Citation Nr: 21068627 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 17-35 147 DATE: November 10, 2021 ORDER Effective August 1, 2015, a 100 percent rating for service-connected posttraumatic stress disorder with alcohol abuse (PTSD) is granted. Effective May 22, 2019, special monthly compensation (SMC) under 38 U.S.C. § 1114(s) is granted. FINDINGS OF FACT 1. The Veteran's PTSD is reasonably shown to have manifested in total occupational and social impairment. 2. The Veteran's service-connected PTSD has been rated at 100 percent disabling, effective August 1, 2015. 3. Since May 22, 2019, the Veteran's service-connected disabilities have had a combined rating of 60 percent. CONCLUSIONS OF LAW 1. Effective August 1, 2015, the criteria for a 100 percent rating for PTSD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.132, Diagnostic Code 9411. 2. The criteria for SMC at the housebound rate, effective May 22, 2019, have been met. 38 U.S.C. §§ 1114(s), 5107; 38 C.F.R. §§ 3.102, 3.350. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from June 2000 to May 2005, including service in Iraq. In March 2019, the Board restored the prior 70 percent rating for PTSD, effective August 1, 2015 and remanded entitlement to a rating in excess of 70 percent. In September 2021, the Board again remanded this issue for additional development in September 2021. As the Board has determined that the Veteran is now entitled to a 100 percent rating for his service-connected PTSD, effective August 1, 2015 and the combined total of his additional service-connected disabilities separate from his PTSD is 60 percent from May 22, 2019, the issue of entitlement to SMC under 38 U.S.C. § 1114 (s) and 38 C.F.R. § 3.350 (a) is raised by the record and is addressed below. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); AB v. Brown, 6 Vet. App. 35, 38 (1993); see also Bradley v. Peake, 22 Vet. App. 280 (2008). 1. Entitlement to a rating in excess of 70 percent PTSD. The Veteran's service-connected PTSD is rated at 70 percent, effective August 1, 2015, under Diagnostic Code 9411. Under 38 C.F.R. § 4.130, Diagnostic Code 9411, a 70 percent rating is prescribed when 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 work like setting); inability to establish and maintain effective relationships. A 100 percent rating is prescribed when 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. 38 C.F.R. § 4.130, Diagnostic Code 9433. The list of symptoms under the rating criteria are meant to be examples of symptoms that would warrant the rating, but are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. Mauerhan v. Principi, 16 Vet. App. 436, 442-3 (2002). However, a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration, and that such symptoms have resulted in the type of occupational and social impairment associated with that percentage. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117-18 (Fed. Cir. 2013). The use of the phrase "such symptoms as," followed by a list of examples, provides guidance as to the severity of symptomatology contemplated for each rating. The use of such terminology permits consideration of items listed as well as other symptoms and contemplates the effect of those symptoms on the Veteran's social and work situation. See Mauerhan v. Principi, 16 Vet. App. 436 (2002). The Board acknowledges that symptoms recited in the criteria in the rating schedule for evaluating mental disorders 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." Id, at 442. In adjudicating a claim for a higher rating, the adjudicator must consider all symptoms of a claimant's service-connected mental condition that affect the level of occupational or social impairment. Id, at 443. Analysis The Board notes the Veteran has multiple psychiatric diagnoses including chronic severe PTSD, with panic attacks; severe alcohol use disorder; severe recurrent major depressive disorder (MDD) and moderate cannabis use disorder. The examiner stated that the symptoms of the Veteran's PTSD, MDD and substance use disorder are co-mingled, and she would be unable to differentiate without resorting to speculation. She noted, the Veteran's MDD, alcohol use and cannabis use are secondary to his PTSD, a progression and that the Veteran uses alcohol and cannabis to self-medicate his PTSD and panic attacks. See December 2020 PTSD DBQ. The December 2020 PTSD examiner summarized the Veteran's impairment as occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and or mood. The Veteran exhibited the following symptoms: depressed mood; anxiety; suspiciousness; panic attacks more than once a week; chronic sleep impairment; impaired judgment; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances, including work or a worklike setting; inability to establish and maintain effective relationships; suicidal ideation; impaired impulse control, such as an unprovoked irritability with periods of violence and neglect of personal appearance and hygiene. See December 2020 PTSD DBQ. The examiner noted that the Veteran's depression is part of his PTSD complex. The examiner stated the Veteran's severe depression, PTSD lack of sleep and substance use has resulted in his being homeless almost half of the time since his military service ended. Id. In a December 2015 statement, the Veteran reported his PTSD symptoms had worsened. He reported severe sleeplessness. He stated he sometimes went 2 to 3 days without sleep which caused sometimes caused him to miss work. He reported having suicidal ideation, hypervigilance, chronic depression, lack of motivation, isolating himself, easily angered, neglecting his personal hygiene and appearance. He stated, "I am tired of life", "I feel like I do not want to live". I feel like I do not want to do anything. See December 2015 VA Form 21-4138 Statement in Support of Claim. Having reviewed the medical and lay evidence of record, to include the Veteran's treatment records, the December 2020 PTSD examination and the Veteran's lay statements, and resolving all reasonable doubt in the Veteran's favor, the Board finds that the Veteran's psychiatric disorder is most accurately reflected by a 100 percent disability rating. The medical evidence and the Veteran's statements demonstrate the Veteran has had persistent, daily, suicidal thoughts and anxiety and depression throughout the appeal. As noted, the evidence shows that the Veteran has severe social impairment and that with respect to his ability to work, his occupational impairment most closely approximates the criteria for total occupation impairment. As such, the Board finds that a total 100 percent rating for other specified trauma and stressor related disorder with persistent depressive disorder is warranted throughout the appeal. 2. Entitlement to special monthly compensation (SMC) pursuant to 38 U.S.C. § 1114(s). SMC on the basis of being housebound is warranted where a veteran has, in addition to a single, permanent service-connected disability rated 100 percent disabling, (1) additional service-connected disability or disabilities independently evaluated as 60 percent or more disabling which are separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems. 38 U.S.C. § 1114 (s); 38 C.F.R. § 3.350 (i). As a result of the Board's decision herein, the Veteran's service-connected PTSD has been assigned a total rating, thereby satisfying the criteria for a 100 percent disabling disability from August 1, 2015. Since May 22, 2019, he has had other service-connected disabilities independently rated as 60 percent disabling. In light of the foregoing, SMC based upon housebound status from May 22, 2019, to present, is warranted. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jordan, Jacquelynn 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.