Citation Nr: 21013783 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 15-31 997 DATE: March 10, 2021 ORDER Entitlement to an initial disability rating in excess of 30 percent for posttraumatic stress disorder (PTSD) is denied. FINDING OF FACT The severity, frequency, and duration of the Veteran’s symptoms associated with his PTSD did not more closely approximate occupational and social impairment with reduced reliability and productivity. CONCLUSION OF LAW The criteria for a disability rating in excess of 30 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1967 to September 1970. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO), which granted service connection for PTSD with panic attacks and assigned an initial disability rating of 30 percent effective June 6, 2013. In May 2019, the Board remanded this case to the RO for further development. Specifically, the Board directed the RO to obtain an updated VA examination with respect to the Veteran’s PTSD, which the RO accomplished. The case now returns to the Board. Entitlement to an initial rating in excess of 30 percent for PTSD is denied. In deciding claims, it is the Board’s responsibility to evaluate the entire record on appeal. 38 U.S.C. § 7104(a). VA is required to give due consideration to all pertinent medical and lay evidence when rating disabilities. Golden v Shulkin, 29 Vet. App. 221, 224 (2017) (citation omitted); see 38 C.F.R. §§ 4.1, 4.6. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 C.F.R. § 4.3. To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Relevant to this case, an initial rating is one assigned at the time service-connection is granted. When an initial rating decision is on appeal, evidence contemporaneous with the claim and with the initial rating decision granting service connection would be most probative of the degree of disability existing at those times and should be the evidence used to decide whether an original rating was erroneous. Fenderson v. West, 12 Vet. App. 119, 126 (1999). Separate ratings can be assigned for separate periods of time based on the facts found—a practice known as “staged” ratings. Id. A staged rating is a rating that looks backwards and retroactively assigns specific ratings to discrete periods. See Reizenstein v. Shinseki, 583 F.3d 1331, 1337 (Fed. Cir. 2009). This practice accounts “for the possible dynamic nature of a disability while the claim works its way through the adjudication process.” O’Connell v. Nicholson, 21 Vet. App. 89, 93 (2007); see also 38 C.F.R. § 4.1. The effective date for a staged rating is when it is factually ascertainable that a particular rating is warranted. Hart v. Mansfield, 21 Vet. App. 505, 509 (2007). In cases where staged ratings are appropriate, it is necessary to consider all “the evidence of record from the time of the veteran’s application.” Fenderson, 12 Vet. App. at 127. The law requires the Board address its reasons for rejecting evidence favorable to the Veteran. Timberlake v. Gober, 14 Vet. App. 122, 128‒29 (2000). The Board must review the entire record but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1381 (Fed. Cir. 2000). The analysis below focuses on the most salient and relevant evidence within the period on appeal and on what this evidence shows, or fails to show, on the claim. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule), found in 38 C.F.R. Part 4. The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Diagnostic Codes (DCs) are assigned to individual disabilities and provide rating criteria specific to a particular disability. If two DCs are applicable to the same disability, the DC that allows for the higher disability rating applies. 38 C.F.R. § 4.7. When a question arises as to which of two ratings apply under a particular DC, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. Id. Under the General Formula for Mental Disorders (General Formula), 38 C.F.R. § 4.130, the Board must conduct a “holistic analysis” that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017). The symptoms listed in the VA’s General Formula are not intended to constitute an exhaustive list, but rather serve as examples of the type and degree of the symptoms, or their effects, which would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114‒18 (Fed. Cir. 2013). The General Formula, 38 C.F.R. § 4.130, DC 9411, provides, in pertinent part, as follows: Rating (%) 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. 100 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 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. 70 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. 50 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, mild memory loss (such as forgetting names, directions, recent events). 30 Although DC 9411 provides for ratings lower than 30 percent, an analysis of the ratings lower than 30 percent is unwarranted as the Veteran is currently in receipt of a 30 percent rating, absent legal and factual bases to issue a reduction in the Veteran’s current rating. See 38 C.F.R. § 3.344. Considerations in rating a mental disorder include the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran’s capacity for adjustment during periods of remission. 