POSTTRAUMATIC STRESS DISORDER (PTSD)

Summary

The veteran, who served in the United States Marine Corps from April 1988 to April 1993, appeals the denial of an increased rating for PTSD with major depressive disorder and the denial of an earlier effective date for a temporary total rating for PTSD. The veteran also sought TDIU. The Board reviewed evidence including VA examinations from March 2019 and May 2020, treatment records, and personnel records. The March 2019 VA exam documented symptoms consistent with a 70% rating for PTSD, including suicidal ideation and impaired impulse control. The May 2020 exam noted stabilization of symptoms but still indicated occupational and social impairment. The Board found the evidence did not support a 100% rating, as total social and occupational impairment was not demonstrated. The claim for an earlier effective date for the temporary total rating was denied, as the assigned August 26, 2020, date correctly reflected the start of hospitalization. However, the Board granted TDIU, finding that the veteran's combined service-connected disabilities, including PTSD, bilateral carpal tunnel syndrome, and bilateral knee conditions, rendered him unable to secure or follow substantially gainful employment. The Board found the AOJ's conclusion that the veteran could perform sedentary work contradicted the medical evidence showing significant physical and mental limitations.

Rationale

Evidence does not support total social and occupational impairment.; VA examiners opined symptoms met criteria for 50% (March 2019) and 30% (May 2020) ratings.; Symptoms do not rise to the level of 100% rating criteria.

Full Decision Text

Citation Nr: A26039945
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 210721-182874
DATE: April 29, 2026

ORDER

Entitlement to a rating in excess of 70 percent for posttraumatic stress disorder (PTSD) with major depressive disorder is denied.

Entitlement to an effective date prior to August 26, 2020, for the temporary total evaluation for hospitalization for service-connected PTSD with major depressive disorder is denied.

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

FINDINGS OF FACT

1. During the period on appeal, the Veteran's PTSD with major depressive disorder has been manifested by occupational and social impairment, with deficiencies in most areas.

2. The date of the Veteran's admission to a VA Medical Center for PTSD treatment was August 26, 2020, followed by 21 days of continuous hospitalization, after which he became entitled to a temporary total rating.

3. The Veteran's service-connected disabilities render him unable to secure or follow substantially gainful employment.

CONCLUSIONS OF LAW

1. The criteria for a rating in excess of 70 percent for PTSD with major depressive disorder have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.126, 4.130, Diagnostic Codes 9411.

2. The criteria for an effective date prior to August 26, 2020, for the temporary total evaluation for hospitalization for service-connected PTSD with major depressive disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.400, 3.401, 4.29, 4.130.

3. The criteria for a TDIU have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Marine Corps from April 1988 to April 1993.

These matters come before the Board of Veterans' Appeals (Board) on appeal from rating decisions issued in October and November 2020.

In the July 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. The Veteran was scheduled for a hearing in October 2024; however, he indicated his desire to withdraw his hearing request in October 2024.

Therefore, the Board may only consider the evidence of record at the time of the October and November 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative within 90 days following receipt of the withdrawal of the hearing request. 38 C.F.R. § 20.302(b). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

1. Entitlement to a rating in excess of 70 percent for posttraumatic stress disorder (PTSD) with major depressive disorder

The Veteran contends that a rating in excess of 70 percent is warranted for his service-connected PTSD (exclusive of periods of assigned a temporary total rating). The Veteran filed this claim for increase on December 13, 2019, in conjunction with a claim for a TDIU. Accordingly, the period on appeal dates back to December 13, 2019, in addition to a one-year lookback period.

The Board has reviewed all of the evidence in the record, with an emphasis on the evidence relevant to this appeal
 Id. Specific instructions for filing a Supplemental Claim are included with this decision.

1. Entitlement to a rating in excess of 70 percent for posttraumatic stress disorder (PTSD) with major depressive disorder

The Veteran contends that a rating in excess of 70 percent is warranted for his service-connected PTSD (exclusive of periods of assigned a temporary total rating). The Veteran filed this claim for increase on December 13, 2019, in conjunction with a claim for a TDIU. Accordingly, the period on appeal dates back to December 13, 2019, in addition to a one-year lookback period.

The Board has reviewed all of the evidence in the record, with an emphasis on the evidence relevant to this appeal. Although there is an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Hence, the Board will summarize the relevant evidence as deemed appropriate and the analysis will focus specifically on what the evidence shows, or fails to show, as to the claim.

The Veteran's PTSD is rated under the General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130. Under § 4.130 a 70 percent rating is warranted where the evidence reflects occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships.

A 100 percent rating is warranted where the evidence reflects 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.

