POSTTRAUMATIC STRESS DISORDER (PTSD)

Summary

The veteran, who served in the U.S. Army from October 1967 to October 1969, including combat service in Vietnam, appeals the denial of an increased disability rating for his service-connected PTSD prior to January 15, 2018. The veteran sought a rating higher than 50 percent, arguing his symptoms warranted a 70 percent rating due to irritability, anger, and other impairments. The Board reviewed a private psychiatric evaluation from August 2013 and multiple VA examinations and treatment records from August 2014 through January 2018. The Board acknowledged the veteran's reported symptoms, including anxiety, depression, memory issues, and occasional irritability, as noted in both private and VA evaluations. However, the Board found that prior to January 15, 2018, the veteran's symptoms did not rise to the level required for a 70 percent rating, citing a lack of pervasive irritability, consistent denial of anger issues in VA records, and evidence of maintaining relationships and assisting neighbors. The Board found the medical evidence, particularly the VA examinations, more persuasive than the veteran's self-reports regarding the severity of his symptoms and their impact on occupational and social functioning. The Board concluded that the veteran's symptoms prior to January 15, 2018, more nearly approximated the criteria for a 50 percent rating. The Board also noted that while the veteran's condition worsened after January 15, 2018, that period was not under appeal. The appeal for a rating in excess of 50 percent prior to January 15, 2018, was denied.

Rationale

Private and VA examinations noted symptoms like anxiety, depression, memory issues, and occasional irritability.; Board found symptoms did not rise to the level for a 70 percent rating prior to January 15, 2018.; Evidence indicated ability to maintain relationships and assist neighbors, weighing against higher rating.; Medical evidence from VA examinations was considered more persuasive than veteran's self-reports on severity.

Full Decision Text

Citation Nr: A26011633
Decision Date: 02/06/26	Archive Date: 02/06/26

DOCKET NO. 200730-101852
DATE: February 6, 2026

ORDER

Entitlement to an initial rating in excess of 50 percent for the service-connected posttraumatic stress disorder (PTSD) prior to January 15, 2018, is denied.

FINDING OF FACT

Prior to January 15, 2018, the Veteran's service-connected PTSD was manifested by symptomatology resulting in occupational and social impairment with reduced reliability and productivity; without more severe manifestations that more nearly approximate occupational and social impairment with deficiencies in most areas, or total occupational and social impairment.

CONCLUSION OF LAW

The criteria for an initial rating in excess of 50 percent for the Veteran's service-connected PTSD prior to January 15, 2018, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the U.S. Army from October 1967 to October 1969, including combat service in Vietnam.

These matters are currently before the Board of Veterans' Appeals (Board) on remand from the United States Court of Appeals for Veterans Claims (Court). By way of history, the Board denied the above claims in an April 2022 decision and in April 2023 the parties filed a Joint Motion for Partial Remand (JMPR) to vacate and remand that portion of an April 2022 Board decision that denied the issues currently on appeal. In April 2023, the Court issued an Order granting the JMPR and remanding the appeal for action consistent with the JMPR. Subsequently, in a September 2023 Board Decision the claims were again denied by the Board. However, in June 2025 the Court issued a Memorandum Decision vacating the September 2023 Board Decision insofar as it denied a rating in excess of 50 percent prior to January 15, 2028, without disturbing the grant of a 100 percent rating as of that date, and ordered the Board to readjudicate the appeal. The claim has now returned to the Board. 

This matter came before the Board on an appeal from an August 2019 higher-level review decision, following an April 2018 opt-in to the Appeals Modernization Act (AMA) via the Rapid Appeals Modernization Program (RAMP). The Veteran selected the evidence submission docket. July 2020 VA Form 10182. Accordingly, as in the previous decision, the Board may only consider evidence of record at the time of the RAMP opt-in and that received within 90 days of the 10182. 38 C.F.R. § 20.303. The appeal originally arose from an August 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office.

Upon return from the Court, the Veteran contends that he is entitled to an initial rating in excess of 50 percent for his service-connected PTSD prior to January 15, 2018.

In April 2022, the Board denied entitlement to an initial rating in excess of 50 percent for the service-connected PTSD prior to March 23, 2018, while granting entitlement to a 100 percent rating effective March 23, 2018. In the JMPR, the parties agreed that the Board erred by not addressing a private August 2013 PTSD behavioral health evaluation that also described the Veteran's active symptomatology during the appeal period. Additionally, the parties agreed the Board failed to provide reasons or bases for relying on the date of receipt of evidence of increased rating (March 23, 2018) and did not address whether it was factually ascertainable that an increase in disability had occurred prior thereto based on the date the evidence was generated (January 15, 2018). 

