POSTTRAUMATIC STRESS DISORDER (PTSD)

WILLIAM H. DONNELLY · 2026 · Case ID: 26005108

MIXED

Summary

The veteran, who served in the Army National Guard and on active duty in the U.S. Army from April 2006 to August 2011, appeals the denial of increased disability ratings for PTSD and the denial of TDIU. The Board reviewed the Veteran's PTSD claim across several periods. For the period prior to June 3, 2014, the Board found the Veteran's symptoms, including depressed mood, anxiety, chronic sleep impairment, concentration problems, impaired judgment, hypervigilance, and isolative behaviors, warranted a 50 percent rating, consistent with the existing evaluation, and denied a higher rating. For the period of June 3, 2014, to January 6, 2017, the Board found the Veteran's symptoms, including intrusive thoughts, anxiety, hypervigilance, and difficulty motivating himself, warranted a 70 percent rating, denying a higher evaluation. For the period of January 6, 2017, to April 13, 2018, the Board found the Veteran's symptoms, including persistent suicidal ideation, poor hygiene, and intermittent inability to perform activities of daily living, warranted a 100 percent rating, granting the increase. For the period of April 13, 2018, to June 30, 2022, the Board found the Veteran's symptoms, including suicidal ideation without plan, depressed mood, anxiety, and difficulty maintaining relationships, warranted a 70 percent rating, denying a higher evaluation. For the period since November 14, 2022, the Board found the Veteran's symptoms, including severe anxiety, problems with sleep and work, and social isolation, warranted a 70 percent rating, denying a higher evaluation. The claim for TDIU was remanded due to the agency of original jurisdiction's failure to comply with prior remand directives to obtain the Veteran's SSA earnings history.

Rationale

Symptoms prior to June 3, 2014, did not more closely approximate criteria for a rating higher than 50 percent.; Symptoms from June 3, 2014, to January 6, 2017, warranted a 70 percent rating, but not higher.; Symptoms from April 13, 2018, to June 30, 2022, warranted a 70 percent rating, but not higher.; Symptoms since November 14, 2022, warranted a 70 percent rating, but not higher.

Service Branch

ARMY

Special Benefit

TDIU

Docket No.

18-41 737A

Full Decision Text

Citation Nr: 26005108
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 18-41 737A
DATE: April 30, 2026

ORDER

Entitlement to an initial rating in excess of 50 percent for posttraumatic stress disorder (PTSD) prior to June 6, 2014, is denied.

Entitlement to a disability rating in excess of 70 percent for PTSD for the period from June 6, 2014, to January 6, 2017, is denied

Entitlement to a disability rating of 100 percent for PTSD for the period beginning January 6, 2017, to April 13, 2018, is granted.

Entitlement to a disability rating in excess of 70 percent for PTSD for the period from April 13, 2018, to June 30, 2022, is denied

Entitlement to a disability rating in excess of 70 percent for PTSD for the period since November 14, 2022, is denied.

REMANDED

Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded.

FINDING OF FACT

1. Prior to June 6, 2014, the severity, frequency, and duration of the Veteran's symptoms did not more closely approximate occupational and social impairment with deficiencies in most areas. His symptoms manifested in depressed mood, anxiety, chronic sleep impairment, problems with concentration, impaired judgment, hypervigilance, and difficulty in establishing and maintaining effective relationships resulting in occupational and social impairment with reduced reliability and productivity.

2. From June 6, 2014, to January 7, 2017, the Veteran's PTSD symptoms manifested in occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as depression, anxiety, suspiciousness, chronic sleep impairment, problems with concentration, impaired impulse control, difficulty in establishing and maintaining effective relationships, occasional neglect of personal appearance and hygiene, disturbances in motivation and mood, and suicidal thoughts. The severity, frequency, and duration of the Veteran's symptoms do not more closely approximate total occupational and social impairment.

3. From January 7, 2017, to April 13, 2018, the severity, frequency, and duration of the Veteran's symptoms more closely approximate total occupational and social impairment manifesting in persistent danger to self and the intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene.

4. From April 13, 2018, to June 30, 2022, the severity, frequency, and duration of the Veteran's symptoms did not more closely approximate total occupational and social impairment. His symptoms manifested in suicidal ideation, depressed mood, anxiety, chronic sleep impairment, intrusive thoughts, impaired impulse control, disturbances in motivation or mood, difficulty in establishing and maintaining effective relationships, high level of self-isolation, and some working memory impairment resulting in occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.

5. Since November 14, 2022, the severity, frequency, and duration of the Veteran's symptoms have not more closely approximated total occupational and social impairment. His symptoms manifest in depressed mood, anxiety, suspiciousness, chronic sleep impairment, detachment, impaired impulse control, markedly diminished interest in or participation in significant activities, irritable behavior and angry outbursts with little or no provocation, hypervigilance, problems with concentration, and high level of self-isolation resulting in occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood..

CONCLUSION OF LAW

1. Prior to June 6, 2014, the criteria for a rating in excess of 50 percent for PTSD have not 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.

2. From June 6, 2014, to January 7, 2017, the criteria for a rating in excess of 70 percent for PTSD have not 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.

3. From January 7, 2017, to April 13, 2018, the criteria for a 100 percent rating for PTSD have been
4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411.

3. From January 7, 2017, to April 13, 2018, the criteria for a 100 percent rating for PTSD 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.

