Citation Nr: 21072910 Decision Date: 12/06/21 Archive Date: 12/06/21 DOCKET NO. 17-45 282 DATE: December 6, 2021 ORDER From October 10, 2012, a 100 percent rating for generalized anxiety disorder (GAD) and persistent depressive disorder is granted. FINDING OF FACT Throughout the appeal period, the Veteran's GAD and persistent depressive disorder has resulted in total occupational and social impairment. CONCLUSION OF LAW The criteria for entitlement to a 100 percent rating for GAD and persistent depressive disorder are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9400. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from July 2001 to November 2001, from November 2002 to November 2003, and from December 2007 to September 2008 with periods of reserve service in the Army National Guard. This case comes before the Board of Veterans' Appeals (Board) on appeal from a July 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In January 2020, the Board remanded the case for additional evidentiary development to include obtaining outstanding medical treatment records and obtaining a new VA examination. There has been substantial compliance with previous remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). The Veteran has not raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board"); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). The Board has reviewed all of the evidence in the Veteran's claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-130 (2000). Increased Rating for GAD and Persistent Depressive Disorder Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule). 38 C.F.R. Part 4. The Rating Schedule is primarily a guide in the evaluation of disabilities resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. VA should interpret reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability. 38 C.F.R. § 4.2. Any reasonable doubt regarding the degree of disability shall be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two evaluations apply, the higher of the two should be assigned where the disability picture more nearly approximates the criteria for the next higher rating. 38 C.F.R. § 4.7. The Veteran's service-connected acquired psychiatric disorder has been rated under Diagnostic Code 9400, which provides that a 70 percent rating is warranted when there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, 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); and the inability to establish and maintain effective relationships. Id. A 100 percent rating requires 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; disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. When evaluating an acquired psychiatric disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the capacity for adjustment during periods of remission. The rating agency shall assign an evaluation 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 evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment but shall not assign an evaluation solely on the basis of social impairment. 38 C.F.R. § 4.126. The specified factors for each incremental psychiatric rating are not requirements for a particular rating but are examples providing guidance as to the type and degree of severity, or their effects on social and work situations. Analysis should not be limited to whether the symptoms listed in the rating scheme are exhibited; rather, consideration must be given to factors outside the rating criteria in determining the level of occupational and social impairment. Mauerhan v. Principi, 16 Vet. App. 436 (2002). 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). At the outset the Board notes the Veteran filed his claim for TDIU on October 10, 2013. Thus, the period on appeal begins October 10, 2012 which includes the one year look back provision. In determining whether the Veteran's acquired psychiatric disorder was rated appropriately, the Board has thoroughly reviewed the evidence of record and finds that the Veteran's condition has more nearly approximated the criteria for a 100 percent rating. Turning to the evidence of record, medical treatment records from 2011 to 2012 note the Veteran's continued hospitalizations for depression, suicidal and homicidal ideations. A September 2012 VA examination report noted the Veteran was diagnosed with anxiety disorder, adjustment disorder with depression, and alcohol abuse. The examiner noted the Veteran's level of occupational and social impairment was 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. The Veteran exhibited symptoms of depressed mood, anxiety, disturbances of motivation and mood, and an inability to established and maintain effective relationships. The Veteran reported he had an unsuccessful relationship with his girlfriend that only lasted a year due to his alcohol abuse. The examiner included medical treatment records from 2011 that noted his VA psychiatric admissions for complaints of suicidal and homicidal ideations and noted his violent ideation. January 2013 VA treatment records noted the Veteran had thoughts of wanting to kill himself and a February 2013 VA treatment record noted the Veteran had three suicide attempts the most recent in July 2012 and the Veteran was issued a protection order due to him threatening physical bodily harm to his pregnant fiancée. An April 2014 VA examination report noted the Veteran had a diagnosis of GAD, persistent depressive disorder, and other specified personality disorder. The Veteran's level of occupational and social impairment was with deficiencies in most areas. The examiner noted that it was