Citation Nr: A25035303 Decision Date: 04/16/25 Archive Date: 04/16/25 DOCKET NO. 250311-527489 DATE: April 16, 2025 ORDER Entitlement to a maximum schedular 100 percent rating for posttraumatic stress disorder (PTSD) is granted. FINDING OF FACT For the entire rating period on appeal, the evidence is at least in approximate balance as to whether the Veteran's PTSD has been manifested by symptoms resulting in both total occupational and social impairment. CONCLUSION OF LAW The criteria for a 100 percent disability rating for PTSD are met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.21, 4.126, 4.130, Diagnostic Code (DC) 9411. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1967 to February 1971. This matter is before the Board of Veterans' Appeals (Board) on appeal from a November 2024 Appeals Modernization Act (AMA) rating decision that considered the evidence of record on that date. In its decision, the Agency of Original Jurisdiction (AOJ) denied the claim on appeal. The Veteran timely appealed this decision to the Board by requesting the AMA Direct Review lane for a reevaluation of the evidence considered by the AOJ. As this is a Direct Review appeal under the AMA, the record closed on the date of the November 2024 rating decision. This appeal has been advanced on the Board's docket. 38 U.S.C. § 7107(a)(2); 38 C.F.R. § 20.902(c). Under 38 C.F.R. § 20.202(c)(2) the appellant has until November 2025 to modify his choice of Board appeal lane, and the "Board ordinarily may not decide an appeal before this time period is up." See Williams v. McDonough, 37 Vet. App. 305 (2024). However, because in this matter a full grant of the issue on appeal is warranted, the Veteran is not prejudiced by the Board issuing this decision without such a delay. Rating for PTSD Disability-Laws and Analysis The Veteran is currently in receipt of a 70 percent evaluation for his PTSD disability pursuant to 38 C.F.R. § 4.130, DC 9411 for the entire rating period on appeal. Additionally, the Veteran has been awarded a total disability rating based on individual unemployability (TDIU) for the period beginning March 3, 2010 based solely on his service-connected PTSD disability. See February 2012 rating decision. He has also been awarded special monthly compensation under 38 U.S.C. § 1114 (s) for housebound status as he has a single service-connected disability rated as total and additional service-connected disabilities that are independently rated at more than 60 percent combined. Accordingly, the decision herein will only address whether a schedular rating in excess of 70 percent for PTSD is warranted. Under DC 9411, a 70 percent rating is assigned for 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 that is 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 work-like setting); and inability to establish and maintain effective relationships. 38 C.F.R. § 4.130. A 100 percent rating is assigned 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; and memory loss for names of close relatives, or for the veteran's own occupation or name. Disability percentage ratings are based on the average impairment of earning capacity. 38 U.S.C. § 1155, 38 C.F.R. § 4.1. 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). If two ratings are potentially applicable, the higher rating will be assigned if the disability picture more nearly approximates the criteria under such holistic analysis. VA shall give the benefit of the doubt to the claimant when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. Upon review of all evidence of record, both lay and medical, the Board finds that the evidence is in approximate balance as to whether the Veteran's PTSD results in total occupational and social impairment, warranting a 100 percent schedular rating. The relevant evidence of record includes a March 2024 VA PTSD Disability Benefits Questionnaire. At that time, the examiner indicated that the Veteran's PTSD resulted in symptoms of depressed mood, anxiety, suspiciousness, panic attacks, near-continuous panic or depression affecting the ability to function independently, chronic sleep impairment, impairment of short and long term memory, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, inability to establish and maintain effective relationships, suicidal ideation, obsessional rituals, impaired impulse control, neglect of personal appearance and hygiene, and intermittent inability to perform activities of daily living. The examiner also indicated that the Veteran "has no friends and is completely isolated." Following the in-person examination and review of the electronic claims file, the examiner opined that the Veteran's PTSD resulted in "total occupational and social impairment." In a subsequent September 2024 VA PTSD Disability Benefits Questionnaire, the examiner opined that the Veteran's PTSD resulted in only "occupational and social impairment with reduced reliability and productivity." Nonetheless, the examiner did note that the Veteran experienced symptoms specifically contemplated by the 100 percent rating criteria. For example, the Veteran was found to have neglect of personal appearance and hygiene. He was also noted to have almost complete social isolation. Specifically, the Veteran reported frequent arguments with his wife, a "poor" relationship with his siblings and children, and denied having friends, hobbies, interests, or other social interactions. He also indicated that his PTSD had worsened in the past two years. The Veteran also stated that he had attempted suicide in the past (no date provided) and had been arrested 13 times. He reported issues with trusting others, including his wife, and endorsed symptoms of paranoia. VA treatment records include an August 2022 mental health note where the Veteran reported his depression as an 8 out of 10, with 10 being the most severe. During a May 2024 VA mental health note, the Veteran was asked the following question: "over the past month, have you wished you were dead or wished you could go to sleep and not wake up?" The Veteran responded "YES." Several VA treatment records have characterized the Veteran's PTSD as "severe." See e.g., VA mental health notes dated in October 2024 and August 2024. The evidence also includes a September 2024 statement from a readjustment counselor at the Fresno Vet Center. This statement indicated that the Veteran had been participating in group meetings and individual counseling at the Vet Center since August 2009. The Veteran was noted to have continued symptoms of PTSD, including anxiety, suspiciousness, hypervigilance, and unprovoked irritability. Upon review of all evidence of record, both lay and medical, the Board finds that the evidence is in approximate balance as to whether the Veteran's PTSD results in total occupational and social impairment, warranting a 100 percent schedular rating. The VA examination reports and VA treatment records indicate that the Veteran continues to isolate himself from his family and other social settings. As noted by the March 2024 examiner, the Veteran's psychiatric disability resulted in an "inability" to establish and maintain effective relationships and resulted in the Veteran having "no friends" and being "completely isolated." As it pertains to occupational impairment, the AOJ has determined that the Veteran is unable to secure and follow a substantially gainful occupation due solely to his service-connected PTSD disability. See February 2012 rating decision; see also June 2011 mental health evaluation report from Dr. Venter. The Board finds that this determination, in addition to the medical evidence of record, weighs in favor of a finding that the Veteran's PTSD results in total occupational impairment. In sum, the Board finds that the medical reports and the lay statements of record show that the Veteran has PTSD symptoms indicative of both the 70 percent and the 100 percent rating criteria. As such, the evidence is at least in approximate balance as to whether the Veteran's PTSD results in total occupational and social impairment, warranting a 100 percent schedular rating. For these reasons, and resolving reasonable doubt in the Veteran's favor, the Board finds that a rating of 100 percent for PTSD is warranted for the entire rating period on appeal. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. M. HYLAND Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Casadei, 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.