Citation Nr: 21025775 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 09-26 311 DATE: April 29, 2021 ORDER Entitlement to an initial 50 percent disability rating for posttraumatic stress disorder (PTSD) is granted. Beginning January 04, 2013, a 70 percent rating for PTSD is granted. FINDINGS OF FACT 1. The probative evidence of record reflected that the Veteran’s PTSD symptoms more nearly approximated occupational and social impairment with reduced reliability and productivity and did not cause occupational and social impairment in most areas. 2. Beginning January 04, 2013, the probative evidence of record reflects that the Veteran’s PTSD symptoms more nearly approximate occupational and social impairment with deficiencies in most areas and do not cause total occupational and social impairment. CONCLUSIONS OF LAW 1. The criteria for an initial 50 percent rating for PTSD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.125, 4.130, 4.126, Diagnostic Code 9411. 2. Beginning January 04, 2013, the criteria for the 70 percent rating for PTSD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.125, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1982 to December 2006. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2007 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran’s PTSD was originally rated as primary insomnia with adjustment disorder. The initial rating assigned to this disability was noncompensable, but a June 2009 rating decision increased the evaluation to 30 percent disabling, effective January 1, 2007. In the November 2007 rating decision, the Veteran was granted service connection for primary insomnia with adjustment disorder at a noncompensable disability, effective January 01, 2007. A rating of June 2009 increased the Veteran’s primary insomnia with adjustment disorder to 30 percent disabling, effective January 01, 2007. In a rating decision of June 2020, the RO increased the Veteran’s PTSD (previously primary insomnia with adjustment disorder), from 30 percent disabling, to 70 percent, effective January 15, 2020. In August 2010, the Veteran testified before a decision review officer (DRO). In May 2016, he testified at a Board hearing before a Veterans Law Judge (VLJ). Transcripts of both hearings are of record. As the VLJ who presided over the May 2016 hearing is no longer at the Board, the Veteran in November 2020 correspondence was afforded an opportunity for another hearing before a different VLJ. The Veteran did not reply within the allotted time frame. Therefore, the Board will proceed with adjudication of the above-said issues. The issue was before the Board in September 2016, September 2017, and January 2019. The September 2017 Board decision denied the Veteran’s claim for a higher than 30 percent rating for his PTSD. The Veteran appealed the denial to the U. S. Court of Appeals for Veterans Claims (Court). In a May 2018 Order, the Court granted the parties’ Joint Motion for Remand (JMR), vacated the Board’s denial, and remanded the matter to the Board for development consistent with the JMR. In September 2016 and September 2017, the Board remanded the issue. In the September 2017 remand, the Board mandated that the RO procure any outstanding treatment records and provide the Veteran with a VA examination to determine the severity of his PTSD. The February 2020 and September 2020 VA examinations addressed the current severity of the Veteran’s PTSD. Additional records were obtained. There was substantial compliance with the Board’s remand directives. 1. Entitlement to an initial 50 percent disability rating for posttraumatic stress disorder (PTSD) is granted. 2. Beginning January 04, 2013, a 70 percent rating for PTSD is granted. Disability ratings are determined by applying the criteria established in VA’s Schedule for Rating Disabilities, based on the average impairment of earning capacity. Individual disabilities are assigned separate Diagnostic Codes. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.20. Where there is a question as to which of two evaluations shall be applied under a particular diagnostic code, the higher evaluation is assigned if the disability more nearly approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the claimant. 38 C.F.R. § 4.3. Staged ratings are appropriate for an increased rating claim when the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007) (citing Fenderson v. West, 12 Vet. App. 119, 126 (1999)). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a competent source. Second, the Board must determine if the evidence is credible. Barr v. Nicholson, 21 Vet. App. 303 (2007). Third, the Board must weigh the probative value of the evidence considering the entirety of the record. Initially, the Veteran’s PTSD was rated at 30 percent from January 01, 2007, and as of January 15, 2020, 70 percent disability rating under Diagnostic Code 9411. 38 C.F.R. § 4.130. The Veteran contends that a higher initial rating than 30 percent and a higher than 70 percent are warranted. Under the General Rating Formula for Mental Disorders, a 30 percent rating is warranted for 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). Id. A 50 percent rating is warranted for 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 effective work and social relationships. Id. A 70 percent rating is warranted for 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 that 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. 