Citation Nr: 21076802 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 17-42 884 DATE: December 27, 2021 ORDER Entitlement to an initial 50 percent rating for posttraumatic stress disorder (PTSD) is granted. Entitlement to an initial rating greater than 10 percent prior to November 1, 2016, and greater than 30 percent thereafter, for coronary artery disease is denied. Entitlement to an initial 10 percent rating for chest scars is granted. Entitlement to service connection for bilateral hearing loss is denied. FINDINGS OF FACT 1. Resolving any reasonable doubt in the Veteran's favor, the record evidence shows that his service-connected PTSD results in occupational and social impairment with reduced reliability and productivity throughout the appeal period. 2. The record evidence does not show that, prior to November 1, 2016, the Veteran's service-connected coronary artery disease (CAD) is manifested by a METs level less than 7 or cardiac hypertrophy or dilatation. 3. The record evidence does not show that the Veteran's service-connected CAD is manifested by a METs level less than five, congestive heart failure, or left ventricular ejection fraction less than 50 percent at any time during the appeal period (i.e., before or after November 1, 2016). 4. The record evidence shows one of the chest scars is painful but does not show that the scars are unstable, at least 929 centimeters in area, or result in functional impairment. 5. The record evidence does not show bilateral hearing loss for VA disability purposes. CONCLUSIONS OF LAW 1. The criteria for an initial 50 percent rating for PTSD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9411. 2. The criteria for an initial rating greater than 10 percent prior to November 1, 2016, and greater than 30 percent thereafter, for coronary artery disease have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.104, DC 7005. 3. The criteria for an initial 10 percent rating for chest scars have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.3, 4.7, 4.118, DC 7805. 4. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303, 3.304, 3.385. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from February 1968 to September 1969. This appeal has a long procedural history. It comes before the Board of Veterans' Appeals (Board) on appeal from a November 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO) which granted, in pertinent part, claims of service connection for PTSD, assigning a 30 percent rating effective June 9, 2014, CAD, assigning a 10 percent rating effective June 19, 2013, and for a chest scar, assigning a zero percent (non-compensable) rating effective June 19, 2013. The Veteran appointed his current service representative to represent him before VA by filing a completed VA Form 21-22 at the RO in February 2015. In a July 2017 rating decision, the RO assigned a higher 30 percent rating effective November 1, 2016, for the Veteran's service-connected CAD. Having reviewed the record evidence, the Board finds that the issues on appeal should be characterized as stated above. The Board notes that VA amended the criteria for rating skin disabilities effective from August 13, 2018. As relevant to the current appeal, under the former Diagnostic Code 7802, the term "superficial" was used to describe a scar "not associated with underlying soft tissue damage;" the remainder of the criteria were not significantly changed. Diagnostic Codes 7804 and 7805 were not changed by the August 13, 2018, amendments. 1. Entitlement to an initial 50 percent rating for PTSD is granted Resolving any reasonable doubt in the Veteran's favor, the Board finds that the criteria for an initial 50 percent rating for PTSD have been met. 38 C.F.R. § 4.130, DC 9411. The record evidence shows that, during an initial evaluation in June 2014, the Veteran reported nightmares, flashbacks, hyperarousal, depressed mood, little interest or pleasure in doing things, sleep trouble, trouble concentrating, self-isolation, and low motivation and energy. The evaluator found no evidence of suicidal or homicidal ideation or hallucinations and found the Veteran had depressed mood, normal thought, cooperative attitude, good attention, good impulse control, fair insight, and good judgment. VA treatment records continue to show symptoms of depressed mood, low motivation, forgetfulness or issues with memory, anxiety, panic attacks, nightmares, impaired sleep, and isolative behaviors. Treating providers consistently found the Veteran with appropriate dress and grooming with occasional instances of him being unshaven, normal thought and speech, fair judgment and insight, and appropriate concentration and cooperation. The October 2014 examiner noted the Veteran as having on-going relationships with his sibling and working as a locksmith. The examiner recorded recurrent and distressing memories and dreams, persistent negative emotional state, markedly diminished