Citation Nr: 21071449 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 18-53 908 DATE: November 30, 2021 ORDER Restoration of the 100 percent rating assigned for the Veteran's service-connected posttraumatic stress disorder with severe major depressive disorder, recurrent, severe, with anxious distress, with psychotic features (previously rated as major depressive disorder recurrent with anxiety NOS) (hereinafter PTSD), effective December 1, 2018, is granted. FINDING OF FACT The improvement in the Veteran's service-connected PTSD was not sustained under the ordinary conditions of life and work. CONCLUSION OF LAW The criteria for restoration of the 100 percent rating assigned for the Veteran's service-connected PTSD, effective December 1, 2018, have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.105, 3.344. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May to November 1991, July 2003 to May 2004, September 2005 to August 2007, and March 2009 to July 2010. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO), which reduced the rating for the Veteran's service-connected PTSD from 100 percent to 70 percent, effective December 1, 2018. In November 2021, the Veteran testified at a hearing before the undersigned. Restoration of the 100 percent rating assigned for the Veteran's service-connected PTSD, effective December 1, 2018, is granted. As an initial matter, the Board notes that a rating reduction case focuses on the propriety of the reduction and is not the same as an increased rating issue. See Peyton v. Derwinski, 1 Vet. App. 282, 286 (1991). The provisions of 38 C.F.R. § 3.105(e) allow for the reduction in rating of a service-connected disability when warranted by the evidence, but only after VA has met certain procedural and substantive requirements. Procedurally, where the reduction in the rating of a service-connected disability is considered warranted and the lower evaluation would result in a reduction or discontinuance of compensation payments currently being made, a rating proposing the reduction or discontinuance will be prepared setting forth all material facts and reasons. 38 C.F.R. § 3.105(e). Substantively, the criteria governing rating reductions for service-connected disabilities is found in 38 C.F.R. § 3.344. The provisions of 38 C.F.R. § 3.344(a) and (b) apply to ratings that have been continued for five years or more. In such cases, the regulation prescribes more stringent criteria that must be met before a rating may be reduced. Where a disability rating has continued at the same level for less than five years, as in this case, the analysis is conducted under 38 C.F.R. § 3.344(c), which provides that reexaminations disclosing improvement, physical or mental, in these disabilities will warrant reduction in rating. VA is also required to comply with several general VA regulations applicable to all rating-reduction cases, regardless of the rating level or the length of time that the rating has been in effect. See 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.13; see also Brown v. Brown, 5 Vet. App. 413, 420 (1993). These provisions impose a clear requirement that VA rating reductions be based upon review of the entire history of a Veteran's disability. See Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Such review requires VA to ascertain, based upon review of the entire recorded history of the condition, whether the evidence reflects an actual change in the disability and whether the examination reports reflecting such change are based upon thorough examinations. Thus, in any rating-reduction case not only must it be determined that an improvement in a disability has actually occurred but also that that improvement actually reflects an improvement in a Veteran's ability to function under the ordinary conditions of life and work. Faust v. West, 13 Vet. App. 342, 349 (2000). In an April 2015 rating decision, the Veteran was granted service connection for PTSD and assigned a 100 percent rating, effective December 3, 2014, based on the Veteran's symptoms, including, persistent danger of hurting self and others; difficulty adapting to work; difficulty in adapting to stressful circumstances; suicidal ideation; difficulty in adapting to a worklike setting; occupational and social impairment with deficiencies in most areas such as work, school, family relations, thinking, or mood; disturbances of motivation and mood; panic attacks more than once a week; depressed mood; chronic sleep impairment; anxiety; and suspiciousness. In a September 2018 rating decision, the Veteran's rating for her service-connected PTSD was reduced to 70 percent based on the Veteran's symptoms including forgetting names; unprovoked irritability with period of violence; occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgement, thinking, or mood; suspiciousness; depressed mood; suicidal ideation; disturbances of motivation and mood; mild memory loss; forgetting recent events; impaired impulse control; chronic sleep impairment; weekly panic attacks; difficulty adapting to stressful circumstances; neglect of personal appearance and hygiene; difficulty adapting to work and worklike settings; flattened affect; anxiety; difficulty in establishing and maintaining effective work and social relationships; and forgetting directions. A May 2017 VA examination reflects that the Veteran neglects her personal appearance and hygiene. A January 2019 psychosocial evaluation performed by a private physician noted chronic suicidal ideation, a reported history of dissociation, as well as periods of being paralyzed at home, sometimes for hours at a time, that are marked by total inactivity and dissociation. The private clinician also noted neglect of personal hygiene that can last two to three weeks at a time, spatial disorientation, disorientation for time and space, persistent danger of hurting self, intermittent inability to perform daily living activities, and significant memory loss including for well-known information. The private physician found the Veteran's PTSD to be marked by total occupational and social impairment. Finally, a November 2021 statement from the Veteran's spouse reflects that the Veteran often goes numerous days without a shower and sometimes wears the same undergarments more than one day in a row as well as has frequent suicidal ideations. Based on this evidence, the Board finds that there has not been sustained improvement in the Veteran's ability to function under the ordinary conditions of life and work with regard to her service-connected PTSD since she was rated at 100 percent. Accordingly, the Board finds the RO's reduction in rating was improper and restoration of the 100 percent rating for her service-connected PTSD, effective December 1, 2018, is warranted. M. HYLAND Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Elias, 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.