POSTTRAUMATIC STRESS DISORDER (PTSD)

Summary

The veteran, who served from January 1986 to January 2006, appeals for an increased rating for his posttraumatic stress disorder (PTSD) prior to January 24, 2022. The Board previously remanded the claim twice. The veteran was rated at 50 percent for PTSD prior to January 24, 2022, and received a 100 percent rating effective that date. The sole issue is entitlement to an increased rating prior to January 24, 2022. The veteran reported symptoms including irritability, depression, anxiety, concentration difficulties, and memory issues. He noted losing a job due to concentration problems and having a strained relationship with his wife, with few social connections. He also reported violent outbursts and hypervigilance. However, medical examinations consistently found his thoughts to be normal, with no evidence of suicidal or homicidal ideation, nor gross impairment in daily activities. While the veteran endorsed some symptoms aligning with a 70 percent rating, the evidence did not support a higher rating, as it did not demonstrate total occupational and social impairment or inability to perform basic daily activities. The Board found the medical evidence supported a 70 percent rating for PTSD prior to January 24, 2022, based on the veteran's reported symptoms and occupational/social difficulties. However, the evidence did not meet the criteria for a 100 percent rating. Therefore, the Board granted a 70 percent rating for PTSD prior to January 24, 2022.

Rationale

Endorsed symptoms of irritability, depression, anxiety, memory, and concentration difficulties.; Reported strained relationship with wife and few social connections.; Evidence did not support total occupational and social impairment or inability to perform daily activities.

Full Decision Text

Citation Nr: 22036006
Decision Date: 06/22/22	Archive Date: 06/22/22

DOCKET NO. 16-01 493
DATE: June 22, 2022

ORDER

A 70 percent rating, but no more, for posttraumatic stress disorder (PTSD) with dissociative symptoms and derealization prior to January 24, 2022, is granted.

FINDINGS OF FACT

1. The Veteran served on active duty from January 1986 to January 2006; he has been rated at 100 percent, has been in receipt of Dependents' Educational Assistance benefits, and has been in receipt of special monthly compensation due to being housebound since January 2022. 

2. Prior to January 24, 2022, PTSD had been manifested by subjective complaints of irritability, depression, anxiety, and difficulties with concentration and memory, among others; objective findings included depression, anxiety, irritability, normal thoughts, and no evidence of suicidal or homicidal ideation, among others. 

CONCLUSION OF LAW

The criteria for a 70 percent rating, but no more, for PTSD with dissociative symptoms and derealization prior to January 24, 2022, have been met. 38 U.S.C. §§ 1155 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.31, 4.59, 4.7, 4.71a, Diagnostic Code (DC) 9411 (2021).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The Board remanded the claim in October 2020 and again in August 2021. The case has now been returned to the Board for adjudicative action.

Turning to the relevant laws and regulations, disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. §§ 4.1. Separate diagnostic codes identify the various disabilities.  

Prior to January 24, 2022, the Veteran was rated at 50 percent under DC 9411 for PTSD. Effective that date, he was awarded a 100 percent (total) rating.  As this represents the maximum schedular rating, the sole issue before the Board is entitlement to an increased rating prior to that date.  

Under DC 9411, a 70 percent rating 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 work-like setting); and inability to establish and maintain effective relationships.  

A 100 percent evaluation for a psychiatric disability is warranted 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; memory loss for names of close relatives, own occupation, or own name.    

Turning to the medical evidence, in November 2017 clinical records, the Veteran reported a lack of focus, concentration, and short term memory. He explained that he lost his job in August 2017 due to his inability to concentrate and remember assignments. Upon examination, he was alert and oriented, speech was normal, and he denied suicidal or homicidal ideation. Further, he performed "average" on short term and delayed memory indexes.

In an August 2018 clinical record, the Veteran reported not having a good relationship with his wife. Further, he explained that while he was currently a deacon for his church, he did not have any close social relationships. He also explained that in 2014, he was taking online college classes but had to quit due to a lack of focus and concentration. He also stated that he worked for G4S security until 2017 but had to quit because his lack of focus and concentration made it difficult for him to supervise other employees.

At the time of the examination, the Veteran endorsed violent outbursts, avoidance of crowds, hypervigilance, and sitting with his back to walls. He also reported
 delayed memory indexes.

In an August 2018 clinical record, the Veteran reported not having a good relationship with his wife. Further, he explained that while he was currently a deacon for his church, he did not have any close social relationships. He also explained that in 2014, he was taking online college classes but had to quit due to a lack of focus and concentration. He also stated that he worked for G4S security until 2017 but had to quit because his lack of focus and concentration made it difficult for him to supervise other employees.

At the time of the examination, the Veteran endorsed violent outbursts, avoidance of crowds, hypervigilance, and sitting with his back to walls. He also reported exaggerated startle responses, concentration difficulties, insomnia, and patterns of excessive worry. Upon examination, impulse control was below normal limits, but thoughts were normal and there was no evidence of suicidal/homicidal ideation. 

In a January 2020 clinical record, the Veteran endorsed the following symptoms: little interest or pleasure, feeling down and depressed, trouble sleeping, low energy, overeating, feelings of failure, nervousness, and restlessness, trouble concentrating, and becoming easily irritable. However, upon examination, his mood was rated as pleasant, speech was normal, and there was no evidence of suicidal or homicidal ideation.

Further, in an August 2020 clinical record, he reported forgetting appointments and forgetting to take his medication. He also endorsed depression, anxiety, and irritability. In addition, in a May 2021 clinical record, there was no evidence of suicidal or homicidal ideation, anxiety, stress, depression, or insomnia.

In an August 2021 clinical record, the Veteran endorsed having a quick temper. However, in a September 2021 clinical record, the clinician wrote that the Veteran did not have a tendency to become violent. 

Based on the above, the medical evidence supports a 70 percent rating, but no more, for PTSD prior to January 24, 2022. In this regard, the evidence showed that the Veteran endorsed symptoms of irritability, depression, anxiety, and difficulties with memory and concentration, among others. Further, he reported not having a good relationship with his wife, not having other friends, and having to quit one of his jobs due to concentration difficulties. However, the medical evidence does not support a rating in excess of 70 percent, as the evidence does not show that the Veteran engaged in grossly inappropriate behavior, endorsed delusions, or was unable to independently perform activities of daily living. Therefore, the medical evidence supports a 70 percent rating, but no more, for PTSD prior to January 24, 2022. 

In granting a higher rating, the Board has considered the Veteran's lay statements regarding his symptoms as well as the evidence provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations.

Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28. Vet. App. 366, 369-370 (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).     

 

T.D. JONES

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	D. Ragofsky, Associate 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.