Upon return to the Board, in September 2023 the Board denied a disability rating in excess of 50 percent prior to January 15, 2018, and assigned a 100 percent rating thereafter. However, the June 2025 Memorandum Decision partially vacated the September 2023 Board Decision, as noted above, after determining the Board did not adequately address the Veteran's impaired impulse control to include anger and irritability. Specifically, the Board did not address the frequency and severity of the Veteran's irritability. Moreover, the Court found the Board "misapplied the law" in regard to the severity of irritability by "treating violence as a requirement, rather than
 generated (January 15, 2018). 

Upon return to the Board, in September 2023 the Board denied a disability rating in excess of 50 percent prior to January 15, 2018, and assigned a 100 percent rating thereafter. However, the June 2025 Memorandum Decision partially vacated the September 2023 Board Decision, as noted above, after determining the Board did not adequately address the Veteran's impaired impulse control to include anger and irritability. Specifically, the Board did not address the frequency and severity of the Veteran's irritability. Moreover, the Court found the Board "misapplied the law" in regard to the severity of irritability by "treating violence as a requirement, rather than a suggested factor or guiding symptom." Lastly, the Board erred by not adequately addressing the Veteran's lay statements that his anger and irritability warrant a 70 percent rating. 

Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38?U.S.C. §?1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38?C.F.R. §?4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38?C.F.R. §?4.2. All reasonable doubt will be resolved in the claimant's favor. 38?C.F.R. §?4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38?C.F.R. §?4.7.

Separate ratings can be assigned for separate periods based on the facts found - a practice known as "staged" ratings. Fenderson v. West, 12?Vet. App.?119 (1999); Hart v. Mansfield, 21?Vet. App.?505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id.

The Veteran's service-connected PTSD is evaluated under the criteria of Diagnostic Code 9411, which provides that such disability is evaluated pursuant to the General Rating Formula for Mental Disorders. See 38?C.F.R. §?4.130. Under this Code,?a 50 percent rating is assigned 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; and 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); inability to establish and maintain effective relationships.

A maximum 100 percent rating requires 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. 

The evaluation under 38?C.F.R. §?4.130 is "symptom-driven," meaning that "symptomatology should be the fact-finder's primary focus when deciding entitlement to a given disability rating" under that regulation. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-117 (Fed. Cir. 2013). The symptoms listed are not exhaustive, but rather "serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating." Mauerhan v. Principi, 16
); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. 

The evaluation under 38?C.F.R. §?4.130 is "symptom-driven," meaning that "symptomatology should be the fact-finder's primary focus when deciding entitlement to a given disability rating" under that regulation. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-117 (Fed. Cir. 2013). The symptoms listed are not exhaustive, but rather "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, 442 (2002). In the context of determining whether a higher disability evaluation is warranted, the analysis requires considering "not only the presence of certain symptoms, but also that those symptoms have caused occupational and social impairment in most of the referenced areas" - i.e., "the regulation...requires an ultimate factual conclusion as to the Veteran's level of impairment in most areas." Vazquez-Claudio, 713 F.3d at 117-118; 38?C.F.R. §?4.130, DC 9411. 

Further, when evaluating a mental disorder, the Board must consider the "frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission," and must also "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).

PTSD prior to January 15, 2018

The Veteran seeks entitlement to a disability rating in excess of 50 percent. As this is an initial increased rating claim, the period on appeal begins June 9, 2014, the date VA received his service connection claim. Considering the lengthy procedural history of this case and for the sake of clarity, the Board will include a detailed review of the pertinent evidence of record. 

Turning to the evidence of record, for the sake of background, in roughly 2007, the Veteran was working at his gas station when a customer left without paying for gas and the Veteran shot at the customer. See August 2014 VA Examination.

In August 2013, the Veteran underwent a private psychiatric examination from a psychotherapist. The Veteran presented as oriented to time, place, person, and situation. His speech was clear and not pressured; but his conversation was guarded, he exhibited restricted affect, and he appeared anxious and overly alert. His hands were very cold and damp to the touch. His mood was noted as depressed. The Veteran described a sense of foreshortened future and it being hard to get close to people based on issues of trust and suspicion. He also stated that he owned three guns and was always on the alert, describing two of the guns ready for action if needed. He mentioned that he was a church member and engaged in fishing as a hobby. The Veteran also stated he preferred to be alone, avoided crowds, and felt isolated. He discussed that when he went out in public, he chose to sit with his back against the wall and near the door. He denied homicidal or suicidal ideation, and stated that he loved his grandchildren and wife and wanted to live to be around them.

