Citation Nr: 21005830 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 08-38 171 DATE: February 2, 2021 ORDER Entitlement to an effective date earlier than March 19, 2008 for the grant of service connection for posttraumatic stress disorder (PTSD) is denied. Entitlement to a 70 percent rating for the service-connected PTSD, effective March 19, 2008, is granted. REFERRED ISSUE In May 2018, the Board remanded a claim for a total disability rating based on individual unemployability (TDIU), for extraschedular consideration prior to May 6, 2014. In December 2020, the Veteran’s attorney requested that the Board take jurisdiction over the issue of entitlement to a TDIU if the claim for a higher rating for PTSD was granted. The Board finds, however, that entitlement to a TDIU prior to May 6, 2014 is in remand status at the RO and is unable to take jurisdiction. However, the entire TDIU claim remains, in general, part of this appeal and considering the grant herein, the RO should adjudicate entitlement to a TDIU prior to May 6, 2014 on a schedular basis. If that claim continues to be denied, the Board can consider it in a future decision. FINDINGS OF FACT 1. The Board’s March 1975 decision denying service connection for a nervous condition is final. 2. The Veteran’s March 2008 claim for service connection for PTSD constitutes a petition to reopen the June 1973 claim of service connection for a nervous condition. 3. The military personnel records received after the March 1975 Board decision are not “relevant” and do not warrant reconsideration of the previously denied claim under 38 C.F.R. § 3.156(c). 4. The Veteran’s PTSD has been manifested by depression, irritability, impaired memory and concentration, auditory hallucinations, suicidal ideation, social isolation, anhedonia, and disorientation for the entire period on appeal. CONCLUSIONS OF LAW 1. The criteria for an effective date earlier than March 19, 2008 for the grant of service connection for PTSD have not been met. 38 C.F.R. §§ 3.156, 3.400. 2. The criteria for a 70 percent rating for the service-connected PTSD effective March 19, 2008 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 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1966 to August 1968. The matter comes before the Board of Veterans’ Appels (Board) on appeal from June 2008 and August 2014 rating decisions. In May 2018, the Board denied the Veteran’s claims for an earlier effective date and entitlement to a higher rating for the service-connected PTSD prior to May 6, 2014. The Veteran appealed the denials to the U.S. Court of Appeals for Veterans Claims (Court). In November 2019, the Court issued a Memorandum Decision in which the Court vacated the denials and remanded the matter to the Board. The matter is now before the Board for readjudication consistent with the Court’s Memorandum Decision. 1. Entitlement to an effective date earlier than March 19, 2008 for the grant of service connection for PTSD is denied. A. Whether the March 2008 claim for service connection for PTSD was a new claim or a petition to reopen the June 1973 claim for service connection for a nervous condition The Veteran seeks an effective date earlier than March 19, 2008 for the grant of service connection for PTSD. The Veteran claims that the March 2008 claim for service connection for PTSD was a petition to reopen the previously-denied June 1973 claim for service connection for a nervous condition. See Veteran’s Appellant Brief, Third Party Correspondence (received Dec. 11, 2020). He further argues that an effective date of June 4, 1973 is warranted for the grant of service connection for PTSD under 38 C.F.R. § 3.156(c) because “new and relevant” service records were associated with the claims file after the final denial of that claim. See id. The Board notes that the Veteran previously argued that he “does not have to show that he was seeking to reopen his prior 1973 claim for § 3.156(c) to be applicable.” Appellant’s Brief, at 17 (submitted Feb. 25, 2019). However, if the June 1973 claim is separate and distinct from the March 2008 claim, then there would be no basis for an effective date of June 1973 under 38 C.F.R. § 3.156(c) for the claim on appeal (the March 2008 PTSD claim). That provision only applies, by its explicit terms, to claims that were previously decided. Thus, the Board must first address whether the Veteran’s March 2008 claim for service connection for PTSD constituted a petition to reopen the June 1973 claim for service connection for a nervous condition. On June 4, 1973, the Veteran filed a claim for service connection for a nervous condition, which the RO denied in an August 1973 rating decision. The Veteran submitted new evidence within one year and the RO denied the claim again in April 1974. The Veteran appealed the denial and the Board denied the claim for service connection in March 1975. The decision became final at this time. See 38 U.S.C. § 7104; 38 C.F.R. § 20.1100. On March 19, 2008, the Veteran filed a claim of service connection for PTSD, which was granted by the Board in May 2015. The Board notes that neither VA nor the Veteran characterized the March 2008 claim as a petition to reopen the June 1973 claim until the service connection claim was granted and a rating was assigned. In his January 2016 Form 9, the Veteran’s attorney argued that his March 2008 claim for service connection for PTSD was in fact a petition to reopen the June 1973 claim for service connection for a nervous condition. The scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant’s description of the claim, reported symptoms, and the other information of record. