Citation Nr: 21040447 Decision Date: 07/03/21 Archive Date: 07/03/21 DOCKET NO. 18-13 287 DATE: July 3, 2021 ORDER An initial rating in excess of 50 percent for post-traumatic stress disorder (PTSD) with major depressive disorder is denied. FINDING OF FACT For the period on appeal, the Veteran's PTSD with depression symptoms has caused occupational and social impairment with reduced reliability and productivity. However, for no distinct period on appeal have they been shown to cause occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, or worse. CONCLUSION OF LAW The criteria for an initial rating in excess of 50 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.130, Diagnostic Code (DC) 9411. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Army from December 1968 to July 1970. The matter is on appeal before the Board from a February 2018 rating decision. The Veteran provided testimony at a February 2020 Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. 1. Increased Rating PTSD Procedurally, the Veteran was granted service connection for PTSD with major depressive disorder in an August 2016 rating decision, with a 30 percent evaluation effective April 25, 2016, the date his claim for service connection was received by VA. The Veteran filed a Notice of Disagreement (NOD) in November 2016, in which he disagreed with the initial 30 percent evaluation. In a February 2018 rating decision, the Veteran was granted an increased rating for his PTSD to 50 percent effective April 25, 2016, the date of receipt of his claim. Following the issuance of a Statement of the Case (SOC) in February 2018, the Veteran filed a Form 9 Appeal to the Board in March 2018, in which he disagreed with the 50 percent evaluation. As previously noted, the Veteran provided testimony at a Board hearing in February 2020. Applicable Law The Veteran's PTSD is rated under DC 9411, which is rated under the General Rating Formula for Mental Disorders and provides the following evaluations. 100 percent: 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. 70 percent: 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 worklike setting); inability to establish and maintain effective relationships. 50 percent: 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; difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130, DC 9411. Analysis The Veteran contends that a rating in excess of 50 percent is warranted for his service-connected PTSD. A review of the Veteran's VA treatment records, VA examinations, and lay statements reflects that a rating in excess of 50 percent is not warranted at any time during the period on appeal. The Board notes that the Veteran has undergone regular treatment for mental health through VA during the appeal period. The Veteran's VA treatment records have been thoroughly reviewed, however, as the Veteran's VA mental health treatment records are extensive during the appeal period, only a portion of the Veteran's VA mental health treatment notes will be recited below in chronological order, in conjunction with the two VA examinations he has undergone, and the lay statements that have been submitted. The Veteran was seen for a mental health evaluation in April 2016, at which he stated that he had been having problems with anger since he had worked for a little while as a security guard in a local hospital. He reported that it had "brought back" many negative memories from his military experiences. He relayed that his medications were working well for anger, however, he still gets anxious and angry. He finds himself cursing, and noted that this was not like him. It was indicated that the Veteran had put a pistol to his head in 1993. Following the incident, he was hospitalized for a week and started on medications and treatment. The Veteran denied any suicidal or homicidal ideations, intents, or plans. He admitted to difficulty concentrating on tasks, and having little energy or motivation. He noted that he used to enjoy showing his classic cars, but that he now has little energy to get them ready. A statement from the Veteran's wife was submitted in May 2016, in which she began by noting that she and the Veteran had been married for 38 years. She reported that in the beginning of their marriage the Veteran never seemed to be happy about anything. Originally, she thought that his unhappiness and moods were her fault, but once she realized it was not her fault, she asked him to get help. However, he did not see himself as having problems. She relayed that over the years she has seen so much anger and depression in the Veteran. She explained that after the Veteran would settle down from bouts of anger, which could last days, he would always be remorseful and ask for forgiveness, while saying "why do I act this way?" In her statement, the Veteran's wife also noted that he experienced nightmares in which he heard a loud noise and then ran outside to see what he heard. She reported that he was always looking around him in public as if someone was following him, and that he looked out the windows a lot at home. In a PTSD questionnaire that the Veteran submitted in June 2016, he reported having a fear of large crowds in which he feels he has no control. He relayed that he is always looking around himself to see if someone is behind him. When he goes out to eat, he always has to have his back to the wall. He indicated that he does fear for his life and/or safety. He remarked that before he had entered the army, he had been a fun-loving carefree person, but when he returned home nothing was the same. He noted having bad dreams, and no longer being able to hunt because he was afraid of being shot. He relayed that due to his anger, he had been in quite a few fights. He also reported that due to his personality and depression he and his wife had separated many times. In an additional statement submitted by the Veteran in June 2016, he