The examination also documented the Veteran suffers from minor memory problems. However, his concentration skills and judgment were identified as adequate, although he did make complaints of such symptoms. Additionally, on verbal cognitive assessments, the Veteran demonstrated some difficulty engaging in abstract thinking regarding the meaning of a common proverb. The psychotherapist noted the Veteran did not suffer from looseness of associations or mental confusion. Although the Veteran denied delusions, he described problems with seeing things other people do not see, having flashbacks, intrusive thinking, and hearing soldiers talking to one another and giving orders to him. He also described having a phobia of snakes and feeling something crawling on his skin when nothing is there. Additionally, the Veteran reported only sleeping a couple of hours per night and always waking up in a sweat, causing him to feel tired and worn out the next morning.

In finding severe PTSD, the psychotherapist noted the Veteran was obsessive and ruminative, and that he was less able to work than he had been. The psychotherapist also noted the Veteran feeling irritable or having fits of anger, having much less interest or participating much less often in important activities, and feeling distant or cut off from people around him. The psychotherapist concluded that the Veteran's PTSD and related problems most significantly impacted his ability to work, relationships with others, fun and leisure activities, sex life
 and feeling something crawling on his skin when nothing is there. Additionally, the Veteran reported only sleeping a couple of hours per night and always waking up in a sweat, causing him to feel tired and worn out the next morning.

In finding severe PTSD, the psychotherapist noted the Veteran was obsessive and ruminative, and that he was less able to work than he had been. The psychotherapist also noted the Veteran feeling irritable or having fits of anger, having much less interest or participating much less often in important activities, and feeling distant or cut off from people around him. The psychotherapist concluded that the Veteran's PTSD and related problems most significantly impacted his ability to work, relationships with others, fun and leisure activities, sex life, general satisfaction with life, and overall level of function in all areas of his life. The psychotherapist also characterized the Veteran as suffering from significant emotional distress and had a fair prognosis.

In August 2014 the Veteran underwent a VA psychiatric examination. The examiner found that the Veteran's psychiatric symptoms included depressed mood, anxiety, suspiciousness, chronic sleep impairment, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and difficulty in adapting to stressful circumstances, including work or a work like setting. Also, the examiner noted recurrent, intrusive distressing memories, dreams, intense or prolonged psychological distress, and marked physiological reactions. The examiner also stated that the Veteran displayed a persistent negative emotional state. The examiner went on to identify irritable behavior and angry outbursts, hypervigilance, exaggerated startle response, and sleep disturbance. The Veteran reported a strained relationship with his wife due to his symptoms and that he feels anxious around people in crowds and in social settings. He also stated he retired "a few years ago" after an incident where he shot at a customer at work and that it was hard for him to return to work after the incident, as it triggered thoughts of his service in Vietnam. Suicidal ideation was not reported or indicated. The examiner concluded that the Veteran's disability resulted in occupational and social impairment with reduced reliability and productivity.

In September 2014 he underwent an initial behavioral health evaluation with a VA psychologist. It was determined the Veteran had an appropriate affect, he was attentive and engaged, and denied any suicidal or homicidal ideation. The Veteran subjectively reported increased distress described as "nightmares, intrusive thoughts about his experiences in Vietnam, and emotional numbness." It was also determined he experienced "severe level of distress related to symptoms associated with depression." The Veteran did not report any issues with irritability or anger. An October 2014 VA mental health record indicates "continued anxiety and depression." It was determined he was alert and oriented to person, place, time, situation, and he was moderately groomed and appropriately dressed. His mood was neutral, affect was constricted, and he denied hallucinations and suicidal or homicidal ideation. His thought process was logical and organized, he was alert and oriented, and spoke in a normal rate. He stated he was "not physically or mentally able to work." He reported that he is married, has two children, and he has three grandchildren. The Veteran did not report any issues with irritability or anger. A January 2015 VA mental health record subjectively reports he is "improved" and "less depressed" and thinking of beginning a part time job and that he helps his neighbors. It was determined he was pleasant, cooperative, casually dressed, spoke normally, his affect was appropriate to mood, had logical thought processes, and denied hallucinations and suicidal and homicidal ideation. The Veteran did not report any issues with irritability or anger. A July 9, 2015, VA psychiatry outpatient note indicates "he is doing well" and is walking more. It was determined he was pleasant, cooperative, casually dressed, spoke normally, affect was appropriate to mood, had logical thought processes, and denied hallucinations and suicidal and homicidal ideation. The Veteran did not report any issues with irritability or anger.