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). In Murphy v. Wilkie, the Federal Circuit held that “the Clemons lenient-claim-scope rule applies to requests to reopen.” 2020 U.S. App. LEXIS 39954, at *16 (Fed. Cir. Dec. 21, 2020). After consideration of the evidence and case precedent, the Board finds that the March 2008 claim should have been characterized as a petition to reopen the June 1973 claim. As a general rule, “when a claim is disallowed by the Board, the claim may not thereafter be reopened and allowed and a claim based upon the same factual basis may not be considered.” 38 U.S.C. § 7104(b). The Federal Circuit held that “a properly diagnosed disease or injury cannot be considered the same factual basis as distinctly diagnosed disease or injury.” Boggs v. Peake, 520 F.3d 1330, 1334 (Fed. Cir. 2008). The Federal Circuit also held that “a misdiagnosis cannot be the basis for a new claim.” Id. at 1336. The evidence, particularly the December 2020 psychiatric evaluations, show that the Veteran’s condition was previously misdiagnosed and “the nerves and anxiety the veteran endorsed during this timeframe are best understood as early manifestations of trauma-based illness.” The Board thus finds that the Veteran’s condition claimed in March 2008 is the same condition that was claimed in June 1973, despite the misdiagnosis, and should have been characterized and analyzed as a petition to reopen. Generally, the effective date of an award of service connection based on an initial claim shall not be earlier than the date of receipt of an application for compensation. See 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400(b)(2). For a reopened claim, the effective date is usually the date of receipt of the request to reopen or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400(r). However, 38 C.F.R. § 3.156(c) provides an exception: “[A]t any time after VA issues a decision on a claim, if VA receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim, VA will reconsider the claim.” 38 C.F.R. § 3.156(c)(1); Blubaugh v. McDonald, 773 F.3d 1310, 1313 (Fed. Cir. 2014). The regulation further states that “[a]n award made based all or in part on the records identified by paragraph (c)(1) of this section is effective on the date entitlement arose or the date VA received the previously decided claim.” 38 C.F.R. § 3.156(c)(3). Here, as the date of receipt of the request to reopen was March 19, 2008, and a CUE argument has not been filed, the only basis for an earlier effective date is 38 C.F.R. § 3.156(c). B. Whether an earlier effective date is warranted under 38 C.F.R. § 3.156(c) Initially, the Board finds that at least one copy of the Veteran’s DD 214 was associated with the claims file at the time of the August 1973 rating decision and March 1975 Board decision. There are two (seemingly aged) unstamped copies of the DD 214 in the claims file that show service in Vietnam and that the Veteran was awarded the Combat Infantry Badge. In December 1968, the Veteran submitted a date-stamped application for Program of Education or Training. On that application, the Veteran checked that he attached his DD 214 for all periods of service, and he asked VA to return his DD 214 on the application form. The application also contains a stamp that “acknowledged military file checked” in December 1968 and the unstamped aged copies of the DD 214 in the claims file show check marks by the Veteran’s active service duty dates. In September 1971, VA received a second application on which the Veteran checked that he attached form DD 214 for all periods of service. That form also noted that action on his claim would be delayed if he failed to furnish the DD 214 with his application. It is thus evident the Veteran’s DD 214 was associated with the claims file prior to the August 1973 rating decision and March 1975 Board decision. This determination is further supported by an April 2008 VA form 21-2507, Request for Physical Examination. In the request for an initial PTSD examination, the RO instructed that the Veteran’s “DD 214, of record, shows Veteran was reportedly awarded the combat infantry badge which is evidence of exposure to combat related stressors for VA disability compensation purposes.” (emphasis added). Although the Veteran’s attorney has argued the Veteran’s personnel records were not received until May 2, 2008, it is clear that the Veteran’s DD 214, at least, was already associated with the claims file prior to that date. In addition to the Veteran’s DD 214, the Veteran’s service treatment records were associated with the claims file prior to the March 1975 Board decision. The December 1974 Statement of the Case and March 1975 Board decision explicitly relied on the