Citation Nr: 21010812 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 17-59 942 DATE: February 25, 2021 ORDER A 100 percent rating for a service-connected acquired psychiatric disability is granted throughout the appeal period. Special monthly compensation (SMC) under 38 U.S.C. § 1114(s) is granted throughout the appeal period. FINDINGS OF FACT 1. Records dated before the Veteran filed the instant claim consistently indicate a history of “persistent problems” with sleep, anger outbursts, hypervigilance, exaggerated startle response, and difficulty concentrating (in a July 2010 private psychiatrist’s letter) and a long history of inability to focus at work due to intrusive memories. A prior June 2010 VA examination report also notes more troubling pathology such as completely severing communication with his family for several days at a time when angry, aggression towards objects (i.e., punching holes in walls), impulsively quitting his job twice, heavy alcohol use, flashbacks, suicidal ideation, and panic symptoms that interfere with driving. He had also reportedly taken six weeks off work (i.e., short-term disability leave) as a result of his psychiatric difficulties. 2. Records dated during the appeal period suggest no comparative improvement. In fact, the situation appears to be quite the opposite. A May 2013 statement indicates it was a “daily struggle to go to work” but he pushed himself to do so for his family’s sake. The following month he said he sometimes wants to “quit life” (e.g., suicidal ideation) and took both alcohol and medication to sleep. He also said he often forgot what he is talking about mid-sentence (suggesting severe communication impairment). 3. A detailed February 2014 correspondence from his treating psychiatrist of several years indicates intensified symptoms that left him incapable of discharging work responsibilities. An attached Department of Labor certification by the same provider attributes this to anxiety, depression, frequent mood fluctuations, reliving trauma, sleep disturbance, concentration and memory deficits, intermittent anger explosions, tachycardia, exaggerated startle response, interpersonal irritability, and frustration. The provider indicated he was psychiatrically “incapacitated for a single continuous period of time” and could not identify an estimated recovery date. Furthermore, the examiner felt that PTSD flare-ups were impossible to predict but could last “for days, weeks, or even years.” A private treatment record dated the following month indicates the Veteran was using short-term disability leave to continue intensified treatment due to recent situational stress that made his emotional state unstable. 4. In March 2014, the Veteran confirmed that he had been out of work since February 17, 2014 on disability leave due to mental health problems. He said he had sleepless nights, “inability to communicate at times,” memory loss, anger issues, physical and mental fatigue, and was “always…on the defense for no reason.” A contemporaneous statement from his wife confirmed he was on short-term disability leave for six weeks. He also “shuts down and barely speaks or he rants” (again suggesting severe communication impairment) and was “hardly able to have acceptable work or social relationships,” with family relationships only maintained because they “understand we have to make certain allowances.” 5. A June 2014 private evaluation found severe depressive and PTSD symptoms consistent with his clinical presentation, which included a history of suicidal ideation and frequent drinking (including in dangerous situations, like while driving). While the Veteran reportedly could manage many activities of daily living, he needed help with driving, house chores, finances, cooking, medicating, and shopping and was wholly unable to ride the bus alone. His wife confirmed that she had to help him with many things due to his indecisiveness or wholesale inability to perform the tasks. The Veteran denied any social interactions with friends and only periodic interaction with non-immediate family, though he did identify his wife as his support system. The examiner noted olfactory hallucinations at the time and concluded that, although he retained many cognitive functions, the Veteran presented with “significant levels of depression” since February 2014 that represented a change in daily functioning with a poor prognosis and left him “unable to adapt to stressors that can result from the demands of being in a work environment, daily functioning, and social interactions” overall. 6. A second June 2014 private psychiatric evaluation indicates that his PTSD symptoms had become unmanageable due to changes in his life and that he “re-experiences his trauma almost daily and suffers significant distress rendering him disabled while he trains to regain manageability.” It confirmed that he isolated himself from others and that even family relationships had “suffered significantly.” It also further confirmed continuing reports of olfactory hallucinations (i.e., randomly smelling the odor of dead bodies). The provider noted “severe efforts to avoid or numb his emotions in the form of drinking and isolation that is almost every day in the last 30 days.” A mental status examination indicates further decompensation insofar as he had psychomotor retardation in speech and gait and transient suicidal ideation with an attempt two nights prior when he put a gun to his head. Although the examiner felt his history of adequate functioning meant he might show improvement over time, she seemed cautious about the prognosis and found him “unable to work and make decisions due to his inability to concentrate and focus and his extreme feelings of inadequacy…[or] return to work or engage productively with others.” Such incapacitation further exacerbated his condition by rendering him “incapable of managing his symptoms of PTSD,” and she said drinking put him at a higher risk for greater decompensation and death. 