Citation Nr: 21070521 Decision Date: 11/24/21 Archive Date: 11/24/21 DOCKET NO. 16-63 475 DATE: November 24, 2021 ORDER A 100 percent schedular rating for posttraumatic stress disorder (PTSD) with alcohol use disorder for the period prior to and on and after September 21, 2021, is granted. FINDING OF FACT Prior to and after September 21, 2021, the service connected psychiatric disability has been shown to be manifested by suicidal and homicidal ideation; a depressed mood; a flattened affect; anxiety; suspiciousness; panic attacks more than once a week; chronic sleep impairment; mild memory loss, such as forgetting names, directions, or recent events; impairment of short and long term memory; speech intermittently illogical, obscure, or irrelevant; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances including work or work like setting; impaired impulse control, such as unprovoked irritability with periods of violence; and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. CONCLUSION OF LAW Prior to September 21, 2021, and on and after September 21, 2021, the criteria for a 100 percent rating for PTSD with alcohol use disorder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from September 1988 to February 1992. He served in Iraq and was awarded the Combat Action Ribbon. Increased Ratings for PTSD Disability ratings are determined by comparing the Veteran's current symptomatology with the criteria set forth in the Schedule for Rating Disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. A 50 percent rating is warranted for PTSD which is productive of occupational and social impairment with reduced reliability and productivity due to symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks occurring 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 or 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 requires occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking, or mood due to 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 work like setting); and an inability to establish and maintain effective relationships. A 100 percent rating requires total occupational and social impairment due to symptoms such as gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, a persistent danger of hurting herself or others, an intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene), disorientation to time or place, and memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130, Diagnostic Code 9411. Where there is a question as to which of two disability ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The report of an April 2015 Department of Veterans Affairs (VA) psychiatric examination states that the Veteran worked as a supervisor with a masonry company and experienced "some conflict with subordinates." The examiner observed that the Veteran was casually dressed; well-groomed; and fully oriented, displaying no gross memory impairments or attentional difficulties." On mental status examination, the Veteran exhibited a depressed mood; a flattened affect; tearfulness; anxiety; suspiciousness; panic attacks occur weekly, and chronic sleep impairment; and no hallucinations, delusions, or current homicidal or suicidal ideation. The examiner concluded that the diagnosed PTSD and alcohol use disorder were productive of "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." A June 2015 VA treatment record states that the Veteran complained of worsening PTSD symptoms including suicidal and homicidal thoughts, irritability, impaired sleep, social isolation, and an impaired relationship with his wife. He reported that he "did hold a gun to himself in November but did not pull the trigger." The treating VA psychologist stated that the Veteran "has thoughts of suicide that seem to come and go, with no immediate plans or intentions of suicide." A July 2015 VA mental health clinic conveys that the Veteran reported experiencing suicidal and homicidal ideation that "come and go." A November 2015 VA psychological treatment record states that the Veteran endorsed moderate suicidal ideation. An undated letter received in December 2015 from the Veteran's supervisor states that the Veteran's "explosive and sometimes unapproachable behavior has been a problem at his workplace and had directly affected his ability to do his job effectively." A March 2016 VA treatment record states that the Veteran was "not actively suicidal, though he 'feels dead' inside." The Veteran reported that "last Saturday night, they and other family were at the bar" and "he felt overwhelmed by the crowd and almost got in a fight with another guy." In his December 2016 Appeal to the Board, VA Form 9, the Veteran reported that: he thought "about ending my life on a weekly basis;" drank 12 cans of beer a night; he had been given smaller jobs to supervise at work "because of my temper and my mouth;" he experiences road rage and weekly panic attacks; and slept with a loaded gun under his pillow. An April 2021 VA treatment record states that the Veteran agreed with the statement that "over the past month, have you wished you were dead or wished you could go to sleep and not wake up." The report of a September 2021 psychiatric examination conducted for VA conveys that the Veteran "has had ongoing PTSD symptoms but refuses to go to therapy or take meds" and "reports drinking between 15 and 20 beers per day." He was diagnosed with PTSD and alcohol use disorder. The service connected psychiatric disabilities were found to be manifested by suicidal ideation; a depressed mood; a flattened affect; anxiety; suspiciousness; panic attacks more than once a week; chronic sleep impairment; mild memory loss, such as forgetting names, directions, or recent events; impairment of short and long term memory; speech intermittently illogical, obscure, or irrelevant; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances including work or work like setting; impaired impulse control, such as unprovoked irritability with periods of violence; and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. Prior to and on and after September 21, 2021, the service connected PTSD with alcohol use disorder has been shown to be manifested by suicidal and homicidal ideation; a depressed mood; a flattened affect; anxiety; suspiciousness; panic attacks more than once a week; chronic sleep impairment; mild memory loss, such as forgetting names, directions, or recent events; impairment of short and long term memory; speech intermittently illogical, obscure, or irrelevant; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances including work or work like setting; impaired impulse control, such as unprovoked irritability with periods of violence; and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. Such symptoms most closely approximate the criteria for a 100 percent rating under 38 C.F.R. § 4.130, Diagnostic Code 9411. Therefore, the Board of Veterans' Appeals (Board) concludes that a 100 percent schedular rating is warranted for PTSD with alcohol use disorder during all relevant periods. J. T. HUTCHESON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Emily A. Kotroco 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.