4. From April 13, 2018, to June 30, 2022, the criteria for a rating in excess of 70 percent for PTSD have not 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.

5. Since November 14, 2022, the criteria for a rating in excess of 70 percent for PTSD have not 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 FINDINGS AND CONCLUSIONS

The Veteran was a member of the Army National Guard who served on active duty in the United States Army from April 2006 to September 2006, June 2007 to June 2008, and December 2009 to August 2011. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2017 rating decision by an agency of original jurisdiction (AOJ) of the U.S. Department of Veterans Affairs (VA).

The claim for TDIU was most recently before the Board in January 2024, where the Board denied entitlement to TDIU. The Veteran appealed the Board's January 2024 decision to the United States Court of Appeals for Veterans Claims (Court). In a September 2025 memorandum decision, the Court found that the Board failed to address favorable evidence and committed prejudicial error in failing to ensure substantial compliance with the August 2023 Board remand, which, in part, specifically directed obtaining Social Security Administration earning history records. In the September 2025 memorandum decision, the Court vacated the Board's January 2024 decision and remanded the case for further development and adjudication.

The claim for increased evaluations for the Veteran's service-connected PTSD was most recently before the Board in January 2025, where the Board granted an increased evaluation for PTSD from 50 percent to 70 percent for the period beginning June 6, 2014 to December 23, 2016, and denied the claims for increased ratings for the remainder of the appeal period.

The Veteran appealed the Board's January 2025 decision to the Court, which in a January 2026 order, granted the parties' joint motion for partial remand (JMPR), vacating the Board's January 2025 decision denying a rating in excess of 50 percent for PTSD from August 2, 2011, to June 6, 2014; a rating in excess of 70 percent for PTSD from June 6, 2014, to December 23, 2016; a rating in excess of 70 percent from December 23, 2016, to July 1, 2022; and a rating in excess of 70 percent since November 14, 2022, and remanding the case for compliance with the terms of the joint motion. In the January 2026 JMPR, the parties agreed that the Board did not sufficiently address the Veteran's symptoms and how they correlated to the assigned ratings. Specific examples included intermittent inability to perform activities of daily living, auditory hallucinations, and impairment of judgment.

The matters above have been recharacterized for clarity and simplicity, to reflect the stages of evaluation on appeal. A period of schedular total disability for PTSD, from July 1, 2022, to November 14, 2022, is not on appeal, as the maximum evaluation is already in effect.

Although the Veteran requested in January 2026
November 14, 2022, and remanding the case for compliance with the terms of the joint motion. In the January 2026 JMPR, the parties agreed that the Board did not sufficiently address the Veteran's symptoms and how they correlated to the assigned ratings. Specific examples included intermittent inability to perform activities of daily living, auditory hallucinations, and impairment of judgment.

Although the Veteran requested in January 2026 that his appeal be remanded to the AOJ for review of "additional evidence," no new evidence has been added to the file since the most recent VA adjudications, nor is there a need for further remand.

Increased Rating - PTSD

The Veteran claims entitlement to increased evaluation for service-connected PTSD, claiming his condition was and is worse than his currently assigned evaluations.

Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1.

On a claim for increased rating, the claimant will generally be presumed to be seeking the maximum benefit allowed by the law and regulation, and it follows that such claim remains in controversy where less than the maximum available benefit is awarded. AB v. Brown, 6 Vet. App. 35, 38 (1993).

In evaluating a disability, the Board considers the current examination reports in light of the whole recorded history to ensure that the current rating accurately reflects the severity of the condition. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). The Board has a duty to acknowledge and consider all regulations that are potentially applicable. Schafrath v. Derwinski, 1 Vet. App. 589 (1991).

For claims for increase of initial ratings, separate ratings can be assigned for separate periods of time based on facts found, a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119, 126 (1999). If later evidence indicates that the degree of disability increased or decreased following the assignment of the initial rating, "staged" ratings may be assigned for separate periods of time. See Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007).

Any reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of the symptomatology of the other condition. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994).

When evaluating a mental disorder, VA must consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the claimant's capacity for adjustment during periods of remission. VA shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. 38 C.F.R. § 4.126(a). When evaluating the level of disability from a mental disorder, VA will consider the extent of social impairment, but shall not assign an evaluation solely on the basis of social impairment. 38 C.F.R. § 4.126(b).

Psychiatric disabilities are rated based on the General Rating Formula in 38 C.F.R. § 4.130, which provides disability ratings are based on a spectrum of symptoms. "A Veteran may qualify for a given disability rating by demonstrating the particular symptoms associated with that percentage, or others of a similar severity, frequency, and duration." Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013). The list of symptoms in the Board's general rating formula for mental disorders is not intended to constitute an exhaustive list, but rather is to serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). The Board has an obligation to engage in a "holistic" analysis in which it assesses the severity, frequency, and duration of the signs and symptoms of the Veteran's service-connected mental disorder, quantifies the level of occupational and social impairment caused by those signs and symptoms, and assigns an evaluation that most nearly approximates that level of occupational and social impairment. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017).

In Bankhead, suicidal ideation was described as a continuum, at one end with passive suicidal ideation such as wishing you would not wake up and active suicidal ideation with plan on the other end, but that both were considered suicidal ideation contemplated in a 70 percent rating.

Under the General Rating Formula, a 50 percent rating is warranted when there is 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 in establishing and maintaining effective work and social relationships.

A 70 percent rating is warranted 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 worklike setting); or inability to establish and maintain effective relationships.

