficient to simply match the symptoms listed in the rating criteria against those exhibited by the Veteran.  Rather, “VA must engage in a holistic analysis” of the frequency, severity, and duration of the signs and symptoms of the Veteran’s mental health condition, determine the level of occupational and social impairment caused by those signs and symptoms, and assign an evaluation that most nearly approximates that level of occupational and social impairment.  Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017). Additionally, when impossible to separate the effects of a service-connected condition and a non-service-connected condition, VA regulations at 38 C.F.R. § 3.102, which require that reasonable doubt on any issue be resolved in the Veteran’s favor, “clearly dictate” that such signs and symptoms be attributed to the service-connected disability. See Mittleider v. West, 11 Vet. App. 181, 182 (1998). To this end, the Board initially notes that the record includes a possible diagnosis of dementia and/or Alzheimer’s disease, which may account for the Veteran’s memory problems. However, as the Veteran’s record does not contain definitive diagnoses of these conditions nor evidence that the Veteran’s memory problems can be or have been separated from his PTSD, the Board has herein attributed his memory problems to his service-connected PTSD. Notably, the December 2019 examiner was unable to separate and attribute the Veteran’s memory problems to a diagnosis other than his PTSD. Prior to March 23, 2016 The Veteran was provided his first VA mental health examination in February 2014. At the examination, the Veteran described his marriage as bumpy, but that they got along well. He reported they enjoyed going out to eat, to the movies, to barbeques, and to visit family. The Veteran indicated maintaining a close, but physically distant relationship with his son who lives out of state and a close relationship with his five grandchildren, two of whom he adopted from his ex-daughter-in-law. He reported decreased contact with his siblings and occasionally attending church. He denied other group activities. It was noted that the Veteran exhibited symptoms of anxiety, chronic sleep impairment, and difficulty establishing and maintaining effective work and social relationships. The examination report also includes notations of the Veteran crying through much of the interview, hypervigilance, and problems with concentration. The examiner diagnosed the Veteran with PTSD, and qualified the symptoms as resulting in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily. It was noted that based on this examination, the Veteran did not need to seek follow up treatment. March 2014 notes from an intake assessment conducted by the Veteran’s readjustment counselor indicate the Veteran experienced intrusive thoughts of war, avoidance, and sadness related to the death of a best friend in Vietnam. He denied suicidal thoughts or plans, but did report intermittent feelings of hopelessness triggered by news of war. Records indicate that the Veteran began group therapy sessions in August 2014. In September 2014, the Veteran reported going on a weekend trip to Lake Charles, Louisiana, and that he appreciated the time to relax. He noted work had become more stressful, as he was working more over-time. Otherwise, the Veteran participated well in the group therapy session. A group session from October 2014 focused on member’s ability to control their anger. The Veteran shared past incidents of difficulty controlling his anger and noted that he still had moments when this happens. Later in October 2014, the Veteran indicated that he felt “good” and was making attempts to manage his PTSD symptoms when elevated. In January 2015, the Veteran reported at a group therapy session that he believed recent elevated stress levels have resulted in some memory problems. He also reported continuing to experience intrusive thoughts of war. In February 2015, the Veteran spoke of recent personal stressors and benefited from processing through them. His PTSD symptoms were qualified as mild at the time. In April 2015, the Veteran reported that everything was “okay” in his life. He reported attending multiple medical appointments and considering retirement at the end of the year. In July 2015, the Veteran indicated experiencing nightmares and intrusive thoughts, but that at this time he was managing his symptoms. He noted keeping busy by working on his home, going on various gambling trips, and spending time with his grandchildren. His PTSD was qualified as mild when triggered. Group therapy sessions from August 2015 to December 2015 indicate positive participation from the Veteran. The counselor noted that the Veteran “provided supportive listening to other group members and made appropriate comments to group discussion.” His symptoms were qualified as mild to moderate when triggered. A primary care nursing note from January 2016 indicates that the Veteran was able to take care of all shopping needs; plan, prepare, and serve adequate meals independently; maintain his house; do laundry; travel independently; take medications; and handle finances. Based on the foregoing, the Board finds that the Veteran is not entitled to a disability rating in excess of 30 percent for his PTSD prior to March 23, 2016. To this end, prior to that date, the record does not show that the Veteran had PTSD symptoms that resulted in occupational and social impairment worse than occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. At his February 2014 VA examination, the Veteran was noted to have symptoms of anxiety, chronic sleep impairment, and difficulty establishing and maintaining effective work and social relationships, as well as hypervigilance and some problems with concentration. Approximately a year later, the Veteran self-reported some stress induced memory