Citation Nr: 21006448 Decision Date: 02/04/21 Archive Date: 02/04/21 DOCKET NO. 17-50 848 DATE: February 4, 2021 ORDER Entitlement to an increased rating of 100 percent for posttraumatic stress disorder (PTSD) is granted. Entitlement to special monthly compensation (SMC) at the housebound rate from May 14, 2015 to November 11, 2015 and from February 1, 2016 to April 4, 2016 is granted. FINDINGS OF FACT 1. After resolving reasonable doubt in the Veteran’s favor, his PTSD manifested in total occupational and social impairment. 2. From May 14, 2015 to November 11, 2015 and from February 1, 2016 to April 4, 2016, the Veteran has one service-connected disability rated at 100 percent and additional disabilities rated at least 60 percent. CONCLUSIONS OF LAW 1. The criteria for entitlement to an increased rating of 100 percent for PTSD have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.130, Diagnostic Code (Code) 9411 (2020). 2. The criteria for entitlement to SMC at the housebound rate from May 14, 2015 to November 11, 2015 and from February 1, 2016 to April 4, 2016 have been met. 38 U.S.C. §§ 1114(s), 5107 (2012); 38 C.F.R. §§ 3.102, 3.350(i) (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1996 to October 1999 and February 2005 to February 2006. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2014 rating decision by the Department of Veterans Affairs (VA). The Board must consider entitlement to SMC when fairly raised by the record. See Akles v. Derwinski, 1 Vet. App. 118 (1991). The issue of entitlement to SMC at the housebound rate has been raised by the record in the context of the Board’s grant of a 100 percent rating for PTSD. However, the Board notes that entitlement to SMC at the housebound rate is in effect from November 12, 2015 to February 1, 2016. The Board has accordingly added entitlement to SMC as an issue on appeal, excluding the period of time during which entitlement to SMC is already in effect. Although the Veteran raised the issue of entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) in an undated VA Form 21-8940, see Rice v. Shinseki, 22 Vet. App. 447 (2009), the issue is moot, including in the context of whether SMC at the housebound rate can be granted. See Bradley v. Peake, 22 Vet. App. 280 (2008). 1. Entitlement to an increased rating in excess of 50 percent for PTSD. Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity caused by the given disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular Code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining, including degree of disability, is to be resolved in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). In any claim for an increased rating, “staged” ratings may be warranted where the factual findings show distinct time periods when the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119 (1999). The Veteran’s PTSD is currently rated at 50 percent under the General Rating Formula for Mental Disorders (General Formula). A 50 percent evaluation is warranted where there is occupational and social impairment with reduced reliability and productivity. This may be 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; and difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130, Code 9411. A 70 percent evaluation is warranted where there is occupational and social impairment, with deficiencies in most areas (such as work, school, family relations, judgment, thinking, or mood). This may be 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 worklike setting); inability to establish and maintain effective relationships. Id. A 100 percent evaluation is warranted for total occupational and social impairment. This may be 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; memory loss for names of close relatives, own occupation, or own name. Id. The list of symptoms in the General Formula is not intended to constitute an exhaustive list, but provides examples of the type and degree of symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). However, a Veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013). Furthermore, 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. As relevant to this case, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), states that it was recommended that the use of Global Assessment of Functioning (GAF) scores be dropped for several reasons, including their conceptual lack of clarity and questionable psychometrics in routine practice. The Board recognizes the Court’s holding in Carpenter v. Brown, 8 Vet. App. 240, 242 (1995) regarding the importance of GAF scores, however, as the medical community has determined that GAF scores are an unreliable measure of a psychiatric disability, the Board assigns the GAF scores mentioned in the record no probative value, and will not discuss them specifically. See also Golden v. Shulkin, 29 Vet, App. 221 (2018). The Veteran reported that he was placed on leave at work in August 2013 due to a positive drug screen. He stated that the stress of work, coupled with his increased anxiety and irritability, made it difficult to work. When he was working nights mostly by himself, he was fine but when he started to work during the day and needed to commute, he started using drugs to help cope with the stress and anxiety he felt. See October 2013 Vet Center records. He later reported that he stopped using drugs in August 2013, after his employer put him on leave. See November 2013 Vet Center records. The Veteran reported that he had difficulty trusting people and was suspicious of them. He had difficulty trusting his surroundings and was hypervigilant. He had no friends that he would consider close and he could tolerate some family members only from time to time. Id. During a January 2014 VA examination, the Veteran reported that his wife was his primary source of social and emotional support. He denied regular social contact and was often isolated at home. He denied current hobbies and spent his leisure time at home watching his two year old child. He was able to perform all activities of daily living (ADLs), but reported difficulties driving because it made him nervous. The