Citation Nr: 22018928 Decision Date: 03/30/22 Archive Date: 03/30/22 DOCKET NO. 18-49 989A DATE: March 30, 2022 ORDER Entitlement to an initial disability rating in excess of 30 percent for posttraumatic stress disorder (PTSD) is denied. FINDING OF FACT The Veteran's PTSD is more closely manifested by symptoms of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks; and not occupational and social impairment with reduced reliability and productivity. CONCLUSION OF LAW The criteria for a disability rating in excess of 30 percent for PTSD have not been met. 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 had active-duty service from May 1966 to August 1967. This matter comes before the Board of Veterans' Appeals (Board) from a September 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the Veteran's claim in August 2021 to acquire treatment records, as well as to obtain a new VA examination to assess the current severity of the Veteran's PTSD disability. Now associated with the Veteran's claims file is an October 2021 VA examination report. Lastly, the Veteran did not reply to VA's request for treatment records, and during the October 2021 VA examination the Veteran indicated that currently he is not receiving any medical health treatment, to include not being on medications, for his PTSD. See August 2021 Subsequent Development Letter. As such, the Board finds that its August 2021 remand directives have been substantially complied with. See Stegall v. West, 11 Vet. App. 268 (1998). 1. Entitlement to an initial disability rating in excess of 30 percent for posttraumatic stress disorder (PTSD) The Veteran contends that he is entitled to a disability rating in excess of 30 percent to the extent that he suffers from suicidal ideation, anxiety, irritability, and angry outbursts, as well as problems with his memory. See May 2020 Remarks to Supplemental Statement of the Case; January 2016 private treatment record (self-reported symptoms). 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). The Board concludes that the Veteran's symptoms did not cause the level of impairment required for a disability rating of 50 percent or higher. Instead, the Veteran's symptoms more closely approximated the symptoms associated with a 30 percent rating. Under the General Formula for rating mental disabilities, 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. VA and private treatment records, the October 2021 and July 2015 VA examinations, and the Veteran's lay statements show that the Veteran's PTSD was manifested by symptoms associated with a 30 percent rating (depressed mood, anxiety, chronic sleep impairment, mild memory loss), a symptom associated with a 70 percent rating (difficulty in adapting to stressful circumstances, including work or a work like setting) and a symptom associated with a 100 percent rating (memory loss for names of close relatives, own occupation, or own name). The Board finds the level of impairment caused by the Veteran's symptoms more closely approximates the level associated with a 30 percent rating. The Veteran experienced occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, but was generally functioning satisfactorily, with routine behavior, self-care, and normal conversation. Mental status examinations in VA and private treatment records and the October 2021 and July 2015 VA examination indicate that the Veteran had depressed mood, anxiety, chronic sleep impairment, and mild memory loss. Per the October 2021 VA examination report, the Veteran experiences depressed mood, anxiety, chronic sleep impairment, mild memory loss, and difficulty in adapting to stressful circumstances. The Veteran reported increased episodes of anxiety at least once a week. Of import, the VA examiner noted that the Veteran has good relationships with his friends and family and is not currently seeking medical treatment for his PTSD. The Veteran relayed that he has occasional episodes, to the extent of being verbally aggressive, of which occasionally affects how he gets along with other people, in addition to his work performance. The Veteran denied ever having attempted suicide but stated that he experiences passive thoughts of not wanting to live without a plan, means, and/or intent due to health concerns; however, he is not currently experiencing those thoughts. The VA treatment records confirm consistently negative suicide screenings, with the Veteran expressing that he had many reasons to live, including his mother, wife, and son over the years. Here, the Board does not find that the severity, frequency, and duration of the Veteran's prior suicidal ideations rise to the level contemplated by the 70 percent or 100 percent disability ratings, as there are no indications that he poses a threat to himself or others in terms of causing harm. See also May 2020 Remarks to Supplemental Statement of the Case. Per the July 2015 VA examination report, the Veteran experiences depressed mood, anxiety, and memory loss for names of closed relatives, own occupation, or own name. The July 2015 VA examiner opined that the Veteran occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform tasks only during periods of significant stress. As previously stated, the Veteran relayed that he experienced fleeting thoughts but no suicide plans or intent as he has many reasons to live. The Veteran also indicated that he has problems with irritability and anger, but otherwise denied problems with violence. Here, the Board finds that the July 2015 VA examination report resembles, to a large degree, that of the subsequent October 2021 VA examination report indicating that his disability has not undergone any significant increases in severity relative to his overall occupational and social impairment for the period on appeal. While the Veteran did experience symptoms contemplated by a 70 percent rating (suicidal ideation), and a 100 percent rating (memory loss for names of close relatives, own occupation, or own name), the evidence overall does not demonstrate the level of impairment associated with a 50 percent rating. As noted above, the Veteran's other remaining symptoms, to include those self-reported, were either contemplated by or more consistent with a 30 percent rating. Further, the Veteran indicated that he has good relationships with his friends and family, is not currently seeking any medical treatment for his disability, to include not being prescribed medications, and is not having thoughts of not wanting to live, nor has he had the thought, means, or intent of being a danger to himself or others. While one examination checked a box next to memory loss for "names of close relatives, own occupation, or own name," the narrative accompanying that exam notes that the Veteran appeared to have "some mild memory difficulty according to his report" but was oriented with adequate attention and concentration. Neither private nor VA treatment records throughout the appeal period document a finding of significant memory loss. Therefore, the Board finds that to the extent that the Veteran experiences any memory loss, it is not of such severity or frequency as to warrant a higher rating. In short, 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 50 percent rating. The criteria for a 50 percent or higher rating are not met and the appeal must be denied. Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S.R. Fey, 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.