Citation Nr: 21012538 Decision Date: 03/04/21 Archive Date: 03/04/21 DOCKET NO. 16-49 609 DATE: March 4, 2021 ORDER Service connection for bilateral hearing loss is denied. Service connection for a back disability is denied. An increased rating for service-connected posttraumatic stress disorder (PTSD), evaluated as 30 percent disabling prior to July 26, 2018, and as 70 percent disabling thereafter, is denied. FINDINGS OF FACT 1. The Veteran does not have hearing loss that is related to his military service, to include any noise exposure therein. 2. The Veteran does not have a back disability that was caused by his service. 3. Prior to July 26, 2018, the Veteran’s PTSD the evidence shows that the Veteran’s PTSD has been productive of symptoms that include anxiety, poor memory, nightmares, flashbacks, and social isolation, but the weight of the evidence is against the conclusion that the psychiatric symptoms have been of such pervasiveness or severity as to cause occupational and social impairment with reduced reliability and productivity or worse. 4. At no time is the Veteran’s PTSD shown to have caused total occupational and total social impairment. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 1131, 5107, 5121A; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.385. 2. The criteria for service connection for a back disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107, 5121A; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. 3. The criteria for an increased rating for service-connected PTSD, evaluated as 30 percent disabling prior to July 26, 2018, and as 70 percent disabling thereafter, have not been met. 38 U.S.C. §§ 5107, 1155; 38 C.F.R. §§ 3.102, 4.7, 4.10, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1987 to July 1991. In October 2019, the Board reopened and remanded claims for service connection for bilateral hearing loss, and a low back condition, and denied a claim for an increased rating for service-connected PTSD, evaluated as 30 percent disabling prior to July 26, 2018, and as 70 percent disabling thereafter. The Veteran appealed to the U.S. Court of Appeals for Veterans Claims (Court). In June 2020, while his case was pending at the Court, the VA’s Office of General Counsel and the Veteran’s representative filed a Joint Motion requesting that the Court vacate the Board’s October 2019 decision as to the increased rating claim for PTSD. That same month, the Court issued an Order vacating the October 2019 Board decision as to the increased rating claim for PTSD and remanding the case for compliance with a Joint Motion for Remand (JMR). Service Connection 1. Bilateral hearing loss. The Veteran asserts that he has hearing loss that is related to his service. During his hearing, held in March 2019, the Veteran asserted that he had hearing loss during service, and that was never given an examination upon separation from service. He said that he was exposed to loud noise during service. His specialty was in motor transport. He was exposed to rockets and automatic fire. He denied using hearing protection. He indicated that his post-service employment with the postal service did not involve exposure to loud noise. He said that he currently wears hearing aids. The Board notes that service connection is currently in effect for tinnitus. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may also be granted for an organic disease of the nervous system, such as a sensorineural hearing loss, when manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Applicable regulations provide that impaired hearing shall be considered a disability when the auditory thresholds in any of the frequencies of 500, 1,000, 2,000, 3,000, and 4,000 Hz are 40 decibels or greater; the thresholds for at least three of these frequencies are 26 decibels or greater; or when speech recognition scores are 94 percent or less. 38 C.F.R. § 3.385. 38 C.F.R. § 3.385 does not preclude service connection for a current hearing loss disability where hearing was within normal limits on audiometric testing at separation from service. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Rather, when audiometric test results at a veteran’s separation from service do not meet the requirements of 38 C.F.R. § 3.385, a veteran may nevertheless establish service connection for current hearing disability by submitting medical evidence that the current disability is causally related to service. Hensley v. Brown, 5 Vet. App. 155 (1993). Where the requirements for hearing loss disability pursuant to 38 C.F.R. § 3.385 are not met until several years after separation from service, the record must include evidence of exposure to disease or injury in service that would adversely affect the auditory system and post-service test results meeting the criteria of 38 C.F.R. § 3.385. Hensley, 5 Vet. App at 155. If the record shows (a) acoustic trauma due to significant noise exposure in service and audiometric test results reflect an upward shift in tested thresholds while in service, though still not meeting the requirements for “disability” under 38 C.F.R. § 3.385, and (b) post service audiometric testing produces findings which meet the requirements of 38 C.F.R. § 3.385; then the rating authorities must consider whether there is a medically sound basis to attribute the post service findings to the injury in service, or whether these findings are more properly attributable to intervening causes. Id. at 159. Under 38 U.S.C. § 1154 (b), in any case where a veteran engaged in combat during active service, lay or other evidence of service incurrence of a combat related disease or injury will be considered sufficient proof of service connection if