A 100 percent rating 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; or memory loss for names of close relatives, own occupation, or own name.

Prior to June 3, 2014

The Veteran has an initial rating of 50 percent disabling for PTSD for the period beginning August 2, 2011. He claims his condition warrants a higher rating.

VA treatment records for the period beginning November 2011 to February 2014 indicate regular mental health treatment with the same clinician from November 2011 to January 2012, and from December 2013 to February 2014, which included PTSD and a partner relational problem as part of the Veteran's problem list.

In November 2011 and December 2011, his treating clinician noted that the Veteran's mental status was stable, and his level of function was good. VA treatment records indicate the Veteran expressed little interest or pleasure in doing things nearly every day, and reported feeling down, depressed, or hopeless nearly every day. His regular treating clinician noted numbness detachment, avoidant, and isolative behaviors, as well as hypervigilance and exaggerated startle response. The clinician observed that the Veteran had good hygiene, was alert, attentive, and able to concentrate.

In January 2012, treatment records show the Veteran had been taking antidepressant medication for approximately one month, reported increased motivation and being more engaged in activities, such as playing basketball and games
December 2011, his treating clinician noted that the Veteran's mental status was stable, and his level of function was good. VA treatment records indicate the Veteran expressed little interest or pleasure in doing things nearly every day, and reported feeling down, depressed, or hopeless nearly every day. His regular treating clinician noted numbness detachment, avoidant, and isolative behaviors, as well as hypervigilance and exaggerated startle response. The clinician observed that the Veteran had good hygiene, was alert, attentive, and able to concentrate.

In January 2012, treatment records show the Veteran had been taking antidepressant medication for approximately one month, reported increased motivation and being more engaged in activities, such as playing basketball and games, but his hypervigilance had increased and that had negatively affected his mood as he is always looking out for threats.

In the December 2012 VA examination, the Veteran was diagnosed with adjustment disorder with anxiety, and with polysubstance abuse. The examiner determined that his mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication. The Veteran reported that he had difficulty sleeping and concentrating, as well as hypervigilance. The Veteran stated that he did not have difficulty maintaining friendships but felt nervous and tense in public places. The examiner found symptoms of anxiety, chronic sleep impairment, and impaired judgment.

In January 2013, the Veteran reported several days of little interest or pleasure in doing things and feeling down, depressed or hopeless nearly every day. The Veteran reported continued PTSD and depression issues, requested to restart medication, and requested follow up with a social worker.

In July 2013, the Veteran's sister submitted a statement in which she reported that the Veteran becomes angry easily, jumps to conclusions, thinks everyone is against him, does not go outside to play with his sons anymore, does not sleep well, is irritable, and has low self-esteem.

In VA treatment records from December 2013, the Veteran reported that he does not socialize much beyond his immediate family, even with longtime friends. The Veteran reported that, when in public spaces, he looks directly at people such that others have taken offense to his looks, interpreting them as threatening or aggressive. The Veteran stated that previously prescribed medication did not help and made him moody, and reported daily use of marijuana stating that it keeps him calm. The provider noted that the Veteran did not have difficulty with impulsivity or poor self-control, and the Veteran denied ever being suicidal.

In a February 2014 treatment record, the Veteran's treating clinician noted a more stable mood, a more satisfactory relationship with his long term girlfriend, and a stable level of functioning. The Veteran expressed his interest to remain medication free in the treatment of his mental health conditions.

Throughout VA treatment records from November 2011 to February 2014, the Veteran was observed to have good grooming and hygiene. The Veteran was consistently found to be fully oriented and attentive, to have normal speech, and his thoughts were found relevant, logical, coherent, and goal-directed. Though his behavior was isolative, where he mostly socialized with immediate family, the evidence indicates that the severity of this behavior more nearly approximates difficulty in establishing and maintaining relationships rather than the inability to do so.

The Board has reviewed all evidence of record regardless of whether it is discussed in detail in this decision. See Newhouse v. Nicholson, 497 F.3d 1298, 1302 (Fed. Cir. 2007) (holding the Board must only discuss the evidence which is relevant to the issues on appeal).

After a thorough review of the evidence of record, the Board finds that the Veteran's psychiatric disorder symptoms do not more nearly approximate the criteria for a rating in excess of the 50 percent disability rating he currently receives. For the period prior to June 3, 2014, the Veteran's symptoms manifested in depressed mood, anxiety, chronic sleep impairment, problems with concentration, impaired judgment, hypervigilance, and some isolative behaviors that suggest some difficulty in establishing and maintaining effective relationships. The symptoms manifested prior to June 3, 2014 are either specifically or of the kind contemplated by the 50 percent rating criteria. Moreover, the evidence indicates that the severity, frequency, and duration do not manifest to a degree that warrants a rating in excess of 50 percent.

