Citation Nr: 21042545 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 15-14 093 DATE: July 13, 2021 ORDER The appeal as to the claim of entitlement to an evaluation in excess of 30 percent for service-connected schizophrenia disorder is denied. FINDING OF FACT The Veteran's schizophrenia was manifested by symptoms resulting in mild occupational and social impairment. CONCLUSION OF LAW The criteria for an evaluation on excess of 30 percent for service-connected schizophrenia have not been met. 38 U.S.C. §§ 1155, 5107 (West 2012); 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.7, 4.125, 4.126, 4.130, Diagnostic Code 9202 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service in the United States Army from October 1966 through December 1966. His service was under honorable conditions. The Veteran passed away in November 2013. The Appellant is his surviving spouse, who has been properly substituted, upon the passing of the Veteran. The matter is on appeal from an April 2013 rating decision. In a May 2019 decision, the Board remanded the Appellant's claim for additional development, including a directive regarding the scanning of a document from December 2014 that was unable to be scanned. In December 2019, the RO was notified the item was still not able to be scanned, but it was determined that the documents in question are service personnel records dated in 1966. The records are not pertinent to evaluating the severity of the service-connected schizophrenia disability. The Board also noted a March 2003 favorable Social Security Administration (SSA) benefits decision addressed to the Veteran. The records were requested by the RO; however, in a December 2019 response, SSA indicated that they could not send the records because they were destroyed. In April 2020, the RO notified the Appellant the SSA records were destroyed and requested she submit any available copies of the Veteran's SSA records. The correspondence also requested the Appellant to advise the RO of any possible locations of the records if she was unable to submit them. To date, the Appellant has not submitted any records or advised the RO as to a possible location of the records. In a May 2020 decision, the Board remanded the Appellant's claim for additional development. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). Increased Rating General Legal Criteria Disability evaluations are determined by the application of the VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4 (2020). 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 (2012); 38 C.F.R. §§ 3.321 (a), 4.1 (2020). 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 (2020) 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 disabilities 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. In both initial rating claims and normal increased rating claims, the Board must discuss whether "staged ratings" are warranted, and if not, why not. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). VA must consider all favorable lay evidence of record. 38 U.S.C. § 5107 (b); Caluza v. Brown, 7 Vet. App. 498 (1995). The Veteran is competent to testify regarding the onset and continuity of symptomatology. Heuer v. Brown, 7 Vet. App. 379, 384 (1995); Falzone v. Brown, 8 Vet. App. 398, 403 (1995); Caldwell v. Derwinski, 1 Vet. App. 466 (1991). The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10 (2020). It is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified; findings sufficiently characteristic to identify the disease and the disability therefrom are sufficient; and above all, a coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21 (2020). Entitlement to an evaluation in excess of 30 percent for service-connected schizophrenia disorder. The Appellant contends that the Veteran's schizophrenia disability is more severe than his current rating. In this regard, the Veteran is in receipt of a 30 percent disability rating under 38 C.F.R. § 4.130, Diagnostic Code 9202 for his schizophrenia, which refers to the General Formula for Mental Disorders (General Formula). Under the 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). Pursuant to the General Formula, 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. 38 C.F.R. § 4.130, Diagnostic Code 9202. The issue in this appeal is whether the Veteran's associated symptoms caused the level of impairment required for a disability rating of 50 percent or higher. VA outpatient treatment records dated in June 2012 note the Veteran has difficulty sleeping and fleeting suicidal thoughts with no intent or plan, since his diagnosis of lung cancer. The Veteran reported that he had a supportive family, as he was married for 47 years, with two sons, and his mother lived nearby. The examiner noted symptoms of intermittent depression and found the Veteran to be cooperative, alert, and without symptoms of suicidal ideation. The examiner noted that the Veteran was prescribed medication for anxiety and difficulty sleeping. VA outpatient treatment records dated in October 2012 through December 2012 note the Veteran attended therapy sessions to cope with his diagnosis of lung cancer. Records show the Veteran continued individual therapy session; the Veteran noted that he was "coping fairly well." The Veteran underwent a VA examination in April 2013, during which the examiner diagnosed depression. At the time, the Veteran reported that he remained married to his spouse for more than 40 years. He reported that his son and granddaughter were also supportive of him, as well as one friend. The Veteran reported that he was in counseling and palliative care related to his lung care diagnosis. He described diminished interest and lack of desire for friends, as he didn't want to them to see him in his current state of health. He further reported that he worried about things, such as what would happen the following day. The Veteran also reported that he experienced difficulty sleeping. Examination revealed depressed mood, anxiety, and chronic sleep impairment. The examiner found that the Veteran's depression was manifested by occupational and social impairment due to mild or transient symptoms not severe enough to interfere with occupational and social functioning. Upon examination and review of the record, the examiner found that the criteria were not met for a diagnosis of schizophrenia or psychosis. In support of his finding, the examiner found that the examination, contemporaneous