Citation Nr: 21063698 Decision Date: 10/15/21 Archive Date: 10/15/21 DOCKET NO. 10-48 653 DATE: October 15, 2021 REMANDED Entitlement to an increased evaluation higher than 30 percent for posttraumatic stress disorder is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from October 1966 to October 1968. This matter is before the Board of Veterans' Appeals (Board) on appeal from rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). In May 2017, the Veteran provided testimony in a hearing before the undersigned Veterans Law Judge (VLJ) and a transcript of the hearing has been associated with the claims file. In May 2020, the Board denied an evaluation higher than 30 percent for PTSD. The Veteran subsequently appealed the Board decision to the United States Court of Appeals for Veterans Claims (Court). Pursuant to a February 2021 Order by the Court in accordance with a Joint Motion for Partial Remand (JMPR), the issue was remanded to the Board for additional development and adjudication. Entitlement to an increased evaluation higher than 30 percent for posttraumatic stress disorder The Veteran is in receipt of a 30 percent rating for PTSD. The Veteran claims that he is entitled to a disability evaluation higher than 30 percent for his service-connected PTSD. At a September 2013 visit, he was seen to establish mental health care. He reported chronic sleep disturbance and nightmares. He reported symptoms of depression. Other than an increase in his emotionality and nightmares, he noted no other changes from his baseline. At a December 2013 visit he reported feeling better. He reported waking up once or twice a night and had bad dreams. He reported getting frustrated easily and having a sad mood. He denied suicidal ideation. At a February 2014 visit, he reported feeling ok. At a July 2014 visit, he reported being sad and depressed, but denied suicidal ideation. At a September 2014 visit, he was noted to be taking Zoloft for treatment and reported his mood as being better. His speech was logical and coherent, and his insight and judgment were documented as fair. At a June 2015 visit, he reported not taking any medication and that he was not seeing anyone for treatment purposes. The Veteran underwent an examination in September 2015. The Veteran was found to have 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 medication. The examiner noted the Veteran to have met the PTSD criterion, and his symptoms are at a mild level. For VA rating purposes, symptoms that were deemed to apply to the Veteran were anxiety, suspiciousness, panic attacks weekly or less often, and difficulty establishing and maintaining effective work and social relationships. In an April 2018 statement, he reported suffering from impaired judgment, paranoia, conflictual mood and motivation, and difficulty maintaining relationships. According to an August 2018 entry, the Veteran sought a consult prior to a leisure trip with a tourist group to China. He had planned a leisure trip with a tourist group to China for 10 days in September 2018. On examination in July 2019, for VA rating purposes, his symptoms were identified as anxiety, panic attacks that occur weekly or less often, chronic sleep impairment, and disturbances of motivation and mood. The JMPR noted the Veteran to have impaired impulse control, as evidence by the findings of the September 2015 and July 2019 examinations wherein the Veteran was found to have irritable behavior and angry outbursts, with little or no provocation, typically expressed as verbal or physical aggression toward others. Although the September 2015 and July 2019 examiner checked PTSD Criteria E; noting the Veteran had irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects, when identifying the Veteran's symptoms for rating purposes, issues with anger were not identified. The September 2015 examiner found the Veteran's anger had not been at issue for over 10 years, and his ability for impulse control in the work setting was not impaired. With regard to current symptomatology, the July 2019 examiner did not indicate the Veteran suffered from current impaired impulse control, such as unprovoked irritability with periods of violence. As the JMPR has highlighted the Criterion E were marked for PTSD, an addendum opinion is needed to address the discrepancy between the chosen Criterion E, and current symptomatology findings. The JMPR noted the Board failed to address the Veteran's ability to maintain effective relationships, and highlighted the September 2015 and July 2019 examination. As was stated previously in the Board's May 2020 decision, the 2015 examiner noted the Veteran has been married and has reported a happy relationship with his wife for over 30 years. As for his children, the Veteran has a poor relationship with his children, but does report having a relationship with his wife's children. In 2015, his ability to form close interpersonal relationships was describe as markedly impaired. In 2019, the examiner noted the Veteran was married and has children from his prior marriage and step-children. The Veteran sought a consult prior to a tourist trip to China in 2018. The JMPR noted the Board failed to address the Veteran's persistent negative emotional state and intense and prolonged psychological distress. The September 2015 and July 2019 examiner's selected Criterion B and Criterion C, as for the distressing memories of the event, or at exposure to cues that symbolize ore resemble an aspect of the traumatic event. The 2015 and 2019 examinations made no notation as to symptoms for rating purposes of intense and prolonged distress, with the exception of the selection of the criteria used to establish the current PTSD diagnosis, Criterion B and C. Accordingly, to have clarity as to the Veteran's actual current symptoms an addendum is needed. Further, any indication that the Veteran has reckless or destructive behavior needs to be addressed. The 2019 examiner noted the Veteran reported driving his motorcycle and speeding in an environment changing rapidly, such as rain. An addendum is needed clarifying this statement, and whether and to what extent the Veteran has reckless or destructive behavior and any resultant social and occupational impairment due to such behavior. Accordingly, a remand is needed to provide the Veteran with an examination evaluating the severity of his PTSD. The matters are REMANDED for the following action: 1. Schedule the Veteran for an appropriate VA examination to evaluated the severity of his PTSD. The examiner is asked to address specifically whether the Veteran has had symptoms of impaired impulse control, irritable behavior and angry outbursts, ability to maintain effective relationships, persistent negative emotional state with prolonged psychological distress and reckless or destructive behavior at any time during the appeal period. The examiner is asked to address the Veteran's history of such symptoms and the occupational and social impairment caused by his mental health symptoms. In other words, the examiner is asked to reconcile the prior findings of mild PTSD symptoms in light of his reported symptomatology. H.M. WALKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Skiouris, 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.