Citation Nr: 25004764 Decision Date: 04/08/25 Archive Date: 04/08/25 DOCKET NO. 16-22 162 DATE: April 8, 2025 ORDER Entitlement to an evaluation in excess of 50 percent for posttraumatic stress disorder (PTSD) is denied. FINDING OF FACT Throughout the appellate period, the Veteran's PTSD is manifested by symptoms which most closely approximated occupational and social impairment with reduced reliability and productivity. CONCLUSION OF LAW The criteria for an evaluation in excess of 50 percent for PTSD are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1 - 4.7, 4.21, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from February 1969 to December 1972. The Veteran died in November 2022. The Appellant is his surviving spouse. These matters come before the Board of Veterans' Appeals (Board) on appeal from a May 2015 rating decision of the Agency of Original Jurisdiction (AOJ) of the United States Department of Veterans Affairs (VA). The May 2015 rating decision granted service connection for PTSD and assigned an initial 30 percent disability rating. The Veteran appealed this decision to the Board and, after remands for additional development, in June 2022, the Board issued a decision which continued the previously assigned 30 percent disability evaluation prior to January 7, 2020, and granted a 50 percent disability evaluation for PTSD from January 7, 2020. In June 2023, the Court of Appeals for Veteran's Claims (Court) granted the Appellant's motion to be substituted in this matter. The Appellant appealed the Board's June 2022 decision to the Court. In September 2023, based on a Joint Motion for Remand (JMR) the Board decision was vacated and the matter remanded for further consideration. The parties agreed the Board did not provide an adequate statement of reasons and basis regarding evaluation of the Veteran's PTSD. In a January 2024 decision, the Board granted the claim for an increased evaluation of 50 percent for PTSD prior to January 7, 2020, and denied an evaluation in excess of 50 percent for PTSD from January 7, 2020. The Appellant again appealed the Board's decision. In December 2024, based on a Joint Motion for Partial Remand (JMPR) the portion of the Board's decision that denied an evaluation in excess of 50 percent for PTSD was vacated and remanded for further consideration. The parties agreed that the Board did not provide an adequate statement of reasons and basis regarding an evaluation in excess of 50 percent for the Veteran's PTSD. More specifically, the parties agreed that the Board erred in failing to address evidence that may be potentially favorable to the Veteran. The matter is now before the Board for adjudication. A claim for increased evaluation includes a claim for a finding of total disability based on individual unemployability (TDIU) where there are allegations of worsening disability and related unemployability. Rice v. Shinseki, 22 Vet. App. 447 (2009). Here, the Veteran reported impacts on his employment but did not associate unemployment with his PTSD. He instead noted the impact of COVD and stated in VA treatment records he planned to, and would, return to work when the pandemic abated. No claim for TDIU is inferred. With respect to the Veteran's claim decided herein, VA has met all statutory and regulatory notice and duty-to-assist provisions. See 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326. Neither the Veteran nor his representative has advanced any procedural arguments in relation to VA's duty to notify and assist. See Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015). Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321 (a), 4.1. In evaluating the severity of a disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Separate ratings may be assigned for separate periods of time based on the facts found, however. This practice is known as "staged" ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). Any reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When evaluating a mental disorder, VA must consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the claimant's capacity for adjustment during periods of remission. VA shall assign an evaluation 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 consider the extent of social impairment but shall not assign an evaluation solely on the basis of social impairment. 