treatment records, and the 2009 VA examination did not support such diagnosis, as the symptoms found were indicative of depression, likely related to the Veteran's lung cancer. VA outpatient treatment records include a June 2013 record that notes the Veteran's report that he worried all the times since his lung cancer diagnosis. Records dated in August 2013 note symptoms of depression, and an instance where the Veteran reported that he believed that others think he's lying about hearing voices. Records dated in September 2013 note the Veteran's report of difficulty sleeping and his constant worrying about his lung cancer diagnosis. A September 2013 record notes the Veteran's report that voices try to convince him that his life "ain't worth living." The examiner noted that the Veteran denied suicidal ideation. The examiner noted the Veteran's family, as well as his help-seeking behavior and future orientation. An October 2013 record includes the examiner's comment that the Veteran's mood was dysthymic. In an April 2021 VA opinion, the examiner reviewed the record and noted that the Veteran was diagnosed with schizophrenia. The examiner noted the Veteran's history, to include an episode in 1966, where he heard "questions" and thought others were lying about him. The examiner noted that the Veteran was hospitalized in 2000 for depressive symptoms, suicidal ideation, and homicidal ideation, due to work stressors. The examiner noted contemporaneous VA outpatient treatment records that show symptoms of excessive worry related to lung cancer, depression, moderate loss of interest, poor sleep, fatigue, feelings of guilt, and poor concentration. The examiner noted that the Veteran reported that he heard voices during outpatient treatment. The examiner noted that the evidence was negative for suicidal ideation, plan, or intent of self-harm. Based upon the medical and lay evidence of record, the Board finds that the Veteran is not entitled to a rating in excess of 30 percent for schizophrenia. In this case, the April 2013 VA examiner was able to weigh observed and reported symptomatology and rendered an assessment regarding his service-connected disability. Further, the April 2021 VA examination was able to weigh reported symptomatology, and rendered a similar assessment. The symptoms attributed to the Veteran's schizophrenia were not severe enough to either interfere with occupational and social functioning or to require continuous medication overall, and the examiner relied on the Veteran's reportedly good relationship with family, to include his wife of 48 years, two sons, and granddaughter, and excellent support system. Furthermore, the RO appropriately considered the lay statements submitted in support of the Veteran's claim when continuing the overall evaluation of 30 percent. The lay statements echo the previously discussed symptoms of sleep disturbances, anxiety, and symptoms of depression. While the lay statements indicate a severity slightly more than estimated by the VA examiner (VA outpatient treatment records dated in August 2013 and September 2013 note auditory hallucinations in the context of the Veteran considering his life with lung cancer), they, at most, are analogous to an occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. Moreover, the Veteran's auditory hallucinations were reported during therapy to facilitate coping with his diagnosis of lung cancer, not his service-connected schizophrenia disability. As such, the Board affords significant probative weight to both the medical and lay evidence of record in finding an occasional or intermittent interference with social and occupational functioning. The next highest rating, a 50 percent rating, would require demonstrating symptoms akin to 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. As the evidence of record shows, the Veteran's schizophrenia caused symptoms such as anxiety, sleep disturbances, and depression. These symptoms do not rise to the level of those contemplated in the 50 percent evaluation, such as suicidal ideation, which represent a more substantial impact of social and occupational functioning. Additionally, the Veteran expressed a positive relationship with his wife of 48 years and endorsed an excellent social support system that he relied upon when processing his schizophrenia. The Veteran also never sought out treatment for his schizophrenia specifically, as his mental health treatment was focused on his diagnosis of lung cancer, nor was treatment recommended by the examiner due to the mild nature of his symptoms overall. As such, when considering the VA examination report and lay evidence of record, it is clear that the Veteran did not meet the criteria approximated by the 50 percent, or higher, rating categories. The Board acknowledges that the Veteran, prior to passing away, and thereafter, the Appellant, believes that the service-connected schizophrenia warranted a higher evaluation. Although the Veteran is competent to provide testimony to establish the occurrence of medical symptoms, he is not medically qualified to prove a matter requiring medical expertise. See Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007). The severity of this condition is a medical, not lay, determination, and outside the realm of common knowledge of a lay person. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Further, specialized medical knowledge is required in order to attribute symptoms to a particular diagnosis, which the Veteran did not possess. Instead, the more reliable, competent medical evidence of record indicates that the Veteran's schizophrenia was manifested with only mild or intermittent interference with social and occupational functioning. Although the Appellant may believe that the Veteran's schizophrenia is more severe than the 30 percent evaluation assigned, the medical evidence of record does not support this assertion. As such, the probative evidence of record fails to show that the Veteran's schizophrenia warranted a rating in excess of 30 percent. With the preponderance of the probative evidence of record weighing against the claim, the benefit of the doubt rule need not be applied. See 38 U.S.C. § 5107 (b). Although grateful for the Veteran's service, the claim of entitlement to an increased evaluation for schizophrenia must be denied. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Sara Schinnerer, 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.