Citation Nr: 22010371 Decision Date: 02/23/22 Archive Date: 02/23/22 DOCKET NO. 14-42 795 DATE: February 23, 2022 ORDER Entitlement to a disability rating of 70 percent, but not higher, for posttraumatic stress disorder (PTSD) from October 1, 2015 to September 26, 2018 is granted. FINDING OF FACT From October 1, 2015 to September 26, 2018, the medical evidence of record shows that the Veteran's PTSD disability was primarily manifested by symptoms of depressed mood, anxiety, chronic sleep impairment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, social isolation, irritability and angry outbursts, and difficulty in adapting to stressful circumstances; deficiencies in most areas and total social and occupational impairment was not shown. CONCLUSION OF LAW The criteria for entitlement to a rating of 70 percent for PTSD from October 1, 2015 to September 26, 2018 have been met. 38 U.S.C. § 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.4, 4.7, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1999 to October 2000 and from June 2004 to November 2005. In September 2019 and May 2021, the issue was remanded for further development to include a VA examination and to obtain records from the Social Security Administration as well as private and Vet Center treatment records. After reviewing the actions of the Agency of Original Jurisdiction, the Board finds there was substantial compliance with the requested development including obtaining the SSA records and conducting an examination to determine the severity of the Veteran's PTSD disability. Stegall v. West, 11Vet. App.268 (1998). An August 2020 rating decision increased the Veteran's disability rating for PTSD to 70 percent, effective May 9, 2020. A November 2021 rating decision assigned a temporary evaluation of 100 percent for hospitalization over 21 days effective June 30, 2015 to September 30, 2015, a rating of 30 percent from October 1, 2015, and a 70 percent rating from September 27, 2018. The Board notes that the Veteran has made clear in several statements that he is only appealing the 30 percent rating and is satisfied with the 70 percent disability rating assigned from September 27, 2018. As such, the only issue before the Board is entitlement to a rating in excess of 30 percent from October 1, 2015 to September 26, 2018. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities. 38 C.F.R. Part 4. The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The Veteran's entire history is reviewed when making disability ratings. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, when the question for consideration is the propriety of the initial disability rating assigned, evaluation of the medical evidence since the grant of service connection and consideration of the appropriateness of "staged rating" is required. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). Staged ratings are also appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. The relevant focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. Entitlement to a rating in excess of 30 percent for posttraumatic stress disorder (PTSD) from October 1, 2015 to September 26, 2018 As noted above, the Veteran has submitted correspondence stating that he is satisfied with the 70 percent disability rating assigned from September 27, 2018 and that he wants the 30 percent rating increased to 70 percent as well. In a Veteran statement dated May 19, 2021and statements received July 1, 2021 and December 23, 2021 the Veteran made clear that only desires to appeal the 30 percent rating assigned prior to September 27, 2018. Specifically, he asserts that the 70 percent rating should apply to that time period as well. PTSD is rated using the General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130, Diagnostic Code 9411. A 10 percent rating is warranted for 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 continuous medication. A 30 percent rating is warranted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of the inability to perform his or her 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, mild memory loss (such as forgetting names, directions, 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 ideations; 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 the veteran's personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); 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 processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform the 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. 38 C.F.R. § 4.130, Diagnostic Code 9411, General Rating Formula for Mental Disorders (2018). After a review of all the medical evidence of record, the Board finds that a 70 percent rating, but not higher, is warranted for the Veteran's PTSD disability from October 1, 2015 to September 26, 2018. Treatment records, both VA and private, show that the Veteran has experienced PTSD symptoms equivalent to those stated in the 70 percent rating criteria from October 1, 2015 to September 26, 2018. VA traumatic brain injury (TBI) and PTSD examinations in January 2013 reflect the Veteran reported PTSD symptoms of anxiety, chronic sleep impairment, excessive worry, hypervigilance, easily angered/angry outbursts, irritability, suspicious of others, avoidance of crowds, and difficulty adapting to stressful circumstances, including work or a worklike setting. From June 30, 2015 through September 3, 2015, the Veteran participated in an in-patient PTSD program at Palo Alto VA Medical Center (VAMC). Treatment records from that stay show that the Veteran reported continuing struggles with severe anxiety, depression, avoidance, social isolation, poor anger control (destroying property, hitting and throwing things when angry), hypervigilance, difficulty adapting to stressful circumstances, and intrusive thoughts. Some issues recommended for aftercare following discharge were anxiety and trauma-related symptoms, communication and conflict resolution skills, affect regulation, and relationship building, enhancement, and maintenance. After being discharged from the PTSD program at the Palo Alto VAMC the Veteran continued to suffer with PTSD symptoms and sought treatment from the Vet Center in Idaho Falls, ID. A May 2016 Vet Center mental health note reflects the Veteran had symptoms of depression, irritability, and anger issues. A May 2017 VA mental health note reflects the Veteran continued to have symptoms of anger and irritability, social anxiety, low motivation, depressed mood, and chronic sleep impairment. In May of 2018, the Veteran endorsed symptoms of depression, anger, anxiety, avoidance, irritability, isolation, and relationship struggles. The treating clinician stated that the Veteran's PTSD continued to be a significant struggle in his life. Social Security Administration records received in September 2021 show the Veteran receives benefits for a primary diagnosis of anxiety related disorders and a secondary diagnosis of affective disorders. The Veteran was deemed disabled from these conditions as of November 1, 2012. The Board finds that the medical and lay evidence of record supports the assignment of a 70 percent rating, but not higher, for the Veteran's PTSD disability from October 1, 2015 to September 26, 2018. The Board finds that the evidence is persuasively against the assignment of a higher rating during this time period. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Thomas H. O'Shay Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Mitchell, 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.