explained that he had suffered from bad depression since he had served in Korea. He indicated that he did not want to be around his own family at times, and that he and his wife had separated several times because of his problems. He reported that he had tried to commit suicide in the past, and that he had been committed to a psych ward. He noted that he had been on medication from VA since around 1992. He commented that it seemed that the older he got, the things he had tried to forget, were all coming back again. The Veteran was seen in June 2016 for an individual therapy appointment, at which he was noted to have presented with symptoms of depression, anxiety, and anger. The Veteran stated: "I had an argument with my wife this weekend and it was all my fault, the grandchildren were over [at] my house playing and one of them screamed and I went off, I can't stand to hear screams." The Veteran reported that he has extreme verbal outbursts when he gets angry but then becomes very remorseful after he calms down. He relayed that he does not have any motivation or energy, and that he just wants to lay around his house all day. He reported experiencing continued nightmares and intrusive thoughts about the things he witnessed in Korea. The social worker indicated that the Veteran was open and friendly with speech at a normal rate and flow. The Veteran maintained good eye contact, but had difficulty expressing himself during the session. The Veteran's recent memory was impaired, but his remote memory was intact, and his thought process was normal. He was lucid and oriented in all spheres, and he was alert with coherent and easy to understand responses. The Veteran's judgement was impulsive, and his insight was limited regarding his mental health treatment and symptomatology. He appeared to be in a depressed mood and his affect was congruent. The Veteran's social ability was withdrawn. The Veteran was dressed appropriately for the weather, and his hygiene and grooming were adequate. He denied suicidal or homicidal ideations. The Veteran was seen in July 2016 for a follow-up individual therapy appointment, at which it was indicated that he evidenced symptoms of depression, anxiety, sleeplessness, nightmares, intrusive thoughts, agitation, and social isolation. The Veteran reported that he did well with the fourth of July but became agitated when his grandchildren were making too much noise and screaming. The social worker reported the behavioral observations of the Veteran, his relevant mental status, and his appearance as identical to that reported in the above June 2016 appointment. The Veteran denied suicidal or homicidal ideations, psychosis, or self-injurious behaviors. The Veteran first underwent a VA examination in August 2016. The VA examiner found the Veteran's psychiatric symptomatology to cause impairment most commensurate with occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. Pertaining to relevant social and family history, the Veteran reported that he had been married twice. His first marriage ended in divorce as a result of infidelity. He married his current wife in 1977, and described the marriage as stable, however, there had been many separations with the last occurring around 2003. He attributed the marital problems to his behavior, and stated that "she had to deal with an asshole." He indicated problems with his temper and emotional distance. He reported having two children with his current wife, a daughter, and a son. He was not around his daughter very much during her childhood. His current relationship with his daughter was noted to be "okay but not close." He described his relationship with his son as "a little closer." The Veteran has four grandchildren. He described his relationships with his grandchildren as "pretty good," however, he can get very irritated with their behavior. The Veteran has maintained a good relationship with his sister, and they have regular contact through phone calls and visits. He also stays in contact with some cousins. The Veteran relayed that he has friends "mostly through a car club" that he formed. However, he dropped out of this car club about five years earlier due to a conflict with another member. He explained that he has noticed declining interest and participation in significant activities. For example, he quit bowling about two years earlier, but had previously been involved in bowling leagues. He used to participate in billiard tournaments, but had not done so in eight to nine years. After his return from Korea he quit hunting. He continued to have an interest in old cars, and he owned several. He reported being involved in church on a regular basis since 1993, and noted that he would even sing solos. He did prefer to stay close to home now. He did some yard work, helped his wife some, and occasionally went out to eat with her. He preferred to avoid public places that involved crowds, he would not attend events with fireworks, and he tried to avoid conversations about military service. Pertaining to the Veteran's mental health history, the examiner noted that in 1983 the Veteran began having significant problems with his depression and began taking antidepressant medication. A suicide attempt that resulted in psychiatric hospitalization was indicated to have occurred in 1983. It was explained that the Veteran had gotten a gun out and threatened to kill himself. Pertaining to behavioral observations, the examiner noted that the Veteran arrived on time for his scheduled appointment. There was nothing remarkable about his appearance. He was alert and oriented in all spheres. His thought processes were logical and coherent. He was an accurate historian. The examiner indicated that the reliability of the information provided by the Veteran appeared to be consistent. His speech was fluent, with rate and volume within normal limits. No psychotic processes were