Citation Nr: 21024824 Decision Date: 04/26/21 Archive Date: 04/26/21 DOCKET NO. 13-05 530 DATE: April 26, 2021 ORDER A rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is denied. FINDINGS OF FACT 1. The Veteran had active duty from June 1969 to January 1978, with additional service in the Army Reserve. 2. For the entire period on appeal, PTSD has been manifested by, among other things, subjective complaints of depression, anxiety, irritability, and sleep impairment; objective findings include orientation to person, place, and time, normal speech, and no impairment in thought process or communication. CONCLUSION OF LAW The criteria for a rating in excess of 50 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5103(a), 5013A, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.130, Diagnostic Code (DC) 9411 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSION In June 2016, the Board remanded the issue for a hearing, which the Veteran subsequently withdrew in December 2016. Most recently, in October 2019, the Board granted a 50 percent rating and remanded to consider whether a higher rating was warranted. The appeal is again before the Board for adjudication. Turning to the relevant laws and regulations, 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. Acquired psychiatric disorders, including PTSD, are evaluated under a General Rating Formula for Mental Disorders (General Rating Formula). Under the General Rating Formula, a 70 percent rating is warranted for occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, 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 an 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 an inability to establish and maintain effective relationships. The symptoms listed under the rating criteria are meant to be examples of symptoms that would warrant the rating, but they are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Turning to the medical evidence, during a February 2012 VA examination, the Veteran was found to not have near continuous panic or depression affecting the ability to function independently, appropriately, and effectively; nor was he found to be exhibiting intermittently illogical, obscure, or irrelevant speech. The examiner found that he was not experiencing obsessional rituals which interfered with his routine activities, spatial disorientation, neglect of personal appearance or hygiene, or an inability to establish and maintain effective relationships. Moreover, the February 2012 VA examiner found that the Veteran did not have impaired impulse control, such as unprovoked irritability with periods of violence. Nor did the VA examiner find that he exhibited symptoms of difficulty in adapting to stressful circumstances, including work or a work-like setting. And he denied experiencing any present suicidal ideation, though had experienced it on a passive basis at various points in the past. Similarly, during an October 2013 VA examination, the Veteran reported worry or anxiety that was difficult to control, such as restlessness, avoidance of crowds, complaints of panic attacks about twice monthly, feeling overwhelmed and with a sense of doom or dread, and a depressed mood and frustration coupled with anger outbursts. He also reported difficulty sleeping with occasional nightmares of combat events, significant weight loss related to diminished appetite, and moderate anhedonia with distrust of others and a loss of interest in recreational pursuits beyond watching television. The October 2013 VA examiner found that the Veteran’s occupational and social impairment was best described as due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or which was otherwise controlled by medication. The examiner found that the Veteran experienced symptoms that included depressed mood, anxiety, suspiciousness, chronic sleep impairment, difficulty establishing and maintaining effective work and social relationships, but not panic attacks that occur weekly or less often. In addition, he was on time for his appointment and was neatly groomed and seasonally and casually dressed. The October 2013 VA examiner also found that the Veteran was alert and well oriented to person, place, time, and circumstances. Speech pace, intensity, and amplitude were within normal limits, with no evidence of expressive or receptive articulation dysfluencies. The examiner found no obvious impairment in thought process or communication, as the Veteran’s stream of thought was linear and persistent, and his thoughts were logical and goal directed. For example, he denied suicidal or homicidal ideation, understood the consequences of his behavior, could interpret simple proverbs adequately, and had intact attention and concentration. He also was not found to have, and denied experiencing, symptoms of mania, hypomania, or hallucinations. During a December 2019 VA examination, the Veteran reported being constantly vigilant, always watching the environment around him, and being startled by certain noises that sound like the rocket and bomb attacks he experienced while serving in Vietnam. He reported nightmares related to service, as well as feeling numb and regressing if he stopped attending AA meetings or group therapy for PTSD. He reported generally good health, no suicidal or homicidal ideation, and daily attendance at AA meetings, with weekly attendance at PTSD group therapy but reported severe PTSD symptoms. The December 2019 VA examiner found that the Veteran had symptoms of depressed mood, anxiety, chronic sleep impairment, mild memory loss, disturbed motivation, difficulty establishing and maintaining effective work and social relationships and adapting to stressful circumstances, and that he was experiencing panic attacks occurring weekly or less than weekly. After a mental status examination, the examiner found that the Veteran was alert and oriented, and he was cooperative. He also demonstrated normal speech, appropriate eye contact, and good grooming and hygiene. In addition, he denied and was not found to have symptoms of hallucinations, delusions, or hypomanic or manic episodes, and he can independently manage his activities of daily living. These symptoms and findings from the examinations during the appeal period are most consistent with a 50 percent rating. Significantly, the VA examinations show no suicidal ideation, illogical obscure or irrelevant speech, obsession rituals interfering with routine activities, or periods of violence; nor did the examiners find objective evidence of spatial disorientation, neglect of personal appearance or hygiene, or evidence of near continuous panic or depression affecting his ability to function independently, appropriately, and effectively. Though the Veteran demonstrated some difficulty in adapting to stressful circumstances and establishing and maintaining effective relationships, his symptoms were not so severe as to create an inability to do so. Throughout the period on appeal, the clinical records also show that the Veteran’s symptoms of an acquired psychiatric disorder and the related medical findings are consistent with the above PTSD diagnosis and symptomatology. To that end, VA treatment records show continued care and treatment for symptoms of depression, irritable mood, sleep impairment, anxiety, flashbacks, nightmares, and hypervigilance. Despite ongoing symptoms, the medical evidence does not support a rating in excess of 50 percent. The Board has considered the Veteran’s lay statements regarding the etiology and current severity of the disorders addressed above. He is competent to report symptoms and describe his observations because this requires only personal knowledge as it comes to him through his senses. However, he is not competent to offer opinions as to the etiology or identify a specific level of disability according to the appropriate diagnostic codes of any current disorder due to the medical complexity of the matters involved. Such competent evidence has been provided by the medical personnel who have examined the Veteran during his current appeal and who have rendered pertinent medical opinions in conjunction with the evaluations. The medical findings (as provided in the medical examinations and treatment notes) directly address the criteria under which his disability is evaluated. Moreover, as the clinicians have the requisite medical expertise to render medical opinions regarding the degree of impairment caused by the disability and had sufficient facts and data on which to base the conclusions, the Board affords the medical opinions great probative value. As such, these records are more probative than the lay statements that have been submitted. Based on the above, a rating in excess of 50 percent for PTSD is not warranted and the appeal is denied. Consideration has been given to assigning staged ratings for the disability discussed above. However, at no time during the period in question has the disability in question warranted a higher schedular rating than that assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007). 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 (2017) (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 Associate Counsel Edward P. Vrtis 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.