consistent with the circumstances, conditions, or hardships of such service, notwithstanding the fact that there is no official record of such incurrence during service, and, to that end, VA shall resolve every reasonable doubt in favor of the Veteran. The provisions of 38 U.S.C. § 1154 (b) do not establish a presumption of service connection, but they ease the combat veteran’s burden of demonstrating the occurrence of some in-service incident to which the current disability may be connected. Clyburn v. West, 12 Vet. App. 296, 303 (1999). Thus, the provisions of section 1154(b) apply only to the material issue involved in establishing direct service connection, i.e., evidence of the incurrence of a disease or injury in service. The Veteran’s discharge (DD Form 214) shows that his primary specialty title was motor vehicle operator. His awards include the Southwest Asia Service Medal with two stars, and the Combat Action Ribbon. The Veteran’s service treatment records contain multiple audiograms, to include in August 1987 and July 1991 upon entrance to and separation from service, which do not show hearing loss in either ear for VA purposes, as defined at 38 C.F.R. § 3.385. In the report of medical history associated with the Veteran’s separation examination report, the Veteran indicated that he did not have a history of ear trouble or hearing loss. As for the post-service medical evidence, a March 2001 VA audio examination report shows that the Veteran reported that he was exposed to loud noises during service, to include noise from firearms, machine guns, mortars, tanks, heavy artillery, demolitions, aircraft engines, and noise at the firing range. He reported having about a five-year history of loss of hearing in both ears. Following separation from service, he was noted to have been exposed to loud noise, without the use of hearing protection, from construction work, power tools, power lawn mowers, weed eaters, and leaf blowers. He was noted to report exposure to noise from firearms with hearing protection. On examination, he was not shown to have hearing loss in either ear as defined for VA purposes at 38 C.F.R. § 3.385. A March 2014 VA progress note shows that the Veteran’s test results showed mild SNHL (sensorineural hearing loss) between 250 Hz and 500 Hz. In March 2017, the Veteran reported having hearing loss dating to his service that had worsened on his left side, and overall, over the past two years. He was noted to have borderline mild sensorineural hearing loss, rising to within normal limits from 250 Hz to 8000 Hz, and mild sensorineural hearing loss from 250 Hz to 4000 Hz, sloping to moderate at 4000 to 6000 Hz. The examiner noted that his left ear hearing loss was likely due to rifle use during the Gulf War, however, he would obtain imaging studies to further evaluate. A VA hearing loss DBQ, dated in October 2018, shows that the Veteran had bilateral hearing loss as defined for VA purposes at 38 C.F.R. § 3.385. The diagnosis was bilateral SNHL. The examiner indicated that there was not a permanent positive threshold shift (worse than reference threshold) greater than normal measurement variability at any frequency between 500 Hz and 6,000 Hz for the right ear or the left ear. The examiner also indicated that the Veteran’s right ear and left ear hearing loss was not at least as likely as not caused by, or a result of, an event in military service. The examiner explained that there is no significant permanent shift in hearing thresholds beyond test variability from entrance into service in April 1987 to separation from service in July 1991. This is objective evidence that there was no permanent auditory damage from exposure to noise on active duty. There is no report to show a complaint or treatment for a decrease in hearing during service, to include upon separation from service. Although noise exposure is conceded, and the relationship between noise, auditory damage, and hearing loss is well-established, auditory damage and hearing loss are not conceded based on noise exposure alone. There must be a nexus of auditory damage to relate a current hearing loss to military noise exposure, and not another etiology. The evidence is against a nexus in this case; therefore, it is less likely than not that the Veteran’s hearing loss is related to noise exposure during service. A VA audio DBQ, dated in December 2019, shows that the Veteran has bilateral hearing loss as defined for VA purposes at 38 C.F.R. § 3.385. The examiner stated, however, that the results are not valid for ratings purposes. The examiner noted that the Veteran’s entrance examination report showed that he had normal hearing sensitivity. His separation examination report is hard to read due to multiple audiograms being recorded in one localized area; however, the examination in the actual audiogram box shows no significant threshold shift in the right ear. While there is a notation on separation examination that a shift in hearing was obtained, the Veteran’s initial March 2001 compensation and pension examination, which is dated ten years after his separation from service, shows that he had normal hearing sensitivity. This is objective evidence of no permanent auditory damage on active duty from his conceded exposure to loud noise. Additional post-service audiograms in March 2014 and January 2015 show minimal hearing loss that does not meet the VA’s criteria for hearing impairment. The Veteran’s hearing loss first meets VA’s criteria for hearing impairment on his March 2017 exam, which is 26 years post-separation from military. The evidence is against a nexus in this case; therefore, it is less likely than not that the Veteran’s hearing loss is related to military noise exposure. The Board finds that the claim must be denied. The Veteran’s service treatment records do not show complaints, findings, or a diagnosis of hearing loss. He is not shown to have had hearing loss upon separation from service, and he denied a history of hearing loss at the time. Following separation from service, the Veteran is not shown to have had sensorineural hearing loss within one year of separation from service. 