On July 20, 2015, he underwent another VA psychiatric examination. He presented as casually groomed and casually dressed, and he was observed to be cooperative, but anxious. The Veteran was oriented to person, place, and time, and his thought process was linear and goal directed. The examiner observed that the Veteran demonstrated mild anxiety symptoms manifested by constant tapping of his foot during the examination. The examiner indicated that the Veteran's psychiatric symptoms included anxiety and mild memory loss, such as forgetting names, directions, or recent events. Additional symptoms of hypervigilance, intrusive thoughts, sleep disturbances, vivid dreams, and flashbacks were indicated. The Veteran reported that he was no longer as close with his wife and that he is a loner as he does not want to be around a lot of people and is not comfortable with crowds
 casually groomed and casually dressed, and he was observed to be cooperative, but anxious. The Veteran was oriented to person, place, and time, and his thought process was linear and goal directed. The examiner observed that the Veteran demonstrated mild anxiety symptoms manifested by constant tapping of his foot during the examination. The examiner indicated that the Veteran's psychiatric symptoms included anxiety and mild memory loss, such as forgetting names, directions, or recent events. Additional symptoms of hypervigilance, intrusive thoughts, sleep disturbances, vivid dreams, and flashbacks were indicated. The Veteran reported that he was no longer as close with his wife and that he is a loner as he does not want to be around a lot of people and is not comfortable with crowds. The Veteran also reported meeting a friend for ice cream, fishing with his son-in-law, taking his grandchildren to see the July 4 fireworks, and attending public memorial services for Memorial and Veterans Day. The Veteran stated that he got along well with his daughters and the one grandchild he regularly visited. He continued to note his church attendance. Further, the examiner noted that the Veteran's recent and remote memory was slightly impaired, and the Veteran appeared to have a deficit in attention. The Veteran denied any current or prior suicidal ideations or homicidal ideations. The examiner concluded that the Veteran's psychiatric disability resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.

An August 2015 VA primary care record indicates he was alert and oriented and not in acute distress, his speech was clear and calm, he appeared calm and cooperative, and he denied suicidal and homicidal ideation. The Veteran did not report any issues with irritability or anger. An April 2016 VA psychiatry outpatient record indicates his "meds are helping," he reported intrusive thoughts, his concentration was fair, he was pleasant and cooperative, appeared well groomed, spoke in normal rate and tone, thought process was logical, insight and judgement was good, and denied hallucination and suicidal and homicidal ideation. The Veteran did not report any issues with irritability or anger. A May 2016 VA orthopedic surgical consult indicates he appeared alert and oriented and his mood was described as "calm." A September 2016 VA psychiatric record indicates his "meds are helping," he was pleasant and cooperative, spoke in normal rate and tone, dressed appropriately, had mild stable depression, his thought process was logical and insight and judgment were good, and he denied hallucinations and suicidal and homicidal ideation. The Veteran did not report any issues with irritability or anger. An April 2017 VA primary care record indicates he denied depression, anxiety, and suicidal and homicidal ideation. A May 2017 VA mental health record indicates "I have been doing good on my meds. I have less nightmares." His concentration was good, he was pleasant and cooperative, spoke in normal rate and tone, dressed appropriately, had mild stable depression, his thought process and logical insight and judgment were fair, and he denied hallucinations and suicidal and homicidal ideation. The Veteran did not report any issues with irritability or anger. A September 2017 VA psychiatric outpatient record indicates he "sometimes" has bad dreams, had stable mood, gets along well with his wife, he was pleasant and cooperative, spoke in normal rate and tone, dressed appropriately, had mild stable depression, his thought process and logical insight and judgment were fair, and he denied hallucinations and suicidal and homicidal ideation. The Veteran did not report any issues with irritability or anger. A January 11, 2018, VA psychiatry outpatient record indicates "off and on" bad dreams and that his meds are "helping" and his wife is "supportive." He was pleasant and cooperative, spoke in normal rate and tone, dressed appropriately, had mild stable depression, his thought process and logical insight and judgment were fair, and he denied hallucinations and suicidal and homicidal ideation. The Veteran did not report any issues with irritability or anger.

After a review of the claims file in conjunction with the applicable laws and regulations, the Board finds the weight of the evidence is against finding the Veteran's acquired psychiatric disorder warrants a disability rating in excess of 50 percent prior to January 15, 2018.

As an initial matter, the 2013 private psychiatric evaluation only included a narrative report and did not include a complete VA PTSD Disability Benefits Questionnaire (DBQ). As the psychotherapist did not complete a PTSD DBQ incident to his 2013 meeting with the Veteran, while the Veteran's symptoms are noted, there is less description and quantification as to the frequency, severity, and duration of the Veteran's PTSD symptoms than if the psychotherapist had used the PTSD DBQ. Nonetheless, the report is still probative on how the PTSD symptoms affected the Veteran's
 the weight of the evidence is against finding the Veteran's acquired psychiatric disorder warrants a disability rating in excess of 50 percent prior to January 15, 2018.