38 C.F.R. § 4.126(b). Pursuant to 38 C.F.R. § 4.130, psychiatric impairment is rated under the General Rating Formula for Mental Disorders ("General Rating Formula"). A 50 percent evaluation is warranted where 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; difficulty in establishing and maintaining effective work and social relationships. A 70 percent evaluation is warranted where 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; 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 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 when there is 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 and place; memory loss for names of close relatives, own occupation or name. When determining the appropriate disability evaluation to assign, the Board's primary consideration is the Veteran's symptoms, but it must also make findings as to how those symptoms impact the Veteran's occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013); Mauerhan v. Principi, 16 Vet. App. 426, 442 (2002). Because the use of the term "such as" in the rating criteria demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, the Board need not find the presence of all, most, or even some of the enumerated symptoms to award a specific rating. Mauerhan, 16 Vet. App. at 442; see also Sellers v. Principi, 372 F.3d 1318, 1326-27 (Fed. Cir. 2004). Nevertheless, all ratings in the General Rating Formula are also associated with objectively observable symptomatology, and the plain language of the regulation makes it clear that a Veteran may only qualify for a given disability by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio, 713 F.3d at 118. The Appellant is seeking an evaluation in excess of 50 percent for the Veteran's PTSD. The Veteran's disorder is evaluated under 38 C.F.R. § 4.130, Code 9411. Having carefully considered all the evidence of record, the Board finds that, throughout the period on appeal, the Veteran's PTSD symptoms meet the criteria for a 50 percent disability rating, but no higher. VA treatment records dated April 6, 2015, reflect the Veteran reported having difficulty sleeping at night. He did not want to take any meds, but did state he wanted to see his counselor. His general appearance was noted to be good, though he was tearful. The Veteran was also seen by mental health on April 6, 2015. The provider noted that the Veteran reported that he thinks about the shipwreck at night and is tearful when he thinks about it. He stated that he did not know if he was having nightmares because he cannot remember his dreams. He denied suicidal thoughts or plans. An April 27, 2015, mental health treatment note reflects the Veteran's wife accompanied to his appointment. His wife reported that the Veteran has gotten better over the years, but that any time he hears anything about the shipwreck he will have dreams of swimming. She stated that the Veteran does not sleep well and that she finds him sitting in the living room at 2:00 am. She stated there has been times when he has had a depression come over him, he will snap out of it, but it takes some time. The Veteran stated that every night before he goes to bed, he goes over what happened on the ship. He reported that his concentration is ok because he wants to stay focused on his work. He stated that he has had good jobs and does well with people, he had no issues with others. He stated he does fine at restaurants and in stores. The Veteran was noted to be on time, oriented in all spheres, had good eye contact, affect congruent with mood, hygiene was good, and no suicidal/homicidal ideation. The Veteran underwent a VA initial posttraumatic stress disorder examination on May 6, 2015. The VA examiner noted the Veteran's diagnosis of PTSD. The Veteran reported that for years after the shipwreck he experienced in service he coped with his feelings and memories by drinking excessively to forget and was not careful with his personal safety. He met his wife in 1980 and since that time he had been using work and other activities to keep him busy so he will not think about his experiences all the time. He reported that he has several friends he sees regularly and is actively involved in the shrine and mason organizations. He was unable to relax. He tried to retire 5 years ago but found that he had too much time to think about the wreck and the men who lost their lives, so he returned to work part-time four years ago. He reported that he thinks about it on a daily basis and experiences sleep disruption, fatigue, and survivor guilt. His symptoms worsened since he was contacted by an author who wanted to interview him about the shipwreck incident for a book which was published in 2014. The Veteran stated he was finally ready to talk about his feelings in therapy to learn more about PTSD and effective ways of coping with his symptoms and feelings. The Veteran has been married to his wife since 1981 and has two adult daughters and two grandchildren. He and his wife attend the grandchildren's activities as they did with their own daughters. This was important to him because his father never went to any activities. The Veteran attended three years of college and completed a technical program in 1973. After completing his machine shop program, he was employed as a machinist for approximately 3 months. He then decided he did not want to be a machinist and went to work for his father for about 2 years. He did not like that work either. He did some construction work before finding a steady job with an electrical company. He worked there for approximately 17 to 18 years before being laid off in 1994. Following that he and his wife opened a dollar store and ran it for 14 years until the Veteran "got so tired of it because I was putting in so many hours, 7 days a week." The business closed down