38 C.F.R. §§ 3.307, 3.309. He is first shown to have had hearing loss many years after separation from service. There is no competent opinion in support of the claim. The only competent opinions of record are the October 2018 and December 2019 VA opinions, and both of these opinions weigh against the claim. While the Veteran’s participation in combat is conceded, the United States Court of Appeals for Veterans Claims (Court) has held that 38 U.S.C. § 1154 does not alter the fundamental requirements of a diagnosis, and a medical nexus to service. See Brock v. Brown, 10 Vet. App. 155, 162 (1997). Accordingly, service connection is not warranted. 2. Back disability. The Veteran asserts that he has a back disability due to his service. During his hearing, held in March 2019, the Veteran asserted that he hurt his back while unloading ammunition crates in Kuwait. He reported seeking treatment, and being given Tylenol. As discussed infra, treatment reports show that he has reported the following: He sustained a lower back injury while he was on active duty and during deployment in Kuwait. He was unloading a pallet of ammunition and heard a pop in his back, and that he sought medical treatment and that he was given some Tylenol. His back has continued to hurt over the years. The Veteran’s service treatment records include dental health questionnaires, dated in April 1988, June 1989, March 1990, and July 1991, show that the Veteran indicated that he did not have a history of arthritis or painful joints. The Veteran’s separation examination report, dated in June 1991, shows that his spine was clinically evaluated as normal. In the associated report of medical history, the Veteran indicated that he did not have a history of recurrent back pain. He stated that he was in good health and that he was not taking any medications. As for the post-service medical evidence, a March 2001 VA joints examination report shows that the Veteran reported a one-year history of joint pain. An X-ray was noted to show mild degenerative changes especially in the L3-4 with anterior osteophyte and straightening of the normal lordotic curvature. The vertebral height and disc spaces were preserved. The examiner stated that the Veteran presented with lumbar spine pain that is related to a mechanical problem secondary to degenerative joint disease, and that he had a well-preserved range of motion. A VA Gulf War examination report, dated in September 2013, notes a history of treatment for back pain. A physical examination was normal. A VA back examination report, dated in September 2013, notes a history of progressive low back pain. An X-ray report contains an impression of mild to moderate diffuse degenerative disease, with an otherwise, unremarkable radiographic evaluation of the lumbar spine. The diagnosis was degenerative disc disease. The examiner concluded that the Veteran’s back condition was less likely than not incurred in, or caused by, his service. The examiner explained that the Veteran’s joint and muscle pain, including his back pain, is less likely as not caused by, or a result of, chronic disability patterns based on exposure to environmental hazards experienced during military service in Southwest Asia. There is no evidence of an undiagnosed illness or a diagnosed medically unexplained chronic multi symptom illness that is without a conclusive pathophysiology or etiology. The Veteran has muscle cramps and back pain secondary to a condition or disease with a clear etiology. His muscle cramps could be due to dehydration, electrolyte imbalance, overexertion or increased physical activity. His degenerative disc disease is a condition with a clear etiology, including the aging process, genetic predisposition and trauma among other causes. A VA back DBQ, dated in December 2019, shows that the diagnosis was degenerative arthritis of the spine, with a date of diagnosis in December 2019. In an associated opinion, the examiner noted that the Veteran claimed that he has a lower back injury that occurred while he was on active duty and during deployment in Kuwait. The Veteran said that he was unloading a pallet of ammunition and heard a pop in his back. He said that he sought medical treatment and that he was given some Tylenol. His reported that his back has continued to hurt over the years and that he finally saw a doctor in about 2001. The examiner concluded that the Veteran’s back condition was less likely than not incurred in or caused by his service. The examiner noted that the Veteran’s service treatment records are silent for any injury or complaint of a lower back injury or pain. The Veteran’s July 1991 separation examination report did not contain any mention of a lower back injury or pain. The examiner stated that there is no objective evidence to support the Veteran’s report that he was seen for, or complained of, a lower back injury during active duty. The examiner noted that an August 2013 lumbar X-ray revealed DDD (degenerative disc disease). She concluded that she is unable to verify that the current lower back injury was caused by an injury during active duty. Therefore, a nexus has not been established. Overall, VA progress notes show multiple treatments for complaints of