Citation Nr: 21061455 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 17-40 074A DATE: October 4, 2021 ORDER Entitlement to an initial rating of 50 percent, but no higher, for schizoaffective disorder (previously rated as schizoaffective disorder (also claimed as PTSD)) from June 27, 2014, is granted. FINDING OF FACT From the June 27, 2014 date of the claim, the evidence is at least evenly balanced as to whether the symptoms and overall impairment caused by the Veteran's schizoaffective disorder more nearly approximated occupational and social impairment resulting in reduced reliability and productivity, but it did not more nearly approximate occupational and social impairment with deficiencies in most areas. CONCLUSION OF LAW With reasonable doubt resolved in favor of the Veteran, from June 27, 2014, the criteria for an initial rating of 50 percent, but no higher, for service-connected schizoaffective disorder have been met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. § 4.130, DC 9201. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1980 through September 2000. This case comes before the Board of Veterans' Appeals (Board) on appeal from a September 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO), which granted service connection for schizoaffective disorder, assigning it an initial 10 percent disability rating. In a July 2017 rating decision, the RO increased the Veteran's disability rating to 50 percent, effective May 4, 2016. The Veteran perfected her appeal in August 2017. In October 2019, the Board remanded the claim for evidentiary development. As indicated in the discussion below, the Board finds the Agency of Jurisdiction (AOJ) substantially complied with the Board's remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). Higher Initial Ratings Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. Disability evaluations are determined by evaluating 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 VA's Rating Schedule. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. Where an award of service connection for a disability has been granted and the assignment of an initial evaluation for that disability is disputed, separate evaluations may be assigned for separate periods of time based on the facts found. In deciding this appeal, the Board has considered whether separate ratings for different periods of time, based on the facts found, are warranted, a practice of assigning ratings referred to as "staged" ratings. See Fenderson v. West, 12 Vet. App. 119 (1999). As this is an initial rating claim, the appeal period begins June 27, 2014, the effective date of the grant of service connection. Entitlement to an initial rating higher than 10 percent for schizoaffective disorder. Ratings are assigned according to the manifestation of symptoms and the extent to which they cause occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F. 3d 112, 115 (Fed. Cir. 2013). In this case, the Veteran's schizoaffective disorder is rated under the Diagnostic Code (DC) 9211. Under 38 C.F.R. § 4.130 and DC 9211 of the General Rating Formula, a 10 percent rating is warranted where there is occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication. A 30 percent rating is warranted where there is 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 normal conversation), 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). A 50 percent rating is warranted for 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 effective work and social relationships. A 70 percent rating is warranted 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 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 inability to establish and maintain effective relationships. A total rating of 100 percent, which is currently assigned to the Veteran's schizoaffective disorder, is warranted 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 maintenance of mental and personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130, DC 9201. When determining the appropriate disability evaluation to assign, the Board's primary consideration is the veteran's symptoms, but it must also make findings as to how those symptoms impact the veteran's occupational and social impairment. Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). 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, 114-18 (Fed. Cir. 2013). 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. Pursuant to Bankhead, "VA must engage in a holistic analysis in which it assesses the severity, frequency, and duration of the signs and symptoms of the veteran's service-connected mental disorder; quantifies the level of occupational and social impairment caused by those signs and symptoms; and assigns an evaluation that most nearly approximates that level of occupational and social impairment." In consideration of the above, the Board will review the evidence to determine whether an initial rating higher than 10 percent is warranted for the Veteran's service-connected schizoaffective disorder. For the following reasons, the evidence warrants an initial 50 percent rating, but no higher, for the entirety of the appeal. In a June 2014 statement, the Veteran indicated that she was first treated for mental health issues in Germany in 1983 after being assaulted. She stated that she "flipped out" and was hospitalized. In that statement, the Veteran also recounted that she subsequently reported to a mental health professional on the recommendation of her command, after she reportedly acted "odd" and paranoid. August 2014 private treatment records indicate, that upon examination, a clinician assessed the Veteran as pleasant, easily