evident or endorsed. No psychomotor agitation was observed. His level of consciousness was normal. He was cooperative, and goal directed. Adequate rapport was established. His affect appeared restricted. His judgment and insight appeared grossly intact. There was no acute distress observed. He denied any violent ideations, thoughts, intents, or plans toward himself or others. The symptoms that actively applied to the Veteran's PTSD and depression were found by the examiner to include depressed mood, anxiety, suspiciousness, and chronic sleep impairment. The Veteran was seen in November 2016 for a follow-up individual therapy appointment, at which he was noted to present with symptoms of depression and anxiety. The Veteran reported that he had a couple of incidents since his last session in which he was very angry, but had caught himself and walked off to take a time out. He noted having continued social isolation, no motivation, and no energy. He relayed that his wife and daughter were going to cook the holiday meals and have them at his house. He also reported that he had a friend of his work on the brakes of one of his old cars, because he is getting to where he cannot do those things anymore. He brought his classic car to the therapy appointment and invited the therapist to come out and look at his car. The social worker indicated that the Veteran was open and friendly with speech at a normal rate and flow. He maintained good eye contact, but had difficulty expressing himself during the session. The Veteran's recent and remote memory were intact, and his thought process was normal. He was lucid and oriented in all spheres, and he was alert with coherent and easy to understand responses. The Veteran's judgment was impulsive, and his insight was limited regarding his mental health treatment and symptomatology. The Veteran appeared to be in a depressed mood with a flat affect. The Veteran's social ability was withdrawn. The Veteran was dressed appropriately for the weather, and his hygiene and grooming were adequate. He denied suicidal or homicidal ideations, psychosis, or self-injurious behaviors. The Veteran was seen in February 2017 for a follow-up individual appointment, at which he was noted to present with symptoms of depression and anxiety. The Veteran reported that he had been feeling a little down because of not being able to go outside as much due to the weather. He relayed that he planned on getting his antique cars out and putting them in more shows in the coming year. The Veteran indicated that both he and his wife had noticed a difference in his attitude when dealing with things. According to her, he is not angered as quickly now. The social worker reported the behavioral observations of the Veteran, his relevant mental status, and his appearance as identical to that reported in the above November 2016 appointment. The Veteran denied suicidal or homicidal ideations, psychosis, or self-injurious behaviors. The Veteran was seen in July 2017 for a follow-up individual therapy appointment. He reported that he and a friend had been working on each other's cars, because they show their cars in a lot of car shows. The social worker indicated that the Veteran arrived on time for his appointment, and was appropriately groomed and clothed, and cooperative and pleasant. His mood and affect were constricted. He exhibited good eye contact, and was alert and oriented to four spheres. His speech was coherent and normal in rate and volume. His attention span and concentration were appropriate. The Veteran's thoughts were logical, linear, and without circumstantiality or loose associations. There was no evidence of auditory or visual hallucinations and/or delusions. The Veteran's fund of knowledge appeared average or greater. His remote and recent memory appeared intact. Insight appeared partial and judgement fair. The Veteran denied any current suicidal or homicidal ideations, intentions, plans, or feelings of hopelessness or helplessness. The social worker indicated that the Veteran was indeed depressed concerning social isolation and physical health issues, however, he has strong protective factors including future plans, meaningful recreational activities and creative outlets, spiritual beliefs, and a supportive significant other and family. The Veteran was seen in November 2017 for a follow-up individual therapy appointment, at which he reported that his wife was cooking Thanksgiving dinner this year and that his family would be coming over for dinner. He noted that he tried to help his wife all that he can, but that he cannot cook. He relayed that he had tried to talk to his wife about all the stress and aggravation that the holidays bring, but she asked him "what is wrong with you" and said that "it's a time for families to get together." The Veteran noted that he did not say anything else to her and just went on with his business because she does not understand. The social worker reported the behavioral observations of the Veteran, his relevant mental status, and his appearance as identical to that reported in the above July 2017 appointment. The Veteran denied any current suicidal or homicidal ideations, intentions, plans, or feelings of hopelessness or helplessness. Additionally, the social worker indicated that the Veteran was depressed concerning social isolation and physical health issues, however, he has strong protective factors including future plans, meaningful recreational activities and creative outlets, spiritual beliefs, and a supportive significant other and family. An additional statement from the Veteran's wife was submitted in November 2017, in which she began by noting that she and the Veteran had been married for 40 years. She relayed that since the Veteran had begun therapy and had been placed on medication there was a difference in him. However, he still struggled with a lot of depression and