38 C.F.R. § 4.130. Id. A 100 percent rating is assigned for total occupational and social impairment due to such symptoms as gross impairment in thought processes or communication; persistent delusions; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent ability 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. Id. Symptoms listed in the General Rating Formula for Mental Disorders are not intended to constitute an exhaustive list but rather serve as examples of the type and degree of the symptoms or their effects that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). A veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage or others of similar severity, frequency, and duration. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013). Additionally, while symptomatology should be the primary focus when deciding entitlement to a given disability rating, § 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused the requisite occupational and social impairment. Id. The Veteran’s treatment records show his receiving VA and private treatment for his acquired psychiatric disorder and his taking of medication therefor, including Citalopram, Trazadone, and Prazosin. In an October 2011 correspondence, one of his treating physicians, B. G., Ph.D., LCSW, of the Killeen Vet Center, stated that he had been seeing the Veteran since 2008 for PTSD symptoms and anger issues. He met the Veteran in 2007 at group therapy and then continued individual sessions to address issues of trust, safety, anger, irritability, lack of motivation, and emotional numbing. The Veteran also had panic attacks when stressed at work and had to take a few moments to get back on track, sometimes leaving work to do so. At home, he and his wife got along, but he continued to be irritable with outbursts “about small things,” which created more problems for him because he went into quiet mode and did not talk to his wife for hours. At his hearing in May 2016, the Veteran testified that he would have anxiety, about four to five days per week, and it would go “haywire” and become “uncontrollable.” Further, symptoms of his disorder included noise issues at home, isolation, and as of late, his going to a different room to get away from his wife and children, with whom he had a “good relationship.” He also testified that there were flare-ups, and when they occurred at work, it took him longer to finish tasks because of his anxiety, forgetfulness, and lack of concentration. During a VA treatment in July 2016, the Veteran reported a suicide attempt in 2004 with a plan to “jump down [a flight of] stairs.” He also reported current panic/anxiety attacks, and when driving, a “wave coming on and had to pull over on a bridge.” He also reported problems with concentration, trauma, disturbing nightmares, short-term memory, racing thoughts, paranoia, and the decline in his sex drive. An October 2016 VA treatment record indicated that the Veteran reported experiencing anxiety attacks five times per week. Numerous Mental status examinations (MSEs) are also of record. In a July 2010 MSE, the clinician found his behavior to be cooperative, friendly, and open. He was fully oriented, with slowed speech. Regarding his mood, he endorsed the following descriptions over the past 30 days: anxious, irritable, restless, fatigued, angry, confused, agitated, impatient, argumentative, preoccupied, unmotivated. He rated his level of depression as 8/10 and his anxiety 10/10 on a 10-pt scale, with 10 being the highest. His cognition was within normal limits, with fair judgment. A safety assessment noted that the Veteran had no access to weapons and no current thoughts, plan, or intent about suicide or self-harm, homicide, or hurting others. The Veteran did not report feelings of helplessness or hopelessness. During a MSE of May 2013, it was noted that the Veteran was casually dressed and neatly groomed with the speech of normal rate and rhythm and was depressed, with an anxious mood. His affect was constricted, but he was alert with linear thought processes. He denied audio/visual hallucinations and suicidal and homicidal ideations. During various MSEs of October 2016, the Veteran was observed neatly dressed and well groomed. He was alert and oriented to person, place, time, and situation. The clinician noted that although he was normally a reliable historian, he presented at times as vague. No psychomotor abnormality was observed. The speech was of normal rate, tone, and volume. He was organized, relevant, and coherent, absent word-finding difficulty. His mood was “pretty okay” during the October 7, 2016 session and euthymic during the October 11, 2016 session. His affect was mood congruent, neutral, with fairly good range with Veteran able to smile and laugh appropriately. There was no tangentiality, circumferentially, flight of ideas, or loosening of associations. No delusions or ideas of reference were expressed. The Veteran denied auditory/visual/tactile hallucinations. He also denied suicidal or homicidal ideation, intent, or plan. His cognition was grossly intact with no deficits on general examination, and memory was intact with fair to good insight and judgment. A Suicide Risk Assessment found no ideations, threats, or self-harm. The protective factors identified included no history of any self-injury behavior, no current suicidal thought, no access to weapons, no comorbid substance abuse, and no unemployment. The clinician determined him to be at a “low