Citation Nr: 21023873 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 16-32 006 DATE: April 21, 2021 ORDER Entitlement to an initial disability rating of 50 percent, but no higher, for posttraumatic stress disorder (PTSD) is granted. FINDING OF FACT The Veteran’s PTSD manifested in occupational and social impairment with reduced reliability and productivity. CONCLUSION OF LAW The criteria for entitlement to an initial disability rating of 50 percent, but no higher, for PTSD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 2003 to November 2006, to include service in Iraq and Afghanistan. He was awarded the Purple Heart Medal and Combat Action Badge, among other decorations. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2015 rating decision by a Department of Veterans Affairs (VA) regional office. In April 2019, the Veteran testified before the undersigned Veterans Law Judge. Disability ratings 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 (Rating Schedule). See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Different ratings may be assigned for different periods of time for the same disorder if the facts show distinct time periods with different levels of disability. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. See 38 C.F.R. § 4.3. The Veteran’s PTSD is currently evaluated as 30 percent disabling under Diagnostic Code 9411, which assigns ratings based upon the General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130. A 30 percent rating is warranted when there is 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, weekly or less often panic attacks, chronic sleep impairment, and mild memory loss, such as forgetting names, directions, recent events. Id. A 50 percent rating is warranted when there is 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 such as, 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. Id. A 70 percent rating is warranted when there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to 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, or 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; and the inability to establish and maintain effective relationships. Id. A maximum 100 percent rating is warranted when there is 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 and place; memory loss for names of close relatives, own occupation, or own name. Id. The symptoms listed in the General Rating Formula for Mental Disorders are not intended to constitute an exhaustive list. Rather, the symptoms serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436 (2002). The Veteran first underwent VA examination in connection with his claim in August 2015. He reported that he enjoyed his four children and felt that he was a good father, and that he got along well with his long-term girlfriend. He indicated that he worked full-time at a distribution center for a national drugstore chain. He reported that he enjoyed work and believed himself to be a hard worker with a good work ethic. He stated that he was a homebody but had four good friends that he enjoyed spending time with. The Veteran also reported that he felt jumpy around people, and that this was embarrassing to him. He further stated that any time he saw something on the side of the road while driving, he thought about improvised explosive devices. Loud sounds, or sounds that reminded him of missiles, bothered him. He reported that he slept well and had fewer nightmares than he used to, but that he still had daytime flashbacks. The Veteran denied experiencing hallucinations or delusions, and said that he did not feel depressed. The examiner noted that the Veteran’s short-term memory and attention were grossly intact, but that he experienced symptoms of anxiety and difficulty in establishing and maintaining effective work and social relationships. The Veteran also experienced PTSD symptoms including dissociative reactions, persistent avoidance of stimuli associated with his trauma, negative alterations in cognition and mood associated with his trauma, irritable behavior, angry outbursts, hypervigilance, exaggerated startle response, and problems with concentration. The examiner opined that the Veteran’s PTSD manifested in 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. The Veteran again underwent VA examination in May 2016. He noted ongoing anxiety with occasional panic attacks, mostly triggered by intruding thoughts of past experiences. He reported no ongoing depression and stated that he generally slept well. The Veteran further indicated that was generally able to stay on task at work and concentrate well, but that he was sometimes distracted by sounds. He stated that his flashbacks and nightmares had increased since the previous examination. The examiner noted symptoms including anxiety, panic attacks, and difficulty adapting to stressful circumstances. The Veteran’s memory was generally intact, and he reported no suicidal or homicidal ideation. The examiner ultimately opined that the Veteran’s PTSD manifested in occupational and social impairment with an occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. In March 2019, the Veteran’s treating clinician, Dr. N.L, reported that, at the onset of therapy, the Veteran reported high levels of PTSD symptoms. Specifically, Dr. N.L. noted that the Veteran reported reexperiencing, such as intrusive thoughts and feeling as if the trauma were happening again. The Veteran also had a tendency to self-blame and to avoid difficult thoughts and emotions through numbing, detachment, and unhealthy coping strategies. He also experienced hyperarousal in response to cues from the environment. The Veteran most recently underwent VA examination in November 2019. He reported that he enjoyed spending time with his family, but that he had to ask his children to avoid certain activities, such as snapping or clapping, because the sounds really disturbed him. He was unable to tolerate any loud noises, including fireworks. He reported that he still enjoyed work, but that he could get distracted or irritated by noises such as pallets dropping or someone whistling, which occurred frequently. The examiner noted symptoms including anxiety and difficulty in establishing and maintaining effective relationships, and opined that the Veteran’s PTSD manifested in occupational and social impairment with an occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. Treatment records and lay statements throughout the period on appeal are generally consistent with the examination reports described above, although the Veteran has consistently reported that he believes he tries to minimize his symptoms when undergoing examination as an effort to avoid reexperiencing his trauma. In his February 2016 notice of disagreement, the Veteran indicated that he noticed more frequent nightmares as well as a deterioration of the quality of his interactions with family and friends, a reduced attention span at work, and hypervigilance while in public. In his July 2016 VA Form 9, he reported that he suffered greatly and regressed regularly. During the April 2019 hearing, the Veteran elaborated on the extent to which loud noises bothered him, and reported that he sometimes experienced sudden flashbacks and felt that he was under attack. He indicated that he would sometimes shake his head quickly or mutter to himself when experiencing these symptoms, or chew on his hand to cope with anxiety. Upon review, the Board finds that a 50 percent rating is warranted throughout the period on appeal. In that regard, the Board finds the severity, frequency, and duration of the Veteran’s unlisted symptoms more closely approximate the symptoms contemplated by a 50 percent rating, which are more severe, more frequent, and longer in duration than those contemplated by a 30 percent rating. See 38 C.F.R. § 4.126. The evidence demonstrates that the Veteran experienced occupational and social impairment with reduced reliability and productivity. VA examinations, treatment records, and the other evidence of record indicate that the Veteran had symptoms such as anxiety, difficulty in establishing and maintaining effective work and social relationships, impaired concentration, hypervigilance and hyperarousal, and infrequent panic attacks. The Board finds that these symptoms and their severity, frequency, and duration most closely align with the criteria for a 50 percent rating. While the Veteran did experience some symptoms contemplated by a 70 percent rating, including difficulty in adapting to stressful circumstances and impaired impulse control, the evidence overall does not demonstrate the level of impairment associated with a 70 percent rating. As noted above, the Veteran’s other remaining symptoms were either contemplated by or more consistent with a 50 percent rating. Further, while difficulty in adapting to stressful circumstances was noted, the Veteran reported enjoying work, believing he was a hard worker with a good work ethic, and working in the same position throughout the period on appeal. Similarly, while the Veteran demonstrated impaired impulse control and irritability, he reported that he was typically able to get along well with others. Accordingly, the Board finds that a 50 percent rating, but no higher, is warranted throughout the period on appeal and, to that extent, the claim is granted. Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. D. Bruce, 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.