Citation Nr: A21017113 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 200519-85295 DATE: October 21, 2021 ORDER A 10 percent rating for unspecified trauma and stressor related disorder is granted, throughout, from October 4, 2019, subject to the regulations governing payment of monetary awards. FINDING OF FACT Throughout, the Veteran's unspecified trauma and stressor related disorder disability picture is best characterized as 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; occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks is not shown. CONCLUSION OF LAW The Veteran's unspecified trauma and stressor related disorder warrants a rating of 10 percent, but no higher, throughout, from October 4, 2019. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.126, 4.130, Code 9413. REASONS AND BASES FOR FINDING AND CONCLUSION The appellant is a Veteran who served on active duty from November 1973 to April 1974 and from April 1986 to July 2010. This matter is before the Board of Veterans' Appeals (Board) on appeal from a January 2020 rating decision. The appeal is being adjudicated under the framework established pursuant to the Appeals Modernization Act (AMA), Pub. L. No. 115-55, § 2(w)(2)(c)(2). The Veteran timely appealed the January 2020 rating decision to the Board and requested direct review under the AMA of the evidence considered by the Regional Office (RO). By choosing Direct Review, the Veteran has opted for a closed record, and in this instance, the Board notes that it may consider the evidence of record as of the January 2020 rating decision (only). [Therefore, the May 2020 statement from the Veteran's wife is ineligible for review.] A 10 percent rating for unspecified trauma and stressor related disorder is granted, throughout, from the (earlier effective date of) October 4, 2019. Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earnings capacity caused by the given disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings shall be applied under a particular diagnostic code, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. When the appeal is from the initial rating assigned with a grant of service connection, the severity of the disability during the entire period from the grant of service connection to the present is to be considered. "Staged" ratings may be assigned for distinct periods when different levels of impairment are shown. Fenderson v. West, 12 Vet. App. 119 (1999). Under the General Rating Formula for Mental Disorders (General Rating Formula), a 10 percent rating is warranted when 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 when 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 conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss (such as forgetting names, directions, recent events). A 50 percent rating is warranted where there is 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; and difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is warranted where there is 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); inability to establish and maintain effective relationships. A 100 percent rating 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 (ADLs) (including maintenance of minimal 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, Code 9413. Ratings for psychiatric disability are assigned according to the manifestation of particular symptoms, but the use of the term "such as" in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Accordingly, the evidence considered in determining the level of impairment from a psychiatric disorder under 38 C.F.R. § 4.130 is not restricted to the symptoms listed in the General Rating Formula for Mental Disorders. Instead, VA must consider all symptoms of a claimant's condition that affect occupational and social function. When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, length of remissions, and the Veteran's capacity for adjustment during periods of remission. 38 C.F.R. § 4.126(a). When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment but shall not assign a rating solely on the basis of social impairment. 38 C.F.R. § 4.126 (b). A November 2019 VA treatment record notes that the Veteran reported nightmares (that he asserted were possibly due to his taking of Flexeril prescribed for another disability), poor concentration, fair sleep, and that he is "short fused" (but has not acted on that impulse). He denied having suicidal or homicidal ideation, and the provider noted that he was fully oriented and had fair insight and judgment. On January 2020 VA posttraumatic stress disorder examination, unspecified trauma and stressor related disorder and alcohol use disorder in reported sustained remission were diagnosed. The Veteran reported that he has been married since 1980, he and his wife are very close, and she is supportive and his safety button and buffer from anger and depression. He related that he and his wife had just returned from spending over a month with his mother-in-law and that they made this type of trip a couple of times a year. The Veteran reported that he has two daughters that he sees a couple of times a year, and four grandchildren with whom he enjoys spending time. He related that he did not have any close friends but that he talked by phone a couple of times a year with a friend he served with in the military, attended Sunday services at a local church, belonged to the Knights of Columbus, and was active (and held a leadership position and volunteered with a Veteran's assistance committee) with a DAV chapter. He indicated that he liked going out to eat often and riding motorcycles during the summer with his wife, and that they had a camper which they used to take their grandchildren on vacation to various states. The examiner noted that the Veteran had no impairment of activities of daily living as a result of his psychiatric disorder because he related that he and his wife worked together on chores, shopped together, managed their money together, and took turns driving. The Veteran reported that prior to his retirement, he was once counseled on the job due to his anger and being