examiner opined that the Veteran had occupational and social impairment with reduced reliability and productivity and noted that current symptoms included depressed mood, anxiety, and panic attacks that occurred weekly or less often. The Veteran was aware of his avoidance of work and his fear about returning to work due to his anxiety and nervousness during his interactions with customers. January 2014 Vet Center records reflect that the Veteran was increasing his isolative behaviors. When his wife was working and his kids were at school, he was not sure what to do and tended to lock all the doors and stay indoors. In April 2014, a VA vocational rehabilitation specialist opined that the Veteran had experience that could only be transferred to the civilian workforce in occupations that would aggravate his service-connected PTSD. He did not have the skills currently for competitive employment in other occupations and his PTSD impacted his ability to work around a lot of people at once and in a high-stress setting. In August 2015, the Veteran reported that his caregiver needs to remind him every day to take his medication. She was the one managing finances and household affairs. See August 2015 VA treatment records. The Veteran’s sister reported that she did not want to visit her brother because she would get yelled at for opening a door, touching his cup, or sitting in his spot. The more people that were in the house, the more difficult he would become. He is “really weird” and lost all his social skills. He would force people to watch gory, miliary and war movies and watch people’s reactions. His hygiene deteriorated and he smelled like he never showered. His clothes were dirty. He pinched her arm and teased the children until they cried. She described it as him inviting her and her other brother over “just to verbally abuse both of us.” She once threatened to call the police because the Veteran refused to leave her house. He reported that he hears things in his house, such as his name, the doorbell ringing, or someone breaking in. If it was not for his wife, his sister believed the Veteran would probably be homeless or living with his father. See January 2019 statement. A private psychologist opined that the Veteran had occupational and social impairment with deficiencies in most areas since August 2013. His symptoms included anxiety, suspiciousness, panic attacks that occurred weekly or less often, chronic sleep impairment, mild memory loss, disturbances in motivation and mood, difficulty adapting to stressful circumstances, and obsessional rituals which interfered with routine activities. See July 2019 private opinion. The Veteran’s spouse noted that the Veteran’s heightened levels of anxiety made it difficult for him to work. After he stopped working, he would sit at home alone and could not handle the stress and anxiety of looking for another job. When he went to interviews, he would say odd and unusual things and would not get hired. The Veteran had a hard time dealing with anything outside his normal routine, including being around too many people, even those he is familiar with, and driving to unusual locations, especially out of town or in heavy traffic. See August 2019 statement. The Veteran’s spouse reported that he was constantly stressed about minor things at home, such as a door being left open, the remotes being moved, and items being put away in a different location than he was used to. His spouse had to coach him through everyday activities and give him a verbal schedule; he needed time to process the need to do simple tasks, like taking out the garbage, and become comfortable with what he was going to do next. He would not answer the phone unless he knew who was calling, which caused him to have his truck repossessed. She had to take over all financial and household responsibility to ensure that major bills were paid regularly. She was constantly reminding him to care for his basic hygiene and brush his teeth or shower regularly. Id. After resolving reasonable doubt in the Veteran’s favor, the evidence reflects the Veteran’s PTSD manifested in total occupational and social impairment. Notably, the Veteran’s sister reported that he would physically harm those around him, as well as partaking in the verbal abuse of children. His sister and his spouse reported difficulties with personal hygiene and gross impairment with communication, such as during job interviews and when people were in his house. Although they did not specify how long the Veteran had demonstrated such behaviors, the Board will resolve reasonable doubt in his favor and find that such behaviors were present during the entire appeal period. As a result, a rating of 100 percent for PTSD is warranted. 2. Entitlement to SMC at the housebound rate from May 14, 2015 to November 11, 2015 and from February 1, 2016 to April 4, 2016. SMC at the housebound rate is payable if a Veteran has a single service-connected disability rated at 100 percent and has an additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). At the outset, as noted above, the Veteran is already in receipt of SMC at the housebound rate for the period of time from November 12, 2015 to February 1, 2016. As such, the analysis herein will focus on the appeal period with the exclusion of the time period during which SMC is already in effect. The Veteran’s PTSD is assigned a 100 percent rating. As such, the first element of entitlement to SMC at the housebound rate is shown. The Veteran is service-connected for additional disabilities involving different anatomical segments or bodily systems that are ratable at 60 percent from May 14, 2015 to November 11, 2015 and from February 1, 2016 to April 4, 2016, to include: left lower extremity radiculopathy, rated at 40 percent, and right lower extremity radiculopathy, rated at 40 percent. Thus, the requirements for SMC at the housebound rate have been met from May 14, 2015 to November 11, 2015 and from February 1, 2016 to April 4, 2016, and SMC is warranted. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Sandler, 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.