Citation Nr: A21018646 Decision Date: 11/22/21 Archive Date: 11/22/21 DOCKET NO. 211012-190485 DATE: November 22, 2021 ORDER Entitlement to an initial rating in excess of 30 percent for service-connected other specified trauma and stressor-related disorder is denied. FINDING OF FACT The severity, frequency, and duration of the Veteran's symptoms do not more closely approximate occupational and social impairment with reduced reliability and productivity. CONCLUSION OF LAW The criteria for an initial disability rating in excess of 30 percent for service-connected other specified trauma and stressor-related disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9499-9411. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from April 1966 to March 1969. The rating decision on appeal was issued in September 2021 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In the October 2021 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Evidence, namely an October 2021 statement from the Veteran describing his symptoms, was added to the claims file during a period of time when new evidence was not allowed. As the Board is deciding the claim on appeal, it may not consider this evidence in its decision. 38 C.F.R. § 20.300. The Veteran may file a Supplemental Claim and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. Entitlement to an initial rating in excess of 30 percent for service-connected other specified trauma and stressor-related disorder The Veteran is seeking a rating higher than 30 percent for his service-connected trauma and stressor-related disability. Under the General Formula for Mental Disorders (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). A 30 percent rating is assigned when symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events), cause 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 normal conversation). A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or 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 tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. A 70 percent rating is assigned when 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 worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned for 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; or memory loss for names of close relatives, own occupation or own name. The issue in this appeal is whether the Veteran's associated symptoms caused the level of impairment required for a disability rating of 50 percent or higher. The preponderance of the evidence, inclusive of the August 2021 VA examination, relevant VA treatment records, and the Veteran's lay statements, show the Veteran's service-connected trauma and stressor-related disability is primarily manifested by symptoms associated with a 30 percent rating, such as anxiety and mild memory loss. Review of the record reveals that the Veteran has also endorsed being paranoid and high-strung, which are symptoms that are not listed with specific ratings; however, the Board finds these symptoms are similar to anxiety and suspiciousness, which are contemplated by the 30 percent rating. The Veteran has also exhibited disturbances in motivation and mood, which is associated with a 50 percent rating. After considering the evidence of record, the Board finds the severity, frequency, and duration of the Veteran's listed and unlisted symptoms more closely approximate the symptoms associated with a 30 percent rating and result in a level of impairment that most closely approximates the level of impairment associated with a 30 percent rating. As noted, the evidence shows that the Veteran's service-connected trauma and stressor-related disability is primarily manifested by anxiety and other similar symptoms, such as being paranoid and high-strung. The Veteran has consistently reported that his anxiety occurs especially in the morning, but he has also described worrying about various life stressors which make him feel a sense of dread and confusion. See VA treatment records dated June and July 2021. The evidence also shows the Veteran has described feeling depressed very easily and having no patience and a low mood. Indeed, the VA examiner noted his disturbances in motivation and mood. See September 2019 Veteran statement; June 2021 VA treatment record; August 2021 VA examination. Despite the Veteran's anxiety, paranoia, and depressed and variable mood, the preponderance of the evidence does not reflect that these symptoms result in any difficulty establishing or maintaining effective interpersonal relationships or cause reduced reliability and productivity in social settings. In this regard, the Board notes the Veteran has reported an inability being in crowds and specifically avoiding fourth of July celebrations, but he has also described himself as social and reports being around people all the time. Indeed, the evidence reflects that the Veteran is very active, as he plays golf and pickle ball with others, goes to the gym most days, takes walks, and eats out often. See September 2019 Veteran statement and VA treatment records. The Board notes the Veteran is divorced and the relevant evidence does not provide information as to the quality of his relationships with his three sons and five grandchildren, but the June 2021 treatment record shows that his son suggested he get help with his anxiety which supports a finding that he has intact relationships with his family. The Board also notes that the Veteran is retired, but the evidence does not suggest that his symptoms would likely cause a significant occupational impairment, largely because he is shown to function generally satisfactorily, including in settings that require interacting with others. In this context, the Board notes that, despite the Veteran's reported confusion, there is no evidence of disordered or impaired thinking, impaired judgement, or deficiencies in speech or communication. Instead, the preponderance of the evidence reflects that the Veteran is consistently described as fully oriented and well-groomed with normal speech, attention, concentration, judgement, and insight. The Veteran has endorsed some minor deficits in his short-term memory, but he has also stated that he is not too concerned about his memory and does not believe it is significantly impaired. See June 2021 VA treatment record. In fact, the Veteran's memory was intact during objective evaluation in August 2021. As also noted, the Veteran has also reported having no patience, but there is no evidence showing that his lack of patience has resulted in physical altercations, anger outbursts, or other violent conduct as a result of impaired impulse control. The evidence also shows the Veteran's thought process is coherent and goal-directed with thought content free of suicidal or homicidal ideation, hallucinations, flashbacks, or delusions. Based on the foregoing, the Board finds the severity, frequency, and duration of the Veteran's symptoms more closely approximate those contemplated by a 30 percent rating, which are less severe, less frequent, and shorter in duration than those contemplated by a 50 percent rating. See 38 C.F.R. § 4.126. Indeed, while the Veteran experiences variations and disturbances in mood, which is contemplated by a 50 percent rating, the preponderance of the evidence does not demonstrate the level of impairment associated with a 50 percent rating. As noted, the Veteran's other symptoms, namely anxiety, paranoia, and short-term memory loss, are either contemplated by or more consistent with a 30 percent rating and are not shown to result in more than intermittent periods of inability to function appropriately, including in social or occupational settings. Indeed, despite his symptoms, the Veteran is shown to generally function satisfactorily with routine behavior, self-care, and normal conversation, thinking, judgement, and interpersonal relations. Accordingly, the preponderance of the evidence weighs against finding that the severity, frequency, and duration of the Veteran's symptoms resulted in the level of impairment required for a 50 percent rating. Therefore, the criteria for a 50 percent or higher rating are not met and the appeal must be denied. Jenna Brant Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Turnipseed, 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.