acute risk” for suicide. During MSEs of May 2017 and August 2017, the Veteran was noted to appropriately well-dressed with adequate hygiene. He was alert and oriented to all spheres. His speech was of normal tone and volume. His thought processes and thought content were unremarkable or linear, goal directed. His memory was grossly intact. His insight and judgment were intact or good. Specifically, during the May 2017 MSE, his affect was congruent with mood, while his mood was euthymic. During the August 2017 MSE, his mood/affect was noted as full, bright, euthymic, mood congruent. During both sessions, Suicide Risk was negative for any current thoughts about death, dying, or killing himself or someone else. The Veteran was deemed not in imminent danger of harming himself or others at this time and a low risk level. In addition to the above evidence, the record contains a July 2007 Mental Disorders VA examination. The Veteran reported having had “some close and meaningful relationships.” He also reported irritability and arguments, mainly with his wife. His symptoms included general anxiety, mild depressive symptoms, and insomnia, two days per week where he lies awake for two to three hours. He reported that his insomnia symptom from his disability, had a mild impact on his work performance. A MSE noted that he was well-dressed and well-groomed. Although he had difficulty expressing himself, at times, he had fairly good social skills. His thought process logical, coherent, and relevant. His affect was spontaneous, with no overt signs of depression or anxiety. He was well oriented to time, place, person, and situation. His reasoning and judgment were deemed good. The examiner diagnosed primary insomnia was rendered by the examiner with associated adjustment disorder from military to civilian life. In April 2011, the Veteran was afforded an initial PTSD examination. The Veteran reported that his main problem was anxiety, for he was guarded, watchful, and did not want to be around people when his anxiety is high. He reported sleeping from 2 hours (most nights) to 6 hours (maybe 1-2 nights per week). He reported having relationship problems (frequent flare-ups with his wife; his anger got intense during these times). He reported being forgetful with a reduced sex drive and having had nightmares three to four times per week. He enjoyed activities less than he used to and needed to get away and be alone to keep his stress down. He sometimes went out at times with friends to sporting events, about twice per month (e.g., driving to Dallas to see the Mavericks play) but did not sit still in his seat and roamed around the stadium. He reported that he felt “close” with a few friends, all of whom were fellow veterans. He had 3-4 really close friends. He indicated that he had anger flare-ups and problems with his wife. He also had a conflict with his kids, occasionally. He worked out and enjoyed it. He reported no history of “assaultiveness” and no history of suicide attempts. At work, his anxiety made it more difficult for him to stay on task. He tried to remain disciplined so he can help the soldiers but is at times was disrupted by his anxiety. The examiner determined that the severity and duration of his sleep impairment, lasting throughout the night, was moderate to severe; concentration problems were moderate; irritability/anger, lasting several minutes to an hour or so, was mild to moderate, with no physical violence or breaking things; hypervigilance, which was deemed continuous, was moderate and continuous; nightmares, lasting several minutes, were moderate, causing him to wake up distressed and soaking with sweat. His PTSD symptoms included nightmares, psychological distress, sleep disturbance, impaired concentration, exaggerated startle response, hypervigilance, and increased irritability with anger. A MSE noted no impairment of thought process or communication, panic attacks, or depressed mood, impaired impulse control. There were no delusions, hallucinations and their persistence, nor inappropriate behavior. Neither suicidal, homicidal, nor obsessive or ritualistic behavior that interferes with routine activities was noted. The Veteran maintained minimal personal hygiene and other basic activities of daily living and was oriented to person, place, and time. There were some mild episodes of forgetfulness, a few times per month, such as leaving the house unlocked a couple of times/month, leaving the stove on one time. Moderate anxiety was noted, a few days per week, and caused distraction at work. Moderate to severe sleep impairment was noted about five times per week, which made him drowsy and fatigued during the day and caused difficulty concentrating. “He feels moody and just wants the day to be over.” The examiner diagnosed PTSD and deemed the Veteran mentally capable of managing benefit payments in his best interest. The examiner found that the Veteran’s PTSD caused an occasional decrease in work efficiency or there are intermittent periods of inability to perform occupational tasks due to PTSD/mental condition signs and symptoms, but generally satisfactory functioning (routine behavior, self-care, and conversation normal.). The examiner explained that his concentration was impaired due to PTSD, and as a consequence of chronic sleep deprivation, he is fatigued on the job and with his family, contributing both to reduced interest/motivation and increased irritability. Hypervigilance also