problems. However, there is no evidence in the record that prior to March 23, 2016, the Veteran experienced abnormal speech, had panic attacks, impaired judgment or thinking, or difficulty understanding complex tasks. Moreover, the Veteran was able to repair and renovate a second home, partake in gambling trips, and spend time with his grandchildren. Prior to March 23, 2016, the Veteran noted being able to manage his symptoms, and that he was feeling “good” and “okay.” So, while the Veteran experienced one moderate symptom of PTSD, namely, difficulty establishing and maintaining effective work and social relationships, when his disability picture is considered as a whole, his occupational and social impairment was not worse than occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks prior to March 23, 2016. Therefore, entitlement to a disability rating in excess of 30 percent for PTSD prior to that date is not warranted. 38 C.F.R. § 4.130, Diagnostic Code 9411. From March 23, 2016 Evidence suggests the Veteran’s PTSD symptoms had a greater negative impact on his ability to function beginning in March 2016. On March 23, 2016, the Veteran presented for a formal memory evaluation. He reported that he started misplacing his tools a few years before, but that co-workers have noticed this has become more of a problem. He reported that his job for the last 30 years had been aligning, calibrating, and otherwise adjusting mail processing equipment, but that he was having increased trouble completing work assignments correctly. Outside of work, he noted that, on occasion, he would go to the mall and forget the reason for the trip. He also mentioned forgetting to do things around the house and about medical appointments. He reported that his wife drove him around town and believed he could get easily lost. He denied difficulty remembering names, but did report some word finding difficulty. The examiner assessed these symptoms as relatively isolated memory dysfunction suggestive of mild cognitive impairment until the past year that may now be transitioning to a more serious diagnosis of dementia or Alzheimer’s disease. In June 2016, the Veteran reported at a group therapy session that he recently attended a hometown Memorial Day service. In July 2016, the Veteran provided supportive listening at a group session and spoke of a recent vacation with his family to Las Vegas, noting he had a good time. Later in July 2016, the Veteran underwent a mental health status examination. He appeared to be well oriented. His speech rate and volume were within normal limits. His thought processes and content were within normal limits, appropriate, logical, and reality based. His insight and judgment appeared intact. His remote and recent memory appeared within normal limits, but the examiner did not indicate they were formally assessed. In August 2016, the Veteran spoke of plans to go gambling with his wife at a group session, and attended another mental health status examination. At this examination, he was fully oriented. He maintained good eye contact, but his motor behavior was slightly restless. His mood was recorded as dysphoric with tearful affect. His thought processes were within normal limits. His speech was of average rate, tone, and volume. His attention, memory, and concentration were not formally assessed, but were intact for the purposes of conversation. The provider found no evidence of hallucinations, delusions, or psychosis. The Veteran denied suicidal and homicidal ideation. Later in August 2016, the Veteran reported that for the past six months, he had difficulty at work remembering how to do things he used to know how to do, explaining “my knowledge is not there anymore.” He also reported becoming angry easily both at work and at home. He suggested his long-term therapy goal was to be able to go places. The Veteran also reported seeing things that were not there; however, this was the only note of such symptoms on the record and, overall, the evidence of record weighs against finding the Veteran experienced delusions and/or hallucinations. In September 2016, the Veteran underwent another mental health status examination. He was dressed casually and fully oriented. He maintained good eye contact and calm motor behavior. His mood was anxious with congruent affect. His thought processes were within normal limits. His speech was average in rate, tone, and volume. His attention and memory were not formally assessed, but were intact for the purpose of the conversation. He denied delusions, hallucinations, suicidal ideation, and homicidal ideation. In December 2016, the Veteran reported a desire to begin attending again Vietnam support group therapy sessions for camaraderie with other Vietnam veterans. He noted that he was more willing to go places and engage in activities in public than before. He noted having more fun and an increased confidence. At a group therapy session later in December 2016, the Veteran reported looking forward to spending time with his family during the upcoming holidays. In January 2017, the Veteran reported at a group therapy session that he had been able to prepare financially for retirement, but worried about what he would do with his time. In March 2017, the Veteran reported at an individual therapy session that he had tickets to attend a concert at a local large venue. He and the provider noted that this was his ultimate therapy goal. In April 2017, the Veteran shared at a group therapy session about a recent trip to Biloxi, Mississippi and how he enjoyed visiting their Vietnam Veterans Memorial. He noted feeling good overall, but did report intermittent problems managing his PTSD symptoms, which were qualified as mild to moderate when triggered. Later in April 2017, the Veteran reported at a group session that he experienced sleep disturbances and nightmares. In June 2017, the Veteran described himself