disrespectful. He related that he had been given a task to complete at the end of the day, but he left because compensation time had not been authorized. He stated that he considered himself to be permanently retired and was not planning to go back into the workforce because he has anger issues and has a hard time dealing with the public. He related that he had been meeting with a mental health provider every few months, was taking Zoloft, which appeared to "take the edge off," and had not had any alcohol since a 2016 episode when he had to be hospitalized for 72 hours due to excessive drinking. On mental health examination, the Veteran was clean, neatly groomed, and appropriately dressed. His speech had normal rate and rhythm, he was cooperative and attentive, and he expressed frustration with VA. The Veteran's affect was appropriate, his mood was edgy, he was fully oriented, and his thought process was logical and coherent. He reported some anxiety and depression, that he thought some people stayed away from his because of his (reportedly constant) anger issues, and that he had experienced minor health issues recently that caused him to worry. The Veteran reported that he had experienced nightmares for years, that he was able to get 4-5 hours of sleep each night when he used a CPAP machine, and that he had not experienced any panic attacks. He related that he had not experienced any recent (during the period on appeal) suicidal or homicidal ideation, he spoke his mind, he did not trust people of Middle Eastern decent, he did not like large crowds, and he had no problems with his memory. The examiner opined that the Veteran's occupational and social impairment with regard to all mental diagnoses was best summarized as a mental condition that has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication. She indicated that on current psychological testing, the Veteran endorsed a high frequency of symptoms that were highly atypical in patients with genuine psychiatric or cognitive disorders and that there was subsequent concern with the issue of symptom exaggeration. She noted that because of his significantly exaggerated response style, the Veteran's self-report throughout the current interview was of questionable validity and should only be used cautiously for diagnostic and rating purposes. The examiner indicated that the Veteran had produced invalid testing results during two previous VA mental health examinations in 2017 and 2018 due to overreporting of symptoms. She related, however, that a review of the mental health treatment records did describe the Veteran's consistent involvement in both individual counseling as well as psychiatric medication management from 2013 to present to address his report of mental health difficulties, and that active medications included Sertraline and Trazodone. The examiner further noted that due to the Veteran's extensive involvement in mental health treatment, he was assigned a trauma-based diagnosis, but was not diagnosed specifically with PTSD due to concerns with his self-report of symptom difficulties during the current examination. Considering the record in the light most favorable to the Veteran, the Board finds that a 10 percent rating is warranted for his unspecified trauma and stressor related disorder, throughout, from October 4, 2019. The disability picture presented does not reflect or suggest occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, which would warrant a 30 percent rating. His symptoms, including impaired sleep, anxiety, depression, and anger, are not shown to be of a severity consistent with the types of symptoms associated with the criteria for a 30 percent rating. Although he reported ongoing nightmares, difficulty with crowds, and instances of anger (to include an incident (prior to the period on appeal) at work in which he was counseled for being disrespectful), he also indicated that he had good family and social relationships (in other words, social significant social impairment. He related that he had good relationships with his wife, daughters, and grandchildren, took his grandchildren on trips in their camper, attended church regularly, held a leadership position with a local VA chapter, and liked to eat out regularly. The January 2020 examiner also noted that the Veteran had no impairment of activities of daily living as a result of his psychiatric disorder because he related that he and his wife worked together on chores, shopped together, managed their money together, and took turns driving. Although the examiner opined that the Veteran's occupational and social impairment with regard to all mental diagnoses was best summarized as a mental condition that has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication, she also noted that a review of the mental health treatment records did describe the Veteran's consistent involvement in both individual counseling as well as psychiatric medication management from 2013 to present to address his report of mental health difficulties (suggesting that his reported symptoms were controlled by continuous medication). While the Veteran is retired, he has indicated his symptoms may impact on employability and the Board has taken his accounts into consideration. Therefore, the Board finds that a 10 percent rating (reflecting occupational and social impairment with mild or transient symptoms with decrease work efficiency and ability to perform occupation tasks only during periods of significant stress) but no higher, is warranted throughout from October 4, 2019. The Board acknowledges the Veteran's reports of anger, nightmares, sleep difficulty, depression, and anxiety; however, considering his ability to regularly engage in multiple volunteer activities, ability to tend to all activities of daily living, and ability to go out to eat regularly with his wife and take his grandchildren on vacation, the Board finds the reported symptoms do not reflect occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. GEORGE R. SENYK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Bayles, 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.