The evidence of record persuasively weighs against finding a disability picture where the severity, frequency, and duration of the Veteran's symptoms resulted in the level of impairment consistent with a rating higher than 50 percent. Throughout this period, the Veteran was noted as alert and oriented, with appropriate behaviour, appropriately groomed, and having some impaired judgment, also described as poor judgment, and poor insight. The Board notes that impaired judgment is contemplated by the 50 percent criteria. In some depression screenings, the Veteran reported feeling down, depressed, or hopeless nearly every day, however, no evidence indicates that this feeling affected his ability to function independently, appropriately, and effectively; thus, this report is not analogous to symptoms listed in the criteria for a 70 percent rating. The evidence shows that the Veteran does not experience impaired impulse control, spatial disorientation, inability to establish or maintain effective relationships, illogical speech, near continuous panic or depression affecting the ability to function independently, appropriately and effectively, neglect of appearance or hygiene, or difficulty in adapting to stressful circumstances including work or a worklike setting. The Veteran was able to maintain relationships with his family and friends, albeit with some reports that the Veteran was less friendly and talkative. He consistently denied suicidal and homicidal ideation during this period. Further, there were no reports or findings of memory loss that rise to the level of forgetting the names of close relatives, own occupation, or own name. No delusions or hallucinations were reported or noted in treatment records, nor was there evidence of grossly inappropriate behavior, or disorientation to time or place.

Considering the record as a whole, the Veteran's social and occupational impairment due to PTSD does not more closely approximate a disability picture for a 70 percent rating or higher for the period beginning August 2, 2011, to June 3, 2014. 38 C.F.R. § 4.7. As such, a rating in excess of 50 percent for PTSD prior to June 3, 2014, is not warranted. In reaching this conclusion, the Board considered the doctrine of reasonable doubt but has determined that it is not applicable because the weight of the evidence is against the claim for a higher rating. 38 C.F.R. §§ 4.7, 4.21.

June 3, 2014, to January 6, 2017

In the January 2025 Board decision, the Veteran's disability rating for PTSD was increased to 70 percent, beginning June 3, 2014. He claims that his condition warrants a higher evaluation.

In a June 2014 VA treatment record, the Veteran reported continued difficulty with social anxiety as well as hypervigilance and requested evaluation for medication. The Veteran reported that he feels as if he cannot control the uneasiness he feels and has "difficulty getting going and accomplishing things he wants to do." The Veteran also reported that at a recent family gathering, he became so anxious that he had to stop eating and stand away from the table to observe others.

In July 2014, VA treatment records show that the Veteran experienced intrusive thoughts which led him to be distrustful of others, including those who were close friends. The Veteran reported experiencing a pattern of anxiety including symptoms of shortness of breath, sweating, heart pounding, hypervigilance, distrust of others, and feeling the need to look at everyone. The Veteran reported that he had a hard time motivating himself to look for a job.

In August 2014, the Veteran reported that he thought the antidepressant medication he began was working, stating he felt reduced hypervigilance and more comfortable being away from home. In a later August 2014 treatment record, the Veteran reported that most of his symptoms had resolved.

In an October 2014 VA examination, the Veteran was diagnosed with PTSD, resulting in 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 said that he rarely participated in family activities, he had difficulty focusing on his family when they went out due to excessive concerns about personal safety, and his irritability and other symptoms caused recurrent arguments in his relationship. He stated that these problems have improved slightly since he began taking psychotropic medication in the summer of 2014. The examiner noted that the Veteran exhibited symptoms meeting the PTSD criteria, including a persistent negative emotional state, markedly diminished interest or participation in significant activities, feelings of detachment or estrangement, persistent inability to experience positive emotions,
resulting in 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 said that he rarely participated in family activities, he had difficulty focusing on his family when they went out due to excessive concerns about personal safety, and his irritability and other symptoms caused recurrent arguments in his relationship. He stated that these problems have improved slightly since he began taking psychotropic medication in the summer of 2014. The examiner noted that the Veteran exhibited symptoms meeting the PTSD criteria, including a persistent negative emotional state, markedly diminished interest or participation in significant activities, feelings of detachment or estrangement, persistent inability to experience positive emotions, irritable behavior and angry outbursts with little or no provocation, hypervigilance, problems with concentration, and sleep disturbance. Other symptoms noted were anxiety, chronic sleep impairment, and disturbances in motivation and mood. The Veteran was observed to be friendly and cooperative but exhibited signs of mild distress when discussing in service stressors.

In a January 2015 treatment record, the Veteran reported he discontinued his medication and mental health counseling. In April 2015, the Veteran reported feeling "down" again, avoiding people, and anxiety in crowds.

In August 2015, lay statements from the Veteran's sister, mother, and long-term girlfriend were received by VA. In the statements, they each describe isolative, reclusive behavior. His mother stated that the Veteran does not communicate with anyone, including his family and two sons. His sister stated that he makes untrue accusations about his family and friends, becomes confrontational, and shows signs of anger and aggression. His girlfriend stated that the Veteran has frequent mood swings, where his anger continues for multiple days. In a February 2017 lay statement from the Veteran's brother, he stated that in the last couple of years, the Veteran stopped caring about his appearance and about how he treats his friends and family.

In the November 2015 VA examination, the Veteran's diagnosis was noted as PTSD in partial remission, resulting in occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication. The Veteran reported he had been with his current partner for 14 years and described positive relationships with his family and children. In his free time, the Veteran reported going to sports activities with his son and playing basketball in a local recreation league. He described generally avoiding public places. The Veteran denied having any significant problems getting along with people, including maintaining friendships and getting along with those he does not know. Although he described himself as easily distracted, he also indicated that he was "alright" at learning new things. The examiner noted that the Veteran exhibited symptoms meeting the PTSD criteria, including hypervigilance, problems with concentration, and sleep disturbance. Anxiety was also noted as a symptom of his condition.

