BVA9505634 DOCKET NO. 93-13 327 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUE Entitlement to an increased evaluation for post-traumatic stress disorder, currently evaluated as 70 percent disabling. ATTORNEY FOR THE BOARD Ronald R. Bosch, Counsel INTRODUCTION The veteran served on active duty from September 1969 to September 1971. This appeal arose from a December 1991 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. The RO granted entitlement to service connection for post-traumatic stress disorder which was assigned a 70 percent evaluation; granted a temporary total evaluation based on hospital treatment for post-traumatic stress disorder effective from March 15 to June 30, 1991; and reinstated the prior 70 percent evaluation effective July 1, 1991. The RO affirmed the above determination in May 1992. In November 1992, the RO issued a rating decision granting a temporary total evaluation for post-traumatic stress disorder based on hospital treatment effective from July 1 through September 30, 1992; and reinstated the prior 70 percent evaluation effective October 1, 1992. The RO affirmed the 70 percent evaluation for post-traumatic stress disorder when it issued a rating decision in January 1993. The case has been forwarded to the Board of Veterans' Appeals (Board) for appellate review. References on appeal have been made to entitlement to a total disability evaluation for compensation pursuant to the criteria of 38 C.F.R. § 4.16(c) (1994). In view of the Board's favorable determination below granting a 100 percent schedular evaluation for post-traumatic stress disorder under diagnostic code 9411 of the VA Schedule for Rating Disabilities, this issue has been rendered moot. 38 C.F.R. § 4.132. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that his post-traumatic stress disorder is productive of total disablement, thereby warranting entitlement to a 100 percent evaluation. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the record supports a grant of a 100 percent evaluation for post-traumatic stress disorder. FINDING OF FACT Post-traumatic stress disorder is productive of totally incapacitating psychoneurotic symptoms and has rendered the veteran demonstrably unable to obtain or retain employment. CONCLUSION OF LAW The requirements for a 100 percent evaluation for post-traumatic stress disorder have been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.7, 4.132, Diagnostic Code 9411. REASONS AND BASES FOR FINDING AND CONCLUSION Initially the Board finds that the veteran's claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a), in that it is at least plausible that his post-traumatic stress disorder is more disabling than currently evaluated or has increased in severity. The Board is satisfied that all relevant facts have been properly developed, and that no further assistance to the veteran is required in order to comply with 38 U.S.C.A. § 5107(a). In accordance with 38 C.F.R. §§ 4.1 and 4.2, and Schafrath v. Derwinski, 1 Vet.App. 589 (1991), the Board has reviewed the service medical records and all other evidence of record pertaining to the history of the veteran's post-traumatic stress disorder. The Board has found nothing in the historical record which would lead to a conclusion that the current evidence of record is inadequate for rating purposes. The veteran served as a rifleman with the United States Marine Corps in Vietnam. His decorations include a Combat Action Ribbon, Bronze Star w/"V", Vietnamese Service Medal w/2*, and a Republic of Vietnam Campaign Medal w/dev (60-). The appellant was hospitalized by VA in October 1990 because of depression and suicidal ideation. He had previously been hospitalized at another VA medical facility. His history was significant for post-traumatic stress disorder. It was noted that he was receiving Social Security Disability benefits. The appellant was admitted to a closed psychiatric intensive care unit. While under treatment he continued to complain of flashbacks pertaining to his service in Vietnam. His prognosis was considered guarded. At the time of discharge he was considered unemployable. The hospital discharge diagnosis was post-traumatic stress disorder. The claimant received outpatient treatment at the local VA mental health unit during late 1990. The appellant was hospitalized by VA from March to June 1991 due to exacerbations of post-traumatic stress disorder symptoms including nightmares and flashbacks of Vietnam, insomnia, anxiety, social withdrawal, and depression. He had been participating in a post-traumatic stress disorder program at a local VA mental health clinic. His records revealed a history of psychiatric illness with multiple suicide attempts. Social isolation continued to be a problem outside the hospital setting. His prognosis was considered poor. He was considered unemployable due to post-traumatic stress disorder at the time of discharge. Post-traumatic stress disorder was diagnosed. At a September 1991 