Citation Nr: 24005759 Decision Date: 02/03/24 Archive Date: 02/03/24 DOCKET NO. 17-66 751 DATE: February 3, 2024 ORDER Entitlement to a 70 percent rating, from November 14, 2014 through July 30, 2023, for posttraumatic stress disorder (PTSD), is granted, subject to the law and regulations governing the award of monetary benefits. Entitlement to a rating in excess of 70 percent, from November 14, 2014 through July 30, 2023, for PTSD, is denied. REMANDED Entitlement to a total disability rating based on individual unemployability (TDIU) due to PTSD, from November 14, 2014 through December 13, 2016, is remanded. FINDING OF FACT The evidence is approximately evenly balanced as to whether, during the period from November 14, 2014 through July 30, 2023, the Veteran's PTSD was manifested by occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgement, thinking, and mood; symptoms and impairment did not more nearly approximate total social and occupational impairment. CONCLUSIONS OF LAW 1. With reasonable doubt resolved in favor of the Veteran, the criteria for a 70 percent rating, from November 14, 2014 through July 30, 2023, for PTSD, are met. 38 U.S.C. § §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.125, 4.126, 4.130, Diagnostic Code (DC) 9411. 2. The criteria for a rating in excess of 70 percent, from November 14, 2014 through July 30, 2023, for PTSD, are not met. 38 U.S.C. § §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.125, 4.126, 4.130, DC 9411. REASONS AND BASES FOR FINDING AND CONCLUSIONS The Veteran served on active duty from August 2005 to June 2006, which includes service in the Southwest Asia theater of operations. These matters initially came before the Board of Veterans' Appeals (Board) from a May 2017 rating decision, in which the agency of original jurisdiction (AOJ) denied entitlement to a rating in excess of 50 percent for PTSD. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a December 2022 hearing and a transcript of the hearing is associated with her claims file. In January 2023, the Board expanded the appeal to include the inferred issue of entitlement to a TDIU, as part and parcel of the claim for an increased rating for PTSD. See Rice v. Shinseki, 22 Vet. App. 447 (2009). The Board remanded the TDIU issue, as well as the issue of entitlement to an increased rating for PTSD, for further development. In August 2023, the AOJ awarded a 100 percent rating for PTSD and special monthly compensation (SMC) pursuant to 38 U.S.C. § 1114 (s), both from June 9, 2023. In December 2023, the AOJ made the following determinations: assigned an effective date of July 31, 2023 for the award of an increased (100 percent) rating for PTSD on the basis of clear and unmistakable error (CUE); awarded a 70 percent rating for PTSD, from December 14, 2016 through July 30, 2023; awarded a TDIU due to PTSD, from December 14, 2016; and assigned an effective date of December 14, 2016 for the award of SMC pursuant to 38 U.S.C. § 1114 (s). In the January 2023 remand, the Board instructed the AOJ to, among other things, ask the Veteran to identify any outstanding treatment records and to complete the appropriate authorization form to allow VA to obtain any outstanding private medical records, obtain all outstanding VA treatment records, afford the Veteran an examination to assess the severity of her service-connected psychiatric disability, and readjudicate the issue of entitlement to an increased rating for PTSD. Pursuant to the Board's remand, the Veteran was asked to identify any outstanding treatment records and to complete the appropriate authorization form to allow VA to obtain any outstanding private medical records by way of a January 2023 letter. Copies of the authorization forms (VA Forms 21-4142a and 21-4142) were included with the letter. Also, all outstanding VA treatment records were obtained and associated with the claims file, a VA examination was conducted in July 2023 to assess the severity of the Veteran's service-connected psychiatric disability, and the issue of entitlement to an increased rating for PTSD was readjudicated in a December 2023 supplemental statement of the case. Therefore, the AOJ substantially complied with the Board's pertinent remand instructions. See Dyment v. West, 13 Vet. App. 141, 146- 47 (1999); Stegall v. West, 11 Vet. App. 268 (1998). As for characterization of the issues on appeal, as the Veteran was awarded a 100 percent rating, from July 31, 2023, for PTSD, the rating for this disability during this period will not be addressed by the Board. Cf. AB v. Brown, 6 Vet. App. 35, 38 (1993). Moreover, although a TDIU has been awarded from December 14, 2016, the issue of entitlement to a TDIU, during the period from November 14, 2014 through December 13, 2016, remains on appeal as part and parcel of the claim for an increased rating for PTSD. See Harper v. Wilkie, 30 Vet. App. 345 (2018); Rice, 22 Vet. App. at 447. The Board is considering a TDIU due to the service-connected PTSD alone because that is the primary basis of the Veteran's claim in this regard. Also, as explained below, the Board is awarding a 70 percent rating for PTSD during the entire period from November 14, 2014 through December 13, 2016, and this results in a combined 100 percent disability rating during this period. The receipt of a 100 percent schedular disability rating for a service-connected