back pain, and they include problem lists noting chronic low back pain. In 2014, the Veteran was issued a back brace, and he participated in a back program. A December 2015 magnetic resonance imaging (MRI) study contains an impression noting mild multi-level degenerative disc and facet disease with findings most pronounced at L3-4, with no severe stenosis seen. The assessment noted mechanical low back pain, facet joint arthritis, lumbar degenerative disc disease, and lumbago. The Board finds that the claim must be denied. The Veteran’s service treatment records do not show complaints, findings, or a diagnosis of a back disability. He is not shown to have had a back disability upon separation from service, and he specifically denied a history of recurrent back pain at the time. That is, when separating from service he was specifically asked if he had then, or had ever had, back problems, to which he replied no. Following separation from service, the Veteran is not shown to have had arthritis of his back within one year of separation from service. 38 C.F.R. §§ 3.307, 3.309. He is first shown to have had a back disability in March 2001. This was about eight years after separation from service. There is no competent opinion in support of the claim. The only competent opinions of record are the September 2013 and December 2019 VA opinions, and both of these opinions weigh against the claim. Accordingly, service connection is not warranted. The Veteran’s service records show that his awards include the Southwest Asia Service Medal, and that he meets the criteria for consideration as a Persian Gulf veteran for purposes of 38 C.F.R. § 3.317. However, the Veteran is not shown to have an undiagnosed illness involving the claimed symptoms. See e.g., September 2013 VA DBQ. He has been shown to have degenerative disc disease and arthritis, which are diagnosed conditions, and for which service connection may not be granted on this basis. Stankevich v. Nicholson, 19 Vet. App. 470, 472 (2006). The Board therefore finds that the Veteran is not shown to have a “qualifying chronic disability” involving any of the claimed symptoms. See 38 C.F.R. § 3.317 (a)(2)(i). Accordingly, the provisions of 38 U.S.C. § 1117 and 38 C.F.R. § 3.317 are not applicable. For both service connection claims, the issues on appeal are based on the Veteran’s contention that hearing loss and a back disability have been caused by service. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issues in this case, they fall outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Veteran’s service treatment reports have been discussed. They do not show complaints or findings of hearing loss or a back disorder. His post-service medical records have also been discussed. The claimed conditions are first shown well after service, and there is no competent opinion of record in favor of either claim. Given the foregoing, the Board finds that the post-service medical evidence outweighs the Veteran’s contentions to the effect that service connection is warranted for hearing loss and a back disability. Accordingly, the Board finds that the weight of the evidence is against the claims, and they are denied. Increased Rating, PTSD The Veteran asserts that he is entitled to an increased rating for his service-connected PTSD, evaluated as 30 percent disabling prior to July 26, 2018, and as 70 percent disabling thereafter. During his hearing, held in March 2019, it was argued that the Veteran had been written up numerous times at his job with the postal service due to being late, or having interactions or confrontations with supervisors, to include three instances in the past month. He asserted that he has experienced suicidal ideation, depression, family problems, difficulty concentrating, anger, panic attacks twice a week, disorientation, and that he doesn’t go outside. He reported that he was being harassed about his work performance. The Veteran’s PTSD has been evaluated at 30 percent and 70 percent disabling during the time periods in issue under 38 C.F.R. § 4.130, Diagnostic Code (DC) 9411, under the general rating formula for mental disorders, which became effective prior to the Veteran’s claim for service connection. A 30 percent rating is assigned when a veteran’s PTSD causes occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, recent events). Id. Under DC 9411, a 50 percent rating is warranted when a veteran’s PTSD causes occupational and social impairment with reduced reliability and productivity 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; difficulty in establishing and maintaining effective work and social relationships. Id. Under DC 9411, a 70 percent rating is warranted where a veteran’s PTSD causes occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking or mood, due to such symptoms as: Suicidal ideations; obsessional rituals that 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 work-like setting); inability to establish and maintain effective relationships. Id. Under 38 C.F.R. § 4.130, DC 9411, a 100 percent rating is warranted when a veteran’s PTSD causes total occupational and social impairment, 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. That portion of VA’s Schedule for Rating Disabilities (“the Schedule”) that addresses service-connected psychiatric disabilities was based on the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) IV prior to a change effective August 4, 2014. 