POSTTRAUMATIC STRESS DISORDER (PTSD)

TIMOTHY BERRYMAN · 2022 · Case ID: 22054847

MIXED

Summary

The veteran, who served in the National Guard with periods of active duty between 1985 and 2008, appeals for an increased rating for posttraumatic stress disorder (PTSD). The Board granted a 70 percent rating for PTSD prior to January 11, 2019, finding that the evidence supported the criteria for this rating, including the veteran's reported suicidal ideation and two suicide attempts during that period. The Board noted that while the veteran experienced significant symptoms, she did not meet the criteria for a 100 percent rating due to a lack of total occupational and social impairment, hallucinations, grossly inappropriate behavior, or severe disorientation. The Board denied increased ratings for PTSD for the subsequent periods from January 11, 2019, to May 19, 2019, August 1, 2019, to February 18, 2021, and June 1, 2021, to January 21, 2022. During these later periods, the evidence indicated that while the veteran experienced depression, anxiety, and suicidal ideation, she did not exhibit total occupational and social impairment, nor did she engage in grossly inappropriate behavior or experience severe disorientation. The Board reviewed various clinical records and VA examinations to reach these conclusions, ultimately finding that the evidence did not support a rating higher than 70 percent for PTSD during the denied periods.

Rationale

Evidence showed suicidal ideation on multiple occasions; Two suicide attempts in September and November 2018; Did not experience hallucinations, grossly inappropriate behavior, or severe disorientation

Service Branch

NATIONAL GUARD

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

9411

Docket No.

18-20 812

Full Decision Text

Citation Nr: 22054847
Decision Date: 09/26/22 Archive Date: 09/26/22

DOCKET NO. 18-20 812
DATE: September 26, 2022

ORDER

A 70 percent rating for posttraumatic stress disorder with severe depression, alcohol use disorder, cannabis use disorder, and cocaine disorder (PTSD) prior to January 11, 2019, is granted.

A rating in excess of 70 percent for PTSD from January 11, 2019, to May 19, 2019, is denied.

A rating in excess of 70 percent for PTSD from August 1, 2019, to February 18, 2021, is denied.

A rating in excess of 70 percent for PTSD from June 1, 2021, to January 21, 2022, is denied.

FINDINGS OF FACT

1. Prior to January 11, 2019, the Veteran's PTSD had been manifested by subjective complaints of suicidal ideation, anxious mood, and difficulty focusing among others; objective findings include suicidal ideation, mild memory loss, and logical thoughts, among others.

2. From January 11, 2019, to May 19, 2019, August 1, 2019, to February 18, 2021, and June 1, 20121, to January 21, 2022, the Veteran's PTSD did not result in total occupational and social impairment.

CONCLUSIONS OF LAW

1. The criteria for a 70 percent rating for PTSD prior to January 11, 2019, have been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.59, 4.71a, Diagnostic Code (DC) 9411.

2. The criteria for a rating in excess of 70 percent for PTSD from January 11, 2019, prior to May 19, 2019, have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.59, 4.71a, DC 9411.

3. The criteria for a rating in excess of 70 percent for PTSD from August 1, 2019, to February 18, 2021, have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.59, 4.71a, DC 9411.

4. The criteria for a rating in excess of 70 percent for PTSD from June 1, 2021, to January 21, 2022, have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.59, 4.71a, DC 9411 (2021).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served in the National Guard from September 1985 to September 1986, April 1988 to May 1990, with active service from May 1988 to November 1988, and July 1992 to June 1994 and served on active duty from May 2007 to April 2008; he has been in receipt of total disability based on individual unemployability since January 2019 and his PTSD was rated at 100 percent from May 19, 2019, to August 1, 2019, February 18, 2021, to June 1, 2021, and from January 21, 2022.

Increased Ratings

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 11, 2019, the Veteran was rated at 50 percent under DC 9411 for PTSD. In a June 2018 rating decision
1, 2019, February 18, 2021, to June 1, 2021, and from January 21, 2022.

Increased Ratings

Prior to January 11, 2019, the Veteran was rated at 50 percent under DC 9411 for PTSD. In a June 2018 rating decision, she was assigned a 70 percent rating effective January 11, 2019. In a June 2019 rating decision, she was assigned a 100 percent rating effective May 19, 2019. In a March 2020 rating decision, she was assigned a 70 percent rating effective August 1, 2019. In a February 2022 rating decision, she was assigned a 100 percent rating effective February 18, 2021, a 70 percent rating effective June 1, 202, and a 100 percent rating effective January 21, 2022. Therefore, an increased rating will only be considered for the periods in which the Veteran is not rated at 100 percent.

Under 9411, a 70 percent rating is warranted when the evidence shows 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 is warranted when the evidence shows 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.

