Citation Nr: 22018198 Decision Date: 03/28/22 Archive Date: 03/28/22 DOCKET NO. 17-58 146 DATE: March 28, 2022 ORDER An increased rating to 70 percent, but no higher, for posttraumatic stress disorder (PTSD) from October 5, 2016, is granted. REMANDED Entitlement to a total disability based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran's PTSD manifested with occupational and social impairment, with deficiencies in most areas such as work, family relationships, judgement, thinking and mood with symptoms such as impaired impulse control, spatial disorientation, neglect of dental hygiene, difficulty adapting to stressful situations, and inability to establish and maintain effective relationships. 2. The severity, frequency, and duration of the Veteran's symptoms did not more closely approximate total occupational and social impairment. CONCLUSION OF LAW The criteria for a disability rating of 70 percent, but no higher, for PTSD are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.126, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from February 1969 to February 1971. The Veteran received a Bronze Star Medal and the Combat Infantryman Badge. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2017 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). An increased rating to 70 percent, but no higher, for PTSD from October 5, 2016, is granted. Historically, an August 2013 rating decision granted service connection for PTSD and assigned an initial 30 percent evaluation, effective March 21, 2012. In November 2016, the Veteran filed a claim with VA for increased compensation for his service-connected PTSD. See VA 21-526EZ received 11/09/2016. The Veteran contends that he is entitled to a higher rating of 70 percent, for his PTSD due to symptoms such as memory loss, hypervigilance, hyperarousal, and difficulty adapting to stressful situations and maintaining relationships. See NOD received 3/07/2017 (indicates seeking a 70 percent rating); see also Statement in Support of Claim for PTSD received 11/09/2016. The issue in this appeal is whether the Veteran's PTSD symptomatology causes a level of impairment greater than his current 50 percent rating. 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, 114-18 (Fed. Cir. 2013). In pertinent part, a 50 percent rating is assigned there is 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; 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 there is 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; 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. The Board concludes that the Veteran's symptoms cause a level of impairment more closely approximates symptoms associated with a 70 percent rating but not a 100 percent disability rating. VA and private treatment records, the December 2016 VA examination, and the Veteran's lay statements show that the Veteran's PTSD was manifested by symptoms associated with a 70 percent rating such as impaired impulse control, spatial disorientation, neglect of dental hygiene, difficulty adapting to stressful situations and inability to establish and maintain effective relationships. See VA 21-0781 at pages 5,6,7,8 and 9; see also C&P Exam received 12/13/2016 at pages 2, 5, and 6. The Board finds the severity, frequency, and duration of the Veteran's symptoms more closely approximate the symptoms contemplated by a 70 percent rating, which are less severe, less frequent, and shorter in duration than those contemplated by a 100 percent rating. See 38 C.F.R. § 4.126. While the Veteran did experience symptoms of memory loss and disorientation, they were not to the severity of those same symptoms contemplated by the 100 percent rating, e.g., memory loss of names of close relatives, own occupation, or own name. Rather, the Veteran reported forgetting why he went to the supermarket and needing to write things down due to a spotty memory. See VA 21-0781 received 11/09/2016 at page 6. He reported disorientation such as stumbling on his porch step and forgetting where he parked his car, which does not demonstrate the level of impairment associated with a 100 percent rating, such as or similar to disorientation to time or place or memory loss for names. As noted above, the Veteran's other remaining symptoms were either contemplated by or more consistent with a 70 percent rating and lead to deficiencies in deficiencies in varies areas of life, such as work, family relations, judgment While the Veteran has social impairment, the competent does not tend to show that the Veteran is totally isolated since he socializes with his neighbor quite often and his friend, a Vietnam Veteran about once a month, and maintains relationships with one of his brothers and his son who lives in California. See VA 21-0781 at page 9; see also C&P Exam received 12/13/2016 at pages 21. This evidence does not support total social impairment. See Total, Merriam-Webster, https://www.merriam-webster.com/dictionary/total (defining the adjective "total" as, among other entries, absolute). In sum, the Board finds that the severity, frequency, and duration of the Veteran's symptoms more nearly approximates a rating of 70 percent, as such an increased rating of 70 percent throughout the period on appeal. [The Board notes an October 5, 2016 VA 21-0966, Intent to File, received prior to the November 2016 VA 21-526EZ.] Upon implementation of this grant of increased compensation for PTSD, the agency of original jurisdiction (AOJ) will assign an effective date for the 70 percent rating to preserve one-review on appeal and full due process. 38 U.S.C. § 7104(a). That said, the evidence of record persuasively weighs against finding that the severity, frequency, and duration of the Veteran's symptoms resulted in the level of impairment required for a 100 percent rating. The criteria for a 100 percent or higher rating are not met and the appeal must be denied. REASONS FOR REMAND Entitlement to a TDIU is remanded. The Board finds that entitlement to a total disability based on individual unemployability (TDIU) is raised by the record. Rice v. Shinseki, 22 Vet. App. 447, 453 (2009). The Veteran has provided statements that his PTSD has caused his departure from his job, specifically issues with rage and anger at a co-worker wherein he wanted to use a pipe to hit him in the head. See VA 21-0781, Statement in Support of Claim for PTSD received 11/09/2016 at page 5. However, the Board finds that additional development is required in order to fully ascertain the Veteran's work history and if his service-connected PTSD caused him to be unable to gain and maintain employment, such as obtaining a VA Form 21-8940. Additionally, the AOJ has not yet considered whether the Veteran is entitled to TDIU. For these reasons, this matter is remanded to the AOJ for development and adjudication. This matter is REMANDED for the following action: Provide the Veteran with appropriate notice and assistance regarding the issue of entitlement to a TDIU rating. Specifically, the Veteran should be informed as to the information and evidence necessary to substantiate a TDIU, including which evidence, if any, the Veteran is expected to obtain and submit, and which evidence will be obtained by VA. The Veteran is to be asked to complete and submit a VA Form 21-8940, Veteran's Application for Increased Compensation Based on Individual Unemployability, to provide VA with important information, to include concerning education and occupational history. Paul Sorisio Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Dixon, 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.