38 C.F.R. § 4.126(a). The rating must be based on all evidence of record that bears on occupational and social impairment rather than solely on an examiner’s assessment of the level of disability at the moment of the examination. Id. Although the extent of social impairment is a consideration in determining the level of disability, the rating may not be assigned solely on the basis of social impairment. 38 C.F.R. § 4.126(b). The United States Court of Appeals for the Federal Circuit held that evaluation under 38 C.F.R. § 4.130 is “symptom-driven,” meaning that “symptomatology should be the fact-finder’s primary focus when deciding entitlement to a given disability rating.” Vazquez-Claudio, 713 F.3d at 116‒17. The Veteran contends that he is entitled to a rating in excess of 30 percent for his service-connected PTSD. He asserts he is entitled to the maximum 100 percent rating available under DC 9411. See December 2014 Notice of Disagreement. The Board finds the Veteran’s symptomatology associated with his PTSD most closely resembles occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks throughout the appeal period (30 percent rating criteria). In an April 2014 VA primary care nursing note, a licensed practical nurse documented that the Veteran did not report loss of interest in things, or feelings of depression or hopelessness. At the same visit, the Veteran described to his physician a recurrent, vivid dream about his military service in Vietnam. He woke up from his sleep “drenched” in sweat each time. He reported the dream occurred every two years, occasionally twice in a row. During a May 2014 VA primary care telephone encounter, the Veteran reported continued anxiety/panic attacks but denied suicidal and homicidal ideations. The Veteran visited a VA psychologist in June 2014 for an initial evaluation. This evaluation was later reviewed and confirmed by a VA psychiatrist. During the evaluation by the psychologist, the Veteran reported panic attacks and nightmares since 2002. He was still working during the evaluation, stating, “I have a good career.” He reported anxiety attacks “a few times a week,” which he said he could “pretty much control.” When asked to describe functional or behavioral impairments due to his symptoms, the Veteran stated, “I wait for them (anxiety spells) to pass.” The psychologist determined the Veteran’s symptoms did not impede functioning. The Veteran specifically endorsed the following symptoms: (1) appetite or weight increase/decrease; (2) suicidal ideations, plans or gestures within the past month (the Veteran reported he thought about suicide within the past month; he stated that he has a plan for suicide in the event that he develops a terminal illness); (3) anhedonia; (4) loss of energy; (5) anxiety and panic attacks that developed abruptly and that were recurrent; (6) physical symptoms of dizziness, trembling, sweating, and racing heart; (7) feeling of helplessness; (8) recurrent and intrusive recollections; (9) nightmares; (10) avoidance of stimuli associated with his military service; (11) restricted affect; (12) sleep problems; and (13) hypervigilance. He reported that he did not have trouble with relationships. He had several existing friends, but he did not establish new friendships due to “feeling uncomfortable.” He socialized with his friends weekly at hockey and golf league outings. He reported enjoying hockey, golf, and fishing. He had been married for the past 41 years with one daughter. He described his marriage as “wonderful.” During the evaluation, the psychologist observed the Veteran’s appearance was normal. He was cooperative, alert, and oriented. His short- and long-term memory were intact. His speech was normal. His affect was restricted. He had no delusions or hallucinations. His judgment was fair and he had goal-directed thought processes. In June 2014, the Veteran filed for service connection for his PTSD. He reported that he experienced panic attacks since 2002 for which he was on medication. He experienced paranoia around crowds, mood changes, emotional troubles, hypervigilance, nightmares, sleeping problems, memory issues, thoughts of suicide, and avoidance of speaking or thinking about his military service. His wife likewise reported the Veteran experienced sleeping issues, hypervigilance, crowd avoidance, nightmares, and startled responses to loud noises and surprises. The Veteran was afforded a VA examination in October 2014. During the examination, the Veteran endorsed intrusive thoughts and dreams, flashbacks, avoidance efforts of things that triggered memories of his military service, persistent negative beliefs about himself, markedly diminished interest in activities, feelings of detachment and loss of emotion, irritable mood with angry outbursts, hypervigilance, exaggerated startle response, concentration problems, and sleep disturbances. He further endorsed symptoms of depressed mood, anxiety, suspiciousness, panic attacks that occurred weekly or less often, chronic sleep impairment, and suicidal ideation. During the examination, the examiner observed the Veteran’s appearance was normal. He was cooperative and alert. The Veteran’s speech was