anxiety. She explained that being around a lot of people is hard for the Veteran. She indicated that they go to church, but that he misses often. By the look on his face and his sweating hands when he is at church, she can tell that he is uncomfortable. She also noted that he has always had trouble with crowds and family gatherings. They usually go places in separate cars, so that the Veteran can leave if his anxiety gets to be too much for him. In the past, this has caused a lot of fights between the two of them. She indicated that the Veteran never had much of a relationship with their children. That he has trouble getting close with them, both then and now. She stated that "he talks more to a perfect stranger than his own family." After their daughter had moved out, she relayed that she had moved out of their bedroom because he had so many nightmares and she was never sure when he might jump up and run outside to see where someone was shooting a gun. At least two to three nights per week the Veteran would get up due to a bad dream and then be unable to go back to sleep. She explained that the Veteran has gotten better with going out to shop with her. He used to sit in the car and wait for her, but he had begun entering the store with her. However, even then he frequently sits at the front of the store and waits for her time. He was also doing better going to restaurants unless there was a long waiting line. She commented that the Veteran had always said "I stood in line enough when I was in the Army, I'm not doing it now." She indicated that she used to hear every day "what's wrong with you," however, the Veteran has now almost completely stopped telling her everyday how wrong she was or how she cannot do anything right. She stated that marriage had been hard, and that if it was not for her children and her religious beliefs, that she would have divorced the Veteran. She noted that they had separated a few times, but that the Veteran had always promised that things would get better. The Veteran most recently underwent a VA examination in January 2018, at which he reported an avoidance of crowds, to include going into his room when his family visits. He also noted that he avoids television programming and discussions about the military. He believes that his children's lives were negatively impacted by his anger. He relayed his mood as flat, with feelings of worthlessness, guilt, and thoughts that he does not serve a function. He noted a loss of interest/pleasure in things, sleep disruption, and low motivation. He denied suicidal ideation. The VA examiner found the Veteran to have occupational and social impairment with reduced reliability and productivity. Pertaining to relevant social and family history, the Veteran was noted to have been married for 41 years. He relayed that he sees his grandchildren weekly because his daughter is struggling with bipolar disorder. He sees his son and his family every couple of weeks. He rarely goes to church anymore, and he no longer engages in hobbies that he used to enjoy. His energy was low and therefore he does fewer chores. He avoided running errands and stays home watching TV or sleeping. He stated, "I'd rather live in a dream world because the real world is beginning to be too much to bear." Pertaining to relevant mental health history, the examiner noted that the Veteran typically attends counseling bi-weekly, however, it had been a month since he last attended due to scheduling changes. The Veteran reported that he finds his sessions to be helpful because his counselor is also a Veteran, and he believes that this helps him to understand his experiences. The Veteran had not had any suicide attempts or any inpatient psychiatric hospitalizations since his last VA examination. Pertaining to behavioral observations, the examiner noted that the Veteran arrived early for his appointment. He was alert and oriented, and neatly groomed and dressed, but had limited eye contact, and was slow with responses. His mood was dysthymic, his affect blunted, and his speech was slow, but he was coherent, spontaneous, and articulate. His thought content was appropriate, and thought process was free of evidence of thought disorder. His concentration was appropriate based upon his spelling of WORLD backwards, however, he could not complete serial seven's. His immediate memory was intact, but was only 1/3 when delayed. He demonstrated an ability for abstract thought. He reported feelings of worthlessness, but denied suicidal ideations, intents, or plans. The examiner remarked that based upon the Veteran's report during the examination and a review of his reports in recent therapy sessions, the Veteran has had some improvement in irritability and angry outbursts. However, he has had reduced pleasure, reduced motivation, and he has more limited interest in things he used to find enjoyable. This has further increased his isolation. The Veteran would like to enjoy his family more, but he becomes overwhelmed when they come over for the holidays and he retreats to his bedroom at times. He tried hard to keep his mind focused on things in the present, and to avoid intrusive memories, crowds, military themed events, and loud noises. He reported that "sometimes I don't want to be here," but denied suicidal ideation, intent, or plan. The examiner reiterated that while the Veteran has had some improvement in anger related to his medication, he remains anhedonic, socially withdrawn, minimally motivated, and uninterested in activities he used to enjoy. The symptoms that actively applied to the Veteran's PTSD and depression were found by the examiner to include depressed mood, suspiciousness, chronic sleep impairment, mild memory loss, such as forgetting names, directions, or recent events, disturbances of motivation or 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. Under other symptoms, the examiner also noted