Citation Nr: 21009192 Decision Date: 02/19/21 Archive Date: 02/19/21 DOCKET NO. 18-01 501 DATE: February 19, 2021 ORDER Entitlement to a rating of 100 percent rating for posttraumatic stress disorder (PTSD) with alcohol abuse in remission is granted. Entitlement to an effective date earlier than February 16, 2017, for the award of a 100 percent rating for PTSD with alcohol abuse in remission is denied. FINDINGS OF FACT 1. Throughout the period on appeal, the Veteran’s PTSD most closely approximated total occupational and social impairment due to symptoms such as: near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; gross impairment in thought processes or communication; persistent delusions; memory loss for names of close relatives, own occupation, or own name; inability to establish and maintain effective relationships; impaired impulse control; and intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene). 2. Prior to February 16, 2017, there was no formal claim, informal claim, or written intent to file a claim of entitlement to increased rating for PTSD with alcohol abuse in remission. CONCLUSIONS OF LAW 1. The criteria for a 100 percent rating for PTSD with alcohol abuse in remission have been met. 38 U.S.C. §§ 1155, 5107 (2018); 38 C.F.R. §§ 4.7, 4.130, Diagnostic Code 9411 (2019). 2. The criteria for an effective date earlier than February 16, 2017, for the award of an increased 100 percent rating for PTSD with alcohol abuse in remission have not been met. 38 U.S.C. §§ 5107, 5110 (2018); 38 C.F.R. §§ 3.155, 3.400 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active naval service from May 1988 to May 1992. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an April 2017 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In August 2019, the Board remanded the appeal for further development. The case has now been returned to the Board for further appellate action. Increased Rating – PTSD Historically, a May 2012 rating decision awarded service connection for PTSD and assigned a 30 percent rating. Following a June 2014 claim for increase, a February 2015 rating decision assigned a higher, 50 percent rating. In February 2017, the Veteran filed the claim for increased rating. The April 2017 rating decision on appeal awarded a higher, 70 percent rating. The Veteran contends that a 100 percent rating is warranted throughout the period on appeal. At a March 2017 VA PTSD examination, the Veteran reported he had “little arguments” with his wife. They had been separated here or there for a couple of days. His older brother, whom he was close with, died in December 2016. The Veteran did not have any children. He lived with his wife, who had multiple sclerosis. The following symptoms were noted: depressed mood; anxiety; suspiciousness; panic attacks more than once a week; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; chronic sleep impairment; impairment of short- and long-term memory, for example, retention of only highly learned material, while forgetting to complete tasks; memory loss for names of close relatives, own occupation, or own name; 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; inability to establish and maintain effective relationships; impaired impulse control, such as unprovoked irritability with periods of violence; persistent delusions or hallucinations; neglect of personal appearance and hygiene; and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. The examiner opined that the Veteran’s symptoms resulted in occupational and social impairment with reduced reliability and productivity. Objectively, the Veteran was alert and oriented times four, and cognitively lucid. His attention and concentration appeared to be within normal limits (WNL). His expressive and receptive language skills were WNL. His speech was WNL. He was appropriately attired in civilian attire with adequate hygiene and he appeared his stated age. There was no evidence of hallucinations or self-injurious behavior. His suicide risk was low to none. His thoughts were linear and goal-directed. There were no observed obsessions or compulsions. The Veteran’s insight and judgment were good. His impulse control was intact. The Veteran, however, had difficulty recounting with specificity recent mental health/substance abuse related hospitalizations. A May 2018 statement from the Veteran’s wife indicated that his mood and demeanor could “go from agitation to emotional in an instant.” She described a “severe” lack of motivation, in that he did not “want to get out or do anything.” She stated the Veteran did “not want to be social or interact at all,” noting he did not trust most people. He has been isolated and disconnected from interactions for 10 years or longer, and his isolation continued to worsen. She described panic attacks, difficulty sleeping, increased irritability, and poor concentration. The Veteran was distracted or frustrated easily when trying to complete a task. He could not remember “anything.” She had to remind him to take his medications, go to his doctor’s appointments, and complete tasks. He had a hard time with directions and would get lost. He wore the same clothes over and over. He might shower once a week, but she had to “get on him” often. She did most of the shopping, errands, paying the bills, cooking, and home maintenance. A December 2018 private PTSD examination, the Veteran reported that he was previously divorced and remarried for 17 years. The Veteran had a strained marriage and social anxiety. His agitation, suspiciousness, and hypervigilance diminished his participation in social and daily activities. He reported having flashbacks and panic attacks every day and night. The Veteran had poor impulse control relating to his unprovoked irritability, anger outbursts with verbal aggression, domestic conflicts, and destruction of personal property. He had poor judgment relating to his past alcohol abuse self-medication tendency. The Veteran had passive suicidal ideation twice a month without intentions or plans. He struggled with constant depression with no energy or motivation to intermittently perform activities of daily living. He neglected his personal hygiene and appearance by not showering or grooming up to a week. The Veteran admitted his wife performed most of the household tasks such as cleaning, grocery shopping, meal preparation, and finance management. He had obsessional rituals with home security. He admitted to ongoing cognitive, concentration, memory, complex and abstract task impairments. Regarding the Veteran’s daily activities, he said he felt constantly worried and anxious about how his day would be and who might be “out to get him.” He felt depressed and constantly reactive to PTSD triggers and symptoms on a daily basis. He reported he was in chronic pain and disabled from his physical health impairments which continually aggravated his PTSD. He ate two meals a day prepared by his wife. He stayed at home and tried to nap during the day. He left the house only for doctor’s appointments or absolute necessities. Symptoms included: depressed mood; anxiety; suspiciousness; panic attacks more than once a week; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; chronic sleep impairment; impairment of short- and long-term memory; flattened affect; speech intermittently illogical obscure or irrelevant; difficulty in understanding complex commands; impaired judgment; impaired abstract thinking; gross impairment in thought processes or communication; disturbances of motivation and mood; difficulty in adapting to stressful circumstances, including work or a work like setting; inability to establish and maintain effective relationships; impaired impulse control; neglect of personal appearance and hygiene; suicidal ideation, obsessional rituals which interfere with routine activities; and persistent delusions or hallucinations. The examiner opined that these symptoms resulted in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. At a September 2019 VA PTSD examination, the Veteran reported his relationship with his wife was “up and down,” as they had arguments and would separate from each other for a few days. His short-temper and irritability led to a lot of their conflict. He assisted his wife who has multiple sclerosis, and this added additional stress on him when he was not in a good mood. The Veteran denied having any friends or any contact with family. He felt depressed and anxious every day. He did not leave his home unless necessary because he did not want to engage with others. The Veteran was very suspicious of others, as he felt that others were out to sabotage him or set him up in any type of instance. Panic attacks reportedly occurred every day. He had trouble and falling asleep every day; he had a “good night” if he slept for a few hours. He continued to have frequent nightmares. The Veteran reported that his memory issues caused him frustration. He often worried about when he would have a blank spell. He had moments when he could not remember ever going to the mailbox, and this caused him to become paranoid because he would start to feel as though someone else was in the home. He had forgotten appointments for both himself and his wife. The Veteran stated he had periods of unprovoked irritability with violence, as he could not control when it occurred, and he would want to “destroy stuff.” He neglected his hygiene as he did not bathe or shave as often as he should. It was worse when he was in a down mood. The following symptoms were noted: depressed mood; anxiety; suspiciousness; panic attacks more than once a week; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; chronic sleep impairment; impairment of short- and long-term memory; disturbances of motivation and mood; difficulty in adapting to stressful circumstances, including work or a work like setting; inability to establish and maintain effective relationships; impaired impulse control; and neglect of personal appearance and hygiene. The examiner opined that the Veteran’s symptoms resulted in occupational and social impairment with deficiencies in most areas. Objectively, the Veteran was well-dressed with full beard. He initially presented with flat affect, but he became tearful when detailing his feelings of guilt related to how his symptoms impacted his marriage. The Veteran denied suicidal or homicidal ideation or psychosis. His thoughts were logical and coherent. The Veteran was oriented to time, person, place, and situation. His speech was normal. He appeared to have fair insight/judgment. After careful review of the record and after resolving all reasonable doubt in favor of the Veteran, the Board finds that the Veteran’s psychiatric symptomatology more closely approximates the criteria for a 100 percent rating for his PTSD. As evidenced by his VA and private examinations, the Veteran’s symptoms consisted of a near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; gross impairment in thought processes or communication; persistent delusions; memory loss for names of close relatives, own occupation, or own name; inability to establish and maintain effective relationships; impaired impulse control with periods of violence; and intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene). The Veteran and his spouse reported that many of his symptoms occurred daily, including nightmares and panic attacks. They have also stated that the Veteran would not be able to function without the daily assistance of his spouse. The Board acknowledges that the results of the examinations do not indicate that the Veteran has experienced all of the symptoms associated with a 100 percent rating for PTSD for the entire period on appeal. However, the symptoms enumerated under the schedule for rating mental disorders are not intended to constitute an exhaustive list, but rather are intended serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular disability rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). The evidence appears to be at least evenly balanced as to whether the severity, frequency, and duration of Veteran’s PTSD symptoms more nearly approximate total occupational and social impairment. Thus, by resolving reasonable doubt in the Veteran’s favor, his claim for an increased rating for PTSD to 100 percent is granted for the entire appeal period. 38 U.S.C. § 5107 (b) (2018); 38 C.F.R. §§ 4.3, 4.7. See Wise v. Shinseki, 26 Vet. App. 517, 531 (2014) (“By requiring only an ‘approximate balance of positive and negative evidence’. . . , the nation, ‘in recognition of our debt to our veterans,’ has ‘taken upon itself the risk of error’ in awarding . . . benefits.”). Earlier Effective Date – Rating Assigned for PTSD As a general rule, the effective date for increased ratings claims is assigned when it is factually ascertainable that an increase in disability occurred and the claim for increase was received within one year from that date, but otherwise the effective date is the date of receipt of the claim. 38 C.F.R. § 3.400 (o)(2) (2019). The record indicates that the Veteran filed a formal claim for increased rating for PTSD with alcohol abuse that was received by VA on February 16, 2017. There is no indication from the record that the service-connected PTSD with alcohol abuse increased in severity from February 16, 2016. Although the Veteran presented to the VA for detox from alcohol and methadone in June 2016, the medical record does not suggest that the Veteran demonstrated any of the symptoms associated with a 100 percent rating. Consequently, it is not factually ascertainable that an increase in disability occurred within one year of the date the claim was received. (Continued on the next page)   Based on the foregoing, the proper effective date for the claim is February 16, 2017, the date of the Veteran’s claim for increased rating. The Veteran’s claim for earlier effective date of the award of the increased 100 percent rating for PTSD with alcohol abuse in remission is denied. 38 U.S.C. § 5107 (b) (2018); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Roya Bahrami, 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.