interest or participation in significant activities, feelings of detachment from others, irritability and angry outbursts, hypervigilance, chronic sleep impairment, depressed mood, anxiety, and suspiciousness. The examiner found the Veteran casually dressed with adequate hygiene, the ability to establish and maintain rapport with the examiner, normal speech, no hallucinations or delusions, no obsessions or compulsions, normal thought, full orientation, adequate insight and judgment, and the capability to manage his own finances. During the October 2016 examination, the Veteran reported being close to his sister and brother and working fulltime as a locksmith. The examiner recorded recurrent and distressing memories and dreams, 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, depressed mood, anxiety, suspiciousness, and chronic sleep impairment. The examiner noted the Veteran was casually dressed, with adequate personal hygiene, the ability to establish and maintain rapport, normal speech, no hallucinations or delusions, no obsessions or compulsions, dysphoric mood, normal thought, full orientation, intact judgment and insight, and the capability of managing his own finances. The Board finds the Veteran's PTSD is most consistent with the criteria of occupational and social impairment with reduced reliability and productivity. Most of the symptoms of the Veteran's PTSD depressed mood, anxiety, suspiciousness, infrequent panic attacks, chronic sleep impairment, and mild memory loss are specifically enumerated by the 30 percent criteria found in DC 9411. Id. Nevertheless, he reported disturbances of motivation and mood and showed a significant impairment in social functioning. He also reported self-isolating most of the time except for some family functions and work. He preferred to work alone. Given this level of impaired social functioning, the Board finds the criteria for an initial 50 percent rating for the Veteran's service-connected PTSD have been met throughout the appeal period. Id. The Board also finds that an initial rating greater than 50 percent for service-connected PTSD is not warranted. For example, there is no evidence of impairment of thought, speech, judgment, or notable difficulty in occupational functioning to warrant a 70 or 100 percent rating. Id. Although he had a limited number of relationships, the Veteran reported good relationships with his siblings and enjoying spending birthdays and holidays with his family. He was able to successfully work fulltime as a locksmith for the same employer throughout the period on appeal. He lived independently and cared for himself. There is no evidence of inappropriate behavior or impaired impulse control. He interacted well with examiners and treating providers. He reported giving his gun to his sister after once grabbing it in anger which demonstrated good judgment. Treating providers noted he was unshaven on a few occasions but there is no evidence that he neglected his hygiene. While he admitted to occasionally thinking about his death, he denied thoughts or plans of suicide. Accordingly, the evidence does not support PTSD symptoms resulting in deficiencies in most areas or total impairment (i.e., a 70 or 100 percent rating under DC 9411). Id. In summary, and after resolving any reasonable doubt in the Veteran's favor, the Board finds that the criteria for an initial 50 percent rating for PTSD have been met throughout the appeal period. 2. Entitlement to an initial rating greater than 10 percent prior to November 1, 2016, and greater than 30 percent thereafter, for CAD is denied. After reviewing the evidence, the Board finds the criteria for an initial rating greater than 10 percent prior to November 1, 2016, and greater than 30 percent thereafter for coronary artery disease (CAD) have not been met. See 38 C.F.R. § 4.104, DC 7005. The record evidence shows that the October 2014 examiner found greater than 7 to 10 METs level based on the Veteran's reports of angina with activities consistent with climbing stairs quickly, moderate bicycling, or jogging. The examiner found no evidence of congestive heart failure or cardiac hypertrophy or dilatation. The November 2016 examiner found the Veteran had a METs level of greater than 5 to 7 based on his report of the onset of angina with activities consistent with walking one flight of stairs, mowing the lawn, or heavy yard work. The examiner added the results of an echocardiogram completed later in November 2016 with left ventricular ejection fraction of 55 to 60 percent and evidence of cardiac hypertrophy and dilatation. The examiner found no evidence of congestive heart failure. VA treatment records also do not show cardiac hypertrophy or dilatation prior to November 2016 or congestive heart failure at any time during the period on appeal. Prior to the November 1, 2016, examination, the evidence does not show METs level less than 7 or cardiac hypertrophy