disability or disabilities does not necessarily moot the issue of entitlement to a TDIU because a TDIU rating may still form the basis for assignment of SMC pursuant to 38 U.S.C. § 1114 (s). When a veteran has a service-connected disability rated as total and has additional service-connected disability(ies) independently ratable at 60 percent or more, she is entitled to SMC. 38 U.S.C. § 1114 (s)(1). In this case, the evidence reflects that it is only the Veteran's psychiatric disability that may alone have rendered her unable to secure and follow substantially gainful employment during the period from November 14, 2014 through December 13, 2016. There is no other single service-connected disability that, alone, may have rendered her unable to secure and follow substantially gainful employment during this period. Therefore, the TDIU issue that remains on appeal has been characterized as entitlement to a TDIU due to PTSD. Entitlement to an increased rating for PTSD, rated 50 percent disabling prior to December 14, 2016 and 70 percent disabling from December 14, 2016 through July 30, 2023 Disability ratings are determined by the application of rating criteria set forth in the VA Schedule for Rating Disabilities (38 C.F.R. Part 4) based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155. If two ratings are potentially applicable, the higher rating 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 view of the number of atypical instances 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, and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § 4.21. In evaluating a disability, the Board considers the current examination reports considering the whole recorded history to ensure that the current rating accurately reflects the severity of the condition. The Board has a duty to acknowledge and consider all regulations that are potentially applicable. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The medical as well as industrial history is to be considered, and a full description of the effects of the disability upon ordinary activity is also required. 38 C.F.R. §§ 4.1, 4.2, 4.10. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). Staged ratings are, however, 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). When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission. The rating agency shall assign a rating based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. 38 C.F.R. § 4.126 (a). When evaluating the level of disability from a mental disorder, VA will also consider the extent of social impairment, but shall not assign a rating solely on the basis of social impairment. 38 C.F.R. § 4.126 (b). The schedular criteria for rating psychiatric disabilities incorporate the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). See 38 C.F.R. §§ 4.125, 4.130. The Veteran's PTSD is rated under 38 C.F.R. § 4.130, DC 9411. This disability is rated according to the General Rating Formula for Mental Disorders (General Rating Formula). Under the General Rating 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 when symptoms such 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 cause total occupational and social impairment. Under the General Rating 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 list of symptoms under the rating criteria are meant to be examples of symptoms that would warrant the rating, but are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. On the other hand, if the evidence shows that the Veteran suffers symptoms or effects that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the diagnostic code, the appropriate equivalent rating will be assigned. Sellers v. Principi, 372 F.3d 1318, 1326 (Fed. Cir. 2004); Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002). The criteria for a 70 percent rating are met if there are deficiencies in most of the areas of work, school, family relations, judgment, thinking, and mood. Bowling v. Principi, 15 Vet. App. 1, 11-14 (2001). Considering the pertinent evidence in light of the applicable rating criteria and considerations, the Board finds, for the following reasons, that the symptoms of the Veteran's PTSD resulted in deficiencies in most of the areas needed for a 70 percent rating, but no higher, under the General Rating Formula during the entire claim period from November 14, 2014 through July 30, 2023. The Veteran's claim for an increased rating for PTSD was received on November 14, 2014 (see a November 2014 "Application for Disability Compensation and Related Compensation Benefits" form (VA Form 21-526EZ) and the Board's explanation in its January 2023 remand). A December 2014 statement from the Veteran (VA Form 21-0781a), VA treatment records dated from October 2014 to March 2015, and the report of an April 2015 VA psychiatric examination indicate that the Veteran lived with her parents, had never been married, was not dating, and did not have any children. She had positive and "very close" relationships with her mother, stepfather, brother, and grandparents, but did not have any friends due to distrust of others, and did not belong to any social groups or clubs. She was in school, but was underperforming because she was unable to complete tests in the allotted time and experienced problems with focus and concentration. She taught yoga at a university approximately 4 hours per week, did personal training