Citation Nr: 21015124 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 20-16 426 DATE: March 16, 2021 ORDER 1. Entitlement to service connection for obstructive sleep apnea, to include as secondary to service-connected posttraumatic stress disorder (PTSD), status post compression fracture of T7 (thoracic spine disability), history of C4 facet fracture (cervical spine disability), and/or traumatic brain injury (TBI), is denied. 2. Entitlement to an initial compensable disability rating for hypertension prior to March 19, 2020, and in excess of 10 percent thereafter is denied. 3. Entitlement to an initial increased rating in excess of 30 percent for posttraumatic stress disorder (PTSD) prior to February 24, 2020, and in excess of 70 percent thereafter is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against a finding that the Veteran’s sleep apnea had its onset in service or is caused or aggravated by the service-connected PTSD, cervical spine disability, thoracic spine disability, and/or TBI. 2. Prior to March 19, 2020, hypertension was not manifested by diastolic pressure predominantly 100 or more, or systolic pressure predominantly 160 or more, and while the Veteran has required continuous medication for control of his symptoms, he does not have a history of diastolic pressure predominantly 100 or more. 3. From March 19, 2020, hypertension has not manifested with diastolic pressure predominantly 110 or more; or, systolic pressure predominantly 200 or more. 4. Prior to February 24, 2020, the PTSD was not manifested by occupational and social impairment with reduced reliability and productivity. 5. From February 24, 2020, the PTSD has not been manifested by total occupational and social impairment. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for sleep apnea, to include as secondary to PTSD, cervical spine disability, thoracic spine disability, and/or TBI, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. 2. The criteria for an initial compensable disability rating for hypertension prior to March 19, 2020, and in excess of 10 percent thereafter have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.31, 4.104, Diagnostic Code (DC) 7101. 3. The criteria for an increased rating in excess of 30 percent for PTSD prior to February 24, 2020, and in excess of 70 percent thereafter have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.126, 4.130, Diagnostic Code (DC) 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the United States Air Force from January 1997 to December 2001. Service Connection 1. Entitlement to service connection for obstructive sleep apnea The Veteran believes his obstructive sleep apnea is due to his service-connected disabilities of status post compression fracture of T7, transverse process fractures of T6 and T8, and thoracic kyphosis (thoracic spine disability); history of C4 facet fracture (cervical spine disability); PTSD (previously rated as anxiety); or residuals of TBI. In a written statement, his wife alleged that right after the accident, the Veteran started snoring and would stop breathing while he was sleeping. Thus, while the Veteran’s main contention was that sleep apnea was secondary to service-connected disabilities, the submission from his wife raises a direct theory of entitlement. Thus, the Board will address both theories of entitlement. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be granted for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). When service connection is established for a secondary disability, the secondary disability shall be considered a part of the original disability. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, each piece of evidence of record. The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, regarding the Veteran’s claim on appeal. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. After having carefully reviewed the evidence of record, the Board finds that the preponderance of the evidence is against entitlement to service connection for sleep apnea, to include as secondary to a service-connected disability or disabilities. The reasons follow. Regarding evidence a current disability, a December 2017 VA examination shows that the Veteran was diagnosed with obstructive sleep apnea. Thus, the facts establish that the first element of a service-connection claim is met. As to evidence of an in-service disease or injury, the service treatment records do not show that the Veteran was diagnosed with sleep apnea while in service, and the Veteran did not contend having sleep apnea in service when he filed his claim for service connection for sleep apnea in November 2017. There, he specifically wrote that he was claiming service connection for sleep apnea as being secondary to his service-connected disabilities of TBI, cervical spine disability, and psychiatric disorder. The evidence shows that while in service, the Veteran was in a roll-over motor vehicle accident in Jamaica in July 2000. He sustained various injuries, such as a cervical spine facet fracture at C4, thoracic compression fracture at T7, and facet and transverse process fractures in the thoracic spine. He was hospitalized on two occasions during service, which was immediately after the accident in July 2000 and again in April 2001, when he underwent a thoracic spine fusion to alleviate his thoracic spine symptoms. The hospital course and