7. Subsequent treatment records show daily suicidal thoughts with a second attempt, mirroring the first, in October 2015. May 2016 VA records note he previously coped by distracting himself with work, but “had more trouble coping” after being denied additional VA benefits in 2013, had to take short-term disability, and was eventually fired, further exacerbating his depressive symptoms and leading to the two prior suicide attempts. Notably, mental health records through at least March 2017 show he continued to be classified as high-risk due to daily suicidal thoughts. 8. The most recent November 2016 private psychiatric evaluation showed further decompensation with significant higher-level executive functional deficits (e.g., concentration and attention impairment, organizational impairment, significant problems initiating or finishing tasks, agitation when required to reason and think on the spur of the moment, frustration with even slight pressure, memory impairment, social anxiety, inability to spell words backwards or say the days of the week backwards, confusion), communication impairment (e.g., mildly abnormally scattered verbalizations, “not much spontaneous communication,” mild to moderate word search difficulty), and disorientation to time (e.g., could not say how long it was until Christmas) in addition to olfactory hallucinations and other impediments to basic functioning (e.g., he could do occasional yard work or house work but also tended to leave the stove on when cooking, required reminders for personal hygiene and medication management, and was incapable of managing his finances). Ultimately, the June 2016 evaluation found “[p]rominent findings... suggest a pattern of chronic and complex PTSD dynamics with significant higher level executive skills deficits, chronic emotional adjustment problems with panic episodes and agitated features as well as episodic psychotic features, and reported chronic restrictive activities of daily living.” 9. An October 2017 Social Security Administration decision found that his psychiatric disability alone rendered him unable to perform any past relevant work and that there were no jobs in significant numbers that he could otherwise perform. It specifically found that his “ability to perform work at all exertional levels has been compromised by nonexertional limitations” due to symptoms like “intermittent explosion, nightmares, distractibility, mood fluctuation, anhedonia, withdrawal, fatigue, memory deficit, and passive suicidal ideations.” In addition, the Veteran testified at an SSA hearing that, “by the time he left his job” in 2014, “he could not talk to people without getting angry and yelling” and “was regularly missing work due to panic attacks.” Although he testified that he stopped drinking in April 2016, he said he was previously self-medicating with alcohol. Despite seeking counseling and using medication, he said at the time that he had not yet seen any improvement in his symptoms. 10. Under the circumstances, the Board finds the evidence is certainly at least in relative equipoise as to whether the Veteran’s service-connected psychiatric disability caused severe functional impairment of reasonably similar frequency, severity, and duration as those contemplated by the 100 percent criteria throughout the appeal period, particularly considering the absence of clear evidence allowing for distinction between nonservice-connected diagnoses from service-connected PTSD in terms of symptoms or impairment. In so finding, the Board finds that, while his symptoms certainly continued to worsen during the appeal period, the evidence reasonably shows they first began worsening around the time he originally filed the instant claim. 11. Moreover, while the VA examination reports of record show much milder impairment, the Board finds them lacking because they contain unreconciled internal and external inconsistencies (e.g., notation of symptoms on the same examinations or in other contemporaneous clinical records that suggest much more severe impairment) and do not appear to be based on as thorough or detailed examination or records review as the three private evaluations during the appeal period. 12. Given the Board’s award of a 100 percent schedular rating for psychiatric disability and the Veteran’s other service-connected disability ratings combining to 60 or more percent during the appeal period, SMC under 38 U.S.C. § 1114(s) is also warranted throughout. CONCLUSIONS OF LAW 1. The criteria for a 100 percent rating for service-connected acquired psychiatric disability throughout the appeal period are met. 38 U.S.C. §§ 1155, 5107(b) (2018); 38 C.F.R. §§ 4.3, 4.7, 4.130 (2020). 2. The criteria for SMC under 38 U.S.C. § 1114(s) throughout the appeal period are met. 38 U.S.C. §§ 1110, 1114, 5107(b) (2018); 38 C.F.R. §§ 3.102, 3.350 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a Veteran who served on active duty from November 1990 to May 1991, January 2005 to June 2006, and October 2007 to February 2009. This appeal is before the Board of Veterans’ Appeals (Board) from a March 2014 rating decision appealed in a timely November 2014 notice of disagreement (NOD) and perfected by a timely November 2017 substantive appeal in response to an October 2017 statement of the case (SOC). In January 2021, a hearing was held before the undersigned. For the detailed reasons outlined above, the Board grants a 100 percent schedular rating for the Veteran’s service-connected psychiatric disability as well as SMC under 38 U.S.C. § 1114(s) throughout the appeal period, obviating the need for further detailed discussion thereof at this time and rendering the Veteran’s separate claim for TDIU during the same period moot. VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Yuan, 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.