Citation Nr: 23055232 Decision Date: 10/10/23 Archive Date: 10/10/23 DOCKET NO. 14-00 068 DATE: October 10, 2023 ORDER Entitlement to a disability rating in excess of 50 percent for service-connected posttraumatic stress disorder (PTSD) is denied. FINDING OF FACT The severity, frequency, and duration of the Veteran's symptoms did not more closely approximate occupational and social impairment with deficiencies in most areas. CONCLUSION OF LAW The criteria for a disability rating in excess of 50 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 served on active duty from January 1966 to January 1969 in the United States Marine Corps. In January 2017, the Veteran testified at hearing before the undersigned Veterans Law Judge. A transcript of the proceeding is of record. The Board initially denied the claim in June 2019. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (CAVC) which issued a May 2022 memorandum decision vacating the June 2019 Board decision and remanding the issue for further development. The Board then remanded the claim in November 2022. There has been substantial compliance with the remand in connection with claims decided here and the Board will proceed with adjudication. Stegall v. West, 11 Vet. App. 268 (1998). This appeal has been advanced on the docket pursuant to38 C.F.R. § 20.902(c). Entitlement to a disability rating in excess of 50 percent for service-connected PTSD. The Veteran contends that his service-connected PTSD manifests with symptoms more severe than currently rated. Disability evaluations are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities found in 38 C.F.R. Part 4. Disability ratings are intended to compensate impairment in earning capacity due to a service-connected disorder. 38 U.S.C. § 1155. Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). Evaluation of a service-connected disorder requires a review of the veteran's entire medical history regarding that disorder. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). When a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. If there is a question as to which evaluation to apply to the veteran's disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. In all claims for an increased disability rating, VA has a duty to consider the possibility of assigning staged ratings. See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibited diverse symptoms meeting the criteria for different ratings during the course of the appeal, the assignment of staged ratings is necessary. 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). Under the General Formula, 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. The Board concludes that the Veteran's symptoms did not cause the level of impairment required for a disability rating of 70 percent or higher. The Veteran's symptoms do not more closely approximated the symptoms associated with a 70 percent rating, but rather resulted in a level of impairment contemplated the by the currently assigned 50 percent rating. A review of VA treatment records notes the presence of PTSD on a list of the Veteran's past medical history. However, these medical records do not show the Veteran has ever received psychiatric treatment for his PTSD. The Veteran's claim has been pending since an August 2010 rating decision. In July 2010, the Veteran underwent a VA examination to evaluate the severity of his PTSD. The Veteran reported having a difficult time readjusting to civilian life following military service. He stated he was married five times, and his only close friend was also a Vietnam veteran. He reported having problems with sleep, experiences hypervigilance at home and is always on alert in public places. He avoids closed spaces such as elevators and avoids television programming that remind him of war. At the time of the examination, he had never been in psychiatric treatment. During the examination the only symptoms the Veteran demonstrated were restricted affect and anxiety. The examiner noted there was no impairment in thought process or communication. In February 2018, the Board determined that another VA examination was needed in light of the Veteran's Board testimony reporting worsening PTSD symptoms. On remand, VA attempted to schedule the Veteran for a VA examination but no examination was conducted. Pursuant to the May 2022 CAVC decision, the Board remanded the claim to provide the Veteran an examination. The Veteran underwent a VA examination in August 2023. He reported that since his last examination his social functioning "has not changed much." He reported general contentment with engaging in activities by himself, including some travel and general daily activities. The Veteran reported no mental health treatment since his last examination and symptoms consistent with that examination. He reported no sleep issues, panic attacks, appetite issues, and concentration/memory issues. He continues to be unemployed. On examination, the examiner described the Veteran as cooperative and engaged in the interview. He was oriented, speech was unremarkable, thought process was linear and goal oriented. The Veteran denied current suicidal or homicidal ideation and said his mood was neutral. The examiner noted that affect was mood congruent and there were no overt signs of psychosis. The examiner identified symptoms of suspiciousness, disturbances of motivation and mood, difficulty establishing and maintaining effective work and social relationships, and difficulty adapting to stressful circumstances, including work or a work like setting. The examiner characterized the related level of occupational and social impairment as "occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation." While the Veteran did experience a symptom contemplated by a 70 percent rating-difficulty adapting to stressful situations-the evidence overall does not demonstrate the psychiatric symptoms resulted in occupational and social impairment with deficiencies in most areas, as contemplated by the 70 percent rating. The record includes the two VA examinations, but the Veteran has not had psychiatric treatment. The evidence overall does not show that the symptoms he experienced have impacted his social and occupational functioning to the extent the disability picture more closely approximates deficiencies in most areas. The examinations note normal thought process and communication. While the VA examinations show the Veteran had not worked since prior to 2010, the evidence does not support a finding that the Veteran's PTSD alone caused the unemployability. The Veteran has been in receipt of a total disability rating due to service-connected disabilities (TDIU), effective October 12, 2018. See January 2019 rating decision. The Veteran filed two applications for entitlement to TDIU and the second application, prior to the award granting the Veteran entitlement to TDIU, does not list PTSD as a service-connected disability contributing to his unemployability. Additionally, the Veteran's VA examinations note his lack of work since 2010, there is no indication that the examiners attributed this to his PTSD. 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 rating in excess of 50 percent, and the appeal must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P.S. McLeod 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.