summaries did not document that the Veteran exhibited symptoms of sleep apnea during those times, with the latter hospitalization occurring well after the July 2000 accident. This evidence does not lend to a finding that the Veteran had sleep apnea during service. A May 2001 examination shows that the examiner performed a thorough physical examination of the Veteran’s head and neck. The examiner described the oral pharynx as clear with the tongue and palate being midline, and there were no temporomandibular joint syndrome signs. In a June 2001 Post-Deployment Health Assessment, the Veteran was not referred for fatigue, but rather solely for back pain. A July 2001 Medical Board Report listed six diagnoses following the July 2000 accident, which included diagnoses associated with the cervical spine, the thoracic spine, and the right upper extremity. There was no diagnosis related to sleep apnea. In the December 2001 Report of Medical Assessment that the Veteran completed near service discharge, he reported disabilities involving his fractured vertebrae and did not report symptoms of sleep apnea. At this point, the Veteran had undergone multiple examinations following the motor vehicle accident, and there was no diagnosis of sleep apnea, and the Veteran was not reporting symptoms of sleep apnea, while reporting multiple other medical complaints. In a November 2017 statement, the Veteran’s wife, A.N., stated that immediately after his motor vehicle accident in July 2000, she started observing that the Veteran began to snore very loudly. A.N. wrote that the Veteran began snoring so loudly that it would keep her up at night. She described observing the Veteran would stop breathing for a while. Additionally, she stated that it sounded as if he was choking and gasping for air in his sleep. She also stated that the Veteran did not have sleeping problems before the motor vehicle accident. Additionally, A.N. wrote the Veteran was tired during the day and irritable. A January 2004 VA treatment record documented the Veteran reported that his wife related to him that at times, when he was dosing off, that he would have a startled sensation, which sounded like he was short of breath, and his limbs would jump. The VA examiner noted that she asked the patient to follow up with his primary care physician for sleep apnea. At this point, the Veteran had been receiving treatment from VA since November 2002 and regularly sought treatment, where he would report various medical symptoms that he was experiencing at that time, which did not include symptoms indicative of sleep apnea, such as snoring or breathing pauses. Private medical records from July 2002 to February 2003 document complaints surrounding his spine and not snoring or breathing pauses. The private physician consistently performed a review of systems, which included the ear, nose, and throat and respiratory system, which were consistently negative for complaints. In September 2002 and February 2003, the private physician also performed physical examinations of the Veteran’s ear, nose, and throat and respiratory systems, which both revealed negative findings. By October 2004, the Veteran’s wife had recorded a video of the Veteran sleeping, and it was then that the Veteran decided to be evaluated for sleep apnea. A May 2005 private sleep study confirmed the diagnosis of mild to moderate obstructive sleep apnea. The Board finds that the preponderance of the evidence is against a finding that the Veteran’s sleep apnea had its onset in service between January 1997 and December 2001, and, instead, had its onset in approximately January 2004, which was two years following service discharge. The Veteran was seen regularly following the July 2000 motor vehicle accident both in service and following service, and he did not start to discuss sleep apnea symptoms until January 2004. The service treatment records, the post-service private treatment records, and the VA treatment records consistently show the Veteran was capable of identifying, reporting, and seeking treatment for medical problems as necessary, which did not include sleep apnea until more than two years after service. As stated above, he was seen regularly by a private physician from July 2002 to February 2003, where a review of systems involving the ear, nose, and throat and respiratory system were negative, and physical examinations were negative in September 2002 and February 2003. The Board finds that the preponderance of the evidence is against a finding that sleep apnea had its onset in service, and, instead, had its onset after service discharge. The statement from the Veteran’s wife, A.N., does not necessarily attribute the Veteran’s obstructive sleep apnea to service, but rather she describes symptoms she personally heard and witnessed after the July 2000 motor vehicle accident. However, a diagnosis of obstructive sleep apnea requires specialized training for determinations as to diagnosis and causation, and therefore is not susceptible to lay opinions on etiology. Thus, A.N.’s statements are not qualified to competently diagnose a current disability or opine about medical etiology, as she has not been shown to be medically trained. Thus, for all the reasons laid out above, the Board finds the preponderance of the evidence is against a finding that the Veteran had obstructive sleep apnea during service, and the facts