In this case, the Veteran was afforded a VA examination in March 2019. He reported moving into a remote log cabin, that his only companion was his dog, having few friends, and no social life. He reported that he last worked in 2018 and that his PTSD symptoms limited his ability to function. The examiner documented several symptoms coinciding with the 70 percent rating criteria, to include suicidal ideation; obsessional rituals which interfere with routine activities; impaired impulse control (such as unprovoked irritability with periods of violence); neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); and inability to establish and maintain effective relationships. The Veteran's PTSD was found to be manifested by occupational and social impairment with reduced reliability and productivity.

The Veteran was also afforded a VA examination in May 2020. The examiner noted that since the last examination, the Veteran had a voluntary admission into a PTSD treatment program and that he was currently participating in individual therapy. The examiner indicated that although the Veteran had persistent symptoms of PTSD, they had reduced and stabilized since his last examination. His symptoms were documented as depressed mood; anxiety, chronic sleep impairment; mild memory loss, such as forgetting names, directions or recent events; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; and difficulty adapting to stressful circumstance, including work or a work like setting. The Veteran's PTSD was found to be manifested by occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. 

The Board also notes that the Veteran was voluntarily admitted into PTSD inpatient treatment programs in October 2019 and August 2020. The treatment records document the Veteran's reports of suicidal ideation, sleep impairment, irritability, anxiety, and social isolation. Following his discharge from treatment, he reported maintaining contact with fellow Veterans and participating in outpatient group therapy. The remaining VA treatment records during this period document similar symptoms as those recorded during VA examinations and the Veteran's inpatient treatment.

The Board finds that although the Veteran's PTSD symptoms are serious, they do not rise to the level of the criteria for a 100 percent rating, as the evidence is against a finding of total social impairment due to PTSD. The Board finds the VA examiners' opinions regarding the overall level of severity of the Veteran's PTSD to be particularly persuasive. Notably the examiners opined that the Veteran's
 treatment records document the Veteran's reports of suicidal ideation, sleep impairment, irritability, anxiety, and social isolation. Following his discharge from treatment, he reported maintaining contact with fellow Veterans and participating in outpatient group therapy. The remaining VA treatment records during this period document similar symptoms as those recorded during VA examinations and the Veteran's inpatient treatment.

The Board finds that although the Veteran's PTSD symptoms are serious, they do not rise to the level of the criteria for a 100 percent rating, as the evidence is against a finding of total social impairment due to PTSD. The Board finds the VA examiners' opinions regarding the overall level of severity of the Veteran's PTSD to be particularly persuasive. Notably the examiners opined that the Veteran's PTSD met the criteria for a 50 percent rating at the time of the March 2019 examination and a 30 percent rating at the time of the May 2020 examination.

The next higher, 100 percent rating criteria contemplate total social and occupational impairment, which the Board finds is not shown in this case. Notably, none of the symptoms listed under the criteria for a 100 percent rating have been documented during VA examinations. Likewise, the Veteran has not reported the presence of such symptoms. Additionally, no VA examination of record has found that the Veteran's PTSD was manifested by total social and occupational impairment.

As a result, the Board finds that the Veteran's PTSD symptoms, though serious, demonstrate a level of functionality not contemplated by the criteria for a 100 percent rating. Accordingly, the Veteran's claim for an increased rating must be denied.

2. Entitlement to an effective date prior to August 26, 2020, for the temporary total evaluation for hospitalization for service-connected PTSD with major depressive disorder 

A total disability rating (100 percent) is assigned without regard to other provisions of the rating schedule when it is established that a service-connected disability has required hospital treatment in a VA or an approved hospital for a period in excess of 21 days or hospital observations at VA's expense for a service-connected disability for a period in excess of 21 days. 38 C.F.R. § 4.29. VA regulations specifically state that a "temporary increase" total rating begins on the date of entrance into hospital, after 21 days of continuous hospitalization for treatment. 38 C.F.R. §§ 3.401(h)(2).

On August 26, 2020, the Veteran was admitted into the Northampton VA facility for treatment for his service-connected PTSD. An October 2020 rating decision assigned a temporary total rating for PTSD, effective August 26, 2020, because of hospital treatment in excess of 21 days for a service-connected condition. He was hospitalized until September 16, 2020, and was paid the temporary total rating through the end of the month per regulation.

After review of the evidence, an earlier effective date is not warranted. Under 38 C.F.R. § 3.400(o), the effective date of an increase is the date of receipt of claim or the date entitlement arose, whichever is later. Here, the evidence shows that the Veteran was hospitalized for PTSD on August 26, 2020. This is the assigned effective date of his temporary total rating. Accordingly, an earlier effective date is not warranted, as the "entitlement" to the temporary total rating did not arise and could not have arisen until the Veteran's hospitalization.