in 2008. He had a delivery route for about 6 months before his route was done away with. He was offered an opportunity to relocate, but decided to retire because he did not want to relocate. After approximately 9 months of retirement, he took a part time job at an Auto Zone store. He found that he could not tolerate being home alone because he was thinking about things he wanted to forget. He is still working at Auto Zone. The Veteran denied having difficulty with co-workers or bosses at any of his jobs. The Veteran reported waking up at night thinking about the shipwreck and the 74 men that were lost and having difficulty going back to sleep. The Veteran denied experiencing a history of panic attacks or OCD symptoms. The VA examiner noted the Veteran was on time for his appointment, was well-groomed and casually dressed. He was pleasant and cooperative, and maintained good eye contact. He described his mood as anxious, and his affect was congruent. No unusual mannerisms or behaviors were detected, though he did intermittently fidget with his fingers. He cried and had difficulty speaking while describing his shipwreck experience. He was not suicidal or homicidal and denied any attempts with the exceptions of reckless behaviors while intoxicated for a while after the shipwreck. He stated he was "doing things I think I was asking for help" such as riding his motorcycle at 120 mph and wrecking it while intoxicated. He denied auditory and visual hallucinations, thought insertion, withdrawal, and broadcasting. There were no overt psychotic symptoms. The Veteran's attention, concentration, and memory appeared to be good. The VA examiner noted symptoms including depressed mood, anxiety, chronic sleep impairment, and mild memory loss. The VA examiner noted that the Veteran met all of the diagnostic criteria for a diagnosis of PTSD. VA mental health treatment notes dated July 2015 note the Veteran reported experiencing difficulty sleeping, an anxiety level that is "sky high," and irritability. He denied suicidal/homicidal ideation, intent, or plan. There was no indication of psychosis, attention and concentration were fair, insight and judgement were poor. VA treatment notes from a mental health visit dated August 5, 2015, note the Veteran reported taking medication that was helping him get at least 6 to 7 hours of sleep per night. He reported that he is "irritable when things don't go the way they should . . . I'm trying to get where I think before I speak but it's hard . . . I just blow up on people." The Veteran was alert and oriented to person, place, time and situation. He displayed average eye contact. He denied suicidal/homicidal thoughts, intent or plans. He exhibited no psychomotor abnormalities. His speech was clear and coherent, language intact. His mood/affect was dysthymic. Thought process was organized. He endorsed hallucinations, denied paranoid delusions. Attention and concentration were intact. He reported difficulty with memory. Insight and judgment were poor. An August 5, 2015, VA mental health treatment notes reflect the Veteran reported taking medication that was helping him get at least 6 to 7 hours of sleep per night. He reported that he is "irritable when things don't go the way they should . . . I'm trying to get where I think before I speak but it's hard . . . I just blow up on people." He was alert and oriented to person, place, time, and situation. He displayed average eye contact. He denied suicidal/homicidal thoughts, intent, or plans. No psychomotor abnormalities were present, speech was clear and coherent, language was intact. His mood/affect was dysthymic, thought process was organized. The Veteran endorsed hallucinations, stating he often hears the voice of his deceased friend who served with him. He denied paranoid delusions. Attention and concentration were intact. He reported difficulty with memory. His insight and judgment were noted to be poor. He reported an 80 percent improvement in managing anxiety and an 80 percent reduction in his depressive symptoms. The clinician noted the Veteran was to start taking Lexapro for "mood lability, PTSD symptoms, depression, 'unmotivation,' irritability." An October 7, 2015, VA mental health treatment note documents the Veteran endorsed hallucinations, reporting that "every so often I hear my best friend's voice . . . he was on the ship with me." The Veteran denied experiencing paranoid delusions. He stated that he thinks about the shipwreck every day. He stated that he had been sleeping better, waking up one time a night and going right back to sleep. The Veteran stated, "I get a lot more rest than I've gotten my whole life." The Veteran reported he was going to Shriner meetings once a month, and he would have a drink at these meetings. He reported that he had gone to a reunion and that it went fair. He was asked to stand up in front of the group and talk about what happened, which he did. He reported that he had several flashbacks while he was there, but that he did not regret going and would maybe go again next year. He and the clinician