Prior to January 11, 2019

Turning to the medical evidence for the first period on appeal, in a June 2015 clinical record, the Veteran admitted to mild depression and anxiety as well as having thoughts of harming herself and others. However, upon examination, she denied thoughts of suicide and her mood and thoughts were stable and logical.

In November 2015, the Veteran was hospitalized for two weeks for psychiatric symptoms. At the time of hospitalization, she reported being unable to sleep or eat. She would not bathe for days and did not care about herself. She was also noted to be severely anxious and her thoughts were noted as barely coherent. She also talked of death and endorsed suicidal ideation with no plan.

However, in a November 25, 2015 clinical record, she reported nightmares, flashbacks, intrusive thoughts, and anger outbursts. However, she denied hallucinations, suicidal and homicidal intent, and current and past episodes of mania or hypomania.

Further, in a December 2015 clinical record, the Veteran reported difficulty focusing. Upon examination, her thoughts were noted to be moderately coherent with her having difficulty expressing herself and forming complete sentences.

In addition, in an April 2016 VA examination, the Veteran endorsed symptoms of intrusive memories, avoidance, anxiety, depression, and sleep disturbance. However, she denied current suicidal and homicidal ideation and symptoms of mania and psychosis. While she denied panic attack symptomatology, she endorsed difficulty breathing and palpitations

Upon examination, the examiner marked that the Veteran experienced the following psychiatric symptoms: depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, chronic sleep impairment, mild memory loss, and disturbances of motivation and mood.

In a May 2016 clinical record, the Veteran was noted to have good grooming and hygiene. While her mood was noted as agitated, her thoughts were normal, and she denied suicidal and homicidal ideation.

The record reflects that the Veteran was hospitalized from May 2018 to June 4, 2018. In a May 2018 inpatient note, the Veteran reported trouble sleeping and periods of intense fear. She also endorsed depressed mood, being unable to tolerate stressful situations, and suicidal ideation with no plan.

In a June 2018 clinical
: depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, chronic sleep impairment, mild memory loss, and disturbances of motivation and mood.

In a May 2016 clinical record, the Veteran was noted to have good grooming and hygiene. While her mood was noted as agitated, her thoughts were normal, and she denied suicidal and homicidal ideation.

In a June 2018 clinical record, the Veteran endorsed depressed mood, loss of interest in activities, and low energy. She also reported sleep difficulties and suicidal ideation with no plan. However, she denied hallucinations. Upon examination, thoughts were "for the most part" linear and logical.

The record reflects that from September 6, 2018 to September 12, 2018, the Veteran was hospitalized for a week after trying to jump out of her car. In a September 10, 2018. She reported feeling depressed. However, she denied hallucinations. Further, while she endorsed recurrent suicidal ideation, she did not have plans or intentions at present.

The Veteran also was hospitalized from November 11, 2018 to November 30, 2018 after trying to cut herself and striking a nurse. In a November 29, 2018 clinical record, she endorsed intrusive thoughts. However, speech and thoughts were normal, and she denied suicidal and homicidal ideation.

In a January 2019 clinical record, the Veteran reported feeling suicidal. Upon examination, her sleep was rated as poor, and her mood was rated as anxious. However, she did not exhibit psychosis.

Based on the above, the medical evidence supports a 70 percent rating for PTSD prior to January 11, 2019. Specifically, the United States Court of Appeals for Veterans Claims has held that suicidal ideation generally rises to the level contemplated in a 70 percent evaluation, noting that it may alone cause occupational and social impairment in most areas. See Bankhead v. Shulkin, 29 Vet. App. 10, 20 (2017). In reviewing the clinical evidence for the relevant appeal period, the evidence showed that the Veteran endorsed suicidal ideation on multiple occasions and had two suicide attempts in September 2018 and November 2018. However, the medical evidence does not support a rating in excess of 70 percent, as the Veteran did not experience hallucinations, did not engage in grossly inappropriate behavior, and was not severely disoriented. Therefore, the medical evidence supports a 70 percent rating, but no more, for PTSD prior to January 11, 2019.

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 her during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations.

Accordingly, the criteria for a 70 percent rating for PTSD prior to January 11, 2019, have been met, and the claim is granted.

From January 11, 2019, to May 19, 2019

Turning to the medical evidence for the second period on appeal, in a January 2019 VA examination, the examiner marked that the Veteran experienced the following symptoms: depressed mood, anxiety, suspiciousness, panic attacks more than once a week, chronic sleep impairment, mild memory loss, impaired judgement, disturbances of motivation and mood, difficulty in establishing and maintaining effective relationships, difficulty in adapting to circumstances, suicidal ideation, impaired impulse control, neglect of hygiene, and an intermittent inability to perform activities of daily living. Further, upon examination, the Veteran's appearance was noted to be unkempt and she cried frequently. However, speech and thoughts were normal and there was no evidence of psychosis.