fluent and clear. His thought processes were logical and goal-directed. His thoughts were appropriate. There were no signs of psychosis. His affect was constricted, and his mood was anxious and tense. His insight was fair, and his judgment was adequate. The examiner opined that the Veteran’s symptomatology reflected occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behaviour, self-care, and conversation. The Veteran submitted a January 2015 letter from his private physician, Dr. M.S., who stated that she had treated the Veteran since 1999. The Veteran’s anxiety and panic attacks had been successfully treated with Klonopin without side effects. She opined that if the Veteran were to stop his medications, then he would regress, his anxiety and panic attacks would come daily, not monthly. “That would affect his ability to function in the semi-normal manner, which he is doing now.” She also explained that his anxiety and panic attacks could affect his ability to work and socialize, have an effect on his memory and judgment, and cause mood swings. But his condition “is controlled by his medication.” In his July 2015 VA Form 9 substantive appeal, the Veteran reported his depression, panic attacks, and general inability to function occurred on a regular basis. He stated he had impaired judgment, mood swings, nightmares, and struggled with short- and long-term memory. He was startled by noises. He specifically stated, “I believe because of most of those symptoms described in the 50–70 percent range in the rating schedule is what I deal with but are controlled by prescribed medication.” He stated that when he does not take his medication he is “completely incapacitated and unable to function even in a semi-normal way.” During a May 2017 psychiatry consult, a VA psychiatrist found the Veteran had no acute issues and no evidence of a mood disorder was present. He was in a stable marriage without acute social stressors. The Veteran was “doing well without clear adverse effects from Clonazepam.” During the evaluation, the Veteran reported “mild symptoms,” including breaking out in a sweat, tingling, and mild fearfulness a few times per month. The Veteran admitted that he has gone as long as two to three days without taking his medication occasionally. The Veteran reported that he retired in 2016 from sales. He received income from social security, VA benefits, and a pension. He lived with his wife. He had “many close friends” and long-term friendships. He spent time engaging in “sports and recreation,” to include hunting, fishing, and playing hockey and golf. He had no impairment to his daily living activities. The psychiatrist documented that during the interview the Veteran had a normal appearance, normal movements and gestures, and normal speech. His mood and affect were appropriate. His thought process and content were coherent. He denied suicidal and homicidal ideations. His insight, judgment, and cognition were good. During his May 2017 VA psychiatric evaluation, the Veteran underwent a VA mental health diagnostic study by the same psychiatrist. He used the World Health Organization Disability Assessment Schedule 2.0 (WHO evaluation). The evaluation asks the participant to rate difficulties due to health conditions using: “none, mild, moderate, severe, extreme/cannot do.” The Board observes the psychiatrist provided a general disclaimer, which was, “Information contained in this note is based on a self-report assessment and is not sufficient to use alone for diagnostic purposes. Assessment results should be verified for accuracy and used in conjunction with other diagnostic activities and procedures.” (Emphasis added). The Board is not using the information alone but rather in conjunction with other medical evidence of record, to include multiple mental health evaluations. Accordingly, the information contained within the May 2017 evaluation is capable of being verified and is being used in conjunction with other appropriate evidence. The May 2017 WHO evaluation is lengthy, and the Board will address the most relevant portions of the evaluation. The Veteran reported no difficulties associated with getting along with people close to him or maintaining a friendship, but he did have “severe” difficulty making new friends. He reported “moderate” difficulty concentrating on doing things for 10 minutes, remembering important things, analyzing and finding solutions to problems in day-to-day life, learning a new task, generally understanding what people say, staying by himself for a few days, dealing with unknown people, joining in community activities, and starting and maintaining a conversation. But he reported his difficulties were not present in the past 30 days. The Veteran appeared for follow-up visits with his VA psychiatrist in October 2017 and May 2018. He reported continued sleeping issues. He reported that he generally experienced two to three panic episodes a month and nightmares one to two times a month. He was still physically active, playing golf, hockey, and hunting. Nothing was remarkable about his physical or mental status during either visit. He denied suicidal ideations during each visit. During an October 2018 VA