38 C.F.R. § 4.130. The regulation has been changed to reflect the current DSM, the DSM-V. As this appeal was certified to the Board in November 2018, after the effective date for this change, DSM-5 is not applicable to this claim. See 70 Fed. Reg. 45,093-94 (Aug. 4, 2014). As such, the use of global assessment of functioning scores is inappropriate. Golden v. Shulkin, 29 Vet. App. 221 (2018). When determining the appropriate disability evaluation to assign, the Board’s primary consideration is the Veteran’s symptoms, but it must also make findings as to how those symptoms impact the Veteran’s occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013). Because the use of the term “such as” in the rating criteria demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, the Board need not find the presence of all, most, or even some, of the enumerated symptoms to award a specific rating. Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). Nevertheless, as all ratings in the general rating formula are also associated with objectively observable symptomatology and the plain language of the regulation makes it clear that the Veteran’s impairment must be “due to” those symptoms, a veteran may only qualify for a given disability by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio, 713 F.3d at 118. Prior to July 26, 2018. The Veteran’s PTSD has been evaluated as 30 percent disabling from March 21, 2012 to July 26, 2018. A VA mental disorders DBQ, dated in March 2013, shows that the Veteran reported that he had not had any mental health treatment or hospitalizations since his last examination in 2001. He said that he was married and that he lived with his wife and two children. He described all relationships with his family as “good.” He reported having interesting and positive socialization with his four brothers. He reported spending most of his time with his family, and going to his children’s sporting events, talking with his brothers, and reading and relaxing in his garage. He said that he is employed full-time at the postal service, where he has worked since 1993. He denied having any problems getting along with co-workers or supervisors, apart from two verbal confrontations with co-workers in 2008, which resulted in a counseling statement and an unpaid suspension for seven days. He denied any other work-related disciplinary problems since his last examination. He denied symptoms of flashbacks or avoidance of war related media. He reported that he prefers to spend time with himself and worries that he may become aggressive or angry with others if he were to socialize more. The Veteran denied any clinically significant history of anger dysregulation apart from the incidents at work, as previously noted. He denied having nightmares or intrusive thoughts about his military experiences. His wife reported that the Veteran often appears emotionally detached. The Veteran denied nightmares or intrusive thoughts about his military experiences. He denied having nightmares related to military service. He stated that some of his dreams occasionally include content related to, his military experiences in general but not any identifiable stressor. The Veteran is currently prescribed no psychotropic medications. The examiner concluded that the Veteran was not currently experiencing any clinically significant symptoms of anxiety as of the time of this interview. His diagnosis of an anxiety disorder NOS (not otherwise specified) was therefore not continued. The examiner concluded that the Veteran did not have a mental health diagnosis at that time and was fully employable from a mental health standpoint. A VA mental disorders DBQ, dated in September 2013, shows that the Veteran complained of transient irritability, which he managed effectively by leaving the situation. He also reported night sweats and nervousness in the form of intermittent hand tremors. He reported that he was employed as a postal worker. The examiner stated that he could not find a psychological cause for the Veteran’s night sweats and hand tremors. The Veteran denied any clinically significant behavioral dysregulation or negative impact in occupational or social functioning associated with anger since his previous examination. He was noted to have had dreams of being in Kuwait, with no relationship to a reported index event consistent with Criteria A for PTSD, and no identifiable impairment. The Veteran denied any significant changes since his February 2013 examination. The examiner concluded that the Veteran does not have an Axis I or Axis II diagnosis. A VA mental disorders DBQ, dated in October 2014, shows that the Veteran reported that his symptoms included depression, anger, social avoidance, and that he thinks about combat events “all the time,” and that he has nightmares two to three times per week. He stated that he lives with his wife and two children. He has been married 21 years. They have two children together, ages 14 and 17 years old. He described his relationship with his spouse as “okay,” with some arguments. He denied any significant conflicts, or violence in the relationship. He described his relationship with his children and his parents as good. He occasionally visits with his parents. He reported an “okay” relationship with his siblings, who also live in the area. They see each other sporadically and at family gatherings. He reported not having many friends and that he preferred to spend time with his family. He said that he has worked full-time for the postal service for about 20 years. He described his job as “not good” and “okay.” He is having trouble due to the time requirements of medical appointments. He denied a history of interpersonal conflicts with other workers, inability to perform work duties, or terminations. The Axis I diagnosis was unspecified trauma and stressor-related disorder. The examiner stated that the Veteran’s symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication. The