Based on the above, the medical evidence does not support a rating in excess of 70 percent for PTSD from January 11, 2019, to May 19, 2019. In this regard, the evidence showed that the Veteran experienced psychiatric symptoms such as depression, anxiety, panic attacks, and suicidal ideation, among others. However, she was not noted to engage in inappropriate behavior, be a danger to herself or others, and be disoriented. She was not shown to have total occupational and social impairment. While clinical records for the relevant appeal period were reviewed, they did not contradict the above findings. Therefore, the medical evidence does not support a rating in excess of 70 percent for PTSD prior to May 19, 2019.

Accordingly, the criteria for a rating in excess of
of 70 percent for PTSD from January 11, 2019, to May 19, 2019. In this regard, the evidence showed that the Veteran experienced psychiatric symptoms such as depression, anxiety, panic attacks, and suicidal ideation, among others. However, she was not noted to engage in inappropriate behavior, be a danger to herself or others, and be disoriented. She was not shown to have total occupational and social impairment. While clinical records for the relevant appeal period were reviewed, they did not contradict the above findings. Therefore, the medical evidence does not support a rating in excess of 70 percent for PTSD prior to May 19, 2019.

Accordingly, the criteria for a rating in excess of 70 percent for PTSD from January 11, 2019, to May 19, 2019, have not been met, and the claim is denied.

From August 1, 2019, to February 18, 2021

Turning to the evidence for the third period on appeal, the record reflects that the Veteran was hospitalized from January 24, 2020, to January 30, 2020. In a January 30, 2020 clinical record, her speech and thoughts were normal. Further, she denied suicidal ideation, homicidal ideation, and hallucinations.

Further, in a March 2020 VA examination, the Veteran endorsed dysphoric mood, lack of ability to perform activities of daily living, lack of energy, crying spells, and irritability. She also endorsed a history of suicidal ideation, with plans to overdose on pills or crash her car. The examiner noted that the Veteran crashed her car a month ago.

In addition, the Veteran endorsed worry, concentration problems, short term memory deficits, sleep disturbance, nightmares, flashbacks, intrusive memories, hyper startle response, hypervigilance, and avoidance behaviors. However, she denied panic attack and manic symptoms.

Upon examination, the examiner marked that the Veteran experienced the following symptoms: depressed mood, anxiety, suspiciousness, near continuous panic or depression, chronic sleep impairment, mild memory loss, flattened affect, speech intermittently illogical, impaired judgement, disturbances of motivation and mood, difficulty in establishing effective relationships, difficulty adapting to stressful circumstances. inability to establish relationships, suicidal ideation, impaired impulse control, spatial disorientation, and an intermittent ability to perform activities of daily living.

Further, the record reflects that the Veteran was hospitalized from July to August 2020, November 2020, and January 2021 for psychiatric symptoms.

Based on the above, the medical evidence does not support a rating in excess of 70 percent for PTSD prior to February 18, 2021. In this regard, the medical evidence showed that the Veteran experienced symptoms such as depression, anxiety, suicidal ideation, and an intermittent ability to perform activities of daily living among others. However, she was not noted to be a persistent danger to herself or others, did not experience hallucinations, and was not severely disoriented. She was not shown to have total occupational and social impairment. Therefore, the medical evidence does not support a rating in excess of 70 percent for PTSD from August 1, 2019, to February 18, 2021.

Accordingly, the criteria for a rating in excess of 70 percent for PTSD from August 1, 2019, to February 18, 2021, have not been met, and the claim is denied.

From June 1, 2021, to January 21, 2022

Turning to the evidence for the fourth period on appeal, in a July 2021 clinical record, the Veteran's mood was rated as mildly anxious. However, her speech was coherent and she did not endorse hallucinations. Further she was not noted to be a danger to herself or others. Further, in a September 2021 clinical record, she denied suicidal ideation, homicidal ideation, and hallucinations.

Based on the above, the evidence does not support a rating in excess of 70 percent for PTSD prior to January 21, 2022. In this regard, the Veteran was not noted to be a danger to herself or others and she denied suicidal ideation, homicidal ideation, and hallucinations. She was not shown to have total occupational and social impairment. Therefore, the medical evidence does not support a rating in excess of 70 percent for PTSD from June 1, 2021, to January 21, 2022.

Accordingly, the criteria for a rating in excess of 70 percent for PTSD from June 1, 2021, to January 21, 2022, have not been met, and the claim is denied

Timothy Berryman

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the

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