In the September 2016 VA examination, the diagnosed condition continued to be PTSD in partial remission, which resulted in occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medication. The Veteran described good relationships with his partner and children but indicated that he was less outgoing with people he does not know. The Veteran reported difficulty with concentration, stating that while he is able to generally focus on work tasks, he spaces out and loses interest. He indicated he is capable of learning new things. The examiner noted that the Veteran exhibited symptoms meeting the PTSD criteria, including irritable behavior and angry outbursts with little or no provocation, exaggerated startle response, and problems with concentration. Anxiety was also noted as a symptom of his condition.

On December 5, 2016, the Veteran contacted the Veteran's Crisis Line. During the call he denied current suicidal ideations but reported that he has had suicidal ideations over the previous two months without plan.

In VA treatment records from December 23, 2016, the Veteran reported that his depression was an 8 or 9 out of 10 and he was experiencing passive suicidal thoughts. His mood was observed as dysphoric, noting that he wept several times during the session, but that he had no disruption in thought process or content. The clinician noted that the Veteran "is almost proactive at destroying relationships as a means of protecting himself from caring."

After careful review of the evidence of record, including medical records, VA examinations, and lay statements, the persuasive evidence supports finding that the Veteran's symptoms from June 6, 2014, to January 6, 2017, include depression, anxiety, suspiciousness, chronic sleep impairment, problems with concentration, impaired impulse control, demonstrated by angry outburst with little to no provocation, difficulty in
out of 10 and he was experiencing passive suicidal thoughts. His mood was observed as dysphoric, noting that he wept several times during the session, but that he had no disruption in thought process or content. The clinician noted that the Veteran "is almost proactive at destroying relationships as a means of protecting himself from caring."

After careful review of the evidence of record, including medical records, VA examinations, and lay statements, the persuasive evidence supports finding that the Veteran's symptoms from June 6, 2014, to January 6, 2017, include depression, anxiety, suspiciousness, chronic sleep impairment, problems with concentration, impaired impulse control, demonstrated by angry outburst with little to no provocation, difficulty in establishing and maintaining effective relationships, occasional neglect of personal appearance and hygiene, disturbances in motivation and mood, and suicidal thoughts. The symptoms manifested by the Veteran for this period are either specifically or of the kind contemplated by the 70 percent rating criteria.

Moreover, the evidence indicates that the severity, frequency, and duration do not manifest to a degree that warrants a rating in excess of 70 percent. No evidence of record shows gross impairment in thought processes and behavior, evidence of delusions or hallucinations, inability to perform activities of daily living, presents a persistent danger to self or others, disorientation to time and place, or memory loss consistent with a 100 percent rating. Rather, the Veteran was consistently found to be alert and oriented, with linear, logical, and goal directed thought processes. He was regularly observed by his providers as having good or appropriate hygiene and grooming, and no evidence suggests that the Veteran was unable to perform activities of daily living. Nor is there evidence of symptoms similar to those listed in the criteria for a 100 percent rating, or symptoms that would otherwise result in total occupational and social impairment. Thus, the Veteran's PTSD disability picture does not more closely approximate a higher rating.

Due to the foregoing, the evidence of record persuasively weighs against finding a disability picture where the severity, frequency, and duration of the Veteran's symptoms resulted in the level of impairment required for a 100 percent rating. As such, a rating in excess of 70 percent for PTSD for the period beginning June 3, 2014, to January 6, 2017, is not warranted. In reaching this conclusion, the Board considered the doctrine of reasonable doubt but has determined that it is not applicable because the weight of the evidence is against the claim for a higher rating. 38 C.F.R. §§ 4.7, 4.21.

From January 6, 2017, to April 13, 2018

Beginning in January 2017 until April 13, 2018, however, the Veteran's acquired psychiatric condition manifested in worsening symptoms, including problems with hygiene and a more persistent suicidal ideation, including plans and intent. Reviewing the evidence in the light most beneficial to the Veteran, symptoms worsened, beginning January 6, 2017.

In a January 6, 2017 VA treatment record, the Veteran reported depressive symptoms including anhedonia, self-loathing, staying in bed, poor hygiene, isolation, distrust of others, paranoia, and passive suicidal ideations. In a later January 2017 treatment record, the Veteran discussed the recent breakup with his longterm girlfriend, which led to some unspecified poor decisions and unspecified stalking like behavior. The concern for his hygiene was noted in his January 2017 therapy plan to include getting out and staying out of bed after his son gets up, showering at least every other day, and wearing clean clothes daily. In the followup appointment a week later, the Veteran stated that he did not achieve any of the objectives regarding getting out of bed and engaging in better hygiene.

In February 2017, VA received a lay statement from a longtime friend of the Veteran, who described the Veteran as going to his kid's football games wearing dirty clothes and "not taking care of himself hygiene wise."

In VA treatment records for the period between January 2017 and May 2017, the Veteran's regular mental health treatment provider observed multiple occasions where the Veteran was observed to have poor or fair hygiene, sometimes wearing soiled clothing; improved hygiene was also noted during this period, but was not consistent. In a May 2017 VA treatment record, the Veteran reported that he often neglected his hygiene.

In a January 2018 VA treatment record, the Veteran appeared to his telemedicine appointment wearing 3 coats, and the clinician noted he was walking around in "extremely dangerous[] cold weather." The Veteran reported suicidal ideation with plan 2 weeks prior, where he planned to stab himself with a screwdriver, then looked for a sharper object but could not find one. The Veteran reported that a gun was present, but there were no bullets. The Veteran
observed multiple occasions where the Veteran was observed to have poor or fair hygiene, sometimes wearing soiled clothing; improved hygiene was also noted during this period, but was not consistent. In a May 2017 VA treatment record, the Veteran reported that he often neglected his hygiene.