discussed re-experiencing symptoms and went over flashbacks, nightmares, intrusive thoughts and talked about how he has had them all over the years. VA mental health treatment notes dated December 2015 reflect the Veteran was alert and fully oriented, cooperative, and pleasant. He made good eye contact and speech was within normal limits. His mood was mildly anxious and depressed with an overall somber affect but improved during the course of the session. There was no evidence of current psychotic process. Attention, concentration, and memory were impaired by self-report. His insight and judgment were good. He denied suicidal ideation. Potential for self-harm was noted to be minimal to none. VA mental health treatment notes dated January 2016 note the Veteran denies suicidal/homicidal thoughts, intent, or plans, endorses hallucinations, denies paranoid delusions, reports difficulty with memory and exhibits poor insight and judgment. He stated that he gets agitated quickly, noting, "it seems like little things get to me." He stated that his agitation had lessened "maybe a little bit but not that much" since he started taking Lexapro. The VA examiner noted the Veteran's diagnosis of major depressive disorder, recurrent, moderate and PTSD. February and March 2016 mental health treatment notes do not document endorsement of hallucinations. VA treatment notes dated April and May 2016 indicate the Veteran exhibited some mild nervousness but is improved. A VA mental health treatment notes dated June and September 2016, and March 2017 reflect the Veteran was on time for his appointment. He was alert and oriented to person, place, time, and situation. He displayed good eye contact, denied suicidal/homicidal thoughts, intent, or plans. No psychomotor abnormalities were present. Speech was clear and coherent, language was intact, mood was calm/euthymic, and affect was pleasant/full. The Veteran's thought process was organized. He denied hallucinations and paranoid delusions. His attention and concentration were intact. He reported difficulty with memory, insight and judgment were fair. He did not appear to be a danger to himself or to others at the time of the appointment. Treatment notes dated October 2017 indicate the Veteran's mood was normal, with logical and goal-directed thoughts. There was no evidence of current psychotic process. He denied hallucinations and paranoid delusions. Attention and concentration were impaired by report. Memory was intact, insight and judgment were good. No suicidal ideation was present and the Veteran's potential for self-harm was minimal to none. The Veteran reported, "I think I'm doing pretty good." Treatment notes dated June 2018 reflect the Veteran was pleasant and cooperative, with euthymic mood and full/cheerful affect. His thought processes were goal directed and organized. He denied hallucinations and paranoid delusions. His attention and concentration were intact. He reported difficulty with memory; insight and judgment were fair. VA mental health treatment notes dated October 11, 2017, reflect the Veteran reported that he felt he was doing better. He went to his ship reunion in September, and it went "alright." He stated that they always have a hard time at the Survivor's meeting. He felt he was doing okay with depression and anxiety. He stated he was "fair with irritable . . . people make me irritable . . . stupidity." He reported that he was sleeping a lot better, "still have nightmares maybe twice a week." When asked what he does with his time, the Veteran stated, "I play with my grandkids . . . in fact we have a football game tonight . . . a volleyball game tomorrow . . . I'm president of the Shrine Club." He denied hallucinations and paranoid delusions, as well as suicidal/homicidal ideation, intent or plan. The Veteran was on time for his appointment, was alert and oriented to person, place, time and situation. He displayed good eye contact. His speech was clear and coherent. Language was intact. He was pleasant and cooperative. His mood was euthymic, and his affect was full. Thought process was organized and goal directed. Attention and concentration were intact. He reported mild difficulty with memory and his insight and judgment were fair. VA mental health treatment notes dated October 2018 indication the Veteran's mood was good; he had no suicidal ideation. His attention and concentration were impaired by self-report. February 2019 mental health notes reflect the Veteran continues to work part-time at Auto Zone as a driver, delivering parts. He denied hallucinations and paranoid delusions. He denied suicidal/homicidal ideation, intent, or plan. A VA mental health treatment note dated July 2019 noted the Veteran was alert and fully oriented. He appeared clean and was cooperative and pleasant. He made good eye contact. His speech was within normal limits. There was no significant disturbance of psychomotor activity. His mood was normal, and thoughts were logical, and goal directed. There was no evidence of current psychotic process. Attention and concentration