Citation Nr: 21022217 Decision Date: 04/15/21 Archive Date: 04/15/21 DOCKET NO. 17-41 138 DATE: April 15, 2021 ORDER A 50 percent rating, but no more, for cognitive disorder, not otherwise specified (NOS), post-concussion syndrome is granted, subject to the payment of monetary benefits. FINDINGS OF FACT 1. The Veteran had National Guard service from May 1997 to July 2005, with active service from June to August 1997, June to August 1999, and October 2001 to October 2002. 2. A cognitive disorder has been manifested by subjective complaints of depression, anxiety, and impairment of memory; objective findings include impairment of memory, coherent speech, and no evidence of suicidal/homicidal ideation, among others. CONCLUSION OF LAW The criteria for a 50 percent rating, but no more, for cognitive disorder, NOS, post-concussion syndrome have been met. 38 U.S.C. §§ 1110, 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.130, Diagnostic Codes (DCs) 9399-9304 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran testified before the undersigned Veterans Law Judge in November 2019. A copy of the transcript has been associated with the claims file. Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. §§ 4.1. Separate diagnostic codes identify the various disabilities. The Veteran has been rated at 10 percent under DCs 9399-9304. Under the relevant diagnostic codes, a 30 percent rating is warranted when the objective medical evidence shows 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). Under DC 9434, 50 percent rating will be warranted when the objective medical evidence shows 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. A 70 percent rating is warranted when the objective medical evidence shows 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. Turning to the medical evidence, in a January 2011 VA examination, the Veteran reported difficulties with memory and concentration. Specifically, he explained that he would misplace objects, forget names and recent events, and forget why he walked into a room; however, he denied depression, anxiety, or irritability. Upon examination, the examiner noted that while the Veteran’s memory problems were mild, they appeared to have interfered with his work to the extent that he had to put in extra effort to perform at the high level in which he currently performed. Further, behavior was appropriate, and speech was clear, coherent, and goal directed. In addition, there was no evidence of psychotic symptoms such as hallucinations or suicidal/homicidal ideation. While concentration and short term memory were grossly intact, he struggled with recalling numbers backwards and had difficult with word recall. Insight and judgment were also adequate. Further, in a June 2013 VA examination, the Veteran denied any current problems at work except for some efficiency problems with work due to concentration. In a March 2015 VA examination, the Veteran reported no problems in his marriage and stated that he had good relationships with his family and friends. While he denied difficulties at work, he explained that he was currently in a Master’s program and had to study twice as long to learn the material. Further, he stated that although his concentration was intact, he would frequently forget names and why he was going somewhere. He did not report suicidal or homicidal ideation. Upon examination, he was cooperative, and no impairments were noted to perception or thought content. There was also no suicidal or homicidal ideation. In a November 2020 VA examination, the Veteran reported difficulties with concentration and being easily distracted. He explained that he occasionally repeated conversations because he had forgotten them. He also stated that he would forget events, objects, and why he went somewhere. He complained of feeling anxious and depressed at night due to an inability to trust his own mind and feeling overwhelmed in social situations. Upon examination, he was alert and oriented and speech was normal. Further, there was no suicidal/homicidal ideation. As to the lay evidence, at the hearing, the Veteran testified that he experienced panic attacks and feelings of depression and anxiety. He also explained that he used his apple watch for reminders due to impairments in memory. Further, the Veteran, who worked as a teacher, submitted an October 2019 statement from his supervisor. His supervisor explained that the Veteran had to be reminded to complete and submit assignments. He also stated that the Veteran repeated conversations and would forget what he was talking about mid-conversation. He also reported that the Veteran would show up in his office and forget why he was there. In addition, in a November 2019 statement, the Veterans wife explained that he had long and short term memory issues. Specifically, he did not remember names of people he went to high school with or names of his students or friends. She stated that they had an automatic lock on the front door because he would forget to lock the door. She also explained that he would leave cabinets and car doors open, forget to wash dishes, and leave food out. Further, she stated that all of their bills were on autopay, that he would misplace things, and would walk into a room and forget why he was there. Based on the above, the evidence supports a 50 percent rating, but no more, for a cognitive disorder. In this regard, the evidence showed that the Veteran’s depression, anxiety, and impairment of memory affected social and occupational functioning. Specifically, he would forget to complete tasks at work and at home which in turn would cause him to feel depressed, anxious, and overwhelmed. However, the evidence does not support a rating in excess of 70 percent, as the evidence does not show that the Veteran engaged in obsessional rituals, experience near continuous panic or depression, had impaired impulse control, or neglected personal hygiene. Therefore, the evidence supports a 50 percent rating, but no more, for a cognitive disorder. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28. Vet. App. 366, 369-370 (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Ragofsky, Attorney Advisor 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.