In a January 2018 VA treatment record, the Veteran appeared to his telemedicine appointment wearing 3 coats, and the clinician noted he was walking around in "extremely dangerous[] cold weather." The Veteran reported suicidal ideation with plan 2 weeks prior, where he planned to stab himself with a screwdriver, then looked for a sharper object but could not find one. The Veteran reported that a gun was present, but there were no bullets. The Veteran expressed feelings of hopelessness and continued passive thoughts of suicide. The provider discussed inpatient treatment for the Veteran for mental health, which the Veteran agreed to; however, he did not enter into inpatient treatment at that time. In January 2018, VA treatment notes show that the Veteran was placed on the facility's high risk for suicide list. Follow up contacts to the Veteran throughout January 2018 include reports of frequent suicidal ideation and hopelessness.

In a February 2018 VA treatment record, the Veteran denied active homicidal ideation and denied auditory or visual hallucinations. The provider observed no psychosis or delusions, thoughts were clear "at times" with fair insight and judgment.

In early April 2018, the Veteran reported chronic, fleeting, intrusive suicidal ideation, with no plan or intent. He also discussed intrusive thoughts, including overdosing on medications; he made a safety plan with his provider to restrict access to medications, including use of a pill planner.

On April 13, 2018, VA treatment records show a review of the Veteran's suicide risk was undertaken. Since his self-interrupted suicide attempt around December 2017 or January 2018, the Veteran affirmed passive suicidal thoughts, along with intrusive thoughts of enacting a suicide where he is saved and felt relief due to being saved. Since the attempted suicide, he consistently denied suicidal plan or intent within the monitoring period and the clinician recommended that he no longer be monitored as a high risk for suicide. The clinician noted that the suicide risk was still moderate.

The Board has carefully reviewed the evidence of record for the period beginning January 6, 2017, until April 13, 2018. Resolving doubt in the Veteran's favor, VA treatment records and reports of symptoms include the intermittent inability to perform activities including maintenance of minimal personal hygiene and persistent danger to self, as demonstrated in the Veteran's suicide attempt and considered a high suicide risk by his providers, plus a period of unspecified "stalking like behavior" in January 2017 hints at grossly inappropriate behavior. Thus, taken together, the evidence is at least in approximate balance that the frequency, severity, and duration of his symptoms during this time more nearly approximate total social and occupational impairment, warranting a 100 percent evaluation under the General Rating Formula. 38 C.F.R. §§ 4.3, 4.7, 4.21.

Accordingly, for the period beginning January 6, 2017, until April 13, 2018, a 100 percent rating for PTSD is warranted.

April 13, 2018, to July 1, 2022

For the period beginning April 13, 2018, to July 1, 2022, the Veteran's disability rating for PTSD was 70 percent.

As noted above, on April 13, 2018, the Veteran was no longer considered high risk for suicide by his treatment providers, and he denied suicidal plan or intent for the duration of the monitoring period. Moreover, after May 2017, the Veteran's providers no longer noted hygiene issues and the Veteran's reports did not raise concern about hygiene or his ability to perform basic activities of daily living.

In a May 2018 VA treatment record, the Veteran reported feeling less anxiety and depression, as well as more stability in his moods. He reported continued problems in his relationship with his long term girlfriend, and stated that he decided to stop investing in the relationship emotionally. He was observed as appropriately groomed, with normal speech, mood, and affect. Thought processes were clear and goal directed, and his judgment and insight were noted as improved. The provider indicated no psychosis or delusions. He denied suicidal or homicidal ideations as well as auditory or visual hallucinations.

In the VA examination conducted in May 2018, the Veteran's PTSD resulted in 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 reported good relationships with his long term girlfriend, children, and mother, as well as a few close friends. The examiner noted that the Veteran exhibited symptoms meeting the PTSD criteria, including persistent and exaggerated negative beliefs and expectations, feelings of detachment or estrangement, hypervigilance, exaggerated startle response, and sleep disturbance. Other symptoms noted were depressed mood, anxiety, suspiciousness, and chronic sleep impairment. The examiner observed the Veteran as adequately groomed, pleasant, cooperative, alert, and oriented. His mood was somewhat euthymic with congruent affect. His remote memory was grossly intact, but his working memory appeared to be impaired. Abstract reasoning, social judgment, and insight appeared intact. The examiner noted that the Veteran is capable of maintaining steady work, though his symptoms impact his ability to function effectively at times.

The Veteran was observed to be appropriately groomed with appropriate hygiene. He reported improved sleep after May 2018. Treatment records show the Veteran used marijuana to help with his symptoms. In October 2020, the Veteran reported use of cocaine on and off for over a year, but reported that he stopped use. In February 2022, the Veteran's lab work showed presence of cocaine and cannabis.

In a June 2022 treatment record, the Veteran reported that he was doing well, and denied suicidal or homicidal ideations. The June 2022 mental status exam was unremarkable, showing adequate hygiene, appropriate thought process and content, and adequate attention, as well as good judgment, insight and impulse control. Memory was grossly intact. In the depression screening, the Veteran replied "not at all" to little interest or pleasure in doing things, feeling down, depressed, or hopeless, trouble concentrating, or having thoughts that he would be better off dead or hurting himself.