occasionally contributed to occasionally reduced efficiency on the job and makes it more difficult for him to socialize or to relax around his family and friends. His PTSD/mental condition symptoms required continuous medication. His PTSD/mental condition symptoms are severe enough to interfere with occupational and social functioning. In January 2013, the Veteran was afforded a second initial PTSD examination. The Veteran reported that he was still living with his wife and two dogs. His two sons live in town, and he saw them and/or talk to them once a week. He had not seen his two grandsons recently due to custody issues. On a typical day, he worked, read, and watched sports. He reported having Army friends with whom he talked three times per week. His social activities consisted of church weekly. The examiner noted that the Veteran was alert and oriented x 3. The Veteran was cooperative with appropriate and eye contact. His thought processes were clear, logical, linear, coherent, and goal directed. His speech was within normal limits regarding rate, rhythm, and volume. His affect was appropriate to the content of the discussion in both intensity and direction. The Veteran’s ability to maintain minimal personal hygiene and other basic ADLs appeared intact. The Veteran denied suicidal and homicidal ideation, auditory or visual hallucinations. The examiner noted that the Veteran endorsed feeling withdrawn, “like he want[ed] to cry, anxious.” He endorsed attending group PTSD therapy two times weekly, for the past three; endorsed taking medication, Celexa, Buspirone, Trazadone, starting about three years ago, around 2008. The Veteran denied suicide attempts, current suicidal ideation, and homicidal ideation. He, however, reported that the last time he had suicidal ideation was over the summer. The examiner noted that the Veteran used spirituality to cope with suicidal thoughts. The Veteran described his current mood as “anxious, 7/10.” The examiner noted that the Veteran’s symptoms included depressed mood, anxiety, panic attacks that occurred weekly or less, and chronic sleep impairment. The examiner diagnosed PTSD and determined that his disability was best summarized by occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily. The Veteran was mentally capable of managing his financial affairs. During a Review PTSD examination February 2017, the Veteran reported being married for 30 years with two children. He reported that his “relationship with them depend[ed] on the way [he] felt; if [he felt] sad [he] would withdraw.” He talked to his sons. He also reported that he enjoyed “reading,” but he does not attend church anymore, even though he described the “church and [his] wife” to be his support system. The Veteran denied a suicide attempt since the last examination, also denied a history. There were no current suicidal or homicidal ideations. The Veteran’s symptoms included depressed mood and anxiety. The examiner diagnosed PTSD and determined that his disability was best summarized by occupational and social impairment due to mild or transient symptoms with decreased work efficiency and ability to perform occupational tasks only during periods of significant stress or symptoms controlled by medication. A MSE noted that the Veteran was neatly dressed and was cooperative during the interview. His speech was within normal limits, and he maintained sufficient eye contact during the interview. His psychomotor activity was normal, and he appeared dysthymic. His affect was congruent, and his thought process was linear, logical, and goal directed. There were no indications of derailment or any bizarre behavior. His thought content showed no suicidal or homicidal thoughts. No auditory/visual hallucinations, delusions, paranoia, obsessions, or compulsions were noted. His insight and judgment were adequate. Sufficient impulse control was reported and demonstrated. His cognition was alert and oriented to person, place, time, and purpose. His recent and remote memories were appropriate. The Veteran was deemed capable of managing his financial affairs. During a second Review PTSD examination in January 2020, the Veteran reported being married for over 30 years, and now has four grandchildren. The examiner diagnosed PTSD and noted that the Veteran reported sadness and anger with verbal outbursts. It was also noted that he reported difficulty with falling and staying asleep with nightmares about Iraq. He reported that he typically received about four hours of sleep a night that was interrupted. He reported that he had difficulty with focus and concentration with short and long-term memory issues. He reported trying to avoid being around people and did not attend any type of get-togethers. He had difficulty making and keeping friendships, and his avoidance created difficulty with his marital relationship. He reported noises, including sirens, fireworks, gunshots, and being around bridges, were triggers. He reported being suspicious of Middle Eastern people. He reported that his wife tells him he is in denial about his symptoms. The examiner also diagnosed major depressive disorder, severe recurrent. He noted that the Veteran reported being depressed, with the depression draining all of his energy and motivation. He reported the depression wears him down, and he feels lifeless. He reported fatigue. He reported suicidal ideation in the past, where he planned to throw himself down the stairs. Generalized anxiety