Veteran’s service treatment records in denying his claim. At issue in this case is a third set of service records, military personnel records, which the Veteran contends was not associated with the claims file until May 2008. The Veteran argues that, prior to the receipt of these records, VA was unaware of the Veteran’s specific Vietnam service dates, his assigned unit, and his initial MOS of an automatic rifleman. The Veteran asserts that, because the records contained detailed information regarding his deployment to Vietnam and the Board considered these records in granting service connection for PTSD, the records are “new and relevant” and warrant reconsideration of the initial claim under 38 C.F.R. § 3.156(c). In the alternative, the Veteran submitted new personnel records in December 2020 and argues that these records trigger reconsideration under 38 C.F.R. § 3.156(c). The Board finds that the evidence does not indicate whether the personnel records were associated with the claims file prior to the March 1975 Board decision. Assuming that the personnel records were not associated with the claims file until May 2008, the Board finds that reconsideration of the original claim is not warranted under 38 C.F.R. § 3.156(c). In reaching this conclusion, the Board relied on the Federal Circuit’s recent decision in Kisor v. Wilkie, 969 F.3d 1333 (Fed. Cir. 2020). The Veteran in Kisor sought an earlier effective date for his grant of service connection for PTSD under 38 C.F.R. § 3.156(c) based on newly-received military personnel records that confirmed his combat in service. See id. at 1335. The RO originally denied his claim in May 1983 based on the lack of a current diagnosis of PTSD. See id. At the time of the original denial, the Veteran’s lay statements describing his combat service were associated with the claims file. See id. The Veteran submitted a petition to reopen his claim in June 2006 and submitted new service personnel records, including his DD 214 and a Combat History, Expeditions, and Awards Record documenting his service in Operation Harvest Moon. A new daily unit log was also associated with the claims file. The RO granted service connection and, after appealing his effective date under 38 C.F.R. § 3.156(c), the Board denied his claim, finding that the basis of the original denial was the lack of a current PTSD diagnosis, not whether he engaged in combat. Therefore, the new personnel records confirming combat were not “relevant” under the regulation. Id. The U.S. Court of Appeals for Veterans Claims affirmed the Board’s decision, which was in turn affirmed by the Federal Circuit. The Federal Circuit held that “the Board did not err in holding that the records cited by [the veteran] were not ‘relevant’ because they did not pertain to the basis of the 1983 denial, the lack of a diagnosis of PTSD.” Id. at 1341. The Federal Circuit concluded that the term “relevant” under 38 C.F.R. § 3.156(c) “must speak to a matter in issue, in other words, a matter in dispute.” Id. at 1343. The Board finds that Kisor is dispositive in this case. Like the veteran in Kisor, the Veteran here contends that newly-received service personnel records confirming his combat status are relevant under 38 C.F.R. § 3.156(c) such that reconsideration of his claim is warranted. It is clear, however, that the Veteran’s combat status and the presence of an in-service injury or event were not in dispute. Prior to the March 1975 Board decision, the Veteran’s DD 214 was associated with the claims file and showed the Veteran had 1 year of foreign service in Vietnam during the Vietnam War period and he was awarded the Combat Infantry Badge related to that service – an indicator of his combat status. The Veteran’s lay statements, in which he described the negative toll his Vietnam service caused, were also associated with the claims file. In its March 1975 decision, the Board specifically discussed the Veteran’s contentions regarding “the emotional trauma of his service in Vietnam,” the effect such memories had on his employability, and his change in his behavior. The Board also noted the Veteran’s wartime service. The Board did not deny the Veteran’s claim because there was no evidence of combat or in-service event, illness, or injury. Instead, the Board denied the Veteran’s claim because “[a] nervous condition was not manifested during or at the time of discharge from service.” In short, there was evidence of a current disability and an in-service injury or event, but there was no evidence of nexus. Thus, the Veteran’s combat status was never in dispute and any personnel records received after the March 1975 Board decision are not “relevant” under 38 C.F.R. § 3.156(c). See Kisor, 969 F.3d at 1341. The Veteran argues that the new personnel records are “relevant” because they provided specific details about his combat status that the DD 214 did not. A similar argument was made in Kisor and rejected. The Federal Circuit held that although the newly-received service personnel records “provide further support to [the Veteran’s] prior statements that he participated in Operation Harvest Moon and indeed could provide ‘credible supporting evidence that the