As an initial matter, the 2013 private psychiatric evaluation only included a narrative report and did not include a complete VA PTSD Disability Benefits Questionnaire (DBQ). As the psychotherapist did not complete a PTSD DBQ incident to his 2013 meeting with the Veteran, while the Veteran's symptoms are noted, there is less description and quantification as to the frequency, severity, and duration of the Veteran's PTSD symptoms than if the psychotherapist had used the PTSD DBQ. Nonetheless, the report is still probative on how the PTSD symptoms affected the Veteran's overall level of function in all areas of his life.

In this case and prior to January 15, 2018, the Board does not find his acquired psychiatric disorder manifested as occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.

Specifically, the Board finds the Veteran does not indicate he experiences obsessive rituals that interfere with routine activities. While the Board acknowledges that during the 2013 private examination, he indicated he "has problems checking and rechecking" his activities such as closing or locking the door and the psychotherapist described his symptoms as "obsessive," there is no indication these events interfere with his life or routine activities. Indeed, the Veteran does not at any point refer to these events as "obsessive" or indicate he is "obsessive" about ensuring they are completed. Moreover, the evidence of record, to include two VA examinations and 12 VA medical appointments, are devoid of any reported issues with such acts indicating they rise to an "obsessive" level.

Likewise, at no point during the one private and two VA psychiatric examinations and 12 VA medical appointments does the Veteran report or do the records indicate his speech is intermittently illogical, obscure, or irrelevant, had issues with spatial orientation, or that he neglected his appearance or hygiene. Indeed, the previously mentioned records all indicate the opposite.

Similarly, at no point does the evidence indicate he experiences near-continuous panic or depression affecting the ability to function independently, appropriately and effectively. Indeed, in October 2014 he reported his depression "comes and goes." Moreover, throughout his 12 VA medical appointments he generally reports he is "improving" or "doing well" and that his "medication is helping." See January and July 2015 and September 2016 and January 2018 VA Treatment Records. Additionally, the evidence indicates he interacts with his grandchildren to include public activities, assists neighbors with activities, and interacts with friends. See January 2015 VA Treatment Record and July 2015 VA Examination. While the Board acknowledges the Veteran reported during his 2013 private examination that he experiences panic and often sits with his back against a wall, the weight of the evidence does not indicate that overall his panic or depression affects his ability to function independently, appropriately, and effectively. 

As to impaired impulse control, the Board finds again that his symptoms do not rise to the level contemplated by a 70 percent rating. Specifically, while the 2013 private examination indicates he experiences such difficulties, the report itself is devoid of any contemporary examples or reasoning for such determination. Instead, it appears the examiner relies on the Veteran's 2007 reported gas station shooting; however, that occurred roughly seven years prior to the current appeal period. While supportive for background purposes, it is not dispositive on the issue and such treatment is informative of the severity and manifestation of the Veteran's psychiatric disability; however, it cannot be solely considered and relied upon to indicate his functioning during the current period on appeal. Additionally, while the August 2014 VA examiner listed irritable behavior and angry outbursts under Criterion E, they did not indicate the Veteran experienced impaired impulse control under the symptoms and similarly did not provide any examples of, or cite to examples of, irritable behavior and angry outbursts. Instead, again, it appears the examiner relies on the Veteran's 2007 reported gas station shooting. As it pertains to impaired impulse control, this incident also was notably provoked, as the Veteran believed someone was trying to leave without paying for gas, and he consistently reported that he was aiming for the tires of the car, showing some control over his impulses to intentionally inflict less damage and only hitting the individual by accidental ricochet.

Further supporting the Board's determination is that throughout the Veteran's 12 VA appointments during the appeal period, he does not at any point voice issues related to irritability, anger, violence, or similar issues. Indeed, during these 12 appointments he cites other symptoms and it is reasonable that if irritability and anger were present, he would have reported it. Moreover, during the July 201
 reported gas station shooting. As it pertains to impaired impulse control, this incident also was notably provoked, as the Veteran believed someone was trying to leave without paying for gas, and he consistently reported that he was aiming for the tires of the car, showing some control over his impulses to intentionally inflict less damage and only hitting the individual by accidental ricochet.

Further supporting the Board's determination is that throughout the Veteran's 12 VA appointments during the appeal period, he does not at any point voice issues related to irritability, anger, violence, or similar issues. Indeed, during these 12 appointments he cites other symptoms and it is reasonable that if irritability and anger were present, he would have reported it. Moreover, during the July 2015 VA examination he explicitly denied such issues. Thus, as the evidence only cites to a single incident of impaired impulse control due to anger prior to the rating period on appeal and considering the Veteran denied irritability and anger issues and continually and routinely did not report such issues, the frequency and duration of his symptoms did not rise to the level contemplated by a 70 percent rating. To the extent the Veteran argues otherwise, the above evidence of record all points to the contrary. Indeed, it cannot be stated his irritability and anger were so pervasive and affecting the Veteran that he then denied the issues and did not report the issues on 12 occasions from 2014 to 2018.