disorder was also diagnosed. The examiner noted that the Veteran reported being easily overwhelmed, and when anxious, his heart races, and he had difficulty breathing and became shaky. He also reported gastrointestinal distress. Since the last evaluation, he remained working as a medical clerk at the Bonham VA Hospital. His duties include checking claimants in/out and answering the phone. Relevant Mental Health history included prescribed Trazodone, Prazosin, and Citalopram, and attending family mental health. The examiner noted that the Veteran had more than one mental disorder diagnosed. However, he stated that to determine what symptoms were due to each disorder would be speculative since the symptoms overlap. The examiner determined that the Veteran’s disability was best summarized by occupational and social impairment with reduced reliability and productivity. The Veteran’s symptoms of his disability included depressed mood, anxiety, suspiciousness, panic attacks more than once a week, chronic sleep impairment, impairment of short and long term memory, for example, retention of only highly learned material, while forgetting to complete tasks, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, impaired impulse control, such as unprovoked irritability with periods of violence, and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. The examiner noted as his behavioral observations: The Veteran arrived at the evaluation accompanied by his wife. There seemed to be some irritability between the two of them during the initial interaction in the waiting room. He intentionally chose to sit with his back towards the wall where he could see the office door. He was very alert to random noises in the suite. Eye contact was poor; good rapport was established. The mood was depressed; the affect was flat. Thought processes were somewhat loose, and he rambled. No suicidal or homicidal ideation was noted, although he did report thoughts of harm to himself several years ago. No delusions or hallucinations were noted; however, he did report paranoia. He was oriented to person, place, and setting. He knew that it was January 2020 but did not know the day of the week or the exact date. He stated it was early January; the date was the 15th. The examiner noted that the Veteran was deemed capable of managing his financial affairs. The examiner remarked that the PHQ-9 score was a 20, which was in the severe range of depression. The Beck Anxiety Inventory score was a 58, which was in the area of concern for anxiety. The PCL-5 scored a 74, which was a positive screen for PTSD. He opined that he did not believe this Veteran should be considered a current imminent or increased risk. Lastly, in a September 2020 Review PTSD examination, the Veteran reported that he made friends with difficulty, disliked hanging out with other people socially. He described himself socially as “very poor.” His social support network included his wife and daily/weekly/monthly contact with friends. He reported a good relationship with his family. His marriage of 32 years was reported “challenging rocky” and “not good.” The Veteran reported being employed as a “clerk operator” with the VA for “12-years.” He reported that he “like[d] working with other veterans.” He, however, reported work-related issues such as “informal counseling by a manager for anger outbursts.” The examiner diagnosed PTSD and determined that the level of impairment was occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood. The symptoms of the disability included depressed mood, anxiety, suspiciousness, panic attacks more than once a week, chronic sleep impairment, mild memory loss, such as forgetting names, directions, or recent events, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, including work or a work like setting, and obsessional rituals which interfere with routine activities. The Veteran was capable of managing his financial affairs. The examiner remarked that the Veteran denied having a specific intent or plan to kill himself and that he was familiar with the Veterans Crisis Line and had the telephone and email contact information. The examiner specifically found that the Veteran did not appear to pose an imminent threat, at this time, to himself or others. Further, the examiner noted that the Veteran indicated his “mental health condition had led to my quality of life totally deteriorating as a result of military service, [with] symptoms include[ing] panic attacks, sleep deprivation, sexual deterioration, lack of social interaction, depression, anxiety, anger.” When asked how symptoms affect relationships, daily living and/or work life (functional impact) Veteran reported, for “work-life, I have a lack of any attention, cannot stay on task; for social interactions, I am always angry, can’t sleep, anger outbursts at home and work, panic attacks and I can’t drive, I am jumpy at noises, I am always hearing voices like something is coming after me, I can’t be in crowds, I don’t want to have no interest with sexual activity with my wife or activities like I used to do like sports/exercising, I barely even take baths, I am very forgetful, I tend to isolate even at home I tend to stay to myself.” Based on the above, the Board finds that the evidence before January 04, 2013, supports occupational and social impairment with reduced reliability and productivity due to the symptoms of similar severity. Thus, an initial 50 percent rating for the Veteran’s