psychiatry visit, the Veteran reported that he was “doing fine.” He experienced two panic attacks over the preceding six months. He continued to have a strong relationship with his wife and continued to play hockey. He had a trip coming up that he looked forward to. Nothing was remarkable about his physical or mental status during either visit. He denied suicidal ideations during each visit. The Veteran visited his VA psychiatrist in July 2019. During the visit, he reported he was “about the same.” He continued to have a good relationship with his wife. He played hockey and golf. He experienced panic attacks and nightmares at “relatively low levels” over the preceding three months. He reported chronic hypervigilance, avoidance of crowds, and “obsessive” attention to where he sits in a restaurant. Nothing was remarkable about his physical or mental status during the visit. He denied suicidal ideations. The Veteran was afforded a VA examination in December 2019. During the examination, he reported his medications helped his panic attacks, and he was able to function. He experienced panic attacks three to four times a month, lasting 10 to 30 minutes. He still experienced sleep disturbances and avoided crowds. He denied suicidal and homicidal ideations. He still experienced anxiety, depression, emotional detachment, and concentration issues. The examiner observed the Veteran’s appearance was normal, and he was cooperative and pleasant. The examiner concluded that the Veteran’s associated symptoms were not severe enough either to interfere with occupational and social functioning or to require continuous medication. In April 2020, the Veteran visited his VA psychiatrist who documented that he was having difficulty with isolation due to Covid-19. He experienced mild panic symptoms a few times a week but was able to “walk it off.” The psychiatrist observed the Veteran had coherent thought processes. He denied suicidal thoughts. Overall, the psychiatrist found the Veteran has some increased dysphoria/anxiety in the context of social restrictions but was managing them adequately. In July 2020, the Veteran submitted correspondence to VA stating he experienced panic attacks more than once a week and depression daily. He stated, “I don’t need effective work or social relationships, I retired because they were failing me.” He continued to have nightmares. He said his short- and long-term memory were deteriorating. To be entitled to a 50 percent disability rating under DC 9411, the Veteran’s symptomatology needs to demonstrate “occupational and social impairment with reduced reliability and productivity.” 38 C.F.R. § 4.130, DC 9411. Diagnostic Code 9411 provides a non-exhaustive list of criteria for the Board to consider, which the Board will consider each in turn. First, the Boards does not find that the Veteran suffered from a flattened affect throughout the appeal period. The evidence does indicate that at some points the Veteran had a restricted affect, but otherwise there were no documented observations by medical professionals that indicated or reasonably suggested the Veteran had a flattened affect. The Veteran indicated that he had a loss of interest in things at various points throughout the appeal period, but the objective and subjective evidence of record does not indicate or reasonably suggest his loss of interest resulted in a flatted affect. Second, the evidence of record does not indicate or reasonably suggest that the Veteran experienced circumstantial, circumlocutory, or stereotyped speech during the appeal period. Rather, the medical professionals documented the Veteran’s speech was generally normal or unremarkable. Third, the evidence of record establishes the Veteran experienced panic attacks throughout the appeal period. The severity and frequency of his panic attacks varied. In particular, the Veteran’s medication helped him control his panic attacks and anxiety. Generally, when assigning a disability rating, the Board may not consider the ameliorative effects of medication where those effects are not explicitly contemplated by the rating criteria. See generally Jones v. Shinseki, 26 Vet. App. 56, 63 (2012). “Thus, if [the applicable DC] does not specifically contemplate the effects of medication, the Board is required pursuant to Jones to discount the ameliorative effects of medication when evaluating [the disability]. Conversely, if [the applicable DC] does specifically contemplate the effects of medication, then Jones is inapplicable.” McCarroll v. McDonald, 28 Vet. App. 267, 271 (2016) (en banc). Diagnostic Code 9411 provides for a noncompensable disability rating when symptoms of a mental disorder do not require continuous medication for control; a 10 percent disability rating when symptoms are controlled by continuous medication; and, by implication, higher disability ratings when psychiatric symptoms of greater severity are not controlled by continuous medication. Therefore, DC 9411 does contemplate the effects of medication. In October 2014, the Veteran reported panic attacks that occurred weekly or less often. In October 2017, he reported experiencing panic attacks two to three times per month. In October 2018, he