with a couple of woman one or times per week, and volunteered at a gym on the weekends (approximately two to three hours) teaching yoga. She used to work full-time at the gym, but limited her hours because she was in school full-time and her time at the gym interfered with school. She did not do much socially outside of work, school, and volunteering, did not actively go out with any friends, and often kept to herself and studied. As for the symptoms of the Veteran's psychiatric disability, she experienced recurrent, involuntary, and intrusive distressing memories of traumatic events in service; recurrent distressing dreams in which the content and/or affect of the dreams were related to the traumatic events; intense or prolonged psychological distress at exposure to internal or external cues that symbolized or resembled an aspect of the events; marked physiological reactions to internal or external cues that symbolized or resembled an aspect of the events; avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic events; avoidance of or efforts to avoid external reminders that aroused distressing memories, thoughts, or feelings about or closely associated with the traumatic events; persistent and exaggerated negative beliefs or expectations about herself, others, or the world; persistent distorted cognitions about the cause or consequences of the traumatic events; markedly diminished interest or participation in significant activities; and feelings of detachment or estrangement from others. She also experienced irritable behavior and angry outbursts, hypervigilance, a hyperstartle response, problems with concentration, anxiety, panic attacks, chronic sleep impairment, an inability to wait in rooms with other people, obsessive behaviors (e.g., exercise, running), impaired memory, thoughts of being a burden to others, and difficulty in establishing and maintaining effective work and social relationships. Examinations revealed that the Veteran was cooperative and appropriately and casually attired, had good personal hygiene, and had normal eye contact and interaction. Her mood was anxious, her affect was anxious with a sense of time pressure, her psychomotor activity was restless/slowed, and her speech was occasionally fast. Her thought processes were goal directed, her memory appeared to be grossly intact, her attention and concentration were "ok"/fair, she was fully oriented, and she did not experience any hallucinations, delusions, paranoia, preoccupations, obsessions, or suicidal/homicidal thoughts. She endorsed a good history of maintaining minimal personal hygiene and other basic activities of daily living. The Veteran was diagnosed as having PTSD. The examiner who conducted the April 2015 examination concluded that the symptoms and impairment caused by the Veteran's psychiatric disability met the criteria for a 10 percent rating under the General Rating Formula (i.e., 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 medication). VA treatment records dated from May 2015 to April 2017, statements from the Veteran dated in September 2015 and August 2016, statements from the Veteran's brother and grandparent dated in August 2016, a February 2017 statement from J.S., an April 2017 VA psychiatric examination report, and the Veteran's May 2017 notice of disagreement (VA Form 21-0958) indicate that she was never married and was not in any relationship. She lived with her parents for a period of time and later temporarily lived with a roommate, but her roommate moved out and the Veteran subsequently lived alone with her therapy dog. She had good relationships with her mother, stepfather, brothers, and maternal grandparents. She had a close friend who she saw when she was able, and they had traditions to get together at certain times of the year. She attempted to interact with classmates and meet other people for casual interactions, she reported during a July 2016 VA psychology evaluation that she had gone on a weekend camping trip with friends from school, and she reported during a November 2016 VA psychology evaluation that she was spending more time socializing with her neighbor and that they were planning on going on a hike together with their dogs. At the time of the April 2017 examination, she was not involved in any organized group activities. As for education and employment, the Veteran finished her last semester of college, received a Bachelor's degree in sports science, attempted to continue her education towards completing a Master's degree in the physical health field (exercise science), but was kicked out of the program. She had employment history as a nursing assistant, fitness attendant, food server, newspaper editor, pharmacy stocker, personal trainer, at a golf course, as a yoga instructor, at a hospital, and in sales with a telecommunications company. She was disciplined at one job for having her therapy dog at work and she quit this job in July 2016 due to distrust of a co-worker. She struggled with her job at the hospital because she had difficulty working night shifts and experienced patients becoming aggressive and wanting to harm themselves. Her job with the telecommunications company went well, she met her sales targets, and worked some overtime, but she was sensitive to criticism, would get upset at even minor corrections from her boss, did not like attention drawn to herself, and