claimed in-service stressor occurred,’…these additional service records do not show that [the Veteran] had a medical diagnosis of PTSD as of 1983.” Kisor, 969 F.3d at 1341. Indeed, the evidence that was available to the RO in August 1973 and the Board in March 1975 was as comprehensive in detailing the Veteran’s combat status, if not more so, as the evidence in Kisor. In Kisor, the Federal Circuit found that the Veteran’s lay statements had shown the in-service stressor and additional personnel records demonstrating his combat service, like his DD 214 and unit log, were not “relevant.” See id. Here, the Veteran’s DD 214 and lay statements were associated with the claims file before March 1975 and sufficiently identified the Veteran’s Vietnam service, combat award, and details of his combat service. This finding is supported by the April 2008 VA examination request in which the RO instructed that the Veteran’s Combat Infantry Badge “is evidence of exposure to combat related stressors for VA disability compensation purposes.” It is therefore evident that neither the RO nor the Board found that the Veteran’s combat service or existence of an in-service stressor were in dispute at the time of the August 1973 and March 1975 decisions. The Veteran further argues that the newly-received records are relevant because they contributed to a positive diagnosis of PTSD and the Board explicitly considered them in granting service connection. A similar fact pattern occurred in Kisor, however, and was not persuasive. In Kisor, after the new personnel records were received, the RO issued a Formal Finding of Information Required to Document the Claimed Stressor based on the previous lay statements regarding his service as well as the newly-received daily log from his battalion. See id. at 1337. The Veteran was then afforded a VA examination in which he was diagnosed with PTSD based on the in-service stressors. See id. The RO subsequently issued a rating decision and granted service connection in part based on the new VA examination, diagnosis, and the RO’s Formal Finding. See id. Regardless, the Federal Circuit still held that the newly-received records were not “relevant” under 38 C.F.R. § 3.156(c). Similarly, the newly-received records are not relevant in this case, even though they were considered in the Board’s grant of service connection for PTSD. As the Federal Circuit concluded in Kisor, the records “added nothing to the case because they bore on a matter relating to entitlement to service connection for PTSD that was not in dispute: the presence of an in-service stressor.” Id. at 1341. In sum, any military personnel records received since March 1975, including the records submitted in December 2020, are not “relevant” as required by 38 C.F.R. § 3.156(c) and do not warrant reconsideration of the previously denied claim such that an effective date earlier than March 19, 2008 is warranted. Accordingly, the claim is denied. 2. Entitlement to a 70 percent rating for the service-connected PTSD, effective March 19, 2008, is granted. The Veteran seeks an initial rating higher than 50 percent prior to May 6, 2014. The Board finds that the criteria for a 70 percent rating have been met. The Veteran private psychiatric treatment records from May 2007 to August 2008 and March 2012 to November 2012 are associated with the claims file. From May 2007 to August 2008, the Veteran’s psychiatrist consistently noted an appropriate general appearance, intact thought processes, adequate judgment and insight, as well as no evidence of compulsive features, suicidal risk, and homicidal risk. In November 2007, however, his psychiatrist noted nightmares and “voices that call him.” The Veteran applied for SSA disability based on his PTSD and, in November 2007, the Veteran underwent a psychiatric evaluation. The Veteran complained of depressed feelings, anhedonia, tiredness, and impaired concentration. The examiner noted that he had adequate hygiene, normal communication, coherent and logical thought processes, intact orientation, intact concentration, and some memory issues. The examiner also stated the Veteran’s judgment was affected because of impulsivity but did not expand on this description. He further noted that there was no evidence of deliriums, auditory or visual hallucinations, compulsions, obsessions, or suicidal or homicidal ideation. In terms of recreational activities and relationships, the Veteran reported that he went to church, he visited with family, he had some friends and relationships with his neighbors, and he attended family activities. He underwent a second psychiatric evaluation for his SSA disability claim in February 2008. The Veteran complained of anxiety, irritability, nightmares, insomnia, and depression. The examiner noted he had a normal appearance and behavior, normal speech, normal thought processes, intact orientation, adequate attention and concentration, and adequate judgment and insight, and no evidence of deliriums, compulsions, or suicidal and homicidal ideation. The examiner also noted that the Veteran mentioned aural hallucinations and that he was “worried about the bad thoughts I might have in the future.” This