experienced only two panic attacks over the preceding six months. In July 2019, he experienced panic attacks at “relatively low levels” over the preceding three months. The Board interprets “relatively low levels” to be equivalent to his preceding experiences because his VA psychiatrist did not indicate an increase in the Veteran’s panic attacks. He reported to the December 2019 VA examiner that he experienced panic attacks three to four times per month, lasting 10 to 30 minutes. In April 2020, the Veteran reported he experienced mild panic attacks a few times a week but was able to “walk it off.” The Veteran did not explain the severity of his “mild” attacks, but based on his statement that he was able to “walk it off,” the Board finds his severity and duration of panic attacks were similar to his prior episodes in December 2019. Finally, in his July 2020 correspondence with VA, the Veteran reported panic attacks more than once per week. He did not indicate the severity or duration of these episodes. Notably, the Veteran has been on medication to control his anxiety and panic attacks since 1999 based on the January 2015 correspondence from his private physician, Dr. M.S. She stated that the Veteran’s anxiety and panic attacks have been successfully treated with Klonopin without side effects. She opined that if the Veteran were to stop his medications, then he would regress, “his anxiety and panic attacks would come daily, not monthly.” This implies he generally experienced panic attacks monthly, not daily, while taking his medication. She also explained that his anxiety and panic attacks “could” affect his ability to work and socialize, effect his memory and judgment, and cause mood swings. She acknowledged his condition “is controlled by his medication.” This reasoning implies the Veteran’s proper use of medication prevents such symptoms. The Veteran has acknowledged that his medications helped him control his panic attacks. Specifically, in his July 2015 VA Form 9, he stated, “I believe because of most of those symptoms described in the 50–70 percent range in the rating schedule is what I deal with but are controlled by prescribed medication.” He has occasionally missed taking his medications. However, there is no indication in the record that those times he missed taking his medications resulted in extended periods of increased symptoms. Overall, the Veteran’s panic attacks ranged from once a month to weekly throughout the appeal period. The Board acknowledges that the Veteran has described certain periods where he experienced panic attacks more than once per week, but these panic attacks were isolated in time, that is, they were not constant or continuous. The Board is to analyze the evidence holistically, and when viewing the evidence as a whole, the Veteran’s panic attacks were relatively mild in severity based on his statements and use of medication; occurred, at most, weekly, but were generally monthly; and lasted for relatively short periods of time, 10 to 30 minutes, such that the Veteran was able to “walk it off” most recently. Fourth, the Board does not find that the evidence of record indicates or reasonably suggests that the Veteran experienced difficulty in understanding complex commands. His treating and evaluating medical professionals found no such symptoms and he has not reported such symptoms with any type of specificity. Fifth, while the Veteran has expressed that he suffered from impairment of short- and long-term memory, the Board does not find his statements probative. The Veteran has not offered evidence about the severity of his memory issues. The mere assertion of memory issues, without more, does not provide the Board with evidence to assess his asserted memory impairment. Notably, none of his treating or evaluating medical professionals objectively identified memory issues outside of his assertions. The Board recognizes that during his May 2017 WHO evaluation, the Veteran endorsed “moderate” difficulty concentrating on doing things for 10 minutes, remembering important things, analyzing and finding solutions to problems in day-to-day life, and learning a new task. But he made these assertions without context. Particularly, he endorsed that he had not experienced these symptoms within the preceding 30 days. The Board can find no other evidence where he endorsed these specific symptoms. Instead, the Veteran has only endorsed broad, generalized short- and long-term memory issues without specific examples or context as to severity, frequency, or duration. Therefore, the Board cannot afford his assertions probative value. Nevertheless, providing the Veteran the benefit of the doubt, the Board finds his broad, generalized assertions constitute mild memory impairment, which is consistent with the 30 percent disability rating already assigned. Sixth, the Board finds the evidence of record establishes the Veteran did not suffer from impaired judgment or impaired abstract thinking throughout the appeal period. His treating and evaluating medical professionals found no such symptoms and he has not reported such symptoms with any specificity. Seventh, the Veteran has generally described disturbances of motivation and