were impaired by report. His memory was intact. His insight and judgment were good. When asked about scheduling another appointment in 6 months, as he typically requested, the Veteran said he would try to go it alone. The Veteran was remined that he can call anytime to schedule and was discharged. The clinician noted the Veteran was doing very well and no longer required therapy. The appellant submitted a statement in support of the Veteran's claim in October 2019. She stated that the Veteran has always been claustrophobic, to the point that it is difficult for him to travel on planes and ships. He cannot sleep without a fan and a small light, as he has frequent nightmares about the shipwreck. She stated that the Veteran has anxiety and depression which cause feelings of inadequacy and low self-esteem. The Veteran has difficulty expressing his feelings, emotion and affection towards the appellant, his daughters, his family, and friends. His loss of libido puts a strain on the marriage. The Veteran does not seem to enjoy life, has lost interest in hobbies he used to enjoy, such as fishing, camping and golf. He does not participate in social activities on a regular basis including Masonic and Shrine meetings and some family gatherings. He does not like to have visitors in the home other than family. The Veteran frequently stares off into the distance, having memories of the shipwreck. He constantly relives the shipwreck thinking he could have done more to save lives. The appellant stated that after starting counseling with VA, the Veteran has been attending shipwreck reunions and she thinks he is realizing the other survivors has similar feelings. However, she feels that the other survivors seem to have overcome these feelings better than the Veteran. In January 2020, the Veteran underwent a VA PTSD examination. The VA examiner summarized the Veteran's occupational and social functioning as occupational and social impairment with reduced reliability and productivity. The Veteran reported he continued to live with his wife of 39 years. He stated that he has a shaky relationship with her, but has a good relationship with his two children, and his sister. He has some friends that he works with. The Veteran continued to work part-time at Auto Zone and had been there for 8 years. He reported taking trazadone and escitalopram oxalate. He had regular treatment in the past, but now talks with his therapist every once in a while. He reported experiencing symptoms including depressed mood, anxiety, hypervigilance, easily startled, distressing memories, nightmares, difficulty falling asleep, irritability, less interest in usual activities. He reported difficulty dealing with stress. He stated that he and his wife have been struggling and that he picks fights with her. He stated that he often feels "blah." He said sometimes he talks before thinking about what he is going to say. The VA examiner noted symptoms including depressed mood, anxiety, suspiciousness, chronic sleep impairment, mild memory loss, flattened affect, difficulty in establishing and maintaining effective work and social relationships, and difficulty in adapting to stressful circumstances including work or a worklike setting. The Veteran was observed to exhibit orientation within normal limits, with appropriate appearance and hygiene. His behavior was appropriate, and he maintained good eye contact throughout the examination. His affect and mood were flat. Communication was within normal limits. His speech was normal. There was no report of past or present panic attacks, delusions, hallucinations, or obsessions. His thought processes were appropriate. He was able to understand directions and answer direct questions. He did not appear confused. He reported a mild degree of memory impairment related to names, directions, and recent events. Suicidal and homicidal ideation was absent. At a February 2020 mental health follow-up visit the Veteran stated that his mood was "okay." He reported that he stopped going to Mason and Shiner meetings six months ago and was still not going because he just wasn't interested. He reported that he had not been anxious but had been a little irritable. He stated that he had a nightmare at least a couple of times a week. note - Veteran stated I stopped going to Mason and Shriner meetings 6 months about and I'm still not going . . . I stopped going because I just wasn't interested." The Veteran was on time for his appointment. He was alert and oriented to person, place, time, and situation. He displayed good eye contact. He denied suicidal/homicidal thoughts, intent, or plans. He had no psychomotor abnormalities. His speech was clear and coherent, language was intact. The Veteran was cooperative with a calm mood and pleasant affect. His thought process was organized, and goal directed. He denied hallucinations and paranoid delusions. His attention and concentration were intact. He reported difficulty with memory. His insight and judgment were fair. The Veteran had VA mental health telephone appointments in May 2020, August 