that the Veteran will occasionally wake up from a nightmare and find himself out of bed and in a different part of the house or outside. The Veteran reported that he had recently awoken outdoors by his carport with a pistol in one hand and a flashlight in the other. The Veteran was seen for a follow-up individual therapy appointment in September 2018. He described some work that he had been doing on one of his cars. He reported that he had gone to one of his grandchildren's schools for grandparent's day, where he had somehow been able to sit down at one of those little tables without getting stuck. They played bingo and had a little piece of cake with some lemonade. The Veteran also relayed that he had gone to a festival with his wife, where they had listened to a concert for over two hours, which he described as good. He stated that there had been over 600 people there and that "you could not get a toothpick in between all those people." He reported that there was no noticeable increase or decrease in his symptoms of depression or anxiety. The social worker indicated that the Veteran arrived on time for his appointment, and was appropriately groomed and clothed, and cooperative and pleasant. His mood and affect were constricted. He exhibited good eye contact, and was alert and oriented to four spheres. His speech was coherent and normal in rate and volume. His attention span and concentration were appropriate. The Veteran's thoughts were logical, linear, and without circumstantiality or loose associations. There was no evidence of auditory or visual hallucinations and/or delusions. The Veteran's fund of knowledge appeared average or greater. His remote and recent memory appeared intact. Insight appeared partial and judgement fair. The Veteran denied any current suicidal or homicidal ideations, intentions, plans, or feelings of hopelessness or helplessness. The social worker indicated that the Veteran was indeed depressed concerning social isolation and physical health issues, however, he had strong protective factors including future plans, meaningful recreational activities and creative outlets, spiritual beliefs, and a supportive significant other and family. The Veteran was seen for a follow-up individual therapy appointment in April 2019. He reported that his wife had gotten mad at him on Easter because he had not been very sociable with his family. He explained that they had gone to church on Easter Sunday, and that afterwards they went home, and his daughter came over with her family. His wife had cooked a meal, and after eating, everyone went outside to hide easter eggs. However, he went into his room, shut the door, and laid down. When he came back out of his room after everyone had left, his wife was very mad, and he could not explain it to her, but he felt uncomfortable around his family, like he did not belong there. He told her he was sorry, and that he felt really bad about it. He relayed that he needed to become more sociable and get out around more people. He commented that he hoped his going to car shows would help with that. The social worker reported the behavioral observations of the Veteran, his relevant mental status, and his appearance as identical to that reported in the above September 2018 appointment. The Veteran denied any current suicidal or homicidal ideations, intentions, plans, or feelings of hopelessness or helplessness. Additionally, the social worker indicated that the Veteran was depressed concerning social isolation and physical health issues, however, he has strong protective factors including future plans, meaningful recreational activities and creative outlets, spiritual beliefs, and a supportive significant other and family. At the Veteran's February 2020 Board hearing, the Veteran's representative asserted that the Veteran's symptoms more closely approximate a 70 percent rating. The representative noted the Veteran's affect, his ability to make eye contact, an inability to enjoy his family even at holidays, and being overwhelmed when his family is around. Additionally, the representative indicated that while the Veteran does not endorse suicidal ideation, he sometimes feels like he does not want to be here. The Veteran reported that due to his PTSD he had distanced himself from his own family, which really hurts him. He relayed that he was married, however, there had been periods of time where he and his wife had separated and gotten back together. He reported that he has two children and four grandchildren. He explained that there are times when his grandchildren come over, and if one of his granddaughters starts screaming, he will either have to get the children to settle down, or he will have to go into his room and go to sleep, because he cannot handle the screaming. This in turn makes him feel bad for not being able to enjoy his family, which turns into a continuous cycle, where he gets riled up and then feels bad. The Veteran specifically noted that two of his grandchildren know that with a lot of noise he can get really short and sometimes a little bit mad. Therefore, he feels that he cannot be close with them. As to his relationship with his wife, the Veteran relayed that when they travel somewhere together in the car, he turns on the radio and they do not speak very much. He noted that he can sometimes become irritated with his wife, and that he hates himself for getting irritated. He also explained that he feels bad for not having any motivation, such as when his wife tells him something needs done and he does not want to do whatever it is that needs done. With his temper, he indicated that there are periods through every day, where something in some way, shape, or manner will set him off. He reported that he has trouble with both anxiety and depression. When he is around crowds, his grandchildren, or even sometimes his wife, he deals with anxiety. He explained that sometimes