Citation Nr: 21067058 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 17-29 224 DATE: November 3, 2021 ORDER Entitlement to an initial 50 percent, but no higher, rating for posttraumatic stress disorder (PTSD) prior to March 24, 2020, is granted. Entitlement to a rating in excess of 50 percent for PTSD beginning March 24, 2020, is denied. FINDING OF FACT The Veteran's PTSD has been productive of no more than occupational and social impairment with reduced reliability and productivity. CONCLUSIONS OF LAW 1. Prior to March 24, 2020, the criteria for an initial 50 percent, but no higher, rating for PTSD are met. 38 U.S.C. § 1155 (2018); 38 C.F.R. §§ 4.7, 4.126, 4.130, Diagnostic Code 9411 (2020). 2. Beginning March 24, 2020, the criteria for a rating in excess of 50 percent for PTSD are not met. 38 U.S.C. § 1155 (2018); 38 C.F.R. §§ 4.7, 4.126, 4.130, Diagnostic Code 9411 (2020). REASONS AND BASES FOR FINDING AND CONCLUSIONS The Veteran had active service from August 2004 to February 2006 in the United States Marine Corps (USMC). This case initially came before the Board of Veterans' Appeals (Board) on appeal from a November 2015 rating decision issued by a Regional Office (RO) of the Department of Veterans Affairs (VA). In February 2020, the Board remanded the claim for additional development. The case has since been returned to the Board. Increased Rating PTSD In a November 2015 rating decision, the RO granted service connection and assigned an initial 30 percent rating for PTSD effective June 23, 2014. The Veteran appealed, requesting a rating in excess of 30 percent. In a July 2020 rating decision, the Agency of Original Jurisdiction (AOJ) increased the rating for PTSD to 50 percent effective March 24, 2020. Because the Veteran is presumed to seek the maximum available benefits, this issue remains on appeal. See AB v. Brown, 6 Vet. App. 35, 38 (1993). During a November 2015 VA examination, the Veteran reported that he had a good relationship with his wife and that they had mutual friends with which they socialized. He indicated that he had been employed in logistics for a company since 2014. During service, he stated that he was treated for PTSD symptoms twice a week for a year. Since service, he stated that he saw a private psychiatrist, Dr. J., once every two months and received Dextroamphetamine to help with concentration and Xanax to help with anxiety. He stated that he only took Xanax a couple of times a week. He stated that he often felt frustrated with the outcome and current situation in Iraq. He stated that he woke up a couple of times a week from dreams of dead bodies. He stated he got about six hours of sleep per night. On mental status evaluation, the Veteran was casually dressed maintaining adequate personal hygiene. His speech was spontaneous with normal rate and tone. No hallucinations or delusions were present. No obsessions, compulsions, or phobias were detected. His mood was neutral, and affect was congruent with his mood. His thought content was devoid of suicidal or homicidal ideations, intentions, or plans. Thought processes were logical, coherent, and goal oriented. His cognitive functions were normal. He was oriented to person, place, time, and purpose. Insight and judgement were intact. The examiner indicated that the Veteran met the criteria for a diagnosis of PTSD and that his symptoms included anxiety and chronic sleep impairment. The examiner indicated that his PTSD symptoms resulted in 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, i.e., the criteria for a 10 percent rating. A January 2016 VA treatment record indicated that the Veteran's depression screen was positive and suggested moderate depression. During a psychosocial assessment, he reported that his family had encouraged him to seek treatment for his PTSD. He stated that he had trouble staying focused at work and experienced reoccurring memories from his time in service. He stated that his wife banned him from watching the news because it provoked negative feelings and that he had lost interest in watching sports, which used to be a pleasurable experience for him. He stated that he slept approximately five to seven hours per night, which he felt was enough. It was noted that he became visibly distressed when discussing his time in service, specifically his experiences during his deployment. In February 2016, he began individual therapy. He stated that his mood had been okay, however, he noticed feeling anxious at times. He stated that watching news made him angry and focus on past traumatic events. It was noted that he was willing to engage in trauma focused therapy and appeared stable at that time. Subsequent records noted that he underwent exposure therapy for PTSD. A March 2016 VA treatment record indicated that the Veteran underwent an initial psychiatric evaluation. He stated that he began seeing a psychiatrist in 2010 because he was excessively distracted at work. He was started an Adderall, which he felt helped. He stated that he was traveling a lot and started having high anxiety when he had to fly places. He also recalled feeling really tense and anxious at times at work. He stated that he had some difficulty falling asleep at bedtime because he was thinking of a lot going on. He stated that he slept six to seven hours and that his sleep was interrupted once or twice per night for a few minutes but that he sometimes could not get back to sleep. He indicated that he did not get as much pleasure from things that he used to. He stated that he was not isolating and denied suicidal ideation. It was noted that his PTSD was in partial remission and that his prognosis was good. A May 2016 VA treatment record indicated that the Veteran reported that he had some really bad days and had been drinking