do not establish that the second element of a service-connection claim on a direct basis is met. Thus, service connection on a direct basis is not warranted. As to evidence of a nexus between sleep apnea and a service-connected disability or disabilities, the Board finds that the preponderance of the evidence is against a nexus. For example, the Veteran was afforded a VA examination in December 2017. As a part of the examination, the VA examiner conducted an in-person physical examination and reviewed the Veteran’s claims file. She opined that the Veteran’s obstructive sleep apnea was less likely than not proximately due to or the result of a service-connected disability and more likely than not due to the Veteran being overweight and male. The examiner noted that the use of pain medication that the Veteran used for his service-connected disabilities could contribute to central sleep apnea; however, she pointed out that the Veteran did not have central sleep apnea, but obstructive sleep apnea. Furthermore, the examiner stated that the Veteran’s thoracic and cervical spine injuries, such as his thoracic kyphosis or C4 facet fracture, would not affect his airway. Finally, the examiner stated that the Veteran’s residuals of TBI and/or PTSD did not cause obstructive sleep apnea. The Board finds the December 2017 opinion of the VA examiner is the only probative opinion addressing whether the Veteran’s sleep apnea is caused or aggravated by a service-connected disability or disabilities, which medical opinion is evidence against the claim for service connection for sleep apnea as being secondary to a service-connected disability or disabilities. For example, the December 2017 VA examiner found that the Veteran’s sleep apnea was not related to the service-connected disabilities, and she provided a rationale for each service-connected disability, which, based on the wording of her opinion, took into consideration both causation and aggravation. For example, she wrote that the medications the Veteran was taking were not implicated with obstructive sleep apnea versus central sleep apnea. She also explained that the cervical and thoracic parts of the spine would not affect the Veteran’s airway, and that TBI and a psychiatric disorder do not cause obstructive sleep apnea. A single rationale is sufficient because the examiner made clear that the Veteran’s obstructive sleep apnea did not have a relationship with a service-connected disability or disabilities. There is no competent evidence of a positive nexus between the Veteran’s obstructive sleep apnea and a service-connected disability or disabilities to weigh against the VA opinion. The Veteran is competent to state that he experienced trouble sleeping at night while in service. However, to the extent that the Veteran has implied that his obstructive sleep apnea had its onset in service or specifically alleged that it is caused by a service-connected disability or disabilities, he is not competent to make such assertions, as medical expertise is required. In this regard, the question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the Veteran’s opinion is nonprobative evidence. The Veteran submitted “Traumatic Brain Injury and Sleep Disorders” by Mari Viola-Saltzman, D.O. and Nathaniel F. Watson, M.D., M.Sc., as well as articles from the Mayo Clinic and MedlinePlus, which latter articles addressed central sleep apnea that described symptoms, causes, risk factors, and complications. These articles do not establish a nexus between the Veteran’s obstructive sleep apnea and service or a service-connected disability or disabilities. In other words, these articles are not specific to the Veteran to establish that his sleep apnea is related to service or a service-connected disability or disabilities. For all the reasons laid out above, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for obstructive sleep apnea, to include as secondary to the service-connected PTSD, thoracic spine disability, cervical spine disability, and/or TBI. Thus, as the preponderance of the evidence is against the claim, there is no reasonable doubt to be resolved, and the claim is denied. 38 U.S.C. § 5107(b). Increased Ratings 2. Entitlement to an initial compensable disability rating prior to March 19, 2020 for hypertension, and in excess of 10 percent thereafter The Veteran asserts that the service-connected hypertension warrants higher ratings than current assigned. Disability evaluations are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. The Veteran’s hypertension is currently rated under DC 7101, which provides ratings for hypertension and isolated systolic hypertension. A 10 percent disability rating is warranted for hypertensive vascular disease with diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; the minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. A 20 percent disability rating is warranted for hypertensive vascular disease with diastolic pressure predominantly 110 or more; or, systolic pressure predominantly 200 or more. A 40 percent disability rating is warranted for hypertensive vascular disease with diastolic pressure predominantly 120 or more. A 60 percent disability rating is warranted for hypertensive vascular disease with diastolic pressure predominantly 130 or more. 38 C.F.R. § 4.104, DC 7101. In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. A. Prior to March 19, 2020 In a June 2011 Statement in Support of Claim, the Veteran stated that he was told by several doctors that his high blood pressure is due to the high pain that he is in after his in-service accident. He stated that he has to take high blood pressure medication daily due to how high his blood pressure is. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the award of an initial compensable disability rating for hypertension prior to March 19, 2020. The reasons follow. In January 2010, the Veteran was provided a VA examination. The examiner noted that the Veteran was currently taking medication for his high blood pressure. At the examination, the Veteran’s three blood pressure readings were 126/86, 134/93, and 131/96. Additionally, the examiner stated that the Veteran’s essential hypertension had not caused hypertensive heart disease and there is no effect on his usual occupation. The Veteran was afforded another VA hypertension examination in April 2017. At that time, the examiner noted that the Veteran was taking continuous medication for his hypertension. Upon examination, the Veteran’s three blood pressure readings were as follows: 124/73, 125/70, and 123/74. The examiner further noted that the Veteran did not have a history of a diastolic blood pressure elevation to predominantly 100 or more. There were no other pertinent physical findings, complications, conditions, signs, or symptoms related to the Veteran’s hypertension. Furthermore, the examiner noted that the Veteran’s hypertension did not result in functional impact on his ability to work. A review of VA treatment and private treatment records documents the following blood pressure readings during the appeal period: 126/86 (January 2010), 107/67 (April 2010), 140/90 (May 2011), 140/80 (January 2012), 127/89 (November 2012), 129/89 (August 2013), 138/82 (August 2015), 168/111 (February 2016), 146/100 (February 2016), 127/77 (February 2016), 117/80 (November 2016), 130/88 (February 2016), 121/86 (May 2017), 135/85 (July 2017), and 113/76 (October 2017). While this is some of the blood pressure readings documented in the VA treatment records, there are more blood pressure readings going back to soon after the Veteran was discharged from service. The Board finds that the preponderance of the evidence is against a finding that hypertension manifested with diastolic pressure predominantly 100 or more, or systolic pressure predominantly 160 or more, and that the Veteran is not an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control of his symptoms. While the record clearly shows that the Veteran has been required to take prescription medication to treat his hypertension, the preponderance of the evidence is against a finding that his systolic blood pressure had been predominantly 160 or more and/or his diastolic blood pressure had been predominantly 100 or more prior to March 19, 2020. There were two instances of when the Veteran had elevated diastolic blood pressure readings in October 2004 and February 2007, and it was specifically documented that the Veteran had not taken his hypertension mediation that morning. Regardless, even accepting these blood pressure readings, the preponderance of the evidence is against a finding that prior to March 19, 2020, the Veteran’s diastolic pressure was predominantly 100 or more or the systolic pressure was predominantly 160 or more or that the Veteran had a history of diastolic pressures predominantly 100 or more prior to going on medication to warrant a compensable rating. The Board is mindful that it may not deny entitlement to a higher rating on the basis of relief provided by medication when those effects are not specifically contemplated by the rating criteria. See Jones v. Shinseki, 26 Vet. App. 56, 62-63 (2012). However, VA has specifically contemplated the effects of medication as a factor to be considered when rating hypertension under DC 7101. Thus, any ameliorative effects of the Veteran’s blood pressure medication were not discounted in arriving at this decision. See McCarroll v. McDonald, 28 Vet. App. 267, 271-73 (2016) (holding that Jones does not apply to DC 7101). Therefore, while the Veteran is on continuous medication to control his hypertension, the clinical evidence fails to support diastolic blood pressure of predominantly 100 or higher during the appeal period, and, as such, a compensable disability rating is not warranted under DC 7101. The Veteran’s attorney argued that the Veteran is entitled to a higher disability rating because February 2016 emergency room records showed that the Veteran’s blood pressure “can reach as high as 200/110 during a panic attack.” While the record shows the Veteran had a systolic blood pressure reading over 160 in February 2016, the evidence shows that the Veteran’s systolic blood pressure was predominately under 160 and his diastolic blood pressure was predominately under 100, which would not establish that the Veteran’s blood pressures would warrant a compensable rating. The Veteran is competent to report observable symptomatology, To the extent that his lay statements assert that his hypertension has manifested to a compensable degree, the Board finds that the objective evidence as documented within VA treatment records throughout the appeal period and the January 2010 and April 2017 VA examinations to be more probative in that regard. In