or dilatation to satisfy the criteria for a 30 percent rating prior to this date under DC 7005. Id. The evidence dated since November 1, 2016, does not show a METs level less than 5, congestive heart failure, or left ventricular ejection fraction less than 50 percent to warrant an initial rating greater than 30 percent for the Veteran's service-connected CAD since this date. He otherwise has not identified or submitted any evidence demonstrating his entitlement to an initial rating greater than 10 percent prior to November 1, 2016, and greater than 30 percent thereafter, for his service-connected CAD. In summary, the Board finds that the criteria for an initial rating greater than 10 percent prior to November 1, 2016, and greater than 30 percent thereafter, for CAD have not been met. 3. Entitlement to an initial 10 percent rating for chest scars is granted. Resolving any reasonable doubt in the Veteran's favor, the Board finds that an initial 10 percent rating is warranted for one painful chest scar. The October 2014 examiner recorded three chest scars with the largest measuring 21 x 1.5 centimeters (cm) and the other two measuring 1 x 1.5 cm. The November 2016 examiner similarly measured the larger scar as 21 x 2 cm, one of the smaller scars as 1 x 1 cm, and the other as 1 x 1.5 cm. The examiner found no evidence of functional impairment from the scars and described the scars as either linear or superficial. The examiners noted the scars were not painful or unstable. The Board finds the Veteran is competent to report a painful scar and there is no reason to doubt the credibility of his report. In his statement, the Veteran indicated "scar" singular which the Board understands to mean that the more prominent scar in the middle of his chest has pain and itching. There is no evidence to suggest that other two very small scars are painful. He also has not reported that the scars have frequent loss of skin covering or cause functional impairment. One painful scar warrants an initial 10 percent rating. The criteria for an initial rating greater than 10 percent for the Veteran's scars are not shown. The scars are not of the head, face, or neck, not deep, and not associated with underlying soft tissue damage; therefore, the other Diagnostic Codes pertaining to scars are not applicable. In summary, and after resolving any reasonable doubt in the Veteran's favor, the Board finds that the criteria for an initial 10 percent rating for a chest scar have been met throughout the appeal period. 4. Entitlement to service connection for bilateral hearing loss is denied. The Board finally finds that the preponderance of the evidence is against granting the Veteran's claim of service connection for bilateral hearing loss. The evidence does not show current bilateral hearing loss which could be attributed to active service. VA regulations provide that impaired hearing is considered a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, and 4000 Hertz is 40 decibels or greater or when the auditory thresholds for at least three of those frequencies are 26 decibels or greater. 38 C.F.R. § 3.385. The October 2014 examiner measured the Veteran's auditory thresholds at frequencies 500, 1000, 2000, 3000, and 4000 to no more than 25 decibels. Similarly, VA treatment records note his hearing was intact bilaterally. Although the Veteran asserted that he has bilateral hearing loss, he does not have the requisite medical training or equipment to provide the information needed to establish bilateral hearing loss as defined by VA regulation. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Thus, his lay statements are entitled to no probative value on the issue of whether his claimed bilateral hearing loss is related to active service. A service connection claim must be accompanied by evidence which establishes that the claimant currently has a disability. Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection is not warranted in the absence of proof of current disability. The Board has considered whether the Veteran experienced bilateral hearing loss at any time during the pendency of this appeal. Service connection may be granted if there is a disability at some point during the claim even if it later resolves or becomes asymptomatic. McClain v. Nicholson, 21 Vet. App. 319 (2007). In this case, there is no evidence other than the Veteran's unsupported lay assertions that he experienced bilateral hearing loss at any time during or after active service which could be attributed to active service or any incident of service. He otherwise has not identified or submitted any evidence demonstrating his entitlement to service connection for bilateral hearing loss. In summary, the Board finds that service connection for bilateral hearing loss is not warranted. MICHAEL T. OSBORNE Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.P. Armstrong 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.