Citation Nr: 21065945 Decision Date: 10/28/21 Archive Date: 10/28/21 DOCKET NO. 14-08 864 DATE: October 28, 2021 ORDER A rating in excess of 30 percent posttraumatic stress disorder (PTSD) is denied. FINDING OF FACT 1. The Veteran served on active duty from June 1967 to March 1971. 2. PTSD has been manifested by subjective complaints of irritability and difficulty with depression, anxiety, and nightmares; objective findings include depressed mood, fleeting suicidal ideation, clear and coherent speech patterns, good insight and judgment, logical thought processes, and impaired impulse control. CONCLUSION OF LAW The criteria for a rating in excess of 30 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.20, 4.59, 4.130, Diagnostic Code (DC) 9411 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSION As a procedural matter, the Board denied the appeal for a rating in excess of 30 percent in July 2020. In June 2021, the Veterans Claims Court Clerk granted a joint motion for partial remand (JMPR) and remanded the claim to the Board for readjudication. Turning to the relevant laws and regulations, 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 30 percent rating is warranted for 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 occurring weekly or less often, chronic sleep impairment, and mild memory loss (i.e. forgetting names, directions, or recent events). 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. Turning to the medical evidence, a November 2010 VA psychologist concluded that the Veteran's PTSD related symptoms did not reach the level of full clinical significance. Further, he noted that any psychiatric symptomatology appeared to be related to family problems rather than incidents that occurred during service. As such, no diagnosis of PTSD or any other psychiatric disorder was given at that time. Next, in August 2012, clinical treatment records showed that the Veteran acknowledged suicidal ideation but denied any plan or intent to self-harm or any history of suicidal behavior. In a September 2012 treatment note, his mood was noted as calm and pleasant, and his affect was flat. His mental status appeared normal, and he denied any history of suicidal or homicidal ideation. Further, his thought pattern was goal oriented, judgment was good, and there was no evidence of delusion. In October 2012, a psychiatry record reflected irritability, outburst of anger, hyperarousal, difficulty concentrating, and exaggerated startle response. The examiner indicated clinically significant distress or impairment in social, occupational, or other important areas of functioning. In addition, a December 2012 social worker reflected that the Veteran had thought about suicide. In a December 2012 VA examination, the psychologist diagnosed PTSD and major depressive disorder which caused occupational and social impairment with occasional decreases in work efficiency and intermittent periods of inability to perform occupational tasks. At the time of the examination, the examiner noted symptoms including depression, anxiety, suspiciousness, panic attacks that occurred weekly or less often, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, difficulty adapting to stressful circumstances, fleeting suicidal ideation, and impaired impulse control. Further, he had anger outbursts and emotional detachment. Next, in a June 2013 social work note, the Veteran said he previously thought about suicide, but he denied suicidal ideation at the time. Further, he denied suicidal ideation during treatment the following week. In February 2015, a VA examiner found evidence of occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and mood. Symptomatology at this time included depression, anxiety, suspiciousness, panic attacks more than once a week, near continuous panic, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, difficulty maintaining and establishing effective relationships, difficulty adapting to stressful circumstances, suicidal ideation, obsessional rituals, impaired impulse control, persistent delusions or hallucinations, and neglect of personal appearance and hygiene. The examiner noted that the Veteran's suicidal thoughts were passive without intent but persistent. He concluded it would be unlikely that the Veteran would be able to maintain adequate employment due to his symptoms and inability to maintain interpersonal relationships. However, in March 2015, just one month after the February 2015 VA examination, the Veteran reported that his nightmares had decreased, and his symptoms had become more manageable due to medication and therapy. There were no signs of hallucinations, delusions, impaired judgment or thought processes, or suicidal intent at this time. In December 2015, the Veteran's mood was calm and happier, and he did not report thoughts of hopelessness or suicidal intent. Further, his sleep improved, and he was getting 6-7 hours of sleep per night. He still experienced some paranoia and avoided crowded places. There were no signs of psychotic symptoms, anxiety symptoms, or manic symptoms. The Veteran denied suicidal ideation, but it was noted that he had thought about suicide in the past. However, he never had intent or desire. July 2019 clinical treatment records reflected appropriate hygiene, a neutral to mildly anxious affect, clear and coherent speech, and good insight, judgment, and concentration. Further, the Veteran denied suicidal or homicidal ideation and auditory or visual hallucinations. He noted that he had difficulties with social isolation, avoidance, and emotional numbing. May 2020 treatment records indicated that the Veteran showed clear and coherent speech patterns and was alert and oriented to person, time, place, and situation. His immediate, remote, and recent memory were intact and his attention and concentration were fair to good. Further, his insight and judgment were noted as fair to good and he denied suicidal ideation and hallucinations. Next, a September 2020 psychiatric treatment report noted that the Veteran's psychological health was "excellent" since his last appointment. His suicide risk was assessed to be low as he directly denied suicidal thoughts and feelings. Further, he described his mood as "really, really good" and his affect was euthymic and mildly restricted. His speech was clear, coherent, and goal-directed and he denied auditory or visual hallucinations. He was alert and oriented and his memory, insight, and judgment were fair to good. The medical evidence as a whole does not support a rating in excess of 30 percent for PTSD. While the February 2015 VA examination suggested impaired impulse control and increased social and occupational impairment, the accompanying clinical treatment records show a more accurate picture of the Veteran's PTSD symptoms throughout the entire course of the appeal. The weight of the evidence does not suggest flattened affect, or circumstantial, circumlocutory, or stereotyped speech, short term memory loss, difficulty in understanding complex commands, impaired judgment, or any other symptoms like or similar to those as contemplated in the 50 percent rating. Further, while the Veteran has verbalized suicidal ideation, he has stated that these were passive thoughts with no intention. In addition, the evidence suggests that suicidal intent was fleeting. While the clinical records reflect suicidal intent at points throughout the period on appeal, suicidal intent is just one symptom among many listed in the rating criteria. Therefore, an increased rating is not warranted based on this symptom alone. In addition, while auditory and visual hallucinations were reported during the February 2015 VA examination, the Veteran denied these symptoms just one month later in a March 2015 treatment note. The medical evidence does not show additional evidence of hallucinations throughout the period on appeal. Therefore, the hallucinations were not shown to be persistent. Throughout the clinical treatment records, the Veteran's insight and judgment were good and his speech and thought patterns were normal. Further, the medical evidence showed that he was alert and oriented to time, person, place, and situation and he does not experience persistent hallucinations or psychotic symptoms. His symptoms of depressed mood, anxiety, suspiciousness, chronic sleep impairment, social avoidance, emotional detachment, and difficulty maintaining effective relationships more closely resemble a 30 percent rating. While the Board has considered all symptoms, including suicidal intent, impaired impulse control, and social and occupational impairment, the disability picture as a whole does not support a rating in excess of 30 percent. As such, the medical evidence does not support a higher rating. The Board has 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 have the requisite medical expertise to render medical opinions regarding the degree of impairment caused by the disability and had sufficient facts and data on which to base the conclusions, 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 T. Kokolas, 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.