was later inferred as possible suicidal ideation in the May 2014 VHA medical opinion. The examiner described his activities of daily living and stress tolerance as adequate and task persistence as reduced, with no evidence of panic attacks. The Veteran reported having some friends and relationships with neighbors but spending most of his time at home. His SSA disability claims file also shows that he underwent a functional capacity assessment in April 2008. The examiner concluded that the Veteran had adequate attention, concentration, and recent and remote memory, but a diminished short term memory. He further concluded the Veteran was able to remember and carry out simple and detailed instructions, could sustain attention for two hour intervals, and could interact with supervisors and adapt to changes in the workplace. In terms of functional limitation, the examiner concluded that there was moderate restriction of activities of daily living, moderate difficulties in maintaining social functioning, mild difficulties in maintaining concentration, persistence, or pace, and no episodes of decompensation. SSA granted his disability claim in May 2009. In the findings, the SSA administrative law judge discussed the testimony of a Board certified psychiatrist, who opined the Veteran’s PTSD caused moderate restriction in activities, marked difficulties in maintaining social functioning, and marked difficulties in concentration, persistence, or pace. The administrative law judge found that the Veteran’s PTSD was “manifested by auditory hallucinations, depressed affect, recurrent recollection of his experience at war, mental block, feelings of worthlessness, irritability, fear to elevators, loss of interest in activities of daily living, and affected judgment due to his impulsivity.” He further found that “his activities of daily living are described as moderately limited and social functioning as markedly limited.” Based on these findings, the administrative law judge granted the claim for SSA disability. In March 2012, the Veteran restarted treatment with his private psychiatrist. The records, dated from March 2012 to November 2012, predominantly show a normal appearance, logical and coherent thoughts, adequate insight and judgment, and adequate sleep, and no evidence of deliriums, hallucinations, or suicidal or homicidal risk. In a September 2012 visit he reported auditory hallucinations, but subsequent records do not document hallucinations. Notably, he also completed a suicide risk evaluation in September 2012, at which time he explicitly denied seeing or hearing things other people do not. He further denied that he had a plan to harm himself, prior suicide attempts, thoughts about death, losing faith in life, acting impulsively or destroying things or property, and being unemployed. In March 2014, the Board forwarded the claims file to a VHA examiner for an expert opinion on whether the Veteran had a psychiatric disorder related to service. In May 2014, the VHA examiner diagnosed the Veteran with PTSD and major depressive disorder after a thorough review of the claims file. At the time of the opinion, the diagnostic criteria for major depressive disorder required a depressed mood and/or loss of interest or pleasure in life activities for at least two weeks and at least five of the following symptoms that “cause clinically significant impairment in social, work, or other important areas of functioning almost every day.” The symptoms included: depressed mood most of the day; diminished interest or pleasure in all or most activities; insomnia or sleeping too much; fatigue or loss of energy; feelings of worthlessness or excessive guilt; diminished ability to think or concentrate, or indecisiveness; and recurrent thoughts of death. The examiner concluded that the Veteran manifested the full symptoms necessary for a diagnosis in the 2007 and 2011 examinations. In December 2020, the Veteran’s attorney submitted two evaluations conducted by private psychiatrists, Dr. B and Dr. C, after a review of the claims file. Dr. B opined that the Veteran’s PTSD symptoms were present daily, including chronic sleep problems, frequent nightmares and flashbacks, avoidance of stimuli and crowds, social isolation, irritability, impaired concentration, auditory hallucinations, paranoia, and suicidal ideation. She theorized that the record suggests the Veteran had a pattern of minimizing the degree of his symptoms and impairment. The record documented a tendency to avoid discussions of his military service which “can lead to an underestimation of his trauma-based mental illness and its impact on his daily life.” She based this conclusion on lay statements in the claims file and VA evaluations which “suggest that he did not always readily volunteer some of his difficulties on interview.” Dr. C echoed this opinion. He opined that the VA examination reports did not document the full severity of the Veteran’s symptoms. Instead, he concluded that the Veteran has been “severely and profoundly mentally ill since his discharge, which culminated in complete impairment in occupational functioning by June 1999.” He stated that the Veteran has “struggled