mood, which included irritability, depression, and anxiety, throughout the appeal period. As to his motivation, the Veteran has not provided particularized evidence about what motivation he lacks or information pertaining to the severity, frequency, or duration of the symptom. Thus, the Board is unable to assess the probative value of his assertions. Instead, the Board finds that he consistently affirmed that he played golf, hockey, and enjoyed nature. In this respect, his motivation was not lacking. As to his mood disturbances, the various medical professionals documented he was always appropriate, cooperative, polite, and able to communicate effectively. Nevertheless, the Board finds the evidence demonstrates his mood was affected by his depression and anxiety. But his depression and anxiety are properly considered as part of his current 30 percent rating, and the Board does not find the evidence indicates or reasonably suggests that these symptoms rise to the level of reduced reliability and productivity as to occupational or social impairment. Eighth, the Veteran has stated that he has several friends, but he did not establish new friends due to “feeling uncomfortable.” He socialized with his friends weekly at hockey and golf league outings. His marriage and home life were good in his view throughout the appeal period. In July 2020, the Veteran asserted he did not need effective work or social relationships due to being retired. The Board interprets this statement as relating to his overall lifestyle, indicating that he does not have occupational relationships because he is retired. The Board finds that the Veteran’s symptomatology does prevent him from establishing new social relationships, primarily because he avoids crowds due to his general anxiety. But the social relationships he has appear well-defined and strong. He has indicated that he engaged in sporting activities on a regular basis when able to do so throughout the appeal period. He has taken at least two trips with his wife and his symptomatology has not otherwise hampered his existing relationships. Considering the Veteran’s other cited symptoms, the Board recognizes the Veteran has previously expressed suicidal ideations as documented by various medical professionals. Importantly, these ideations were not reported in relation to his PTSD symptoms, but rather as part of a fear of terminal illness, should such an event occur. Thus, when speaking of “suicidal ideation,” the Veteran was not speaking of the concept in the terms contemplated by 38 C.F.R. § 4.71a, DC 9411. In fact, he denied suicidal and homicidal ideations with respect to his PTSD many times. The Veteran has also consistently reported chronic sleep impairment due to nightmares, which resulted in reduced sleep, physical sweating and tingling, and reduced energy. The Board finds these symptoms are adequately considered as part of his current 30 percent rating because they reveal occupational and social impairment that would likely result in occasional decreases in work efficiency and intermittent periods of inability to perform occupational tasks. His chronic sleep issues and associated symptoms have not prevented him for participating in daily life, taking care of routing activities, or otherwise interfered with his cognitive processes. Finally, the Board observes the October 2014 VA examiner opined that the Veteran’s symptomatology reflected occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behaviour, self-care, and conversation. And the December 2019 VA examiner opined the Veteran’s associated PTSD symptoms were not severe enough either to interfere with occupational and social functioning or to require continuous medication. The Board finds the October 2014 VA examiner’s opinion generally tracked his symptomatology at that time. Thus, it is afforded fair probative value. But the Board affords the December 2019 VA examiner’s opinion little probative value based on a holistic view of the evidence. Instead, the Board finds the Veteran’s symptomatology at that time more closely resembled occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behaviour, self-care, and conversation. When the evidence is viewed as a whole, the Veteran’s symptomatology associated with his PTSD indicates 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) throughout the appeal period. 38 C.F.R. § 4.71a, DC 9411. This rating properly accounts for the severity, frequency, and duration of the Veteran’s depression, anxiety, panic attacks (weekly or less often), chronic sleep impairment, asserted mild memory loss, hypervigilance, alertness, and associated symptoms. His symptomatology does not more closely indicate occupational and social impairment with reduced reliability and productivity. (CONTINUED ON NEXT PAGE) While VA treatment records show that the Veteran is retired, there is no evidence that he is unemployable due to his service-connected disabilities. As such, the issue of entitlement to a total disability rating based on individual unemployability is not before the Board at this time. T. Matta Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. F. Sawka, 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.