conclusion, the preponderance of evidence weighs against the Veteran’s claim of entitlement to an initial compensable disability rating for hypertension prior to March 19, 2020. As the preponderance of the evidence is against the claim, there is no reasonable doubt to be resolved, and the claim for increase for this part of the appeal period is denied. B. From March 19, 2020 The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the award of a disability rating in excess of 10 percent for hypertension from March 19, 2020. The reasons follow. During his March 2020 VA examination, the Veteran reported that his blood pressure will increase with his panic attacks that he has three to four times daily. He also stated that he has chronic pain that increases his blood pressure. The VA examiner diagnosed hypertension, which currently required daily medication for control. His three recorded blood pressure readings upon examination were as follows: 146/100, 142/110, and 144/104, for an average of 144/104. The examiner indicated that there were no other pertinent findings regarding the Veteran’s hypertension, which did not result in functional impact upon the Veteran’s ability to work. This is evidence against a finding that the Veteran’s diastolic pressure is at predominantly 110 or higher. Therefore, the facts do not establish entitlement to a disability rating in excess of 10 percent from March 19, 2020. In conclusion, the preponderance of evidence weighs against the Veteran’s claim of entitlement to a disability rating in excess of 10 percent for hypertension from March 19, 2020. As the preponderance of the evidence is against the claim, there is no reasonable doubt to be resolved, and the claim for increase for this part of the appeal period is denied. 3. Entitlement to an initial rating in excess of 30 percent for PTSD prior to February 24, 2020, and in excess of 70 percent thereafter Disability evaluations are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects the Veteran’s ability to function under the ordinary conditions of daily life, including employment, by comparing the Veteran’s symptomatology with the criteria set forth in the Schedule for Rating Disabilities. 38 C.F.R. Part 4. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. A 30 percent rating is assigned for PTSD manifested by occupational and social impairment with an occasional decrease in work efficiency and intermittent periods of an 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, and mild memory loss (such as forgetting names, directions, recent events). A 50 percent rating is assigned for PTSD manifested by 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, and difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is assigned for PTSD manifested by 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 work-like setting), or an inability to establish and maintain effective relationships. A 100 percent rating is assigned for PTSD manifested by total occupational and social impairment due to such symptoms as gross impairment in thought process 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, and memory loss for names of close relatives, own occupation, or own name. A. Prior to February 24, 2020 The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the award of an initial increased rating in excess of 30 percent for PTSD prior to February 24, 2020. The reasons follow. In the February 2010 VA examination report, when asked which of the following best summarized the Veteran’s level of occupational and social impairment, the psychologist checked 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 behavior, self-care, and conversation, which is the criteria that falls under the 30 percent rating. While the adjudicator makes the determination of what evaluation is warranted for the service-connected PTSD, the examiner’s conclusion that the Veteran’s psychiatric disorder was summarized best by the criteria described under the 30 percent evaluation is evidence against a finding that the Veteran’s psychiatric disorder caused occupational and social impairment with reduced reliability and productivity to warrant a 50 percent rating. In the VA treatment records during this part of the appeal period and at the February 2010 VA examination, the Veteran regularly referred to his relationship with his wife as “good” or “great.” Additionally, he reported that he had a good relationship with his daughter. The Veteran has been married to his wife since 1996. He has also worked at the same place since at least 2002, and the Veteran has not reported difficulty with getting along with co-workers. The fact he has a long-term relationship with his wife, a good relationship with his daughter, and has been working at the same place since 2002 weighs against a finding of difficulty in establishing and maintaining effective work and social relationships and does not support a finding of this level of social impairment. In a November 2018 statement, the Veteran’s coworker, R.M., stated that he witnessed the Veteran have angry outbursts on several occasions and become angered with people not doing their part on the job. Furthermore, R.M. stated that the Veteran is anxious, irritable, and moody most mornings. The Board finds this as evidence of the Veteran’s depressed mood, anxiety, and suspiciousness, which are symptoms contemplated at the 30 percent