impossible to differentiate what portion of the occupational and social impairment was caused by each diagnosed mental disorder. The Veteran exhibited symptoms of depressed mood, anxiety, suspiciousness, chronic sleep impairment, circumstantial, circumlocutory, or stereotyped speech, impaired judgment, disturbance of motivation and mood, difficulty in establishing, and maintaining effective work and social relationships and difficulty in adapting to stressful circumstances including work or a work like setting. There were no other symptoms attributable to his mental disorders. The Veteran reported living with his girlfriend who was pregnant with his first child. He reported that they just reconciled less than a year ago and things were not going well. He also reported maintaining a relationship with his only brother and his parents by phone. His mother was his VA fiduciary for the past two years and he only had one friend that he saw weekly. The Veteran reported not working since 2012 due to his mental health issues. It was also noted that the Veteran was hospitalized for impulsively engaging in self-harming behavior. Medical treatment records from 2015 to 2016 continued to note the Veteran's reports of suicidal ideations and that he admitted to being paranoid and having angry outbursts with little provocation and being reckless and having self-destructive behavior. In 2017 VA treatment records noted the Veteran had thoughts of death. He was in anger management and had two misdemeanor charges for assault and battery after attacking his girlfriend and her friend. The Veteran was noted to be on probation for driving under the influence (DUI). He had road rage and angry outbursts with family and reported having difficulty controlling or regulating his anger. The Veteran reported feeling paranoid and that he was obsessed with keeping his house clean and engaged in delusional thoughts. It was also noted that he had been engaged three times and never married and he had a two-year-old son that he could only see during supervised visitation. In May 2018, the Veteran was hospitalized for three days due to suicidal ideation. VA medical treatment records from 2019 to 2020 continue to note the Veteran was suicidal, had paranoid thoughts and was hospitalized for his mental disorders. An August 2021 VA examination report noted the Veteran had multiple involuntary hospitalizations, arrests, and a suicide attempt. He had a history of violence and anger outbursts that have been directed towards family and friends. One particular violent outburst caused him to be detained and his son was taken from his custody. The Veteran's level of occupational and social impairment was noted with deficiencies in most areas. The examiner noted the Veteran exhibited symptoms of depressed mood, anxiety, chronic sleep impairment, disturbance of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, including work or a work like setting, inability to establish and maintain effective relationships, suicidal ideation, impaired impulse control such as unprovoked irritability with periods of violence, intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. There were no other symptoms attributable to his mental disorder. The examiner concluded that the Veteran has had a lengthy history of depression, major depressive episodes, anxiety, severe alcohol use and violent outbursts. These symptoms have led to hospitalization, incarceration, child custody loss, and his inability to maintain employment, all of which contribute to his total disability. Based on the evidence discussed above, the Board finds that an increased rating of 100 percent is warranted for the entire period on appeal as the evidence reflects a total occupational and social impairment. The Veteran was noted to be engaged three times, none of which resulted in marriage, and although he has a relationship with his only brother and his parents it is only noted to be through telephonic communication. His relationship with his grandmother, whom he is in close proximity to, is very strained. He has lost custody of his minor child, although he regained custody, he has admitted to angry outbursts towards his child who is autistic. The Veteran has demonstrated an inability to maintain employment, having worked last in 2012 and quit because of his mental disorders. In addition, the Board notes the Veteran has a history of persistent suicidal ideation and suicide attempts, ranging from 2012 to the present, indicating exceptionally severe symptoms and persistent danger to himself throughout the appellate period. Moreover, the Veteran reported difficulty controlling his anger with his family, friends, and child. This uncontrolled anger has led to hospitalizations and arrests. The Veteran also reported experiencing paranoia during the appeal period, that included seeing shadows and hearing voices. Finally, the evidence shows that the Veteran had difficulty completing activities of daily living, which resulted in his mother becoming his fiduciary and paying all his bills and giving him a monthly allowance since 2011. Given the Veteran's overall disability picture, the Board finds this impairment is more closely approximated by the criteria associated with a total occupational and social impairment. Continued on Next Page Accordingly, a 100 percent rating for GAD and persistent depressive disorder is granted. This 100 percent evaluation is a full grant of the benefits on appeal. K.A. KENNERLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. McDuffie, 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.