examiner stated that he concurs with the September 2013 VA examiner’s conclusions, as the Veteran presented with no difficulties in social and occupational functioning and no history of any mental health treatment for more than 20 years after his military service. The report notes that his medications have been continued without changes since April 2014. His tendencies to isolate were better understood by an interpersonal style characterized by a preference to spend time with family and to limit emotional expression. A VA PTSD DBQ, dated in July 2015, shows that the Veteran reported that he has symptoms that include anger, irritability, nightmares (three times per week), checking the home, feeling estranged from others, and difficulty connecting with others. The Veteran reported that he continues to struggle in discussing his combat related experiences. He has worked for the postal service for 21 years. He reported experiencing significant stress related to having to take time off for appointments, for the most part he stays to himself, and that he will only speak with other veterans. He also complained of concentration difficulty related to intrusive thoughts about his trauma and fatigue due to lack of sleep. He was noted to have chronic sleep impairment. He is currently prescribed Lurasidone, Sertraline, Prazosin, Etodolac, Trazodone, Tizanidine, and Menthol/M-Salicylate. The diagnosis was PTSD. The examiner indicated that the Veteran’s symptoms were productive of occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication. A VA headaches DBQ, dated in February 2018, shows that the Veteran reported that he works full-time. The Board finds that an initial evaluation in excess of 30 percent is not warranted for the Veteran’s PTSD prior to July 26, 2018. The Veteran’s symptoms are not sufficiently severe to have resulted in occupational and social impairment with reduced reliability and productivity. The totality of the evidence shows that the Veteran’s PTSD more closely resembles the criteria for not more than a 30 percent evaluation. The Veteran has reported symptoms that include anxiety, poor memory, nightmares, flashbacks, and social isolation. There is no history of hospitalization for psychiatric symptoms. He has generally reported having “okay” to good relationships with his family. The March and September 2013 VA examination findings show that his thought processes were logical, and goal directed. He was appropriately groomed. Speech was unremarkable. There was no evidence of hallucinations or delusions. Mood was euthymic. Affect was mood congruent. He manages his hygiene and household chores independently. He manages his own medication. He is able to drive. He was oriented to person, place, time, and situation. He inaccurately completed the serial 7 task. He accurately completed the serial 3s task. Judgement and insight were good. He denied suicidal ideation, plan, means, or intent. There were no symptoms of PTSD, generalized anxiety, mania, major depression, psychosis, panic, obsessive compulsive behaviors, disordered eating, characterological disturbance, somatoform disorders, or cognitive disorders noted. Thought processes is logical with no evidence of hallucinations or delusions. The October 2014 VA PTSD DBQ shows that the Veteran was alert and oriented to person, place, time, and situation. Mood was euthymic; affect was appropriate and congruent with mood and topics discussed. Thoughts were logical and goal directed. There was no evidence of delusions or hallucinatory phenomena at the time of the evaluation. Speech was clear, relevant and coherent. Immediate recall of three words was 3/3; three-minute delayed recall was 1/3. He responded very slowly during the delayed task. He was aided by the presentation of semantic cues. This finding is somewhat below expectation given that the Veteran’s records and reports do not reveal any trauma or other condition to suggest a cognitive decline. The Veteran’s attention and concentration were variable. He seemingly lost cognitive set mid task, but he was able to correctly calculate three digits in Serial 7s, and he spelled a five-letter word both forward and backward. The fund of general knowledge was fair. He was able to name the current and previous U.S. President and to cite a current event. The Veteran’s judgment/reasoning and analytical skills were good, as measured by interpretation of hypothetical situations and (a) proverbial statement(s). Insight appears good. The Veteran denied current suicidal ideation, plan, means, and/or intent. He also denied homicidal ideation, plan, means and/or intent. There were no symptoms of generalized anxiety, mania, major depression, psychosis, panic, obsessive/compulsive behaviors, disordered eating, characterological disturbance, somatoform disorders, or cognitive disorders were noted. In the view of the examiner, the Veteran is not at risk for harm to self or others at the time of this examination. The July 2015 VA PTSD DBQ shows that he was oriented, with normal speech, and normal thought content and thought process and associations. Insight and judgment were fair. Memory was intact. There was no evidence of suicidal or homicidal thoughts, or psychotic symptoms. Overall, his attire and grooming appeared appropriate and clean with no signs of self-neglect. He was oriented to person, place and time. He showed no apparent difficulties in comprehending interview questions. His cognitive functioning was within normal limits. He displayed no language impairment, either receptively or expressively. There were no signs of tremor or involuntary movements. His thought process was logical. His