2020, February 2021, August 2021. He was on time, alert and oriented to person, place time and situation. He displayed good eye contact and denied suicidal/homicidal thoughts, intent, or plans. There were no psychomotor abnormalities. His speech was clear and coherent. Language was intact. The Veteran was cooperative, mood was calm/euthymic, and affect was pleasant. His thought process was organized, and goal directed. He denied hallucinations and paranoid delusions. His attention and concentration were intact. He reported experiencing difficulty with memory. His insight and judgment were fair/intact. He did not appear to be a danger to himself or to others. He continues to take Lexapro to treat mood lability, PTSD symptoms, depression, unmotivation, anxiety and irritability. At his August 2020 visit, he reported that he was taking precautions against the corona virus. He had been in a good mood and noted an improvement with an increase in his Lexapro. He reported that the Masons and Shriners had not yet started meetings again but were hoping to start in the next month. In February 2021 he reported he was again going to his Mason and Shriner meetings and that his mood was "great." He had not been working at Auto Zone due to COVID but was planning to go back to work. In August 2021 he reported he was feeling good and was going to his Masonic Lodge and Shriner meetings every month and participating in other activities with these groups. The Veteran stated that his mood was good, stating "life's been going pretty good" and denied depression, anxiety, and irritability. Notes from a VA mental health telephone appointment in March 2022 reflect the Veteran reported he was "doing okay." He goes to Masonic Lodge and Shriner meetings every month and to activities with these groups. He reported he has a lot of friends in these meetings who call him. In February 2022 he participated in selling cinnamon rolls for Valentine's Day. He denied experiencing nightmares, hallucinations, and paranoid delusions. The Veteran was on time for his appointment. He was alert and oriented to person, place, time, and situation. He denied suicidal/homicidal thoughts, intent, or plans. There were no psychomotor abnormalities. His speech was clear and coherent. His language was intact. The Veteran was cooperative with a euthymic mood and pleasant affect. His thought process was organized, and goal directed. Attention, concentration, judgment, and insight were intact. He reported difficulty with memory. After a thorough review of the Veteran's file, the Board finds the Veteran's symptoms, documented by VA clinicians and therapists, consistently include chronic sleep impairment, depression, anxiety, survivor guilt, disturbances of motivation and mood, and memory loss throughout the period on appeal; symptoms associated with the criteria for a 50 percent disability evaluation. The Board acknowledges that August 2015, October 2015, and January 2016 treatment notes reflect the Veteran reported experiencing an auditory hallucination. The auditory hallucinations were described as hearing his best friend's voice; however, subsequent treatment notes document the Veteran did not report experiencing any hallucinations, nor is there any indication this symptom caused occupational and social impairment with deficiencies in most areas. An August 2015 treatment note reflects the Veteran reported that he was anxious about going to a ship reunion in September of that year and that he was irritable when things "don't go the way they should" and that he sometimes "blows up on people." At the January 2020 VA PTSD examination, the VA examiner noted that the Veteran experienced difficulty in adapting to stressful circumstances including work or a work like setting. The Veteran reported he had difficulty dealing with stress but was working part-time at AutoZone and had worked there for years. A February 2020 treatment note indicates the Veteran had stopped attending his group meetings for six months because he had lost interest. However, at his next mental health visit, he reported that he was hopeful the Masonic Lodge and Shriner meetings would start up again in the next month and that he noticed an improvement in his symptoms with a change in his Lexapro prescription. The findings of the May 2015 VA examination, the January 2020 VA examination, and the VA treatment notes for the entirety of the appellate period consistently note the Veteran's symptoms of depressed mood, anxiety, suspiciousness, chronic sleep impairment, mild memory loss, flattened affect, difficulty in establishing and maintaining effective work and social relationships, and difficulty in adapting to stressful circumstances including work or a worklike setting. Although depression has always been a symptom the Veteran has experienced, there is no indication in the medical records that his depression has affected his ability to function independently, appropriately, or effectively. The Veteran admitted that he experienced difficulty in adapting to stressful circumstances, particularly with regard