VA psychiatric examination the veteran complained of depression, tremulousness, trouble sleeping at night, combat nightmares and flashbacks, recurrent and increasing recollections of events including a friend being killed, hearing things, screaming for help, not liking to associate with people, and suspiciousness of people. The appellant stated that he avoided activities that aroused recollections of the war. He complained of increasing irritability, weight gain with medications, increased appetite with medications, suicidal thoughts with no plans, and homicidal thoughts from time to time. On mental status examination he was oriented times three with memory intact times three. Insight and judgment were fair. The diagnosis was post-traumatic stress disorder, severe with depression. The claimant was hospitalized by VA from February to March 1992 for a 20 day crisis stabilization program because of increased depression. He had been living by himself in a trailer prior to admission. It was noted he was seeking relief including isolation. He voiced complaints of nightmares, flashbacks, insomnia, intrusive thoughts, poor anger control and depression. His mood was depressed and affect was appropriate. Speech was logical and goal oriented and he was able to answer questions. Thought processes revealed no evidence of thought disorder. Thought processes were positive for hearing voices of dead buddies from combat. The appellant was oriented times 4. Memory, knowledge, insight, and judgment were intact. He had thoughts of hurting himself and others but had no intent at the time of the current admission. At the time of discharge he was considered unemployable. Post-traumatic stress disorder was diagnosed. VA mental hygiene clinic records on file show the veteran has been seen on a regular basis during the 1990's for treatment of post-traumatic stress disorder symptomatology. In an education and employment information statement dated in December 1992, the veteran reported that he had become too disabled to work in 1989. He noted that he had two years of college. He had been self-employed as an insurance agent. Post-traumatic stress disorder is rated as 70 percent disabling under diagnostic code 9411 of the VA Schedule for Rating Disabilities. The 70 percent evaluation requires severe impairment of social and industrial adaptability. 38 C.F.R. § 4.132. In order to qualify for a 100 percent evaluation for post- traumatic stress disorder, the appellant must demonstrate that the attitudes of all his contacts except the most intimate are so adversely affected as to result in virtual isolation in the community. Or it would have to be shown that he has totally disabling psychoneurotic symptoms bordering on gross repudiation of reality with disturbed thought or behavioral processes associated with almost all daily activities such as fantasy, confusion, panic and explosions of aggressive energy resulting in profound retreat from mature behavior, etc. Or, it would have to be shown that the veteran is demonstrably unable to obtain or retain employment. 38 C.F.R. § 4.132, Diagnostic Code 9411. Where there exists a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board acknowledges that the record does show the veteran continues to retain some degree of control over his mental faculties and in this regard is functional as to contact with reality. Nonetheless, the record also shows that he has been in receipt of rather intensive psychiatric treatment on both inpatient and outpatient bases for several years. The record shows that it has been difficult to control his post-traumatic stressor exacerbations which have more than severely adversely affected his life on a daily basis. 38 C.F.R. § 4.7. In many respects the veteran leads a socially isolated lifestyle. His only activity is treatment including inpatient care for post- traumatic stress disorder manifestations. The veteran's overall clinical picture more closely approximates the criteria for the 100 percent evaluation. 38 C.F.R. § 4.7. In this regard the Board observes that the appellant has been repeatedly noted as unemployable by his attendant VA psychiatrists. The veteran in effect has been demonstrably unable to obtain or retain employment. Coincidentally, he terminated employment as an insurance agent in 1989 just prior to commencement of rather intensive exacerbations of post-traumatic stress disorder symptomatology which precipitated several hospitalizations as well as a need for regular outpatient care. For the foregoing reasons the Board finds that the record supports a grant of an increased evaluation of 100 percent for post-traumatic stress disorder. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.132, Diagnostic Code 9411. ORDER Entitlement to a 100 percent evaluation for post-traumatic stress disorder is granted, subject to pertinent criteria applicable to the payment of monetary awards. ALBERT D. TUTERA Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.