as “hanging on” regarding the management of his PTSD symptoms. He reported keeping busy with home projects and medical appointments. His mood was noted to be stable with normal affect, and without suicidal or homicidal ideation. The group session from August 2017 focused on the aftermath of a recent hurricane. The Veteran reported that he received little to no damage to his house, but was required to evacuate to a neighboring town, which the family enjoyed. He reported no elevated PTSD symptoms during this time. In September 2017, the Veteran reported at a group session that he remained busy preparing his home to sell as well as taking care of the home he lived in. Group therapy notes from November 2017 indicate the Veteran’s mood was stable. He was an active participant in the group and offered good points that were well received by fellow group members. His symptoms appeared controlled at this time. In February 2018, the Veteran was able to establish a relationship with a new group counselor. In April 2018, the Veteran reported increased depressive symptoms since April 2017, although he still qualified as negative for depression. Later in April 2018, the Veteran was noted to take care of all shopping needs independently; plan, prepare, and serve adequate meals independently; maintain his house alone or with occasional assistance; do laundry; travel independently; take medication correctly; and manage finances. The Veteran was a positive participant in group therapy sessions for the remainder of 2018. In February 2019, the Veteran reported increased frustrations with his health care. At his March 2019 hearing, the Veteran reported he and his wife no longer slept together because he sometimes hit the air while asleep and ran out of bed without realizing what he was doing. He also testified to memory problems. He reported that he no longer drove to places he did not know. He reported that he was still working, but only because it was repetitive work that he was familiar with. He also testified to staying home and avoiding crowds, noting that crowds could trigger panic attacks. His wife testified that she sometimes did not want to speak to him because of fear he might lash out. At appointments in April 2019, the Veteran stated he had days where he felt depressed, like he could hurt others at work. He endorsed depressive symptoms, including overall sadness, low mood, and loss of interest and motivation. He reported increased symptoms during certain times of the year. He noted anxiety, including a rapid heartbeat, uneasiness and nervousness in crowds, and shallow breathing. He was noted to exhibit hypervigilance and a lack of trust in others. Otherwise, he was fully oriented with normal speech, and denied suicidal and homicidal ideations. He was offered and started again with individual mental health services. Later in April 2019, the Veteran reported that he could not sleep more than five hours due to nightmares and could not resume sleep once awake. However, he noted that the use of a CPAP machine helped him feel more rested. He also reported that his energy was good for the first three days of the week, but then felt tired. He noted his memory was not as good as it used to be, and that his employer was not training him on new things. He endorsed feeling sad on and off, sometimes becoming tearful. He noted sometimes hiding in a corner at work to be by himself when tearful. The Veteran reported enjoying going to baseball games, but feeling uncomfortable around the crowds. He explained he must drink to be in attendance and that he was “always on guard.” In June 2019, the Veteran reported maintaining a good mood since his last session. He shared increased work stressors, although noted he was managing the stressors well. He reported an upcoming family vacation to New Mexico and that he was looking forward to exploring. In July 2019, he shared his vacation activities and photos. He reported continuing to contemplate retirement, but still being concerned with filling his day. He was assessed as fully oriented, with speech rate and volume within normal limits, appropriate, organized, and reality based. His thought processes were within normal limits, appropriate, logical, coherent, and comprehensible. He denied suicidal and homicidal ideation. In August 2019, the Veteran talked about putting his second home on the market, sharing information on ongoing renovations and repair work. He noted experiencing several episodes of anxiety and hypervigilance, for which he used breathing and music to cope. At the beginning of October 2019, the Veteran reported at a mental health appointment that he was experiencing increased work stressors due to increased job duties and work hours. He also reported continuing to work on his second home to sell and making progress on renovations. He was noted to be groomed, fully oriented, with normal speech. His thought processes were within normal limits, appropriate, logical, coherent, and comprehensible. His insight and judgment appeared intact and his remote and recent memory appeared within normal limits, although were not formally assessed. Later in October 2019, the Veteran reported continued maintenance of mood. He noted enjoying watching sports and being with family. He endorsed better coping mechanisms. A mental status examination was within normal limits. Pursuant to the Board’s remand, the Veteran was provided a VA mental health examination in December 2019. At the examination, the Veteran reported maintaining his employment with the United States Postal Service, which he had since 1974. He noted a variable relationship with his supervisor, but better relationships with his co-workers. However, he noted that he could become irritable at work and that he must avoid certain co-workers who upset him. He also reported declining job performance and reliability, stating “I can[not] follow