Citation Nr: 21068545 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 17-15 050 DATE: November 10, 2021 ORDER Entitlement to a rating in excess of 70 percent for posttraumatic stress disorder (PTSD) with alcohol use disorder (in remission) and major depressive disorder is denied. FINDING OF FACT The Veteran's PTSD with alcohol use disorder (in remission) and major depressive disorder manifested as symptoms no greater than occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. CONCLUSION OF LAW The criteria for a rating in excess of 70 percent for PTSD with alcohol use disorder (in remission) and major depressive disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Marine Corps from October 1968 to March 1970. This matter is before the Board of Veterans' Appeals (Board) on appeal from a February 2016, August 2016, and May 2017 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). This case was before the Board in June 2021. The Veteran's claim was remanded for further development. The case is now again before the Board for further appellate action. Entitlement to a rating in excess of 70 percent for PTSD with alcohol use disorder (in remission) and major depressive disorder is denied. By rating action of February 2016, the RO granted an increased rating to 70 percent for the Veteran's PTSD with alcohol use disorder, effective February 21, 2013, under Diagnostic Code 9411. Rating decisions issued in August 2016 and May 2017 denied a rating in excess of 70 percent. The May 2017 rating decision recharacterized the Veteran's disability as PTSD with alcohol use disorder (in remission) and major depressive disorder. The Veteran contends that he is entitled to a higher rating. The Veteran's PTSD with alcohol use disorder (in remission) and major depressive disorder has been rated under Diagnostic Code 9411, which is rated under the General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130. Under the General Rating Formula for Mental Disorders, 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 (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). 38 C.F.R. § 4.130. A 50 percent rating requires occupational and social impairment, but with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, 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 task); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent rating is warranted for even greater occupational and social impairment with deficiencies in most areas, such as work, school, family relationships, judgment, thinking or mood, due to such symptoms as: suicidal ideation; obsessional rituals that interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting 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 work-like setting); and inability to establish and maintain effective relationships. Id. A 100 percent rating is warranted if there is 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; memory loss for names of close relatives, own occupation or own name. Id. When rating a mental disorder, VA must consider the frequency, severity, and duration of the Veteran's psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission. The rating agency must assign a rating based on all the evidence of record that bears on occupational and social impairment, rather than solely on the examiner's assessment of the level of disability at the moment of the examination. When rating the level of disability from a mental disorder, the rating agency must consider the extent of social impairment but cannot assign a rating solely on the basis of social impairment. 38 C.F.R. § 4.126. The Veteran's actual symptomatology, and resulting social and occupational impairment, will be the primary focus when assigning a disability rating for a mental disorder, and the Veteran may qualify for a particular rating by demonstrating the particular symptoms associated with that percentage, or other symptoms of similar severity, frequency, and duration. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). In deciding claims, it is the Board's responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104(a). Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss each and every piece of evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claims and what the evidence in the claims file shows, or fails to show, with respect to the claims. See Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Turning to the evidence, in June 2014, the Veteran was afforded a VA PTSD examination. Based on the clinical evaluation, the examiner diagnosed the Veteran with PTSD and alcohol use disorder in early remission under DSM-5 criteria. The examiner opined that the Veteran had symptoms resulting 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 routine behavior, self-care, and conversation. The Veteran reported having a positive relationship with his wife of 30 years and his three children. He denied current suicidal or homicidal ideation. The Veteran worked as a fireman for 38 years and retired in March 2012. He reported that he had a strong work performance overall, though he was stated he was nearly fired twice for "missing work . . . being drunk." The examiner reported that the Veteran exhibited the following symptoms for VA rating purposes: depressed mood; anxiety; chronic sleep impairment; flattened effect; and difficulty adapting to stressful circumstances. The Veteran was provided another VA PTSD examination in June 2016. Based on the clinical evaluation, the examiner diagnosed the Veteran with PTSD and alcohol use disorder in early remission under DSM-5 criteria. The examiner opined that the Veteran had symptoms resulting 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 routine behavior, self-care, and conversation. The Veteran reported having good relationships with his siblings and his sons and enjoyed spending time with his grandchildren. Regarding his relationship with his wife, he stated "we have our ups and downs." He obtains approximately four to five hours of sleep every night. He reported that he stays if his room for three days as a time approximately three times per year. He has not had suicidal ideation for 15 years. The examiner reported that the Veteran exhibited the following symptoms for VA rating purposes: depressed mood; anxiety; suspiciousness; chronic sleep impairment; mild memory loss; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; and difficulty adapting to stressful circumstances. The Veteran was provided another VA PTSD examination in