immensely, both occupationally and socially, manifesting social isolation, emotional numbing, loss of focus and concentration,…and poor task completion” as well as “neurovegetative symptoms of depression, persistent active suicidal ideation, irritability, excessive anger, [and] altercations with his family.” The psychiatrists’ opinions that the Veteran and/or VA examiners have minimized the Veteran’s symptoms are supported by the record. The Board previously found that the May 2008 and May 2011 examiners’ diagnoses and opinions were inadequate because they failed to consider the entirety of the Veteran’s symptoms that were well documented in the claims file. In the August 2013 VA examination report, the examiner only documented sleep impairment, which is inconsistent with the plethora of evidence showing symptoms such as depression, irritability, impaired memory, and auditory hallucinations. The Board finds that the weight of the evidence, particularly the Veteran’s private treatment records, SSA disability records, May 2014 VHA opinion, December 2020 psychiatric evaluations, and supporting lay statements, shows that a 70 percent rating is warranted, effective March 19, 2008. Specifically, private treatment records documented nightmares and auditory hallucinations as early as November 2007. While records show that the Veteran also denied hallucinations at times, including on a September 2012 suicide risk evaluation, other evidence shows reports of hallucinations and nightmares throughout the period on appeal. In addition to auditory hallucinations, the evidence shows the Veteran had suicidal ideation during the period on appeal. In addition to the explicit documentation of suicidal ideation in the September 20007 SSA disability application, the Veteran reported that he was “worried about the bad thoughts I might have in the future” in February 2008 and that he “would be better off dead” and “had been feeling that death is an option” in May 2011. Furthermore, the May 2011 examination and lay statements show the Veteran’s mental health disability has caused disorientation, irritability, social isolation, and interpersonal conflict. In the May 2011 examination, the Veteran stated “yes” to a history of violence/assaultiveness, reporting that he “had episode in which he has become aggressive with people both at home and in other social environments.” In December 2020, the Veteran’s wife and daughter submitted statements detailing the Veteran’s nightmares, disorientation, irritability and social isolation. Finally, the SSA disability records, May 2014 VHA opinion, and December 2020 submissions detail how the Veteran’s symptoms cause significant occupational and social impairment. The SSA records show that a medical expert testified the Veteran’s symptoms cause moderate restriction of activities of daily living, marked difficulties in maintaining social functioning, and marked difficulties in maintaining concentration, persistence or pace, and no episodes of decompensation. The administrative law judge found that the Veteran’s disability was manifested by auditory hallucinations, depressed affect, irritability, loss of interest in activities of daily living, and affected judgment due to impulsivity. The May 2014 VHA examiner wrote that the Veteran’s disability was manifested by symptoms that caused “clinically significant impairment in social work, or other important areas of functioning almost every day.” Such symptoms included a depressed mood, diminished interest or pleasure in all or most activities, and recurrent thoughts of death. The RO increased the Veteran’s PTSD disability rating to 70 percent based on this report, but the evidence suggests that the symptoms and impairment detailed in the report have been present since the Veteran filed his claim for service connection. This is supported by the evaluations submitted in December 2020, in which both psychiatrists opine the Veteran has been unable to obtain or maintain substantially gainful employment since June 1999. Based on the above, the Board finds that the criteria for a 70 percent rating have been met for the entire period on appeal. The Board finds that a 100 percent rating is not warranted because the evidence does not show gross impairment in thought or communication, persistent delusions or hallucinations (only occasional reports), grossly inappropriate behavior, persistent danger to self or others, intermittent ability to perform activities of daily living like maintenance of personal hygiene, or the inability to remember the names of his close relatives or his own name, or symptoms that cause a similar level of impairment. The Board acknowledges that several pieces of evidence documented disorientation to place but finds that this symptom alone does not warrant a 100 percent rating. The evidence also shows that the Veteran attended treatment visits independently, maintains relationships with some family members, friends, and neighbors, goes to church, maintains his appearance, and can remember his name and names of his close relatives. MICHELLE L. KANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Lavan, 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.