Citation Nr: 21064185 Decision Date: 10/19/21 Archive Date: 10/19/21 DOCKET NO. 16-10 865 DATE: October 19, 2021 ORDER An increased disability rating of 50 percent, and no higher, for posttraumatic stress disorder (PTSD) from April 2, 2012 to June 8, 2016 is granted. FINDING OF FACT From April 2, 2012 to June 8, 2016, PTSD was manifested by occupational and social impairment with reduced reliability and productivity due to symptoms of depressed mood, anxiety, disturbances of motivation and mood, chronic sleep impairment, short-term and long-term memory impairment, difficulty with concentration and attention, and difficulty in establishing and maintaining effective work and social relationships. CONCLUSION OF LAW Resolving reasonable doubt in the Veteran's favor, the criteria for an increased disability rating of 50 percent, and no higher, for PTSD are met from April 2, 2012 to June 8, 2016. 38 U.S.C. §§ 1155, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1-4.7, 4.126, 4.130, Diagnostic Code (DC) 9411. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran, who is the appellant, had active service from August 1965 to April 1969. This matter is on appeal from a May 2013 rating decision. In November 2018, the Board, in pertinent part, denied an increased disability rating higher than 30 percent for PTSD prior to June 8, 2016 (the remaining rating period is from April 2, 2012 to June 8, 2016). In a July 2020 Memorandum Decision, the Court vacated the portion of the Board's decision denying a disability rating higher than 30 percent for PTSD prior to June 8, 2016 on the bases that the Board provided inadequate reasons and bases for the denial of increased disability benefits. The CAVC determined that the Board did not discuss the occupational impairment resulting from anger with other co-workers and losing his temper with his assistant, did not explain why the symptoms caused occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks rather than reduced reliability and productivity, and did not adequately explain why evidence from the June 2016 VA examination report showing detachment and irritability with PTSD symptoms greater than one month duration did not apply to the earlier period. The CAVC affirmed the portion of the November 2018 Board decision denying a disability rating higher than 50 percent for PTSD from June 8, 2016 and reopening service connection for rheumatoid arthritis. In the November 2018 Board decision, the reopened issue of service connection for rheumatoid arthritis was remanded for additional development. Thereafter, in a November 2019 rating decision, service connection for rheumatoid arthritis with a 20 percent rating effective from April 2, 2012 was established. Increased Rating for PTSD Analysis Disability ratings are determined by the application of the VA Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3. For the entire increased rating period from April 2, 2012 to June 8, 2016, the service-connected PTSD has been rated at 30 percent under the criteria at 38 C.F.R. § 4.130, DC 9411. Under the General Rating Formula for Mental Disorders, a 30 percent is provided 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, General Rating Formula for Mental Disorders. A 50 percent rating is provided when there is 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 provided when there is evidence that the psychiatric disability more closely approximates 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 worklike setting); and inability to establish and maintain effective relationships. Id. A 100 percent rating is provided when there is evidence of 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; and memory loss for names of close relatives, own occupation, or own name. Id. After review of all the lay and medical evidence of record, the Board finds that the evidence is in equipoise on the question of whether the disability picture associated with the service-connected PTSD more closely approximates occupational and social impairment with reduced reliability and productivity due to PTSD symptoms so that the criteria for a 50 percent rating are met for the increased rating period from April 2, 2012 to June 8, 2016. Throughout the period, the service-connected PTSD was manifested psychiatric symptoms of depressed mood, anxiety, disturbances of motivation and mood (e.g., anxious and depressed mood, anxious and irritable at work and arguing with spouse at home; irritability and outbursts of anger; detachment and irritability), chronic sleep impairment (e.g., restless sleep; nightmares with disturbed sleep), reported short-term and long-term memory impairment, difficulty with concentration and attention, and difficulty in establishing and maintaining effective work and social relationships (e.g., reported difficulty socializing with others due to moods and becoming argumentative; contentious relationship with a co-worker resulting in loss of temper, which ultimately sabotaged his job promotion). The psychiatric symptoms of impairment of short-term and long-term memory, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships are specifically listed in the 50 percent rating criteria. Also, the demonstrated symptoms in their totality and their impact on functional impairment associated with the psychiatric disability are consistent with a finding of occupational and social impairment with reduced reliability and productivity due to psychiatric symptoms. In consideration thereof, the Board finds that the disability picture for PTSD more closely approximates the 50 percent schedular rating criteria for the rating period at issue. An increased rating higher than 50 percent under DC 9411 is not warranted for any period. The weight of the evidence demonstrates that PTSD is not manifested by the degree of social and occupational impairment or the symptoms contemplated in the schedular criteria for the next higher 70 rating (occupational and social impairment, with deficiencies in most areas, and inability to establish and maintain effective relationships). The evidence does not show psychiatric symptomatology of similar frequency, severity, and duration to cause the social and occupational impairment to warrant a higher 70 percent rating for any period. During the rating period, the evidence shows anxiety and hypervigilance due to PTSD but no obsessional rituals so severe as to interfere with routine activities or the ability to function independently, appropriately, and effectively. Although there is some difficulty establishing and maintaining effective work or social relationships due to PTSD, there is not an inability to do so as evidenced by the Veteran's 46-year marriage, and the generally good relationships with his spouse and children, albeit with some strain at times. There is anxiety, depressed mood, and irritability due to PTSD during the rating period; however, the symptoms are not so severe that they affect the ability to function independently, appropriately, and effectively. Although there was one incident when the Veteran reportedly loudly and publicly lost his temper with a co-worker suggesting poor impulse control, PTSD was typically not shown to result in impaired impulse control during the rating period. Furthermore, PTSD has not been manifested by suicidal ideation, intermittently illogical, obscure, or irrelevant speech, spatial disorientation, neglect of personal appearance and hygiene, or difficulty in adapting to stressful circumstances (including work or a worklike setting) during the rating period. There were no PTSD symptoms of similar frequency, severity, and duration as those contemplated by the 70 percent rating criteria to warrant a higher 70 percent rating for any period. While there was some occupational impairment resulting from anger and outbursts with a co-worker and some social impairment due to detachment and irritability during the rating period, the overall occupational and social impairment due to PTSD is most consistent with the 50 percent rating (i.e., occupational and social impairment with reduced reliability and productivity) and does not approximate the schedular criteria for a 70 percent rating (e.g., occupational and social impairment in most areas due to PTSD symptoms). In granting the increased disability benefits above for the rating period at issue, the Board considered the PTSD symptoms of detachment and irritability greater than one month duration as reported in the June 2016 VA examination report and found that they are consistent with the broader symptom of disturbances of motivation and mood. The Board also considered the occupational impairment resulting from anger with another co-worker and losing his temper and determined that it resulted in a level of occupational impairment consistent with the 50 percent schedular rating criteria (i.e., reduced reliability and productivity). For these reasons, the Board finds that PTSD does not more closely approximate occupational and social impairment with deficiencies in most areas due to PTSD symptoms for any period; therefore, the criteria for a higher 70 percent schedular rating under DC 9411 are not met or approximated for any period. 38 C.F.R. §§ 4.3, 4.7. J. PARKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Palmer, 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.