3. Entitlement to a total disability rating based on individual unemployability TDIU

The Veteran contends that throughout the period on appeal he has been unable to secure or follow substantially gainful employment due to his service-connected PTSD, bilateral carpal tunnel, and bilateral knee disabilities.

A TDIU rating may be assigned when the veteran is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation due to service-connected disabilities. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. If there is only one such disability, it must be rated at 60 percent or more, and if there are two or more disabilities, there shall be at least one disability rated at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent. For the purpose of one 60 percent disability, or one 40 percent disability in combination, disabilities affecting a single body system, e.g., orthopedic, will be considered as one disability. 38 C.F.R. § 4.16(a). In evaluating a veteran's employability, consideration may be given to the level of education, special training, and previous work experience, but not to age or impairment caused by non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19.

A
 are two or more disabilities, there shall be at least one disability rated at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent. For the purpose of one 60 percent disability, or one 40 percent disability in combination, disabilities affecting a single body system, e.g., orthopedic, will be considered as one disability. 38 C.F.R. § 4.16(a). In evaluating a veteran's employability, consideration may be given to the level of education, special training, and previous work experience, but not to age or impairment caused by non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19.

A claim for TDIU may be filed as a freestanding claim. In addition, TDIU may be an element of a claim for an increased disability rating when unemployability is raised by the record. See Rice v. Shinseki, 22 Vet. App. 447 (2009). Rice holds that a claim for a TDIU is part of any open rating issue (initial or increased) when unemployability is expressly raised by a veteran or reasonably raised by the record during the rating appeal, and it attaches for the entire rating period.

In this case, the Board finds that entitlement to a TDIU was raised expressly by the Veteran with the filing of his claim for an increased rating for PTSD on December 13, 2019.

Initially, the Board notes that the Veteran has met the schedular requirements for a TDIU throughout the entire period on appeal, as he was in receipt of a combined 90 percent rating (exclusive of periods of assigned a temporary total rating).

In this case, the evidence of record indicates that the Veteran last worked full-time in 2018 as a rigger at the Portsmouth Naval Shipyard. He reported that he completed four years of college. See VA 21-8940 Veterans Application for Increased Compensation Based on Unemployability, received December 13, 2019. Accordingly, the Board finds that the Veteran has not been employed during the period on appeal. 

Turning to the medical evidence of record, the Board notes that the Veteran experiences significant physical impairment causing difficulty performing employment requiring any level of physical exertion. Notably, a March 2019 VA knee examination documented difficulty with prolonged sitting or walking, having to frequently stand and stretch, and an inability to squat and lift items. 

A March 2019 VA examination related to his service-connected bilateral carpal tunnel documented worsening numbness, constant severe pain, and decreased range of motion of the wrists and hands. From a functional impairment standpoint, this was found to result in an inability to feel items in his hands; difficulty with temperature and feeling hot and cold; an inability to perform activities of daily living, such as grabbing his daily medication and dressing/undressing; inability to type; and pain that causes sleep impairment.

The Board acknowledges that in the November 2020 rating decision on appeal, the AOJ found that the Veteran could perform employment that is sedentary in nature. However, the Board finds that this conclusion contradicts the medical evidence of record. As noted above, the Veteran's service-connected knee and carpal disabilities would preclude employment that required any amount of typing or prolonged sitting.

Additionally, the Board has considered the impairment caused by the Veteran's service-connected PTSD. As discussed in detail above, his condition includes symptoms such as depressed mood; anxiety, chronic sleep impairment; mild memory loss, such as forgetting names, directions or recent events; and disturbances of motivation and mood. More pertinently, his symptoms also include impairment bearing directly on his ability to function in a work environment, such as difficulty in establishing and maintaining effective work and social relationships, and difficulty adapting to stressful circumstances, including work or a work like setting.

Finally, the Board has considered that for a period between June 2018 to June 2019, while the Veteran was still technically employed, he was absent from his employment at the Naval Shipyard for more than 1100 hours due to his service-connected PTSD. See Military Personnel Record, received December 13, 2019. As discussed in detail above, he also sought inpatient treatment for his service-connected PTSD during this period. Ultimately, the Veteran was awarded disability retirement, based on a finding that he was too disabled to perform his duties as a Rigger due to his service-connected PTSD. See Correspondence from United States Office of Personnel Management, dated December 17, 2019.

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Considering the physical and mental impairment discussed above, the Board finds the evidence sufficient to establish that the Veteran's service-connected disabilities render him unable to secure or follow substantially gainful employment regardless of the nature of the employment. Accordingly, the Veteran's claim for a TDIU must be granted