sometimes had to briefly step out at work due to panic symptoms. She remained employed in sales with a telecommunications company at the time of the April 2017 examination. She was doing "really well" in sales and as an employee, and her relationship with co-workers and supervisors was "for the most part good," but there were occasions when she felt uncomfortable at work. With respect to the symptoms of the Veteran's psychiatric disability, she experienced intrusive, distressing memories of traumatic events in service; distressing dreams that involved content or emotion related to the events; dissociative reactions (flashbacks) to the events in which she behaved or felt as if the events were happening again; intense or prolonged psychological distress at exposure to internal or external cues that symbolized or resembled an aspect of the traumatic events; marked physiological reactions to internal or external cues that symbolized or resembled an aspect of the events; avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic events; avoidance of or efforts to avoid external reminders that aroused distressing memories, thoughts, or feelings about or closely associated with the traumatic events; persistent, distorted cognitions about the cause or consequences of the events; and a persistent negative emotional state. She also experienced chronic passive suicidal ideation, anxiety, depression, impaired focus and concentration (which impacted her school performance), impulsive/aggressive tendencies, irritability, hypervigilance, a hyperstartle response, feelings of hopelessness/worthlessness, a sense of a foreshortened future, loss of interest in activities, feeling distant or cut off from other people, emotional numbness, nightmares, chronic sleep impairment, distrust of others, obsessive behaviors (e.g., exercising), panic attacks (reported as daily on the May 2017 VA Form 21-0958), an inability to wait in rooms with other people, anger, paranoia, impaired memory and concentration, difficulty in establishing and maintaining effective work and social relationships, and difficulty in adapting to stressful circumstances (including work or a worklike setting). Examinations revealed that the Veteran was appropriately and casually attired, exhibited good personal hygiene, and was cooperative and pleasant. She was fully alert and oriented, her memory was within normal limits, her eye contact was occasionally poor, her speech was occasionally pressured and detailed, her motor activity was occasionally restless, her mood was anxious/depressed/euthymic, her affect was broad/flat/blunted, her thought processes were goal directed, coherent, and linear, and her though content was void of any delusions. She felt like she was hallucinating when she woke up from nightmares, but she felt that she was more half asleep on these occasions and did not experience any hallucinations while awake. The Veteran was diagnosed as having PTSD and major depression. The examiner who conducted the April 2017 VA psychiatric examination concluded that the symptoms and impairment caused by the Veteran's psychiatric disability met the criteria for a 30 percent rating under the General Rating Formula (i.e., occupational and social impairment with 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). VA treatment records dated from May 2017 to July 2022, a January 2018 statement from the Veteran, a May 2018 VA psychiatric examination report, treatment records from VeraVia Health & Fitness Retreat dated in April and May 2021, the Veteran's testimony during the December 2022 Board hearing, and a December 2022 "Veteran's Application for Increased Compensation Based on Unemployability" form (VA Form 21-8940) reflect that the Veteran returned to school to complete a Master's degree in exercise science. Her psychiatric symptoms impacted her school performance in that hypervigilance contributed to reduced concentration in the classroom. She withdrew from this program in December 2020 and was accepted into chiropractor school. She lived by herself for a period of time (during which her mother stayed with her on weekends as a caregiver and to motivate the Veteran to get out of bed, eat, and take care of her dogs), subsequently moved back in with her parents for a period of time, and began living with a boyfriend in approximately June 2022. She lost her job in approximately January 2018, but she started a new job in February 2018, was working two part-time jobs as a stocker and salesperson at the time of the May 2018 examination, and had additional jobs during this period (including as a personal trainer, a fitness club manager, in customer service, as a sales representative, and working for her parents' gym). Her mother reported during the May 2018 examination that the Veteran had bonded with a group of runners, but the Veteran denied that this was accurate. The Veteran reported during a July 2020 VA psychology evaluation that she was planning on going camping with her "two best friends." As for the symptoms of the Veteran's psychiatric disability, she experienced recurrent, involuntary, and distressing memories of traumatic events in service; recurrent distressing dreams in which the content and/or affect of the dreams were related to the traumatic events; dissociative reactions (flashbacks) in which she felt or acted as if the traumatic events were recurring; intense