PTSD is warranted. The Veteran’s symptoms, as noted above, show that his judgment, thinking, and thought process were normal. His symptoms did not include suicide ideation, obsessional rituals, and near-continuous panic affecting the ability to function independently. Although he was found to have chronic sleep impairment, concentration problems, mild episodes of forgetfulness, mild depression, and anxiety, they were not noted to affect his ability to function independently, appropriately, and effectively. His speech and attention were within normal limits, and he remained alert and oriented x 3, with a well-groomed appearance and denial of suicidal or homicidal ideation, intent, or plan. Moreover, the Veteran was not shown to have an inability to establish and maintain effective relationships. Rather, he remained married to his wife of over 32 years and had a good relationship with his two sons, who live in the same town. Also, he had a close relationship with his Army friends, talking to them three times per week, and 3-4 “really close friends” with whom he attended sporting events at least two times per month. The Veteran also attended church every Sunday. Given the frequency, nature, and duration of the Veteran’s symptoms, the Board finds that before January 04, 2013, the Veteran’s symptoms did not result in occupational and social impairment with deficiencies in most areas. As such, a 70 percent rating is not warranted. Vazquez-Claudio, 713 F.3d at 114 (holding that a veteran “may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration”). However, beginning January 04, 2013, the Board finds that a 70 percent is warranted. During the January 04, 2013, VA examination, the Veteran reported that he “last had suicidal ideations over the summer.” This is the only evidence of reported passive thoughts of suicide. The Board notes the admission of an attempt in 2004, which was before the appeal period. Additionally, the numerous VA examinations noting his denial of intent, thought, or plan for suicide or homicide. Additionally, the numerous MSE’s of record noted his consistent denial of suicidal or homicidal intent. The numerous Suicidal Risk Assessment found him at low acute risk with protective factors of no history of any self-injury behavior, current suicidal thought, access to weapons, comorbid substance abuse, and unemployment. The clinician determined his risk to be “low acute risk.” The Board finds that the Veteran’s frequency, severity, and duration of his PTSD symptoms are contemplated by the 70 percent criteria. Thus, a 70 percent disability rating, beginning January 04, 2013, is warranted. The evidence of record during this period shows that the Veteran’s PTSD is not more closely described by both total occupational and total social impairment. The Board notes that thoughts of suicide are contemplated by the 70 percent criteria and can cause occupational and social impairment with deficiencies in most areas. The Veteran’s PTSD is not more closely described by both total occupational and total social impairment. The risk of self-harm is contemplated by the 100 percent criteria, which addresses whether one is a persistent danger to himself or others. Bankhead v. Shulkin, 29 Vet. App. 10 (2017). Here, the cumulative evidence of record does not show severity enough to cause total occupational and total social impairment. Further, no VA clinician, examiner, nor private clinician has found the Veteran to be a persistent danger of hurting himself or others. The numerous MSEs conducted during this period noted the Veteran’s continuous denial of current suicidal/homicidal intent or plan. Additionally, neither the VA examiners nor the record reflects findings of gross impairment in thought processes or communication, grossly inappropriate behavior, persistent danger of hurting herself or others, persistent delusions or hallucinations, and disorientation to time or place. As such, the Board finds that neither total nor social impairment is approximated during this appeal period. “Total” is defined as “whole, not divided; full; complete” and “utter, absolute.” Black’s Law Dictionary, 1498 (7th ed. 1999). As the most probative evidence of record does not show total social impairment, the 100 percent rating is not warranted. Given the frequency, nature, and duration of the Veteran’s symptoms, the Board finds that they do not result in total occupational and total social impairment for the period on appeal. They do not more closely approximate the types of symptoms contemplated by the 100 percent rating, and therefore, a 100 percent rating is not warranted. Vazquez-Claudio, 713 F.3d at 114 (holding that a veteran “may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration”). In sum, the Board finds that the Veteran’s symptoms from his PTSD are most closely described by an initial 50 percent rating, and beginning January 04, 2013, a 70 percent rating. The probative evidence of record does not show that the particular symptoms associated with the higher percentage or others of similar severity, frequency, and duration result in occupational and social impairment before January 04, 2013, and in total occupational and total social impairment, thereafter. Thus, an initial rating of greater than 50 percent and a 100 percent rating beginning January 04, 2013, are not approximated. D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Stevens, 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.