As to difficulty adapting to stressful circumstances (including work or a work-like setting), the Board recognizes the Veteran did not engage in employment during the appeal period and reported in October 2014 he did not think he was able to work due to his psychiatric disorder. However, the Veteran indicated in January 2015 he was able to assist his neighbors in activities and thinking of engaging in part time work indicating some ability to function in a worklike setting. Yet, the Board acknowledges that the overall evidence in consideration of this factor weighs in favor of the Veteran's claim for an increased rating. However, the presence of a single symptom is not dispositive of the particular disability level. See Bankhead v. Shulkin, 29?Vet. App. 22 (2017).

As to the inability to establish and maintain effective relationships, the Board finds this weighs against the Veteran. Specifically, he indicates he has friends and engages in activities with such friends. See 2013 Private Examination and July 2015 VA Examination. Moreover, he helps his neighbors which again indicates the ability to maintain relationships. See January 2015 VA Treatment Record. Furthermore, throughout the period he indicated he was married and maintained relationships with his children and grandchildren. Indeed, he also reported fishing with his son-in-law and at one point caring for his mother-in-law. See July 2015 VA Examination. The Board does not imply the above relations are easy to maintain, and are likely difficult; nonetheless, the above indicates the Veteran is able to maintain relationships. Indeed, the evidence indicates that the Veterans acquired psychiatric disorder does not manifest as the inability to establish and maintain effective relationships.

As to suicidal ideation, the Board recognizes the later reports of suicidal ideations in the evidence of record, described further below. Notably, suicidal ideation alone may cause occupational and social impairment with deficiencies in most areas. See Bankhead, 29?Vet. App.?at 10. In this case, the Veteran routinely and continually denied suicidal ideation on multiple occasions to multiple practitioners. While the Board acknowledges the 2013 psychotherapist determined he will "likely experience" suicidal ideation, he denied it during the examination and that statement does not indicate he currently experiences such symptoms. Moreover, even if he were to have endorsed the symptom at that time, again the presence of a single symptom is not dispositive of the particular disability level, and his actual occupational and social function was not more commensurate with having deficiencies in most areas. Bankhead, 29 Vet. App. at 22. The record as a whole does not support this symptom being present for this period, and thus it has not resulted in occupational and social functioning with deficiencies in most areas. 

Likewise, the Veteran somewhat endorsed the presence of hallucinations. However, the record again includes numerous times where the Veteran affirmatively denied experiencing such symptoms. The Veteran's reported hallucinations are rare in the record before the Board and have not been tied to any specific impairment in occupational or social functioning that would warrant a higher rating in light of the disability picture as a whole.

The Board acknowledges the 2013 private evaluation determined his PTSD manifested as "severe." However, as outlined above, while the Veteran's symptoms are noted, there is less description and quantification as to the frequency, severity, and duration of the symptoms, including their resulting impact on his occupational and social function. Similarly, the Board acknowledges the September 2014 VA initial behavioral health evaluation determined his PTSD manifested as
 presence of hallucinations. However, the record again includes numerous times where the Veteran affirmatively denied experiencing such symptoms. The Veteran's reported hallucinations are rare in the record before the Board and have not been tied to any specific impairment in occupational or social functioning that would warrant a higher rating in light of the disability picture as a whole.

The Board acknowledges the 2013 private evaluation determined his PTSD manifested as "severe." However, as outlined above, while the Veteran's symptoms are noted, there is less description and quantification as to the frequency, severity, and duration of the symptoms, including their resulting impact on his occupational and social function. Similarly, the Board acknowledges the September 2014 VA initial behavioral health evaluation determined his PTSD manifested as "severe level of distress." However, similarly to the 2013 evaluation, the record provides less description and quantification as to the frequency, severity, and duration of the Veteran's PTSD symptoms. While these descriptions of the severity of the Veteran's symptoms and PTSD are important evidence, which is probative and taken into consideration, they are another factor weighed against the overall symptomatology and resulting occupational and social impairment. In other words, merely being described as severe does not equate to warranting a higher rating.

To reiterate, the record reflects his PTSD manifested as flattened affect, memory deficiencies, impairment of abstract thought and memory, disturbances in motivation and mood, and difficulty in establishing and maintaining effective work and social relationships.

