Citation Nr: 21006664 Decision Date: 02/04/21 Archive Date: 02/04/21 DOCKET NO. 16-00 063 DATE: February 4, 2021 ORDER Entitlement to an initial 100 percent rating for Post-Traumatic Stress Disorder (PTSD) with major depression is granted. FINDING OF FACT The Veteran’s PTSD with major depression has been productive of total occupational and social impairment during the entire period on appeal. CONCLUSION OF LAW The criteria for an initial 100 percent rating for PTSD from February 12, 2013 to June 20, 2018 excluding periods of hospitalization, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.130, Diagnostic Code 9411 (2020) REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1974 to September 1978. The Board of Veterans’ Appeals (Board) notes that the Veteran was granted a 100 percent rating for his PTSD effective June 21, 2018 in the July 2018 Rating Decision. That decision constituted a full grant of the benefits sought from that date forward. However, as the instant appeal dates back to February 2013 (the date the Veteran filed her original claim for service connection), the issue of entitlement to an initial rating in excess of 50 percent for PTSD prior to July 21, 2018, remains before the Board. See AB v. Brown, 6 Vet. App. 35, 38 (1993). 1. Initial rating for PTSD with depression The Veteran contends that her psychiatric symptoms due to PTSD and depression are more severe than is accounted for by the 50 percent rating. See August 2014 Notice of Disagreement (NOD). Legal criteria Under the General Rating Formula, a 100-percent rating is warranted if there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; gross 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. The symptoms listed in the rating schedule are not intended to constitute an exhaustive list, but rather serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). Nevertheless, all ratings in the general rating formula are associated with objectively observable symptomatology, and in Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013), the Federal Circuit stated that “a veteran may only qualify for a given disability rating under Section 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration.” The Federal Circuit further noted that Section 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas.” Vazquez-Claudio v. Shinseki, 713 F.3d 117. Thus, “[a]lthough the veteran’s symptomatology is the primary consideration, the regulation also requires an ultimate factual conclusion as to the veteran’s level of impairment in ‘most areas.’” Id. at 118. Relevant Facts and Analysis The Veteran was granted service connection for PTSD with major depression in effective February 12, 2013. See October 2013 Rating Decision. In May 2014, the Veteran was hospitalized for suicide ideations with plan and depression. See May 2014 University of Colorado Health Record. The psychiatrist noted that the Veteran had not showered and did not appear to be attending to her activities of daily living. Id. The Veteran received inpatient psychiatric treatment from June 2014 to September 2014 and was granted 100 percent rating for the period of hospitalization. See January 2015 Rating Decision. The Veteran was hospitalized in May 2015 for reports of depression and increased suicide ideations along with cutting her arm. See May 2015 University of Colorado Health Record. Subsequently, the Veteran received inpatient psychiatric treatment at Sheridan VA Medical Center from June 2015 to December 2015. See January 2016 VA Form 21-4138; February 2016 Rating Decision (granting 100 percent rating for hospitalization period). In a VA Form 9 dated January 2016, the Veteran stated, “[s]he has been self medicating (drinking) and has been cutting herself…. She has memory loss and does not remember does not remember if she has met someone. She is not able to keep up her hygiene at times.” From September 2017 to February 2018, the Veteran received inpatient psychiatric treatment for continued suicide ideations and cutting her arm. See June 2017 VA Inpatient Mental Health Treatment Plan Note in CAPRI received September 2017. The VA clinician noted that the Veteran’s symptoms worsened during the past year leading to four hospitalizations for suicide ideations with cutting in the past year. Id. The Veteran was also granted a 100 percent rating for a period of hospitalization from June to December 2017. See September 2017 Rating Decision. A January 2018 VA treatment note indicates that the Veteran was still receiving inpatient psychiatric treatment and was expected to be discharged in February 2018. See January 2018 VA Inpatient Mental Health Treatment Note in CAPRI received June 2018. The June 2018, VA examiner opined that the Veteran’s PTSD and major depression resulted in total social and occupational impairment. See June 2018 Review Post Traumatic Stress Disorder Disability Benefits Questionnaire (DBQ). The examiner noted that the Veteran had four extended periods of psychiatric hospitalization due to suicide ideation within past 18 months. Id. The Veteran reported she began cutting herself in May 2018 following her most recent discharge from inpatient psychiatric treatment in February 2018. The Veteran’s psychiatric symptoms on examination included impaired judgment, flattened affect, suicide ideation, persistent danger to self and others, neglect of personal appearance and hygiene, as well as intermittent inability to perform ADLs including maintenance of minimal personal hygiene among other symptoms. Id. On mental status examination, the Veteran was noted to be anxious, depressed, malodorous, with poor hygiene, poor eye contact. In his remarks, the examiner also stated that the Veteran did not appear to be capable of functioning independently. He further stated that the Veteran “presents as significantly impaired and emotionally, relationally, and cognitively impaired secondary to her Chronic, Severe PTSD and Major Depressive Disorder.” Id. The Board finds, after reviewing the entire record, that the Veteran’s PTSD has been shown to be productive of total occupational and social impairment throughout the appeal period. See June 2018 Review Post Traumatic Stress Disorder Disability DBQ. The Board also finds that the frequency, severity, and duration of the Veteran’s symptoms are consistent with the 100 percent criteria because the Veteran was hospitalized four times during the appeal period for extended inpatient psychiatric treatment due to severe suicide ideations manifested by her cutting herself. Additionally, the Board notes that her symptoms did not improve as noted by the Veteran’s report that she continued to cut herself following the most recent extended inpatient hospitalization in February 2018. See June 2018 Review Post Traumatic Stress Disorder Disability In granting the claim, the Board has considered the Veteran’s lay statements concerning the symptoms of the service-connected disability and her medical history and finds that the Veteran provided is competent and credible evidence of her symptoms as noted in his VA treatment or during her VA examinations. Essentially, the evidence recited above, establishes that the Veteran’s PTSD with major depression has resulted in various symptoms including flattened affect, suicide ideation, persistent danger to self and others, neglect of personal appearance and hygiene, as well as intermittent inability to perform ADLs including maintenance of minimal personal hygiene, which are consistent with the frequency, severity, and duration required for the 100 percent rating. Accordingly, the Board concludes that the evidence shows that the overall impairment caused by the Veteran’s psychiatric symptomology, while not squarely falling within the symptomology of the 100 percent rating, it more nearly approximates total and social occupational impairment. See 38 C.F.R. §§ 4.7, 4.130. Resolving all doubt in favor of the Veteran, the Board concludes that the medical and lay evidence of record supports an initial schedular rating for 100 percent, for the entire period on appeal. (Continued on the next page)   Therefore, the Veteran’s claim for an initial rating in excess of 50 percent is granted, excluding the periods of hospitalization. YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Lilly, 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.