or prolonged psychological distress at exposure to internal or external cues that symbolized or resembled an aspect of the traumatic events; marked physiological reactions to internal or external cues that symbolized or resembled an aspect of the events; avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic events; avoidance of or efforts to avoid external reminders that aroused distressing memories, thoughts, or feelings about or closely associated with the traumatic events; persistent and exaggerated negative beliefs or expectations about herself, others, or the world; persistent, distorted cognitions about the cause or consequences of the events; a persistent negative emotional state; and feelings of detachment or estrangement from others. She also experienced irritable behavior and angry outbursts, hypervigilance, a hyperstartle response, problems with concentration, depression, anxiety, suspiciousness, panic attacks more than once per week, chronic sleep impairment, a flattened affect, impaired judgement, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, impaired impulse control, and chronic passive suicidal ideation. Examinations revealed that the Veteran was fully oriented and cooperative, that her concentration, attention, and memory were all within normal limits, that her thought content was appropriate, and that her though process was goal-oriented. Her mood was depressed/euthymic/anxious, her affect was occasionally constricted/tearful/tense, her eye contact was intermittent, her speech was normal, and her judgement and insight were adequate. Diagnoses of PTSD and major depression were provided. The examiner who conducted the May 2018 VA psychiatric examination concluded that the symptoms and impairment caused by the Veteran's psychiatric disability met the criteria for a 50 percent rating under the General Rating Formula (i.e., occupational and social impairment with reduced reliability and productivity). The above evidence reflects that, during the claim period from November 14, 2014 through July 30, 2023, the Veteran experienced some employment problems due to panic symptoms and difficulty handling criticism from others. She was in school during much of this period and her performance in school was negatively impacted by her psychiatric symptoms (including impaired concentration, impaired focus, and hypervigilance). Also, her symptoms of impaired concentration, nightmares, flashbacks, intrusive thoughts of traumatic experiences, suicidal ideation, anxiety, depression, anger, and irritability are reflective of deficiencies in the areas of thinking and mood. Moreover, the Veteran reported passive suicidal ideation during much of the claim period. In Bankhead, the United States Court of Appeals for Veterans Claims (Court) held that suicidal ideation means a veteran's thoughts of his or her own death or thoughts of engaging in suicide-related behavior, and does not require suicidal intent, a plan, or preparatory behavior. The Court also held that the language of the general rating formula indicates that the presence of suicidal ideation alone may cause occupational and social impairment with deficiencies in most areas. Id. The Board acknowledges that the medical professionals who conducted the April 2015, April 2017, and May 2018 VA psychiatric examinations indicated that the severity of the Veteran's psychiatric symptoms met the criteria for 10 percent, 30 percent, and 50 percent ratings under the General Rating Formula, respectively. However, the question of which criteria the symptoms and impairment more nearly approximate is an adjudicatory rather than a medical determination. 38 C.F.R. § 3.100 (a) (delegating the Secretary's authority "to make findings and decisions... as to the entitlement of claimants to benefits" to, inter alia, VA "adjudicative personnel"); 38 C.F.R. § 4.2 ("It is the responsibility of the rating specialist to interpret reports of examination... so that the current rating may accurately reflect the elements of disability present"). Overall, given the above evidence (to include the evidence of chronic passive suicidal ideation), the Board finds that the evidence is approximately evenly balanced as to whether the overall symptomatology described and demonstrated during the claim period most closely approximates occupational and social impairment with deficiencies in most areas during the entire claim period. As the reasonable doubt created by this approximate balance in the evidence must be resolved in favor of the Veteran, a 70 percent rating for PTSD is warranted during the entire period from November 14, 2014 through July 30, 2023. The Board also finds, however, that a rating higher than 70 percent is not warranted at any time during the claim period from November 14, 2014 through July 30, 2023. The Board acknowledges that the Veteran experienced some social impairment during this period, and that she spent much of her time either at work or at home. However, she maintained close relationships with her mother, stepfather, brothers, and grandparents, and had some friendships outside of her family (e.g., friends with whom she camped, hiked, and engaged in other activities) throughout the entire claim period. Therefore, total social impairment has not been met or approximated. Also, total occupational impairment due to her psychiatric disability has not been met