Additionally, while irritability and anger issues were noted, the weight of the evidence does not indicate such issues were so pervasive that the frequency and duration of such symptoms rose to the level contemplated by a 70 percent rating. Moreover, he denied delusions but did describe problems with seeing things other people do not see, having flashbacks, intrusive thinking, and hearing soldiers talking to one another, giving orders to him. Furthermore, his overall activity level with other individuals and self-reports of "doing well" and his medications "helping" indicated his symptoms did not manifest as "near-continuous panic or depression." Also, the evidence continually indicated he did not experience spatial disorientation, and neglect of personal appearance and hygiene. Likewise, the evidence indicated his ability to maintain and establish effective relationships even though his symptoms likely made that difficult. Lastly, the Board acknowledges his symptoms manifested as difficulty in adapting to stressful circumstances such as a work or worklike setting. However, the presence of a single symptom is not dispositive of the particular disability level. Bankhead, 29 Vet. App. at 22. Moreover, in rating the Veteran's disorder the Board must consider the "frequency, severity, and duration of psychiatric symptoms." 38 C.F.R. § 4.126(a). Based on the entire disability picture, the Veteran's symptoms prior to January 15, 2018, more nearly approximate a 50 percent rating. 

Regarding the Veteran's statements addressing the severity of his psychiatric disorder, while the Board sympathizes with the Veteran's complaints and by no means intends to minimize his experiences, the Board finds his symptoms are contemplated in his currently assigned rating. Moreover, the "frequency, severity, and duration of psychiatric symptoms" do not rise to the level contemplated as a whole by the severity of a 70 percent rating. Considering the above and the entirety of the evidence of record, the Board finds the effects of his acquired psychiatric disorder are commensurate with the criteria of his current 50 percent rating. See Mauerhan v. Principi, 16 Vet. App. 436 (2002). 

In comparison, while the period beginning January 15, 2018, is not under the purview of this appeal, as of that date the Veteran showed a clear worsening of the disability picture and resulting occupational and social impairment. Specifically, the Veteran was observed in both private and VA examinations to have symptoms such as an inability to establish and maintain effective relationships, an inability to perform activities of daily living (including maintenance of minimal personal hygiene), and suicidal ideations. The Veteran's psychotherapist cautioned and noted that the Veteran was a persistent danger to himself and others and should be watched closely

On January 15, 2018, the Veteran underwent another private examination which included a completed PTSD DBQ form and a corresponding narrative report. In the narrative report, it was again noted that the Veteran reported emotional distress, distrust of others, withdrawing from others, and lacking self-confidence. The Veteran reported problems with attention, concentration, and memory. The Veteran stated that he thought he saw things that others do not see and that he experienced flashbacks to Vietnam with heavy rains. The psychotherapist found the Veteran to be fully oriented to time, place, person, and situation but observed the Veteran to be anxious and overly alert. The Veteran again reported he was very withdrawn from others, easily embarrassed in social situations, where the psychotherapist identifying that the Veteran's tendency to
2018, the Veteran underwent another private examination which included a completed PTSD DBQ form and a corresponding narrative report. In the narrative report, it was again noted that the Veteran reported emotional distress, distrust of others, withdrawing from others, and lacking self-confidence. The Veteran reported problems with attention, concentration, and memory. The Veteran stated that he thought he saw things that others do not see and that he experienced flashbacks to Vietnam with heavy rains. The psychotherapist found the Veteran to be fully oriented to time, place, person, and situation but observed the Veteran to be anxious and overly alert. The Veteran again reported he was very withdrawn from others, easily embarrassed in social situations, where the psychotherapist identifying that the Veteran's tendency to withdraw and isolate from others only further exacerbated his symptoms. The psychotherapist noted that the Veteran was less able to work now than in the past and that his PTSD significantly impacted his ability to work, his relationships with others, fun and leisure activities, sex life, general satisfaction with life, again opining its effect overall level of functioning in all areas of his life. 

While the 2018 narrative report appears nearly identical to Veteran's 2013 report in most respects, there are some material differences. In 2018, it was noted that the Veteran's dreams were getting worse as the Veteran got older. Additionally, the psychotherapist changed his opinion as the Veteran suffering from "significant" emotional distress in 2018 to "severe" emotional distress in 2018. The psychotherapist also noted that in 2018, the Veteran did not seem to care what happened to himself. Additionally, instead of the fair prognosis provided in 2013, it was determined that the Veteran's prognosis was poor in 2018. The psychotherapist noted that when the Veteran became angry, he did not know what would come over him, as he felt as though he would explode. In 2018, the psychotherapist noted that the Veteran's judgment was not as good as it used to be and that he reported thinking and dreaming of things that the Veteran felt were too bad to talk about. In 2013 the psychotherapist described the Veteran having difficulty trusting others, in 2018 the psychotherapist wrote that the Veteran thought it was better to trust no one. Further, in the 2018 report, the psychotherapist cautioned that the Veteran's suicide potential should be evaluated carefully and monitored regularly. The psychotherapist also stated that the Veteran's PTSD had gotten a lot worse with aging.

