Citation Nr: 21030471 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 17-37 744 DATE: May 19, 2021 ORDER Entitlement to an initial total disability rating, 100 percent, for service-connected post-traumatic stress disorder (PTSD), for the entire period on appeal is granted. FINDING OF FACT For the entire period on appeal, the Veteran' service-connected PTSD was productive of total occupational and social impairment. CONCLUSION OF LAW For the entire period on appeal, the criteria for a disability rating of 100 percent for PTSD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from October 1967 to November 1970 with service in Vietnam. In May 2021, the Veteran and his sister testified before the undersigned Veterans Law Judge (VLJ) in a Virtual Hearing. 1. Entitlement to an initial total disability rating, 100 percent, for service-connected post-traumatic stress disorder (PTSD), for the entire period on appeal The Veteran asserted in his Notice of Disagreement and testified that his PTSD should be rated at 100 percent due to his severe symptoms, described as constant isolation, inability to work for the past 8 years, memory loss, suicidal thoughts, and lack of personal hygiene. Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. In accordance with 38 C.F.R. §§ 4.1, 4.2 and Schafrath v. Derwinski, 1 Vet. App. 589 (1991), the Board has reviewed all evidence of record pertaining to the history of the service-connected disability at issue. The Board has found nothing in the historical record which would lead to the conclusion that the current evidence of record is not adequate for rating purposes. Moreover, the Board is of the opinion that this case presents no evidentiary considerations which would warrant an exposition of remote clinical histories and findings pertaining to the disability under review. The Veteran's service-connected PTSD is rated under the General Rating Formula for Mental Disorders. Under this formula, in pertinent part, 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; and mild memory loss (such as forgetting names, directions, or recent events). 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 and maintaining effective work and social relationships. 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 which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting 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); and inability to establish and maintain effective relationships. A 100 percent rating is warranted for total occupational and social impairment due to such symptoms as: gross impairment in thought process 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; and memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130, DC 9411. In evaluating symptoms and signs to determine their effect on the level of occupational and social impairment in order to arrive at an appropriate disability rating for service-connected mental disorders, the Board will look to their severity, frequency and duration; consider their impact as a whole; and make a quantitative assessment accordingly. See Bankhead v. Shulkin, 10 Vet. App. 26; see also Vazquez-Claudio, 713 F.3d at 115-17; see generally Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table); Gilbert v. Derwinski, 1 Vet. App. 49, 52 (1990); Mittleider v. West, 11 Vet. App. 181, 182 (1998). The Board notes that in Bankhead v. Shulkin, 29 Vet. App. 10 (2017), the Court of Appeals for Veterans Claims (Court) held that the presence of suicidal ideation alone may cause occupational and social impairment with deficiencies in most areas, which meets the criteria for a 70 percent disability rating under 38 C.F.R. § 4.130. In initial rating claims, the Board must discuss whether staged ratings are warranted, and if not, why not. Fenderson v. West, 12 Vet. App. 119 (1999). Here, the Board finds that staged ratings are not warranted as the Veteran's symptomology has met the criteria for a total disability rating for the entire period on appeal. The Veteran and his sister competently and credibly testified before the undersigned VLJ. In his hearing, the Veteran testified that he has constant and severe anxiety and depression which keeps him at home, alone, with his curtains drawn, that he has delusions and hallucinations, that he has suicidal ideation, that he cannot work due to his PTSD which affects his ability to be with or get along with people, and, that his personal hygiene has suffered as he has stopped taking a shower every day. He testified that his sister is his only contact with the outside world, and he only talks to her once a week. His sister testified that the Veteran is very isolated and that she saw him flee from a State Fair because of the presence of a crowd. She stated that she has seen him get up in the middle of the night and walk around the house because he is unable to sleep, and has seen him unable to handle any loud noise. She testified that she is afraid to call him, as the sound of the telephone "going off unexpectedly is an issue." She further testified that she believes the Veteran is in danger of hurting himself or others and that she's apprehensive when she visits him, because she's "afraid of finding him on the floor dead." The Veteran attended a VA PTSD examination in April 2017. The examiner noted that the Veteran has been unemployed since 2013. The examiner reported the Veteran's typical sleep pattern as "falling asleep between 10 and 11 PM and getting up at 1:30 in the morning. He'll then sleep from about 3 AM to 4 AM. He'll sleep from about 4:30 to 5:30. He does not take naps." The examiner reported the Veteran's ongoing depression, described as "lack of motivation, drive, and participation in activities," and that the Veteran had irritability and feelings of worthlessness, occasional crying spells and thoughts of suicide. The examiner noted the Veteran's symptoms as depressed mood; anxiety; chronic sleep impairment; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; and, difficulty in adapting to stressful circumstances, including work or a work-like setting. Based on the competent, credible, and probative evidence outlined above, the Board finds that the severity, frequency and duration of the Veteran's PTSD symptoms most closely approximate the 100 percent disability rating. The Veteran's near complete isolation, hallucinations, and sleep disturbances are severe, frequent, and have been documented through-out the period on appeal. Moreover, his severe symptoms of suicidal thoughts and his inability to maintain minimal personal hygiene are frequent and ongoing. For all these reasons, the Board finds that an initial 100 percent disability rating for the Veteran's PTSD is warranted for the entire period on appeal. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Nelson 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.