speech was normal. He described his mood as “fine;” his affect appeared nervous and tense. A VA PTSD DBQ, dated in July 2018, shows that the Veteran presented with a resolution settlement from his job with the postal service, which indicates that he received a 7-day suspension in November 2017, for unsatisfactory work performance. The records note that the settlement was expunged through union representation. A postal service absentee report indicates nine absences in the past 30 days, with between four and nine absences averaged each month since January 2018. VA progress notes show that the Veteran reported having anxiety, stress, insomnia, irritability, sleep disturbance, and nightmares. In 2014, he reported that he has worked for the postal service for 20 years. The Veteran denied social withdrawal, avolition, anhedonia, grandiose delusions, persecutory delusions, ideas of reference, thought broadcasting, thought insertion, other delusions, hallucinations, ideas of reference, panic attacks, forgetfulness, losing track of time, problems with managing money, word-finding difficulties, difficulty recognizing and/or naming objects, or getting lost. He was started on Sertraline for depression, prazosin for nightmares, and Trazodone for sleep. The findings tend to show that the Veteran denied suicidal or homicidal ideation, plan, or intent. Speech was of normal volume, rate, tone, and prosody, or was “clear.” Cognitive functioning was grossly intact. Thought content was adequate. Thought process was logical. He was oriented to person, place, and time. Concentration and abstraction were intact. Insight and judgment were adequate or good. On examination, remote, recent, and immediate memory, and concentration, were intact. In summary, the March and September 2013 VA examiners concluded that the Veteran did not have a diagnosed acquired psychiatric disorder. The October 2014 VA examiner concluded that a mental condition has been formally diagnosed, but that the Veteran’s symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication. The July 2015 VA examiner concluded that his symptoms were productive of occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication. This most closely corresponds to no more than a 10 percent rating under 38 C.F.R. § 4.130. There is insufficient evidence of such symptoms as flattened affect; irregular speech; difficulty in understanding complex commands; impairment of short- and long-term memory; and impaired abstract thinking, nor are other psychiatric symptoms shown to have resulted in the required level of impairment. Vazquez-Claudio. The Veteran’s records related to his employment, as noted in the July 2018 VA PTSD DBQ, have been considered, to include multiple absences, and a suspension for unsatisfactory work performance in November 2017. However, it appears that his suspension was expunged, and his statements indicate that his absences are related, at least in large part, to the need to attend medical appointments. A disability rating in itself is recognition that the impairment makes it difficult to obtain or keep employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Given the foregoing, the Board finds that the Veteran’s symptoms are not of such severity to approximate, or more nearly approximate, the criteria for a 50 percent rating, and that the findings do not support a conclusion that the Veteran’s symptoms are productive of a “similar severity, frequency, and duration” as those required for a 50 percent rating. See 38 C.F.R. § 4.7; Vazquez-Claudio. As of July 26, 2018. A VA PTSD DBQ, dated July 26, 2018, shows that the Veteran reported the following: He has been married 23 years. He has 2 children (ages 21 and 19). He has a strained relationship with children and wife. His children do not talk to him due to his history of anger (yelling, breaking things, and being easily angered). He often isolates from wife. He stays home. His wife complains that he does not go places with her. He prefers to sit outside of home or in home in quiet environment. He checks on his parents via telephone. He currently works at the post office (22 years). He has frequently received written disciplinarian actions due to frequent absence. His last write up was three days ago. He attributed absence to a panic attack. He received leave under Family Medical Leave Act three years ago. He was harassed at work, and he has panic attacks when he is at work. He has irritability and anger related to dealing with his supervisors. He leaves early as a result, to avoid physical confrontation. He is taking Mirtazapine, Trazodone, Lurasidone, Prazosin, and Venlafaxine. His symptoms include depressed mood. anxiety, suspiciousness, panic attacks more than once a week, chronic sleep impairment, mild memory loss, flattened affect, 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 work like setting, suicidal ideation, and persistent delusions of hallucinations. The DBQ indicates that the Veteran has recurrent intrusive and distressing recollections, dreams, thoughts, psychological distress at point of exposure, and psychological reactivity to exposure (unexpected noises that remind of military trauma). On examination, the Veteran was cooperative and alert. He was oriented times four. Thought patterns were logical and coherent. He denied suicidal or homicidal ideation, and audio or visual hallucinations. Has episodes of feeling that he would be better off dead. He denied intent and plan. He did not present as an imminent risk of danger to self or others. The diagnosis was PTSD. The examiner indicated that the Veteran’s symptoms are productive of occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. A