Citation Nr: A25035360 Decision Date: 04/16/25 Archive Date: 04/16/25 DOCKET NO. 231221-462079 DATE: April 16, 2025 ORDER An increased 70 percent rating for posttraumatic stress disorder (PTSD) with psychiatric disability other than PTSD, with short term memory loss and insomnia (psychiatric disability or PTSD), granted. FINDING OF FACT The severity, frequency, and duration of the Veteran's symptoms more closely approximate occupational and social impairment with deficiencies in most areas. CONCLUSION OF LAW The criteria for an increased disability rating of 70 percent for psychiatric disability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from November 1990 to June 1991, with service in the Persian Gulf from January to April 1991. The Veteran unfortunately died in February 2024 and the Appellant is the Veteran's surviving spouse. In the December 2023 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), challenging the RO's July 2023 rating decision that assigned a 50 percent rating for the Veteran's PTSD, effective April 6, 2010. The Veteran elected the Hearing docket. In December 2024, the Appellant withdrew the hearing request. Therefore, the Board may only consider the evidence of record at the time of notice of the July 2023 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Appellant or her representative within 90 days following receipt of the withdrawal of the hearing request. 38 C.F.R. § 20.302(b). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. In a February 2025 rating decision, the RO expanded the definition of the Veteran's service-connected psychiatric disability and confirmed and continued the 50 percent evaluation. This legal determination is recognized and is binding on the Board. See Green v. McDonough, 37 Vet. App. 127 (2024). As a final point, neither the Veteran nor the Appellant has asserted, and the record does not suggest, that the Veteran was unable to work due to his psychiatric disability. As such, the issue of entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is not before the Board. See, e.g., the Veteran's February 2023 VA Form 21-8940 (Application for Increased Compensation Based on Unemployability), the Veteran reported that he stopped working in June 1999 due to back pain and the impact of medication he used to treat that disability. An increased 70 percent rating for PTSD is granted. The Board finds that a higher 70 percent rating for PTSD is warranted. 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). A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name. VA and private treatment records, the July 2011 and August 2021 VA examinations, and the Veteran's lay statements show that the Veteran's PTSD was manifested by symptoms associated with a 70 percent rating to include near-continuous panic or depression affecting the ability to function independently, appropriately and effectively and obsessional rituals which interfere with routine activities. On July 2011 VA examination, the Veteran reported experiencing irritability, especially when he's feeling emotional pain. Loud noises bothered him. His wife stated that he was easily irritated and would 'fly off the handle.' Mental status examination was mostly within normal limits, but for his ongoing irritability and also some short-term memory loss. He suffered from PTSD symptoms to include intense psychological distress at exposure to his stressors, avoidant behaviors, and trouble falling and staying asleep. From July 2011 to August 2021, there were few psychiatric treatment records. On August 2021 VA examination, the Veteran reported ongoing symptoms to include depression, anxiety, mild memory loss, disturbance to motivation and mood, and obsessional rituals which interfered with his routine activities. He reported ongoing sleep trouble, trouble with concentration, and irritable and angry outbursts, recurrent distressing memories, intense prolonged psychological distress at exposure to cues that reminded him of his stressors, and avoidant behavior. A review of the VA treatment records shows that the Veteran's symptoms described above have been occurring for many decades, as records dated back to 2007 also show this level of irritability, anxiety, and depression. In addition, as noted above, per the Veteran's February 2023 VA Form 21-8940 (Application for Increased Compensation Based on Unemployability), the Veteran reported that he stopped working in June 1999 due to back pain and the impact of medication he used to treat that disability. Given the above, and that the Veteran has been shown to exhibit symptoms contemplated by the higher 70 percent rating, an increase is warranted. However, a rating higher than 70 percent is not warranted. The Veteran has not exhibited the symptoms noted in the 100 percent rating, to include 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, disorientation to time or place, or memory loss for names of close relatives, own occupation or own name. Therefore, a 100 percent rating is not warranted. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Erdheim, 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.