to attending his ship's reunion, yet he did go and admitted that he would likely continue to attend in the future. The Board also acknowledges the Appellant's contention that the Veteran's PTSD impacted his occupational functioning as they had to close the Dollar Shop they ran for years "because the veteran could no longer handle the shop." Yet, at his May 2015 VA examination the Veteran stated that he and his wife closed the Dollar Shop because the Veteran "got so tired of it because I was putting in so many hours, 7 days a week." The Veteran then went on to find other employment which he maintained for many years. The Board finds the evidence does not support the criteria for a 70 percent or greater disability evaluation. At no time during the appellate period did the Veteran display a manifestation of symptoms with the severity, frequency or duration comparable to a 70 percent disability rating. The Veteran did not express or exhibit suicidal and/or homicidal ideation; obsessional rituals which interfere with routine activities; speech that is intermittently illogical, obscure or irrelevant; near continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control; spatial disorientation; neglect of personal appearance and hygiene; or an inability to establish and maintain effective relationships at any time. His speech and thought process was normal. He maintained long term employment and did not exhibit suicidal or homicidal ideation. He was always alert and oriented with no neglect of his personal appearance. The Board notes that while the Veteran described waking up at night and thinking about the shipwreck at his May 2015 VA PTSD examination, there is no indication in the report of that VA examination, or any other treatment records associated with the file that the Veteran exhibited symptoms of OCD or that his remembering of the incident was ever described as or met the criteria to be described as an obsessional ritual such that it interfered with his routine activities; rather it is described as difficulty sleeping and/or chronic sleep impairment. With regard to the Veteran's reports of nightmares, intrusive thoughts and flashbacks, these symptoms are described as resulting in chronic sleep impairment, not as auditory hallucinations, and as such are contemplated by the 50 percent disability evaluation currently assigned. While the Veteran experiences depression that is described as recurrent major depressive disorder, there is no indication that his depressive symptoms affected his ability to function independently, appropriately and effectively. The Veteran was able to maintain employment, was actively involved in the Shriners, and participated in family activities throughout the appellate period. There is no indication in his medical records that he was not able to function independently, appropriately and effectively due to his depressive symptoms. In the JMPR, the parties agreed that the Board failed to address the social and occupational impact of the Veteran's PTSD when it failed to address "the May 2015 VA examiner's statement that the Veteran's symptoms cause 'clinically significant distress or impairment in social, occupation, or other important areas of functioning.'" The Board disagrees. A review of the May 2015 VA PTSD examination reveals this was not an actual statement made by the VA examiner, rather this is the description of Diagnostic Criterion G which is evaluated by the examiner in rendering a determination as to whether or not a Veteran meets the Diagnostic Criteria for a diagnosis of PTSD in accordance with DSM-V. Criterion G, as well as all of the applicable diagnostic criteria, was considered by the VA examiner in rendering the Veteran's diagnosis of PTSD. In conclusion, the Board acknowledges the Veteran endorsed experiencing auditory hallucinations on three occasions (August 2015, October 2015, and January 2016) and difficulty in adapting to stressful circumstances (attending ship reunion and losing patience with others), symptoms which are associated with the criteria for a 70 percent disability evaluation. However, there is no indication in the medical records that these symptoms were of such severity, frequency and duration so as to cause occupational and social impairment equivalent to a 70 percent disability rating. Mauerhan, 16 Vet. App. at 443. The Veteran's most consistently reported symptoms, anxiety, depressed mood, chronic sleep impairment and mild memory loss frequently reported symptoms, are contemplated and compensated by the 50 percent evaluation currently assigned. Therefore, a 70 percent rating or higher, is not warranted as the evidence does not show that the Veteran's symptoms resulted in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking or mood. See Vazques-Claudio, 713 F. 3d at 114 (holding that a veteran "may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage or others of similar severity, frequency and duration"). WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Margaret M. Lunger 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.