more. He stated that he had a couple day period where he became overwhelmed with work and home life and started drinking more. He stated that he became much more emotional during that time and had more difficulty with his wife. He was able to identify that drinking more alcohol during that time made the situation worse and he indicated that he was going to stop drinking. Later that month, he reported that things were going better and that he had a new perspective. In July 2016, he stated that he was feeling good and a lot better. He indicated that he avoided watching the world news and had blocked posting from some friends on Facebook, which helped keep him from getting so angry. In August 2016, he stated that he was doing good but that he was under a high workload and felt he had missed something. He stated that he got an email at the end of the prior week and was anxious that he had made a mistake was going to get in trouble. In October 2016, the Veteran reported that his wife had concerns about him saying things that were hostile or graphic and that she felt it was not normal. She also expressed concerns about how quickly he got angry and yelled at her. He stated that he apologized and noted that he did not yell at his children. In November 2016, he reported that he experienced a panic attack at work and had experienced several recent stressors, i.e., seeing a new war memorial and issues with his wife. In December 2016, he reported that everything was good, but stated that he moved a bag of gift at work and had no memory of it. He stated that it was a stressful day and that he worried about what else he was not remembering. A January 2017 VA treatment record indicated that the Veteran reported that he was good. He stated that he had interviewed someone at work about a theft and then completely forgot about it. He was concerned about what the lapse meant and noted that he had been very stressed and that his boss did not feel he had managerial courage. He stated that his wife believed he got too wrapped up in current events and was still affected by issues from his deployment. In March 2017, he reported that things were great. He stated that he had an annual review the day before and was ranked very low by one of his supervisors. He stated that he started turning his ringer off after work and had not been working weekends. In June 2017, he reported that he was doing well and was working on organization approaches to improve productivity. He stated that he still got cranky with is wife over little things but did not lash out toward other people. In August 2017, he reported that his wife noted that he was still grinding his teeth, worrying about everything, and assuming the worst was going to happen. She felt he was blowing everything out of proportion. He stated that he was worried that his superiors at work were trying to replace him and he was worried about losing his job. He indicated that he had been missing deadlines and believed that his superiors were overwhelming him on purpose. In September 2017, he reported that he had been presented with a performance improvement plan and had six weeks to make changes or he would be fired. He stated that the objectives on the plan were unrealistic and might not be fixable. In October 2017, he stated that he expected to be terminated but did not know when and that the stress was "unreal." He contacted an old employer with a position in Boston and planned to move up there and get a small apartment while his family sold their house in Maryland. He stated that he was grinding his teeth so much that he was getting headaches. A February 2017 VA treatment record indicated that the Veteran reported that his PTSD symptoms were largely under control. His mood was described as depressed with congruent restricted affect. In May 2018, he reported having a very tumultuous time since his last visit. He stated that he started seeing someone at his company and that his bosses found out and she left the job. He stated that his wife found out and they separated. It was noted that he admitted to some symptoms consistent with depression and denied anxiety symptoms. He reported that he had made some connections with other veterans at gatherings and was in contact with them. In June 2018, he reported that he was having a less tumultuous time since his last visit and was trying to reconcile with his wife. He indicated that he believed his PTSD symptoms were under control. Later that month, he was seen for individual therapy and reported experiencing stress related to recent poor decisions and uncharacteristic behavior. He also stated that he felt overwhelmed for the past three months. He stated that he began feeling symptoms of depression as well as an increase in alcohol use to cope with anxiety. In August 2018, he reported that he ruminated about different outcomes and became more anxious. He stated that he was ambitious and liked to work hard, but that had led him to be more anxious at the thought of not being able to perform well. A December 2018 VA treatment record noted that the Veteran had gotten a job in Boston with better income and that he did very well for four months. He stated that he got in a lot of credit card debt during the transition and ended up cheating on his wife. He stated that his wife found out and that he reported himself to his employer because of rules against dating subordinates. He indicated that his work performance began to plummet and that he was running himself into the ground. He was transferred to a store in northern Virginia to be closer to his family and that the change involved a reduction in pay. He stated that he was worried his current store might close and that he was still not performing well. He indicated that that it was hard to get