The Board has thoroughly reviewed the evidence for the period from April 13, 2018, until June 30, 2022, and finds that the Veteran's acquired psychiatric disorder more closely approximates occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. During this period, VA treatment records, VA examinations, and lay statements support finding symptoms of suicidal ideation, depressed mood, anxiety, suspiciousness, chronic sleep impairment, exaggerated startle response, detachment, impaired impulse control, difficulty in establishing and maintaining effective relationships, and difficulty adapting to stressful circumstances. The frequency, severity, and duration of the Veteran's symptoms, as evidenced in the claims file, demonstrates a disability picture that is entirely contemplated by occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, which is consistent with a 70 percent rating either specifically or of the kind contemplated by the 70 percent rating criteria.

Moreover, the evidence indicates that the severity, frequency, and duration do not manifest to a degree that warrants a rating in excess of 70 percent. VA treatment records relating to this period show that while the Veteran had some suicidal thoughts, without a plan or intent, but nothing suggesting a persistent danger to self. The Veteran consistently denied auditory or visual hallucinations or delusions, and no provider found evidence of psychosis or delusions. He consistently denied homicidal ideation. The Veteran was consistently found to be alert and oriented, with normal thought content and process. Judgment and insight were, at worst, noted as poor. He was regularly observed by his providers as having good or appropriate hygiene and grooming, and no evidence suggests that the Veteran was unable to perform activities of daily living. Although the Veteran complained of some memory loss, recent and remote memory were noted as good within the treatment records and VA examinations and nothing supports finding that his memory loss manifested in forgetting names of self or close relatives or his own occupation. Moreover, no symptoms as described in his treatment records, VA examination, or lay statements suggests that the Veteran manifested any symptoms that result in total occupational and social impairment or otherwise analogous to a 100 percent rating under the General Rating Formula. Thus, the Veteran's PTSD disability picture does not more closely approximate a higher rating.

For this period, the evidence is not at least in approximate balance to
having good or appropriate hygiene and grooming, and no evidence suggests that the Veteran was unable to perform activities of daily living. Although the Veteran complained of some memory loss, recent and remote memory were noted as good within the treatment records and VA examinations and nothing supports finding that his memory loss manifested in forgetting names of self or close relatives or his own occupation. Moreover, no symptoms as described in his treatment records, VA examination, or lay statements suggests that the Veteran manifested any symptoms that result in total occupational and social impairment or otherwise analogous to a 100 percent rating under the General Rating Formula. Thus, the Veteran's PTSD disability picture does not more closely approximate a higher rating.

For this period, the evidence is not at least in approximate balance to support finding that his condition manifested symptoms with the frequency, severity, and duration of a level of impairment contemplated by a 100 percent rating. As the evidence of record persuasively weighs against the claim, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7, 4.21. Due to the foregoing, the request for an increased rating for PTSD in excess of 70 percent for the period between April 13, 2018, to June 30, 2022 is denied.

From November 14, 2022

The Board notes the Veteran was rated at 100 percent for the period between June 30, 2022, and November 14, 2022. The Veteran was hospitalized on October 30, 2022, and discharged on November 1, 2022; treatment records from this time included reports of experiencing auditory hallucinations, that is, hearing a voice whispering to him that he is a bad person. During this time, the evidence indicates that the Veteran was a persistent danger to himself, particularly following 3 attempts at suicide. When discharged, he went to stay with his sibling in another city.

Since November 14, 2022, the Veteran's acquired psychiatric disorder has been rated at 70 percent disabling.

After being discharged in November 2022, treatment records show that the Veteran was not in persistent danger of harming himself or others. In a November 14, 2022 VA treatment record, the Veteran denied suicidal ideation or plan since his discharge. The Veteran exhibited moderate symptoms of depression and severe symptoms of anxiety. The Veteran reported problems with sleep, maintaining a job, maintaining friendships, binge drinking with cocaine use. He reported little interest or pleasure in doing things nearly every day, and feeling down, depressed or hopeless more than half the days within the prior 2 weeks. The Veteran replied "not at all" to thoughts that he would be better off dead or hurting himself in somewhat within the prior 2 weeks. The Veteran appeared adequately groomed, was calm and cooperative, with normal speech. He had a stable affect, coherent thought process, with fair judgment. He denied suicidal or homicidal ideations as well as denied any hallucinations or delusions. The Veteran was prescribed medication for his condition.

A February 2023 VA treatment record included a depression questionnaire where the Veteran where he replied "not at all" to little interest or pleasure in doing things, feeling down, depressed, or hopeless, trouble concentrating, or having thought that you would be better off dead or hurting himself. An anxiety questionnaire resulted in finding severe symptoms, including anxiety, unable to stop or control worry, worrying too much, trouble relaxing, feeling restless, and fear of something awful happening with a frequency of "nearly every day." The Veteran reported that his anxiety symptoms made it "extremely difficult to work, take care of things at home, or get along with others."