VA esophageal conditions DBQ, dated in August 2018, and a VA intestinal DBQ, dated in September 2018, show that the Veteran reported that he works for the postal service. The Board finds that the criteria for a rating in excess of 70 percent have not been met. The findings in such areas as the Veteran’s memory, judgment, insight, thought processes, speech, orientation, and hygiene, and the lack of evidence of such symptoms as delusions, or hallucinations, do not warrant the conclusion that the criteria for a rating in excess of 70 percent have been met. In this regard, despite notations of suicidal ideation, and persistent delusions of hallucinations, the DBQ shows that the Veteran denied these symptoms. Furthermore, the presence of these symptoms is not established by history. See e.g., VA progress notes dated between 2014 and 2018. It appears that the Veteran has been working full-time at the postal service for 22 years. The July 2018 VA examiner concluded that the Veteran’s symptoms were productive of occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. This most closely corresponds to no more than a 70 percent evaluation under the General Rating Formula. See 38 C.F.R. § 4.130, General Rating Formula. In addition, there is insufficient evidence of such symptoms as gross impairment in thought processes or communication, grossly inappropriate behavior, intermittent inability to perform activities of daily living, disorientation to time or place, memory loss of names of close relatives, own occupation, or own name; nor are there other psychiatric symptoms of a “similar severity, frequency, and duration” as those required for a 100 percent evaluation under the General Rating Formula. He has maintained employment with the postal service for 22 years, precluding a finding of total occupational impairment, and he has remained married with extensive family relations, precluding a finding of total social impairment. Given the foregoing, the Board finds that the Veteran’s symptoms are not of such severity to approximate, or more nearly approximate, the criteria for a rating of 100 percent under DC 9411. Id.; see also 38 C.F.R. § 4.7. In reaching these decisions, the Board has considered the June 2020 JMR, which states that it was agreed that during his March 2019 Board hearing, the Veteran reported having suicidal ideation prior to July 26, 2018, and afterwards. Specifically, for the period prior to July 26, 2018, he reported suicidal ideation “off and on” around September 2014. Regarding the period after July 26, 2018, he reported that his suicidal ideation had “been going on for a while” and that it “comes and goes.” The JMR states that given these allegations of suicidal ideation, the Board failed to adequately consider whether such allegations would warrant an initial rating in excess of 30 percent for PTSD, prior to July 26, 2018, and a rating in excess of 70 percent for PTSD from July 26, 2018. In fact, the overwhelming majority of the findings show that the Veteran did not have suicidal ideation. For example, the September 2013 VA PTSD examination reports shows that the Veteran denied suicidal or homicidal ideation, plan, means, or intent. The examiner concluded that “he is not currently at risk for harm to self or others at this time.” Beginning in 2014, VA progress notes contain multiple notations which shows that the Veteran repeatedly denied having suicidal or homicidal ideation, plan, or intent. The October 2014 VA PTSD DBQ shows that the Veteran denied having suicidal thoughts or gestures. The July 2015 VA PTSD DBQ shows that the Veteran was negative for past or current suicidal or homicidal ideation, plan or intent. He did not appear to be a threat to himself or others. Between 2016 and February 2018, there are also multiple notations to show that examiners concluded that the Veteran was not a danger to self or others and that he can safely be managed in an outpatient setting. See e.g., VA progress notes, dated in February, April, August, October, and December of 2016, August and October of 2017, February 2018. Therefore, the Board has afforded more weight to the contemporaneous findings in the medical evidence, which show that the Veteran was not noted to have suicidal ideation. The Veteran’s assertions, which are not corroborated by the vast majority of findings in the medical evidence, are insufficiently probative to warrant the assignment of a higher rating during any time on appeal. Madden v. Gober, 125 F.3d 1477 (Fed. Cir. 1997). The Board acknowledges that suicidal ideations are one of the symptoms associated with a 70 percent rating. See Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017). However, the mere presence of suicidal ideation alone does not mandate the assignment of a 70 percent rating. Rather, it is the impact the suicidal ideation has on the Veteran’s social and occupational functioning that is ultimately determinative of the rating that is assigned. The Board in no way wishes to diminish the Veteran’s reports of suicidal ideation and the impact they have. Indeed, the Veteran is strongly encouraged call the all the Veterans Crisis Line at 1-800-273-8255 and Press 1, should he have suicidal ideation. (Continued on the next page)   However, as recounted above, multiple VA examiners considered the impact of the Veteran’s psychiatric symptomatology, but found that the impairment it caused did not cause sufficient social and/or occupational impairment to warrant the assignment of a higher rating. Accordingly, the claim for an increased rating for PTSD is denied. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T.S.E., 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.