instructions like I used to. [My co-workers] know that.” He explained that co-workers had to help him along with his memory issues. Socially, the Veteran reported that he does not spend time with friends and that he did not have too many outside of work, explaining that many had passed away. He denied engagement in group activities, but noted that he and his siblings occasionally got together for family events. The Veteran also reported sleeping four to six hours a night, attributing his sleeping problems to nightmares. The examiner recorded the Veteran’s PTSD symptoms as anxiety, suspiciousness, chronic sleep impairment, and difficulty establishing and maintaining effective work and social relationships. The examiner also noted the Veteran suffered from impairment of short- and long-term memory, retaining only highly learned material. The examiner noted medical records indicate a possible diagnosis of Alzheimer’s disease, but that he would have to resort to mere speculation to assign the Veteran’s memory problems to a diagnosis other than PTSD. The examiner qualified these symptoms as resulting in occupational and social impairment with reduced reliability and productivity, noting “significant memory problems that negatively impact work.” Based on the foregoing, the Board finds that the Veterans PTSD symptoms warrant a disability rating of 50 percent, but no higher, from March 23, 2016. Towards this, the Board notes that in December 2019 the Veteran was noted to suffer from PTSD symptoms consisting of anxiety, suspiciousness, chronic sleep impairment, difficulty establishing and maintaining effective work and social relationships, and significant short- and long-term memory impairment with retention of only highly learned material. The December 2019 examiner also noted the Veteran to be irritable at work and that he must avoid some of his co-workers. The December 2019 examiner qualified these PTSD symptoms as resulting in reduced reliability and productivity. This qualification was based largely on the Veteran’s significant memory problems that negatively impact his ability to work. However, these symptoms are substantially similar to the symptoms on record at the time of the Veteran’s March 23, 2016 memory evaluation. It then follows that if the December 2019 symptoms were productive of occupational and social impairment with reduced reliability and productivity, the substantially similar symptoms noted on the record beginning March 23, 2016 were also productive of occupational and social impairment with reduced reliability and productivity. The Board notes that during this period, the Veteran also explained that he would sometimes need to hide at work to be by himself, which indicates that the Veteran has been unreliable. The Board acknowledges that there may be some discrepancies during this period as to whether the Veteran was able to attend crowded events and generally “go places,” as was recorded as a therapy goal by the Veteran in August 2016. At around the same time he reported he could not attend events and be around crowds to individual therapists, he shared at group therapy sessions about vacations and gambling trips. However, this possible discrepancy does not weigh against the Board’s finding of a 50 percent disability rating during this period. The Veteran’s purported inability to attend events and be around crowds was not included in the December 2019 examiner’s qualification that the Veteran’s PTSD results in occupational and social impairment with reduced reliability and productivity. The operative symptoms were the Veteran’s impaired memory and difficulty with work and social relationships. Finally, a disability rating in excess of 50 percent for the Veteran’s PTSD is not warranted at any time. At no time has medical evidence suggested that the Veteran’s PTSD has resulted in occupational and social impairment with deficiencies in most areas. At worst, the Veteran has shown deficiencies at work and in social settings. For example, he has noted memory problems that affect his job performance and a lacking social network outside of his family. However, his family relations appear stable. He has maintained relationships with his siblings, son, and grandchildren, and been married to the same wife since 1972. Moreover, his judgment and thinking have consistently been deemed appropriate, logical, and coherent, or within normal limits. He has also been able to work on renovating and repairing a second house for sale. Thus, while the Veteran has experienced deficiencies in some areas, there is no evidence that the Veteran suffers deficiencies in most areas, which is required for a 70 percent disability rating under 38 C.F.R. § 4.130, Diagnostic Code 9411. The Board acknowledges the Veteran’s contention that he would have received a higher rating based off the examination from February 2014, if it had been conducted thoroughly. The Veteran alleged at his March 2019 hearing that it was not conducted thoroughly because he did not recall discussing his life prior to, during, and after the military, indicating he was not given an opportunity to reveal all his symptoms. A review of the February 2014 examination report reveals a thorough summary of significant, relevant events prior to, during, and after the Veteran’s military service. Moreover, the symptoms recorded by the February 2014 examiner correspond with symptoms subsequently recorded in other sources in the Veteran’s record. Thus, the Board finds no merit to this contention. However, it does support finding that the Veteran suffers from the memory problems noted herein. In sum, the Board finds that the Veteran’s PTSD is appropriately rated prior to March 23, 2016, but that a 50 percent disability rating is warranted from that date. L. CHU Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P.A. Infante 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.