Citation Nr: 21066272 Decision Date: 10/29/21 Archive Date: 10/29/21 DOCKET NO. 13-26 002 DATE: October 29, 2021 ORDER Entitlement to an initial disability rating of 100 percent for schizophrenia, prior to August 10, 2011, is granted. FINDING OF FACT Resolving doubt in favor of the Veteran, prior to August 10, 2011, his schizophrenia was manifested by symptoms more closely approximating total occupational and social impairment. CONCLUSION OF LAW The criteria for an initial disability rating of 100 percent for the Veteran's schizophrenia prior to August 10, 2011, have been met. 38 U.S.C. § 1155, 5103, 5103A, 5107; 38 C.F.R. § 3.102, 3.159, 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9201. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1973 to August 1973. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2012 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO), which denied the Veteran a compensable rating for schizophrenia. In October 2017, the Board remanded the Veteran's claim to the Agency of Original Jurisdiction (AOJ) for further action consistent with the Board's remand directives. Specifically, the Board remanded to afford the Veteran a VA examination to determine the severity of his schizophrenia. The Board notes that prior to October 2017, the Veteran had not appeared for any scheduled VA examination. The claim has returned before the Board for further appellate proceedings. In August 2018, the AOJ awarded the Veteran a 100 percent rating from August 10, 2011. In September 2021, the AOJ awarded the Veteran a 30 percent rating from June 23, 2003, to August 9, 2011. The Board notes that the 100 percent rating granted from August 10, 2011 constitutes a full grant of benefits from the effective date forward as it is the maximum rating available under the applicable diagnostic code. However, as the Veteran was not granted a 100 percent rating for the entire period on appeal, the issue of entitlement to a disability rating in excess of 30 percent prior to August 10, 2011, remains on appeal. AB v. Brown, 6 Vet. App. 35, 38-39 (1993). Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. When considering the propriety of the initial evaluation assigned, consideration of the medical evidence since the effective date of the award of service connection is required. See Fenderson v. West, 12 Vet. App. 199, 125-26 (1999). Where there is a question as to which of two evaluations shall be applied, the higher evaluation 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. The Veteran contends that his schizophrenia is more severe than his current disability rating would indicate. For the reasons that follow, the Board finds that the Veteran's schizophrenia was manifested by symptoms more closely approximating total occupational and social impairment prior to August 10, 2011. Under the General Formula for Mental Disorders (General Formula), 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). A 30 percent rating is assigned when symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events), cause 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). A 50 percent rating is assigned when symptoms such 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; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; 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); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned 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 minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name. The Veteran's lack of medical records and VA examination within the appellate period frustrate appellate review. However, the evidence of record is still sufficient to find that the severity of the Veteran's schizophrenia rose to the level of total occupational and social impairment when resolving doubt in favor of the Veteran. The evidentiary record shows that, until November 2017, the Veteran has consistently failed to appear for any VA examination. A representative noted that his schizophrenia may be the reason for his missed examinations. See March 2008 informal hearing presentation. The Veteran has explained that he has found a "cure," or "more beneficial remedy," in chiropractic treatment. See September 2009 Veteran's correspondence. He refused to appear for VA examination because he did not want to be a "guinea pig" for prescription drugs, which he saw as a form of ridicule. Id. Moreover, the Veteran believes that medications are a part of some form of sorcery. See November 2017 VA examination report. Thus, the Veteran has opted out of VA examinations and traditional mental health treatment for chiropractic treatment to regulate his schizophrenia. The Board finds that this evidence is illustrative of the severity of the Veteran's impairments, to include a maintenance of his personal health and thought processes. The Board turns to the evidence on before and after the appeal period to illustrate the likely severity of the Veteran's disability during the appeal period. Two medical professionals have opined that the Veteran's schizophrenia started in service and has only worsened since. Indeed, the Veteran has explained that his symptoms and impairments have worsened. See August 2003 and September 2009 Veteran's correspondence. Prior to awarding the Veteran service connection for his schizophrenia, the Board requested an independent medical opinion. The psychiatrist reviewed the Veteran's service treatment records and determined that his symptomatology in service was indicative of schizophrenia manifesting in poor tolerance to stress, inability to persevere in a task, and difficulty dealing with authority. See September 2008 IMO. Relevantly, the Board finds that the November 2017 VA examination report is probative in its discussion of the Veteran's mental health history. Historically, the examiner opined that the Veteran's schizophrenia manifested in multiple, involuntary commitments for hospitalization, "chronic []bizarre behavior such as arguing with inanimate objects and dogs, heightened hostility with minimal provocation, paranoia, command auditory hallucinations, and suicidal ideation. See November 2017 VA examination report. These symptoms produced impairments, to include difficulty maintaining employment, taking public transportation, and a distrust of others. Id. The examiner opined that the Veteran's schizophrenia caused total occupational and social impairment. Using the historical basis provided by the examiner, the Board turns to the few pieces of medical evidence within the appeal period to show that the severity has remained the same throughout the appellate period. The Veteran voluntarily admitted himself into the hospital in March 1986 after a fear of committing suicide. See August 2011 SSA records. The psychiatrist noted that the Veteran had auditory and visual hallucinations, a history of multiple hospital admissions, and presented as depressed, quiet, seclusive, and angry. Id. During his admission to the hospital, he endorsed intentionally hitting himself in the face. Id. In a psychiatric evaluation, the psychiatrist noted problems with impaired interpersonal relationships, distorted perception and thinking, inappropriate affect, and a generalized sense of alienation and withdrawal. Id. The psychiatrist opined that the Veteran's schizophrenia manifested adjustment problems, to include "disturbed affect, bizarre and unusual experiences, breakdowns in reality-contact, and conflicted, ineffectual interpersonal relationships." He discharged himself from the hospital against medical advice. Id. The Veteran's 1986 hospitalization tends to show some worsening since his schizophrenia in service. He endorsed trouble sleeping, depression or excessive worry, loss of memory, and nervous trouble at the time of his separation from service. See STRs. He presented for a medical board examination wherein a physician opined that the Veteran's "severe" condition manifested with poor tolerance to stress, inability to persevere at tasks, inability to deal with stress, and difficulty communicating. Id. Ultimately, he was found unfit for service due to his psychiatric disorder. Id. Within the appellate period, the Veteran has explained that he has nervous breakdowns, was unable to hold any job since service, has amnesia, is disoriented at times, and has lived in a state of depression since service. See August 2003 and September 2009 Veteran's correspondence. Lay observers have noted the Veteran's feelings of anger and incoherent communications. See August 2011 and December 2011 VA Form 21-0820s. Indeed, the Veteran's submissions into the record have included incoherent markings on communications sent to him with and without short, non-premised conclusions. Id. The Board finds that the level of impairment caused by the Veteran's symptoms more closely approximates the level associated with a 100 percent rating prior to August 10, 2011. Medical professionals of record have opined as to the severity of the Veteran's impairments to include "bizarre" behavior, arguing with inanimate objects, persistent auditory hallucinations, isolative tendencies, and difficulty maintaining jobs. The Veteran explained that he has not been able to hold a job at any point since separation from active duty. Moreover, the Veteran's submission themselves are, at times, incoherent. For these reasons, the Bord finds that the Veteran experienced total occupational and social impairment. While the evidentiary record contains very large gaps of contemporaneous mental health treatment, the evidence on either side of the appellate period shows that the Veteran likely experienced total occupational and social impairment throughout the appellate period when resolving doubt in favor of the Veteran. Accordingly, the Board finds that the criteria for an increased disability rating of 100 percent are met. See Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990); 38 C.F.R. §§ 3.102. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Strickland 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.