Citation Nr: A25035708 Decision Date: 04/17/25 Archive Date: 04/17/25 DOCKET NO. 240626-452236 DATE: April 17, 2025 ORDER Entitlement to an initial rating in excess of 50 percent for service-connected posttraumatic stress disorder with alcohol use disorder (PTSD) is denied. FINDING OF FACT The severity, frequency, and duration of the symptoms of the Veteran's PTSD do not more nearly approximate occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. CONCLUSION OF LAW The criteria for an initial rating in excess of 50 percent for PTSD are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9411. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Air Force from May 1992 to December 1996. This matter is on appeal from a June 2023 rating decision. In April and June 2024, the Veteran submitted a VA Form 10182, notice of disagreement, requesting direct review by a Veterans Law Judge. The Board will consider evidence of record at the time of the June 2023 rating decision notification letter. 38 C.F.R. § 20.301. 1. PTSD Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities. 38 C.F.R. Part 4. The Board determines the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.10. Where there is a question as to which of two ratings should be applied, 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 general, when an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, staged ratings are also appropriate in any increased rating claim in which distinct time periods with different ratable symptoms can be identified. Hart v. Mansfield, 21 Vet. App. 505 (2007). Here, analysis in this decision has therefore been undertaken with consideration of the possibility that different ratings may be warranted for different time periods as to the pending claim. In all cases, the Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a "competent" source. The Board must then determine if the evidence is credible, or worthy of belief. The third step of this inquiry requires the Board to weigh the probative value of the proffered evidence in light of the entirety of the record. In this function, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498, 511-12 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996) (per curiam) (table); see Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997). The Veteran's service-connected PTSD is evaluated pursuant to 38 C.F.R. § 4.130, DC 9411. Under this diagnostic code, a 50 percent evaluation is assigned for 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 establishing effective work and social relationships. Id. A 70 percent evaluation is contemplated 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 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; inability to establish and maintain effective relationships. Id. A 100 percent evaluation is warranted when there is evidence of 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. Id. When determining the appropriate disability evaluation to assign, the Board's primary consideration is a veteran's symptoms, but it must also make findings as to how those symptoms impact a veteran's occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013); Mauerhan v. Principi, 16 Vet. App. 436, 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 the veteran's impairment must be "due to" those symptoms, 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. In this matter, the Veteran was granted service connection for PTSD in a June 2023 rating decision, which assigned a 50 percent disability rating from February 16, 2023. He disagreed with the assigned rating, and this appeal follows. For the reasons set forth below, the Board finds that a disability rating in excess of 50 percent is not warranted for PTSD. The Veteran underwent a VA examination for PTSD in March 2023. Here, the examiner noted a diagnosis of PTSD and alcohol use disorder. The examiner noted that the Veteran's PTSD symptoms are exclusively attributable to PTSD and uses alcohol to cope with his symptoms. The examiner found the Veteran's PTSD amounted to 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. The Veteran's symptoms are listed as depressed mood, anxiety, panic attacks that occur weekly or less often, chronic sleep impairment, mild memory loss, disturbance in motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. The Veteran reported working since discharge from service. See March 2023 VA Initial PTSD Disability Benefits Questionnaire (DBQ). The VA medical treatment records note continuous denial of suicidal ideation, homicidal ideation, delusions, and hallucinations. See VA Medical Treatment Records. The Board has thoroughly reviewed the record and has given full consideration to 38 C.F.R. § 4.7 (where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned) and 38 C.F.R. § 3.102 (when there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the Veteran). In determining whether the Veteran meets the schedular criteria for a higher disability rating, the Board's inquiry is not necessarily limited to the criteria found in the VA rating schedule. See Mauerhan, supra. Based on the evidence of record set forth in pertinent part above, the Board finds that the Veteran's PTSD has been manifested by depressed mood, anxiety, panic attacks that occur weekly or less often, chronic sleep impairment, mild memory loss, disturbance in motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. Critically, the evidence demonstrates that the Veteran's psychological symptoms are, at most, indicative of 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. See March 2023 VA Initial PTSD DBQ. The evidence, however, is persuasively against a conclusion that the Veteran's symptoms meet the 70 percent criteria nor the 100 percent criteria. As stated above, the criteria for 70 percent rating are occupational and social impairment, with deficiencies in most areas; and the 100 percent rating that are more nearly approximated total occupational and social impairment at any time. 38 C.F.R. § 4.7. The evidence does not show occupational and social impairment, with deficiencies in most areas; nor does the evidence show total occupational and social impairment due to persistent depressive disorder. There is evidence of significant occupational impairment due to his service-connected psychiatric disability. See March 2023 VA Initial PTSD DBQ. The Veteran has described social impairment caused by depression, anxiety, and irritability. Id. Occupational and social impairment, with deficiencies in most areas, and total social impairment has therefore not been shown. The Board acknowledges the Veteran has difficulty establishing and maintaining effective work and social relationships, which is noted in a 70 percent disability rating. The Board finds that while this symptom is noted in the 70 percent disability rating, this alone does not establish the Veteran's PTSD amounted to a higher rating. As such, neither the 70 percent rating nor the 100 percent rating are demonstrated by the evidence. Accordingly, and based on this evidentiary posture, the Board concludes that the evidence is persuasively against a finding that a disability rating in excess of 50 percent is warranted for the Veteran's PTSD with alcohol use. Additionally, neither the Veteran nor his representative have raised any other issues, nor has the record reasonably raised any other issues. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). Of note, the Veteran reported working for a package delivery company during his March 2023 VA examination. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Glaeser 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.