Citation Nr: 21076226 Decision Date: 12/22/21 Archive Date: 12/22/21 DOCKET NO. 15-12 284A DATE: December 22, 2021 ORDER An initial rating of 70 percent from June 9, 2010, to March 21, 2012, for posttraumatic stress disorder (PTSD) is granted. An initial rating of more than 70 percent since March 22, 2012, for PTSD is denied. A total rating for compensation purposes based on individual unemployability due to service-connected disabilities (TDIU) is granted. FINDINGS OF FACT 1. Since June 9, 2010, the Veteran's PTSD caused occupational and social impairment resulting in deficiencies in most areas. 2. The Veteran's service-connected disabilities prevent him from securing or following a substantially gainful occupation. CONCLUSIONS OF LAW 1. The criteria for an initial rating of 70 percent from June 9, 2010, to March 21, 2012, for PTSD have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.7, 4.130, Diagnostic Code 9411. 2. The criteria for an initial rating of more than 70 percent since March 22, 2012, for PTSD have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.7, 4.130, Diagnostic Code 9411. 3. The criteria for TDIU have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.326(a), 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the U.S. Army from April 1968 to December 1970. He served in the Republic of Vietnam. 1. Entitlement to an initial rating of more than 50 percent from June 9, 2010, to March 21, 2012, and of more than 70 percent since March 22, 2012, for PTSD. A 50 percent rating for PTSD requires occupational and social impairment with reduced reliability and productivity due to such symptoms 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; 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 himself 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. 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. In particular, use of such terminology permits consideration of items listed as well as other symptoms and contemplates the effect of those symptoms on the claimant's social and work situation. See Mauerhan v. Principi, 16 Vet. App. 436 (2002). Where, as here, the issue involves the assignment of an initial rating for a disability following the award of service connection for that disability, the entire history of the disability must be considered. See Fenderson v. West, 12 Vet. App. 119 (1999). In August 2010, the Veteran was afforded a VA examination. He had been married to his current spouse for 26 years and there were marital difficulties caused by his irritability. He had previously been married one time for 9 years, but the marriage ended as he was verbally abusive. He reported having a close relationship with his spouse, and that they went out together approximately one time per week. He had a few friendships, including one friend whom he met monthly for lunch. He had no hobbies. He had symptoms of daily nightmares, intrusive thoughts, avoidance, difficulty establishing friendships, feelings of detachment, sleep disturbance, hypervigilance, an exaggerated startle response, irritability, depression, and low self-esteem. He denied suicidal ideation, had no hallucinations or delusions, and was properly groomed. In a May 2011 letter, the Veteran's spouse stated that the Veteran was easily angered and frustrated, that he had become increasingly more serious and was afraid to be happy, and that he had severe nightmares where he would wake her to comfort him. She stated that the Veteran struggled with his actions in service and that he had survived when others did not. She stated that the Veteran was unable to connect with her emotionally and was always on guard. In March 2012, the Veteran was afforded another VA examination. He reported detachment from others, including his spouse; no relationship with any neighbors or friends; and that he enjoyed riding his motorcycle when the weather permitted. On examination, the Veteran had symptoms of recurrent and distressing recollections of in-service trauma, recurrent distressing dreams of the trauma, intense psychological distress and physiological reactivity when exposed to cues that resembled the trauma, avoidance, feelings of detachment or estrangement from others, restricted range of affect, sense of a foreshortened future, difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, hypervigilance, depressed mood, anxiety, suspiciousness, chronic sleep impairment, flattened affect, 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, and an inability to establish and maintain effective relationships. In October 2021, the Veteran was afforded another VA examination. He reported difficulty sleeping, that he did not know anyone well and did not really like other people. On examination, the Veteran had symptoms of recurrent, involuntary, and intrusive distressing memories of in-service trauma; recurrent distressing dreams of the trauma; dissociative reactions; intense or prolonged psychological distress and marked physiological reactions to cues that symbolized or resembled an aspect of the trauma; avoidance; inability to remember important aspects of the trauma; persistent and exaggerated negative beliefs or expectations about himself, others, or the world; persistent distorted cognitions about the cause or consequences of the trauma; persistent negative emotional state; markedly diminished interest or participation in significant activities; feelings of detachment or estrangement from others; irritable behavior and angry outbursts; hypervigilance; an exaggerated startle response; sleep disturbance; anxiety; suspiciousness; chronic sleep impairment; and mild memory loss. The examiner noted that the Veteran had an anxious but controlled affect, limited insight and judgment, adequate comprehension, fair impulse control, and no suicidal or homicidal ideation. He had faint auditory hallucinations. VA and private treatment records from throughout the period on appeal indicate symptoms consistent with those found at VA examinations. Since June 9, 2010, the Veteran's symptoms indicate occupational and social impairment with deficiencies in most areas. Therefore, a 70 percent rating is warranted throughout the period on appeal. See 38 C.F.R. § 4.7. A 100 percent rating is not warranted as the Veteran had no suicidal or homicidal ideation; had maintained his current marriage for many years; and sometimes participated in hobbies or activities, such as riding his motorcycle and going to lunch with a friend. Therefore, an increased rating to 70 percent is granted from June 9, 2010, to March 21, 2012; a rating of more than 70 percent is denied since March 22, 2012. 2. Entitlement to TDIU. TDIU may be assigned, where the schedular rating is less than total, when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. If there is only one such disability, that disability must be ratable at 60 percent or more. If there are two or more disabilities, there must be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). The Veteran now has a 70 percent rating for his PTSD since June 9, 2010, and, therefore, meets the minimum schedular rating requirement for TDIU. (Continued on the next page) The record indicates that the Veteran has not worked in at least 7 years. Given the severity of his PTSD, combined with his service-connected type II diabetes mellitus, tinnitus, and bilateral hearing loss, the Board finds that the Veteran is unable to secure or follow a substantially gainful occupation as a result of service connected disabilities. TDIU is granted. Jacqueline E. Miller Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board I. Umez-Eronini, 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.