In the 2018 private PTSD DBQ, the psychotherapist found that the Veteran's psychiatric symptoms included: depressed mood; anxiety; suspiciousness; panic attacks more than once a week; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; chronic sleep impairment; mild memory loss such as forgetting names, directions or recent events; flattened affect; difficulty in understanding complex commands; impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty adapting to stressful circumstances, including work or a work like setting; inability to establish and maintain effective relationships; suicidal ideation; obsessional rituals which interfere with routine activities; impaired impulse control, such as unprovoked irritability with periods of violence; persistent danger of hurting self or others; intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. Additional symptoms of difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, hypervigilance, exaggerated startle response, impatience, obsession, rumination, and nervousness. Pursuant to the DBQ, the psychotherapist concluded that the Veteran's disability results in total occupational and social impairment. 

The Veteran was afforded a new VA examination in July 2019. The examiner indicated that the Veteran's psychiatric symptoms included the following: depressed mood; anxiety; suspiciousness; panic attacks more than once a week; chronic sleep impairment; flattened affect; difficulty in understanding complex commands; impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in adapting to stressful circumstances, including work or a work like setting; suicidal ideation; and impaired impulse control. The Veteran was observed to be alert and oriented and was cooperative during the examination. His cognitive processes reflected average intelligence with some blurred, fuzzy thinking, and he appeared to ruminate over his illnesses. His memory and concentration were impaired, and his mood was flat, dysphoric, and anhedonic with restricted affect. He reported passive suicidal ideation, but that he considers following through if his physical health worsens. He denied any homicidal ideation or delusions but asserted that he sees Vietnamese children everywhere. Additional symptoms of irritable behavior and angry outbursts, hypervigilance, exaggerated startle response, problems with concentration, and sleep disturbance were noted
 or a work like setting; suicidal ideation; and impaired impulse control. The Veteran was observed to be alert and oriented and was cooperative during the examination. His cognitive processes reflected average intelligence with some blurred, fuzzy thinking, and he appeared to ruminate over his illnesses. His memory and concentration were impaired, and his mood was flat, dysphoric, and anhedonic with restricted affect. He reported passive suicidal ideation, but that he considers following through if his physical health worsens. He denied any homicidal ideation or delusions but asserted that he sees Vietnamese children everywhere. Additional symptoms of irritable behavior and angry outbursts, hypervigilance, exaggerated startle response, problems with concentration, and sleep disturbance were noted. The Veteran reported a 46-year marriage. that he has three grandchildren, and that he is retired. The examiner concluded that the Veteran's PTSD results in occupational and social impairment with deficiencies in most areas.

Thus, as found in the prior Board decision, resolving all doubt in his favor regarding the disparate reports and lesser impairment noted in 2019, this evidence warranted a 100 percent rating as of January 15, 2018. This evidence is probative to the current appeal to show the contextual worsening of his symptomatology beginning as of that date, and reinforce that he warrants a lower, 50 percent rating prior to that date.

In sum, the Board finds the evidence of record does not support the assignment of a disability rating in excess of 50 percent for his acquired psychiatric disorder prior to January 15, 2018. To the extent that any higher level of compensation is sought, the weight of the evidence is against the claim. Hence, the benefit of the doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; See Lynch, supra. 

In reaching its determination, the Board acknowledges the Veteran's sincerely held belief that the severity of his PTSD symptoms warrants a higher disability rating throughout the periods on appeal, including due to his irritability and anger alone. In this regard, the Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to describe his symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. Woehlaert v. Nicholson, 21?Vet. App.?456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). The Board nevertheless considered his statements as to his symptoms and their resulting impairment in making its determination. However, the Board finds the medical evidence in which professionals with specialized expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disabilities in light of the rating criteria to be more persuasive than his own reports regarding the severity of his disabilities. 

The Board has also considered whether additional staged ratings under Fenderson, supra, are appropriate for the Veteran's PTSD; however, his symptomatology has been stable throughout the period on appeal. Therefore, assigning additional staged ratings is not warranted.

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The Board has also considered the benefit of the doubt doctrine, however the evidence weighs persuasively against Veteran's claim, as symptoms during the period prior to January 15, 2018, more nearly approximate the 50 percent rating. 38?U.S.C. §?5107; 38?C.F.R. §§?4.3, 4.7. Thus, the appeal for a rating in excess of 50 percent prior to January 15, 2018, is denied.

 

 

J.M. ESTES

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Masters, Tyler

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.