or approximated. Specifically, although the Veteran reported some problems at work due to her psychiatric disability and worked for her family during part of the claim period, she was nonetheless employed in various jobs during the claim period. The Veteran reported during the claim period that she felt like she was hallucinating when she woke up from nightmares. However, she explained that she felt that she was more half asleep on these occasions and that she did not experience any hallucinations while awake. There is otherwise no evidence of any persistent hallucinations during the claim period. The Veteran also reported some memory loss during the claim period, but she did not experience impaired memory to such an extent or severity that there was memory loss for names of close relatives, own occupation, or name. Moreover, she did not generally demonstrate gross impairment in thought processes or communication, she did not experience any delusions, she was cooperative with examiners during the claim period and did not exhibit any grossly inappropriate behavior, she remained fully oriented to time and place, she was able to perform activities of daily living, and she was observed to have appropriate appearance and hygiene throughout the claim period. As explained above, the Veteran experienced chronic passive suicidal ideation during much of the claim period. Persistent danger of hurting oneself or others is a symptom listed in the criteria for a 100 percent rating. Here, however, there was no persistent danger of hurting oneself or others. Thus, the severity, frequency, and duration of the Veteran's suicidal ideation did not rise to the level contemplated by the 100 percent disability rating. Although the Veteran expressed passive suicidal ideation, she regularly denied any active intent or plan involving self-harm or harm to others, and suicidal ideation is contemplated by a 70 percent rating. For the above reasons, the Veteran did not exhibit most of the symptoms listed in the criteria for the maximum, 100 percent rating under the General Rating Formula as examples of the type and extent, frequency, or severity, as appropriate, to indicate both total social and occupational impairment at any point during the claim period. Rather, the Veteran's psychiatric symptoms most closely approximated the criteria for a 70 percent rating under the General Rating Formula during the entire claim period. Therefore, a 70 percent rating, but no higher, for PTSD is warranted from November 14, 2014 through July 30, 2023. As a final point, in conjunction with the claim for an increased rating for PTSD, other than the issue of entitlement to a TDIU which is addressed below, the Veteran has not raised any other related issues, and no other such issues have been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). REASONS FOR REMAND Entitlement to a TDIU due to PTSD, from November 14, 2014 through December 13, 2016, is remanded. During the December 2022 Board hearing, the Veteran reported that although she was employed, she worked in a protected family environment and that such employment was necessary due to her service-connected psychiatric disability. As explained above, a TDIU has already been awarded for the period since December 14, 2016. However, as for the period from November 14, 2014 through December 13, 2016, the evidence reflects that the Veteran worked with various employers during this period, to include at a hospital, in sales with a telecommunications company, and as a fitness instructor/personal trainer. It is unclear as to whether some or any of this employment was gainful and, if gainful, when such gainful employment ended. Information as to the Veteran's earnings during the period from November 14, 2014 through December 13, 2016 would be of assistance to the Board in determining whether a TDIU is warranted during this period. Therefore, the AOJ should contact the Social Security Administration (SSA) and request the Veteran's earning statements from 2014 through 2016. Moreover, the Veteran should have another opportunity to provide detailed information as to her employment history and earnings during the period from 2014 through 2016, and should be asked to provide authorizations for VA to contact all identified employers during this period. In this regard, the Veteran submitted a VA Form 21-8940 in June 2023, but she only reported employment beginning in 2017. The matters are REMANDED for the following action: 1. Ask the Veteran to report her complete employment history during the period from November 2014 through December 2016, to include the starting and ending dates of any employment and her earnings for each period. Ask the Veteran to complete authorizations for VA to contact all employers identified during the period from November 2014 through December 2016. Send a VA Form 21-4192 to each identified employer and ask that it be completed and returned. 2. Contact the SSA and request the Veteran's earning statements for the period from 2014 through 2016. If the SSA informs the AOJ that it cannot provide earning statements to VA without the Veteran's approval, the AOJ should undertake to obtain any documentation needed from the Veteran to enable the AOJ to obtain her SSA earning statements. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Elwood, 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.