disability rating. Additionally, the Veteran has been employed at the same place since at least 2002, which is more than 15 years and shows a level of responsibility that is against a finding of occupational impairment that causes reduced reliability and productivity. In a June 2020 submission, the Veteran’s attorney wrote that VA medical treatment records show that the family described the Veteran has “detached, numb, difficult to get along with, easily startled, unable to enjoy activities, mood swings, forgetful, and having poor concentration.” Symptoms such as depressed mood, anxiety, suspiciousness, and mild memory loss are contemplated under the 30 percent disability rating. The contemporaneous VA treatment records during this part of the appeal consistently documented that the Veteran was working full time at the same place he has worked since 2002. This is evidence against PTSD symptoms causing a level of occupational impairment that results in reduced reliability and productivity. In March 2016 and November 2016 VA medical treatment records, the Veteran reported numerous panic attacks. However, the Veteran’s concurrent VA treatment records both prior to and subsequent to these visits do not support a finding that the Veteran has panic attacks more than once a week. Panic attacks are contemplated by the 30 percent disability rating, and the Veteran’s panic attacks are not shown to occur more than once a week. Accordingly, the Board finds the preponderance of the evidence shows that the Veteran’s panic attacks are weekly or less often. Furthermore, VA treatment records show that medical professionals consistently documented that the Veteran has had appropriate speech, has been well oriented, and has demonstrated normal judgment, thinking and mood. See February 2010 VA examination, September 2011 VA mental health note, July 2013 VA MH progress note, August 2015 VA MH progress note, November 2016 VA mental health (MH) progress note, September 2017 VA MH progress note, and October 2017 VA primary care outpatient note. Such findings and symptoms weigh against a finding of circumstantial, circumlocutory, or stereotyped speech, difficulty in understanding complex commands, impaired judgment, impaired abstract thinking, disturbances of motivation and mood, which are some of the symptoms that would demonstrate that the Veteran’s disability picture warranted a 50 percent rating for this part of the appeal period. As the Veteran’s PTSD symptoms do not meet the rating criteria for an increased 50 percent disability rating, it follows that his service-connected PTSD symptoms also do not meet the more severe rating criteria for an increased 70 or 100 percent disability rating. Significantly, he has not shown the required severity of occupational and social impairment necessary for an increased 50, 70, or 100 percent disability rating during the rating period, and his symptoms, as a whole, are not of similar severity, frequency, and duration as those particular symptoms associated with a 50, 70, or 100 percent disability rating. In sum, the preponderance of the evidence is against a disability rating in excess of 30 percent for PTSD prior to February 24, 2020 is warranted. As the preponderance of the evidence is against the claim for a higher rating, the benefit of the doubt doctrine is not for application, and the Veteran’s claim for an increased rating for this part of the appeal period is denied. B. From February 24, 2020 The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the award of an initial rating in excess of 70 percent for PTSD from February 24, 2020. The reasons follow. The preponderance of the evidence is against a finding that the Veteran’s PTSD results in total occupational and social impairment, to warrant a 100 percent rating. For example, in the Veteran’s VA examination, he refers to his relationship with his wife of 23 years as good. Furthermore, the Veteran has been employed at the same place for more than 17 years. The fact the Veteran has a long-term marriage, a positive relationship with his daughter, and long-term employment is affirmative evidence against a finding of total social and total occupational impairment. Both social and occupational impairment must be total, and the Veteran does not have such level of social and occupational impairment. Additionally, during this part of the appeal period, the Veteran has been shown to have appropriate dress, speech, thought processes, judgment and insight, without delusion and without homicidal ideation. Accordingly, the preponderance of the evidence is against a finding that the Veteran’s PTSD is manifested by gross impairment in thought process 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, and memory loss for names of close relatives, own occupation, or own name, or symptoms of similar severity, which are symptoms that demonstrate the criteria for a 100 percent rating. In sum, the preponderance of the evidence is against a disability rating in excess of 70 percent for PTSD from February 24, 2020. As the preponderance of the evidence is against the claim for a higher rating, the benefit of the doubt doctrine is not for application, and the Veteran’s claim for an increased rating for this part of the appeal period is denied. A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Griffin, 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.