July 2017. Based on the clinical evaluation, the examiner diagnosed the Veteran with PTSD, recurrent severe major depressive disorder with anxious distress, and severe alcohol use disorder. The examiner concluded that the Veteran had symptoms resulting in occupational and social impairment with reduced reliability and productivity. The Veteran reported having a close relationship with his sons and grandchildren. He reported the relationship with his wife has "not been a smooth ride." He stated he only socializes with his family. He reported he is depressed all the time but denied suicidal ideation. He has been feeling worse since retirement with an escalating pattern of alcohol use. He reported participating in weekly group therapy and biweekly counseling sessions at the VA. The examiner reported that the Veteran exhibited the following symptoms for VA rating purposes: depressed mood; anxiety; suspiciousness; chronic sleep impairment; flattened effect; circumstantial speech, circumlocutory or stereotyped speech; difficulty in understanding complex commands; impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty adapting to stressful circumstances; inability to establish and maintain effective relationships; suicidal ideation; and impaired impulse control. An August 2017 VA psychology note reported the Veteran's mood was anxious and affect was congruent with moo. No perceptual disturbances or disturbances in thought process/content were noted. The Veteran's insight, judgment, and memory appeared to be within normal limits. The Veteran participated and interacted with other group members appropriately. There was report of suicidal ideation or other crisis issues. A March 2020 VA treatment record reported the Veteran was seen for a routine follow-up appointment. The Veteran denied any relapses with heavy alcohol use. He was future-oriented and denied suicidal ideation. He continues to report trouble sleeping. It was reported that he had to sleep in a separate bedroom from his wife due to his moving/acting out dreams. A March 2021 VA primary care note reported the Veteran attended a routine check up to discuss chronic illnesses. It was reported that he was doing well and denied suicidal ideation. The Veteran was provided another VA PTSD examination in July 2021. Based on the clinical evaluation, the examiner diagnosed the Veteran with PTSD, alcohol use disorder in partial remission, and major depressive disorder with anxious distress, and severe alcohol use disorder. The examiner opined that the Veteran had symptoms resulting 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 routine behavior, self-care, and conversation. The examiner reported that the Veteran's alcohol use disorder is characterized by the maladaptive use of alcohol which impacts important areas of life functioning. He used alcohol as a form of self-medication. His major depressive disorder was characterized by the presence of a depressed mood for more days than not for most of the day, diminished interest in most activities, insomnia, hopelessness, and diminished concentration. The examiner reported the Veteran's memory and speech were unimpaired. There was no thought process or thought content issues perceived. The Veteran denied recent suicidal ideation. The examiner reported that the Veteran exhibited the following symptoms for VA rating purposes: depressed mood; anxiety; suspiciousness; chronic sleep impairment; flattened effect; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty adapting to stressful circumstances; and impaired impulse control. As chronicled above, the Veteran clearly experienced psychiatric symptomatology during this period as a result of his PTSD with symptoms such as depressed mood; anxiety; suspiciousness; chronic sleep impairment; disturbances of motivation and mood; and difficulty in adapting to stressful circumstances. However, the preponderance of evidence weighs against finding that his level of occupational and social impairment was total during this period. In support of such finding, the Board assigns great probative value to the June 2014, June 2016, July 2017, and July 2021 VA PTSD medical examination reports. The VA examiners, licensed psychologists, thoroughly reviewed the Veteran's mental history and concluded that the Veteran's service-connected mental disability did not result in symptoms equating to total occupational and social impairment. The June 2014, June 2016, and July 2021 examiners opined that the Veteran had symptoms resulting 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 routine behavior, self-care, and conversation. The July 2017 examiner opined that the Veteran had symptoms resulting in occupational and social impairment with reduced reliability and productivity. Additionally, the Board has taken into consideration the frequency, severity, and duration of the Veteran's symptoms of mental disorders during the appellate period, as well as his statements regarding his assessment of the severity of his symptoms. However, the symptoms presented here, and their resulting effects, do not rise to the level of the next higher rating for 100 percent. The Veteran was living with his wife of more than forty years. Although the Veteran reported not socializing outside of his family, he had good relationships with his son and grandchildren and enjoyed spending time with his grandchildren. Although it was reported that the Veteran had diminished concentration and a depressed mood for more days than not at his July 2021 examination, the Veteran's memory and speech were unimpaired and there was no thought process or thought content issues perceived. The Veteran also denied recent suicidal ideation. Clearly, such findings are not consistent with a higher 100 percent rating, which is 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; memory loss for names of close relatives, own occupation or own name. 38 C.F.R. § 4.130. (Continued on the next page) For these reasons, the Board finds that the Veteran's PTSD, has not manifested by symptomatology more nearly approximating the criteria for a 100 percent disability rating under 38 C.F.R. § 4.130, Diagnostic Code 9411. The benefit-of-the-doubt doctrine is not for application, and an increased rating in excess of 70 percent under this code is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Accordingly, the claim must be denied. KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Moore, 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.