engaged, and neatly dressed, with a normal affect. The clinician stated that, during the examination, the Veteran reported that she was "doing fine, no complaints." At that time, the Veteran denied depression, anxiety, or suicidal-homicidal ideation. In a September 2014 statement, the Veteran indicated that she had been receiving treatment for mental health issues at the Emerald Coast Behavioral Hospital and Life Management Center since March 2001. November 2014 private treatment records reflect that the Veteran reported to the psychologist that she continued to hear voices, although the voices were "not bad" and they varied in content. The Veteran also stated that she was having difficulty sleeping. February 2015 private treatment records also indicate that the Veteran stated to the clinician that she heard voices 2 or 3 time per week, which she described at that time as minimal. She also indicated to the clinician that she had been compliant with her medication and had not experienced unprovoked panic, "in a long time." In August 2015, the Veteran underwent a VA examination. The Veteran reported to the examiner that she is currently divorced and lives with her mother, nephew, and her sister. She stated that she gets along well with them all and they share cooking and cleaning responsibilities. The Veteran also indicated she has a close friend and enjoys reading and walking. The Veteran attends church regularly where she had friends, acted as Secretary of Sunday school, and participated in the culinary ministry. During the examination, the Veteran stated to the VA examiner that when she finished military service, she "was not able to work," due to being afraid all the time. At that time, she slept with her mother because she was afraid something was going to happen to her. The Veteran indicated that she experienced auditory hallucinations that told her that if she went outside or went to work, she or her family would be killed. She stated that she has been taking medication which do not stop the voices but they help her sleep. The Veteran subsequently earned an associate degree in Office Administration. After college, the Veteran was employed as a secretary and worked in an auto accessory store. She took a full-time housekeeping job in February 2013 and continues to be employed there. The VA examiner found that the Veteran was capable of managing her financial affairs. Upon evaluation, the VA examiner recorded that the Veteran was well-dressed, neatly groomed, and her mood was cheerful. The Veteran reported to the examiner that she felt paranoid "all the time," however it does not bother her the way that it used to. The examiner documented that suspiciousness was a symptoms of the Veteran's mental impairment. The Veteran also stated that she still heard voices every other day, but the voices were no longer threatening and presented now as comforting and positive. The Veteran described the voices as both thought insertions as well as hearing them from outside her head. The Veteran indicated that "every now and then," she felt anxious and scared, although she has not had a panic attack in 5 years. The examiner noted that the Veteran reported being in partial remission from her mental health impairments due to her medication. The examiner concluded that the Veteran experienced occupational and social impairments, due to mild or transient symptoms, which decreased work efficiency and the ability to perform occupational tasks only during periods of significant stress or symptoms controlled by medication. In an October 2015 VA treatment record, the Veteran reported to her clinician that she had been compliant with her medications and her schizoaffective disorder was well-controlled. On May 5, 2016, the Veteran was hospitalized for mental health treatment. The Veteran reported hearing threatening voices and experiencing sleep disturbances. Treatment notes from that date indicate that the Veteran reported experiencing a recent episode of auditory hallucinations telling her to walk into the street naked. The clinician noted that the Veteran had been noncompliant with her medication. Upon evaluation, the clinician assessed the Veteran with good vocational skills, good intellect, and communication. The clinician observed that the Veteran was pleasant and cooperative, and her thought process was goal-directed with no paranoid delusions. The clinician also noted that the Veteran's long-term and short-term memory were normal and she had no problem completing activities of daily living. As noted above, the Veteran was assigned a 10 percent initial rating, prior to May 4, 2016, and a 50 percent rating from May 4, 2016, for her service-connected schizoaffective disorder. However, an "effective date should not be assigned mechanically" and should be based on all of the evidence." Swain v. McDonald, 27 Vet. App. 219, 224 (2015). As contended by the Veteran's representative in the written brief presentation, the Veteran's disability did not suddenly change on May 4, 2016, the date of the Veteran's hospitalization. Swain v. McDonald, 27 Vet. App. 219, 224 (2015) ("effective date should not be assigned mechanically based on the date of a diagnosis. Rather, all of the facts should be examined to determine the date that [the veteran's disability] first manifested"). See also Padilla-Fargas v. Wilkie, No. 19-0717, 2020 U.S. App. Vet. Claims LEXIS 420 (Mar. 13, 2020) (mem dec, Allen, J.) ("The Board seems to treat the dates of examinations themselves as marking the precise dates when it was ascertainable that appellant's bilateral foot disability worsened, justifying higher ratings. After all, the worsening increased