Citation Nr: 21041249 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 16-27 173 DATE: July 8, 2021 ORDER Entitlement to a 50 percent disability rating for post-traumatic stress disorder (PTSD) is granted, subject to the laws and regulations governing the payment of monetary benefits. FINDING OF FACT During the period on appeal the Veteran's PTSD resulted in occupational and social impairment with reduced reliability and productivity, but not more severe. CONCLUSION OF LAW Affording the Veteran the benefit of the doubt, the criteria for a disability rating of 50 percent rating, but not higher, for PTSD have been met for the entire appeal period. 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 from September 1969 to June 1972, to include service to the Republic of Vietnam. He was awarded the Combat Action Ribbon among other decorations. The Veteran testified before the undersigned in April 2019 and the matter was most recently remanded in August 2019 for further development. There has been substantial compliance with the remand and the Board will proceed with adjudication. Stegall v. West, 11 Vet. App. 268 (1998). Subsequent to the remand, the rating was increased to 30 percent, effective February 26, 2014. See August 2020 rating decision. The Veteran contends that his disability is more severe than currently rated. Disability ratings are determined by comparing the Veteran's symptoms with criteria listed in VA's Schedule for Rating Disabilities, which is based, as far as practically can be determined, on average impairment in earning capacity. Separate Codes identify the various disabilities. 38 C.F.R. Part 4. When rating a service-connected disability, the entire history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two ratings shall be applied, the higher rating 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. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). When evaluating a mental disorder, consideration shall be given to the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission. The evaluation will be based on all the evidence of record that bears on occupational and social impairment rather than solely on an examiner's assessment of the level of disability at the moment of examination. It is the responsibility of the rating specialist to interpret reports of examinations in the light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2. Under the General Formula for Mental Disorders (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). A 30 percent rating is assigned when symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events), cause 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 normal conversation). A 50 percent rating is assigned when symptoms such 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; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; 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); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. 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 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; or memory loss for names of close relatives, own occupation or own name. At the April 2019 Board hearing, the Veteran testified that he had insomnia, was withdrawn from society, had anxiety and nightmares, poor short-term memory and a lack of trust in people. The Veteran reported he was not currently seeking treatment for his PTSD as he had difficulty in talking with people, even in a one on one situation. The Board remanded the claim for another examination as the previous March 2016 VA examination was deemed inadequate. The findings related in that examination will be not be discussed further. Following a February 2020 VA examination, the examiner characterized the Veteran's 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. The examiner noted that most of the Veteran's PTSD symptoms are anhedonia or an inability to experience pleasure from activities usually found enjoyable, anger, avoidance behaviors, and violence. The examiner observed that the Veteran's thoughts were clear and logical and there was no evidence of psychotic thought processing. His mood was irritable, and affect was full ranging. The Veteran denied having suicidal thoughts. The examiner specifically noted symptoms of depressed mood, anxiety, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, and difficulty in adapting to stressful circumstances. The examiner noted that the Veteran's PTSD symptoms were "on the mild side" and difficulties he experienced were more related to the illness and subsequent death of his wife. In the April 2019 hearing, the Veteran noted that his wife came into his life "when it was pretty bad." The Veteran stated she was responsible for much of his socializing. Affording the Veteran the benefit of the doubt, the Board finds that throughout the entire period on appeal, the impairment related to the Veteran's PTSD symptoms most nearly approximated the criteria for a 50 percent rating. The record reflects that through this period, the Veteran's symptoms included depressed mood, anxiety, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, and difficulty in adapting to stressful circumstances. The Veteran testified that he had 5 children but was not on good terms with all of them. He reported withdrawal and having no friends or want to socialize. The Board finds that the record reflects that the Veteran had difficulty establishing and maintaining work and social relationships and likely experienced occupational and social impairment with reduced reliability and productivity. Accordingly, the Board finds the frequency and severity of the symptoms more closely approximate the criteria for a 50 percent rating. The criteria for a higher 70 percent rating are not met or more closely approximated at any time during the appeal period. At no point during the period on appeal was the Veteran shown to have suicidal ideation; signs of delusions; obsessive compulsive behavior; speech intermittently illogical, obscure, or irrelevant; impaired impulse control; near-continuous panic or depression affecting his ability to function independently, appropriately, or effectively; spatial disorientation; or neglect of his personal hygiene. There is no evidence of impaired judgment or thinking. The Veteran did have difficulty with some of his family, but he still was able to maintain a relationship with family members. The Board finds that the symptoms did not result in occupational or social impairment with deficiencies in most areas, such as work, school, family relations, judgement, thinking or mood. Accordingly, throughout the entire period on appeal, the Veteran's symptoms more closely approximated in occupational and social impairment with reduced reliability and productivity, and a 50 percent rating is warranted. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Jarman, 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.