motivated. He reported having a panic attack the previous summer and that his drinking increased. In January 2020, the Veteran reported that he worked in asset protection and that his work performance was good. He stated that his relationship with is wife was not working and that they had tried couples therapy, but were told that they were not ready. His mood was mild anxious, and his affect was congruent with mood. During a March 2020 VA examination, the Veteran stated that he had difficulty falling asleep due to anxiety and racing thoughts. He stated that he got about seven hours of sleep per night. He indicated that he typically did not recall his dreams and that he had good daytime energy. He indicated that he had three to four shots of vodka daily and that his wife had expressed concerns about his drinking. It was noted that his PTSD symptoms included depressed mood; anxiety; suspiciousness; panic attacks that occurred weekly or less often; mild memory loss, such as forgetting names, directions, or recent events; impairment of short- and long-term memory; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; and difficulty adapting to stressful circumstances, including work or a work like setting. On mental status evaluation, the Veteran was appropriately dressed. He was cooperative, alert, and oriented. His speech was somewhat rapid, but otherwise normal rhythm and volume. His thought processes were linear and coherent. His mood was described as apathetic. His affect was intense. His though content was devoid of overt delusional ideation and his cognitions were grossly intact. The examiner noted that the Veteran had diagnoses of PTSD and an unspecified attention deficit hyperactivity disorder (ADHD). The examiner indicated that his PTSD was characterized by anxiety, depression, suspiciousness, panic attacks, depressed mood, and lack of motivation. His ADHD was characterized by difficulty concentration, forgetfulness, forgetting to complete tasks, being easily distracted and bored, restlessness, and impulsivity. The examiner noted that the disorders were mutually aggravating and resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily with normal routine behavior, self-care and conversation, i.e., the criteria for a 30 percent rating. An April 2020 VA treatment record indicated that the Veteran reported that he had lost his job due to a furlough. He stated that his marital relationship continued to be challenging. He expressed frustration about marital conflicts. His mood was described as mildly anxious. In July 2020, he reported that marital relations were still challenging. He stated that he was living in a small, crowded apartment, which was stressful. His mood was described as neutral. Prior to March 24, 2020, the Board finds that the Veteran's symptomatology more closely approximates the criteria for a 50 percent rating, i.e. occupational and social impairment with reduced reliability and productivity. 38 C.F.R. § 4.130, Diagnostic Code 9411. During this time period, he experienced impairment of short- and long-term memory, e.g., forgetting to complete tasks. He also experienced disturbances in motivation and mood and difficulty establishing and maintaining effective work and social relationships. The evidence indicated that he often felt overwhelmed by work and stress, and that his anxiety impaired his ability to perform. The Board, however, does not find that a rating in excess of 50 percent is warranted at any point during the appeal period. The evidence does not indicate that the Veteran's symptoms resulted in occupational and social impairment with deficiencies in most areas. See 38 C.F.R. § 4.130, Diagnostic Code 9411. Although he experienced anxiety frequently, the evidence did not indicate that he experienced near-continuous panic or that his anxiety prevented him from function independently, appropriately, or effectively. Although his anxiety reduced his effectiveness at work, it did not prevent from being effective. He generally reported that he was doing good and that his PTSD symptoms were controlled following therapy. Furthermore, the November 2015 VA examiner opined that his psychiatric disability only resulted in occupational and social impairment due to mild or transient symptoms which decreased work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication, i.e., the criteria for a 10 percent rating. In addition, although the March 2020 VA examiner indicated that the Veteran had difficulty in adapting to stressful circumstances (including work and a worklike setting), the examiner opined that his psychiatric disability only resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily with normal routine behavior, self-care and conversation, i.e., the criteria for a 30 percent rating. Furthermore, the evidence does not indicate that the Veteran experienced suicidal ideation, obsessional rituals, abnormal speech or symptoms of similar severity and frequency. Although he reported experiencing difficulties in his marriage, the evidence did not indicate an inability to establish and maintain effective relationships. He reported drinking and socializing with friends and meeting with veterans and maintaining those relationships. Overall, based on the totality of the evidence, the Board finds that the Veteran's disability picture more closely approximates the criteria for a 50 percent rating throughout the appeal period. Therefore, resolving reasonable doubt in his favor, the Board finds that an initial 50 percent rating is warranted prior to March 24, 2020, and that a rating in excess of 50 percent is not warranted at any time during the pendency of the claim. Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Mishalanie, 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.