In a March 2023 VA examination, the Veteran was diagnosed with PTSD, with cannabis use disorder, stimulant use disorder, and alcohol abuse disorder, resulting in occupational and social impairment with reduced reliability and productivity. The Veteran reported that his 20 year relationship ended due to alcohol and cocaine use. He has not seen one of his two children in 3 years, but they talk regularly. He reported that he does not talk to his family much and denied having any friends. His recent employment history included several jobs, including bartending, working for a moving company, refereeing basketball, an Amazon employee, and a Walmart maintenance worker. The examiner noted that the Veteran had attempted suicide three times in 2022, once in September 2022 and twice in October 2022. He denied suicidal ideations at the examination. The examiner noted that the Veteran exhibited symptoms of PTSD, including persistent and exaggerated negative beliefs and expectations, feelings of detachment or estrangement, markedly diminished interest in or participation in significant activities, irritable behavior and angry outbursts with little or no provocation, hypervigilance,
they talk regularly. He reported that he does not talk to his family much and denied having any friends. His recent employment history included several jobs, including bartending, working for a moving company, refereeing basketball, an Amazon employee, and a Walmart maintenance worker. The examiner noted that the Veteran had attempted suicide three times in 2022, once in September 2022 and twice in October 2022. He denied suicidal ideations at the examination. The examiner noted that the Veteran exhibited symptoms of PTSD, including persistent and exaggerated negative beliefs and expectations, feelings of detachment or estrangement, markedly diminished interest in or participation in significant activities, irritable behavior and angry outbursts with little or no provocation, hypervigilance, problems with concentration, and sleep disturbance. Other symptoms noted were depressed mood, anxiety, suspiciousness, chronic sleep impairment, and difficulty in establishing and maintaining effective relationships. The examiner observed the Veteran to be adequately groomed, and his cognition was grossly intact. The Veteran denied hallucination, homicidal, and suicidal ideations. No evidence of delusions or disorganized thought process were found at examination.

In a March 2023 VA treatment record, the Veteran reported that his medications were helping with his anxiety and mood, but that he still keeps to himself after work, watching tv, smoking, drinking alcohol, and using cocaine and/or methamphetamine. The Veteran's mental status examination noted normal speech, thoughts that were logical, linear, relevant, and goal directed. His attention, concentration, judgment, and insight were observed as fair. The Veteran denied suicidal and homicidal ideations. He denied auditory or visual hallucinations, and the provider indicated there was no evidence of grandiose ideas, racing thoughts, delusions, obsessions, or compulsions. The Veteran was alert and oriented.

The Board has thoroughly reviewed the evidence for the period since November 14, 2022, and finds that the Veteran's acquired psychiatric disorder more closely approximates occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. During this period, VA treatment records, VA examinations, and lay statements support finding symptoms depressed mood, anxiety, suspiciousness, chronic sleep impairment, detachment, impaired impulse control, markedly diminished interest in or participation in significant activities, irritable behavior and angry outbursts with little or no provocation, hypervigilance, and problems with concentration. The frequency, severity, and duration of the Veteran's symptoms, as evidenced in the claims file, demonstrates a disability picture that is entirely contemplated by occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, which is consistent with a 70 percent rating either specifically or of the kind contemplated by the 70 percent rating criteria.

Moreover, the evidence indicates that the severity, frequency, and duration do not manifest to a degree that warrants a rating in excess of 70 percent. Since November 14, 2022, treatment records are absent of any notations or findings of suicidal or homicidal ideations, delusions, paranoia, or hallucinations. No evidence suggests that the Veteran was a danger to himself or others since November 14, 2022. The Veteran was consistently noted as alert and oriented, with normal thought process and content. Judgment and insight were generally noted as fair. He was regularly observed by his providers as having good or appropriate hygiene and grooming, and no evidence suggests that the Veteran was unable to perform activities of daily living. Moreover, no evidence supports finding that his memory loss manifested in forgetting names of self or close relatives or his own occupation. No symptoms as described in his treatment records, VA examination, or lay statements suggests that the Veteran manifested any symptoms that result in total occupational and social impairment or otherwise analogous to a 100 percent rating under the General Rating Formula. Thus, the Veteran's PTSD disability picture does not more closely approximate a higher rating.

REASONS FOR REMAND

As to the claim for TDIU, in the August 2023 remand, the Board specifically directed the AOJ to obtain an earnings history from the Social Security Administration (SSA). The AOJ did
a 100 percent rating. As the evidence of record persuasively weighs against the claim, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7, 4.21. Due to the foregoing, the request for an increased rating for PTSD in excess of 70 percent for the period since November 14, 2022 is denied.

REASONS FOR REMAND

As to the claim for TDIU, in the August 2023 remand, the Board specifically directed the AOJ to obtain an earnings history from the Social Security Administration (SSA). The AOJ did not ask for earnings history as directed by the August 2023 remand. This is a duty to assist error and failure to substantially comply with the August 2023 remand directives. See 38 CFR § 3.159(c)(2); Stegall v. West, 11 Vet. App. 268 (1998) (A remand by the Board confers upon the claimant, as a matter of law, the right to substantial compliance with the remand directives.).

Accordingly, a remand is required to comply with the August 2023 Board remand and assist the Veteran in the development of his TDIU claim.

The matters are REMANDED for the following action:

1. Tthe AOJ must make as many requests as are necessary to obtain relevant records as to the Veteran's SSA earnings history relevant to the appeal period. If the records sought do not exist or further efforts to obtain those records would be futile, the AOJ must make an explicit finding to such.

Perform any additional development necessary for the claim of TDIU.

2. Then, readjudicate the remanded claim considering all pertinent evidence added to the claims file since the most recent adjudication. If any benefit sought on appeal is not granted, the Veteran and his representative should be provided with a Supplemental Statement of the Case and an appropriate time period for response. The case should then be returned to the Board for further consideration, if otherwise in order.

WILLIAM H. DONNELLY

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board R. Lyons

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.

Analyze in VA Law Explorer