when he is talking with his wife, he has to control himself to not say something that would hurt her, because he has done so in the past. As to depression, he described going through periods of depression because of his actions, that is the way he acts towards his children, his wife, and his grandchildren. He questions why he cannot be a better person. When questioned whether he was a social fellow, or whether he tended to isolate, he reported that he mostly stays at home and watches TV or sleeps. He noted that he even sometimes feels that he wished he could sleep all the time. He did report that he will run some errands, such as getting gas in his wife's car, or going with her to the grocery store. However, when he goes to the grocery store, he sits on a bench at the front and waits for his wife to do the shopping. When she is done shopping, she will call him, and then he will find her and pay for the groceries. He explained that he does this so that he does not have to be around other people. He also reported that he occasionally goes to church, however, he goes less than he used to, and when he does go, he and his wife drive separately so that he can leave immediately when the service is over. The Veteran reported an incident that had occurred at least six years prior, possibly longer, where he had been hospitalized in the psychiatric ward. He explained that his wife had told him that she could not take it anymore and that she was leaving. He then went into his room and held a gun to his head. There had been no other instances of him trying to hurt himself or others. He noted that there had been instances where things had mounted up and he had asked his wife if she wanted him to go somewhere else and stay. In those instances, she would respond that she did not want him to go somewhere else, that she wanted him here, and that he could get himself straightened back out by going to talk with the doctors and mental health at VA. The Veteran indicated that he knew VA had hotlines and that he knew the number for them, so that if a situation ever arose that he thought about harming himself or others, then the number would be accessible to him. The Veteran relayed that in the past few years, somewhere around 2019 or maybe a little earlier, his medications for his PTSD had increased. The Veteran's treatment was noted to have been through VA. Waiver of review by the regional office of new VA treatment records that had been added to the Veteran's file was provided during the hearing. Based upon the foregoing, a rating in excess of 50 percent for the Veteran's PTSD with depression is not warranted. To begin, the record does not provide any findings or suggestions of the Veteran suffering from 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 minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name; obsessional rituals that interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; spatial disorientation; or neglect of personal appearance and hygiene. The Veteran's VA treatment records reflect that he experiences symptoms of depression, anxiety, anger issues, lack of motivation, and some social isolation. However, neither his anxiety nor depression have been shown to affect his ability to function independently, appropriately, or affectively. His anger, while it may be argued that it has manifested without provocation, it has not been shown to manifest with periods of violence. Rather, his anger has been reported to manifest verbally, and may be considered more of a disturbance of mood. His social isolation is not a complete social isolation either, as he does still have meaningful relationships with his spouse, children, and grandchildren. Additionally, his treatment records reflect that he does still attend church, spends some time with family on holidays, goes to car shows, spends time with friends working on cars, runs errands with his wife, goes out to eat on occasion with his wife, and attends some outside functions. This reflects that the Veteran may have some difficulty in establishing effective work and social relationships, but it does not show an inability to establish and maintain effective relationships, which would be consistent with a 70 percent rating. While the record does reflect an incident pertaining to suicide, it was an isolated incident that occurred in either 1983 or 1993, well before the period on appeal. Since then, there have been no reports of suicidal or homicidal ideation, intentions, or plans. The Board acknowledges the seriousness of the incident, and should the Veteran ever find himself in a similar situation, or having any thoughts pertaining to harming oneself of others, or thoughts of suicide or homicide, he should immediately reach out to VA's helpline and contact his VA mental health providers. However, the one isolated incident is too far removed from the appeal period to rise to the level of suicidal ideation contemplated under a 70 percent evaluation. The VA examiner in the January 2018 VA examination found that the Veteran's PTSD and depression manifested symptoms of depressed mood, suspiciousness, chronic sleep impairment, mild memory loss, such as forgetting names, directions, or recent events, disturbances of motivation or 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. Other than the symptom of difficulty in adapting to stressful circumstances, the Veteran's symptoms as reported by the VA examiner align with a 50 percent evaluation. To have only one symptom that aligns with the examples provided under a 70 percent evaluation is not enough to warrant a 70 percent evaluation. As such, a rating in excess of 50 percent for the Veteran's service-connected PTSD with major depressive disorder is not warranted, and therefore, the claim is denied. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Lutgens-Staley, Associate 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.