Citation Nr: 21041745 Decision Date: 07/10/21 Archive Date: 07/10/21 DOCKET NO. 16-31 941 DATE: July 10, 2021 ORDER Entitlement to an initial 50 percent rating for posttraumatic stress disorder (PTSD) is granted. FINDING OF FACT Throughout the entire period on appeal, the Veteran's service-connected PTSD manifested as occupational and social impairment with reduced reliability and productivity. CONCLUSION OF LAW The criteria for an initial 50 percent rating for PTSD have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 4.130, Diagnostic Code (DC) 9411 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 10, 1996 to December 19, 1996, March 3, 1997 to September 26, 2001, November 15, 2003 to March 27, 2005, and from August 18, 2008 to October 5, 2009. This matter is before the Board of Veterans' Appeals (Board) on appeal from a March 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran timely appealed his initial rating in December 2014. Entitlement to an initial 50 percent rating for PTSD is granted. The Veteran claims entitlement to a higher initial rating for his service-connected PTSD. Specifically, he claims that his endorsed symptoms of short-term memory loss, mood instability, anhedonia, recurring nightmares, difficulty maintaining relationships with family, difficulty establishing relationships with coworkers, anxiety, and anti-social behaviors warrant an initial 50 percent rating. The evidence of record shows that, in March 2014, the Veteran underwent a VA initial PTSD examination. Ultimately, the examiner assessed the Veteran with a formal diagnosis of PTSD; however, the examiner determined that symptoms were not severe enough to either interfere with occupational and social functioning or to require continuous medication. He was appropriately oriented, with average/normal immediate memory, delayed memory, ability to understand/follow directions, persistence, attention, and abstraction. His basic verbal fluency was low/average. He reported that he felt he changed from being outgoing person to being anti-social, wishing to remain home. He got frustrated easily, especially when there were challenges that were ridiculous and near insubordination. He reported that he was once happy all the time and now he was on edge, could not relax, and was worried about everything going on around him. He described his home as his sanctuary and reported feeling reasonably safe in that known environment. He reported that he did not like to be in groups and around crowds, stating he would avoid such situations if at all possible, unless it were required for his work. In crowds, he endorsed being acutely aware of everything in the environment. He reported being suspicious and untrusting. He also reported a possible startle, high irritability with holding the anger within, and getting frustrated more easily. The examiner noted symptoms of suspiciousness and chronic sleep impairment. A January 2015 private sleep study noted that the Veteran had problems with memory and concentration during the day. The Veteran's spouse stated in August 2015 that, after his first tour ended in 2005, he began to act differently and was restless, sleeping only 3 4 hours a night for a long period of time. He often would complain about a recurring vivid dream. In a letter dated October 2015, the Veteran's private physician, Dr. S, opined that it was at least as likely as not that PTSD and sleep apnea were aggravating each other. Dr. S explained that sleep disruption caused by sleep apnea could certainly exacerbate anxiety, mental acuity, and depression, and that the Veteran's PTSD made it difficult for him to tolerate his CPAP or to sleep at all, worsening his daytime excessive somnolence. Private records received in February 2019 show the Veteran was prescribed Fluoxetine for his PTSD. He presented seeking medical and therapeutic treatment for his condition and reported taking Wellbutrin unsuccessfully in the past. The Veteran was oriented, with normal vital signs, cooperation, mood, affect, speech, behavior, thought content, eye contact, dress, and mentation. The clinician also noted the Veteran's sleep disturbance, nervousness, and anxiousness. In March 2019, the Veteran underwent a second VA PTSD examination. Ultimately, the examiner assessed the Veteran with formal diagnoses of PTSD and alcohol use disorder (AUD) with occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medication. He was oriented, with average/normal grooming, clothing, cooperation, eye contact, insight, judgment, thought, speech, volume, and intelligence. His affect was observed to be depressed but congruent, with his affective expression being normal and appropriate. His PTSD symptoms included recurring intrusive thoughts or dreams, avoidance of associated stimuli, negative alterations in mood and cognitions, increased arousal and reactivity, and clinical distress that impacted his life. The examiner differentiated these from AUD reasoning that the AUD symptoms of difficulty cutting back alcohol use, feeling groggy in the mornings due to prior night's drinking, strong urge to use alcohol, and consuming larger quantities of alcohol than intended, were a result of the Veteran using alcohol as a primary coping tool to manage his PTSD symptoms. He denied significant changes in relationships over the past several years, reporting that he communicated regularly with his family and he considered himself close with his sibling and children. He endorsed anxiety during his work as a firearms instructor, stating that his anxiety was 6/10 while working and 1/10 during lunch. He denied issues with his peers and supervisors. He reported that he was once prescribed Fluoxetine and Wellbutrin but stopped taking them after less than a month because he did not feel any benefit. The examiner noted symptoms of depressed mood, anxiety, suspiciousness, chronic sleep impairment. After a review of the evidence of record, the Board finds that an initial 50 percent rating for the Veteran's service-connected PTSD is warranted throughout the appeal period (i.e., since he filed his service connection claim for this disability). During the March 2014 VA PTSD examination, the Veteran reported restricted affect in the form of feelings of detachment or estrangement from others, disturbances of motivation in the form of anhedonia, disturbances of mood in the form of irritability, and anti-social behaviors. He also reported disliking crowds, suspiciousness, and sleep impairment. These symptoms, especially of estrangement, isolation, suspiciousness, irritability, and anhedonia, made it difficult for him to establish and maintain social relationships. In January 2015 he had problems with memory and concentration. While this could have been linked to sleep apnea, the opinion from Dr. S determined that PTSD and sleep apnea were both aggravated by each other. At his PTSD VA examination in March 2019, he was assessed with negative alterations in mood and cognitions, increased arousal, and reactivity, indicating disturbances of motivation and mood. The Board acknowledges that, during the appeal period, the Veteran reported symptoms contemplated by his current 30 percent rating for PTSD. These symptoms included depressed mood, anxiety, suspiciousness, chronic sleep impairment, and mild memory loss. The medical evidence supports finding that these symptoms would exacerbate the Veteran's difficulties in establishing and maintaining effective work and social relationships as would impaired memory, concentration, and wakefulness stemming from the Veteran's chronic sleep impairment. The Board has considered awarding a higher 70 percent rating for PTSD; however, the evidence of record does not indicate occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. The Board also has considered the Veteran's symptoms which are not included in the rating criteria listed under 38 C.F.R. § 4.130 and whether they constitute symptoms that would be comparable in type and degree (frequency, severity, and duration) to the criteria for a higher rating. See Mauerhan, 16 Vet. App. at 443. He reported avoiding crowded spaces and having hypervigilance, sleep impairment, and nightmares. Although these symptoms are significant, the Board does not find that they are of a comparable severity to the more severe symptomatology required for a 70 percent rating for PTSD. In summary, and after resolving any reasonable doubt in the Veteran's favor, the Board finds that the criteria for an initial 50 percent rating for PTSD have been met. MICHAEL T. OSBORNE Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Slomka, 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.