appellant's disability rating effective the date of each examination, to 30% on the date of the April 2015 examination and 50% on the date of the November 2017 examination. But the Board does not explain why for each examination it concluded that appellant's foot disability worsened on the date of the examination"); Calhoun v. Wilkie, No. 18-4896, 2019 U.S. App. Vet. Claims LEXIS 1282 (July 24, 2019 (mem dec, Kramer, J.) ("The problem with the Board's analysis is that it lacks any statement of reasons or bases explaining why [the Veteran's] schizophrenia was no worse than was contemplated by a 30% rating on March 7, 2015, yet was consistent with a 70% rating the following day"); Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992) (single judge decisions may be relied upon for any persuasiveness or reasoning they contain). The medical and lay evidence reflect that the Veteran's psychiatric symptoms and impairment did not suddenly get worse on May 4, 2016. Rather, the record reflects that the symptoms of the Veteran's schizoaffective disorder have been relatively consistent throughout the appeal period. It is noted that the Veteran in the substantive appeal and her representative in the written brief presentation contend that the 50 percent rating should be effective as of the date of claim. For the following reasons, the Board agrees. The evidence, as a whole, reflects that, as the Veteran stated in her June 2016 notice of disagreement, her psychiatric symptoms interfered with her work and social life, with her social life being extremely limited during the entirety of the appeal period. As noted above, 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). In this case, the medical evidence supports the Veteran's statements that she experienced symptoms of schizoaffective disorder that are equivalent to the level of impairment contemplated by a 50 percent rating, including panic attacks, hypervigilance, and auditory hallucinations, and that these symptoms caused at least some difficulty in establishing and maintaining effective work and social relationships as well as occupational and social impairment with reduced reliability and productivity. Vazquez-Claudio; 38 C.F.R. § 4.130. The Veteran's symptoms and impairment have not, however, more nearly approximated the occupational and social impairment required for a 70 percent rating. As indicated above, to receive a higher disability rating, there would need to be 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); and the inability to establish and maintain effective relationships. The VA examination reports, private treatment records and the Veteran's lay statements do not indicate that her symptoms or impairment more nearly approximate those contemplated by a 70 percent rating. The record supports that the Veteran experiences panic attacks, hypervigilance and auditory hallucinations, but not to the extent that it affects her ability to function independently. Specifically, in a May 2016 private treatment record, the clinician documented that the Veteran's insight and judgment were good, and her attention and concentration were intact. The clinician reported that the Veteran's thought process was goal-directed and linear. The Veteran was described as appropriate, pleasant and cooperative. She also holds volunteer positions at her church, including Secretary of Sunday School, and works full-time as a housekeeper. She stated that she enjoys reading and taking walks. Her leisure and occupational activities do not appear to be restricted as a result of her symptoms. The Veteran also indicated in an August 2015 VA examination report that she lives with her mother and nephew and has good relationships with them both. She stated that she shares cooking and cleaning responsibilities with her family members. The Veteran also conveyed that she has a good friend and that she enjoys the people that she works with. The record does not reflect an inability to establish and maintain effective relationships. The Board has considered the Veteran's symptoms and based on the foregoing, the Board finds that, from July 27, 2014, the effective date of the claim, the frequency, severity, and duration of the Veteran's schizoaffective disorder symptomatology and impairment more nearly approximate a finding of occupational and social impairment with reduced reliability and productivity. See Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017). Additionally, the record reflects substantial compliance with the Board's October 2019 remand directive. See Stegall v. West, 11 Vet. App. 268 (1998). In that remand, the Board directed the AOJ to obtain any outstanding medical records in possession of the Tyndall Air Force Base. The records were received in November 2019 and added to the record. For the foregoing reasons, the Veteran's symptoms and overall impairment caused by her schizoaffective disorder more closely approximate those contemplated by the 50 percent rating, and not those in the criteria for a 70 percent rating. Therefore, an initial rating of 50 percent, but not higher, is warranted from June 27, 2014. As the preponderance of the evidence is against a higher initial rating at any point during the appeal period, the benefit of the doubt doctrine is thus not for application in this regard. 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 4.3, 4.7. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record, with respect to his claim. See Doucette v. Shulkin, 28 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)." Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. K. Donaldson, 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.