Citation Nr: 21027503 Decision Date: 05/05/21 Archive Date: 05/05/21 DOCKET NO. 16-36 853 DATE: May 5, 2021 ORDER Entitlement to an initial rating of 70 percent, but no higher, for posttraumatic stress disorder (PTSD) is granted. FINDING OF FACT For the entire period on appeal, the Veteran's PTSD manifested as occupational and social impairment, with deficiencies in most areas including work, family relationships, thinking, and mood, due to such symptoms as suicidal ideation and impaired impulse control. CONCLUSION OF LAW The criteria for an initial 70 percent rating for PTSD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.130, Diagnostic Code 9411. Continued on next page REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Unites States Army from January 1968 to January 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded by the Board in October 2018 to obtain a new VA examination. The Board finds that the October 2018 remand instructions were substantially complied with; the Board will therefore proceed with a decision. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The issue of service connection for erectile dysfunction was previously part of this appeal; since the RO granted service connection for erectile dysfunction in July 2020, that issue is considered granted in full and is no longer on appeal. Entitlement to a Higher Initial Rating for PTSD Disability ratings are intended to compensate impairment in earning capacity due to a service-connected disorder. 38 U.S.C. § 1155. PTSD is evaluated pursuant to the General Rating Formula for Mental Disorders. Under the General Rating Formula, a 50 percent evaluation 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 (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. 38 C.F.R. § 4.130, Diagnostic Code 9411. A 70 percent evaluation 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 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); and the inability to establish and maintain effective relationships. Id. A 100 percent rating is warranted if the Veteran has 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 or place; memory loss for names of close relatives, own occupation, or own name. Id. The symptoms listed within the criteria are examples of what might cause a certain level of impairment, and are not exhaustive; a veteran may qualify for a higher evaluation even if he does not exhibit every listed symptom, and symptoms that are not listed should also be considered when evaluating a veteran's level of impairment. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Suicidal ideation is a unique symptom when it comes to evaluating mental disorders. It appears only at the 70 percent level, with no analogue at lower evaluations, and covers a wide range of thoughts and behaviors. "Suicidal ideation does not require suicidal intent, a plan, or prepatory behavior." Bankhead v. Shulkin, 29 Vet. App. 10, 20 (2017). Even passive thoughts of one's own death can result in occupational and social impairments in most areas. Id. On the subject of suicidal ideation, the August 2019 VA examiner said this: [The Veteran] denied suicidal ideation "where I sit in the basement holding a gun, no. But I do think 'why am I doing this'?" But [he] denied thoughts of what steps he would take to end his life. The Board finds this to be a clear example of the sorts of "passive thoughts of one's own death" contemplated in Bankhead, and therefore finds that the Veteran experiences suicidal ideation as defined by VA. Additionally, the Veteran reported at the August 2019 examination that he had impaired impulse control (specifically, that he had a "short fuse" and periodically ended up in verbal altercation with others), weekly panic or anxiety attacks, chronic sleep impairment, disturbances of motivation and mood, and a flattened affect (noted by the examiner). The Veteran described depressive episodes where he would "sit in a chair, being sad, not moving for six hours some days." Given these symptoms, as well as his passive suicidal ideation, the Veteran's PTSD more closely approximates the occupational and social impairment contemplated by a 70 percent rating. However, a higher, 100 percent rating is not appropriate at any time during the period on appeal, as there is no evidence of symptoms such 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 mental and personal hygiene), or disorientation to time or place. At the August 2019 VA examination, the Veteran denied any work performance issues before his retirement in 2014, and said he currently does part time work that he finds fulfilling. The Veteran attends church weekly, is a member of a golf league, and he and his wife regularly go out to dinner with "a good group of friends." The Veteran's anxiety causes him to prefer sitting in a place where he can keep an eye on entrances and exits, but he reported that he could manage this anxiety without having to leave or otherwise disrupt social events. Based on these facts, it would not be accurate to describe the Veteran as having "total occupational and social impairment." Finally, while the April 2016 VA examination does not reflect PTSD symptoms that are quite as severe, the Veteran claims that he was not given enough time for a thorough examination, and that he had a panic attack at the examination that was not noted. (Indeed, the inadequacy of the April 2016 examination was the reason for the Board's October 2018 remand.) The Veteran reported at his August 2019 examination that he has had elevated PTSD symptoms since 2014. Resolving doubt in the Veteran's favor, the Board finds that his PTSD has been at its present level of severity throughout the entire period on appeal. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). In sum, the Board finds that a rating of 70 percent for PTSD, but no higher, is warranted for the entire period on appeal. 38 C.F.R. § 4.130, Diagnostic Code 9411. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Shermila Sundquist 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.