BVA9507444 DOCKET NO. 91-45 872 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Chicago, Illinois THE ISSUE Entitlement to a disability evaluation in excess of 50 percent for post-traumatic stress disorder. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARINGS ON APPEAL Appellant ATTORNEY FOR THE BOARD William W. Berg, Counsel INTRODUCTION The veteran had active military service from June 1967 to April 1970. When this case was previously before the Board of Veterans' Appeals (Board) in August 1992, it was remanded to the Department of Veterans Affairs (VA) Regional Office (RO) in Chicago, Illinois, for additional development. Following a hearing at the RO in February 1994 and the submission of additional medical evidence, the hearing officer granted a 50 percent evaluation for the service-connected psychiatric disability, effective from February 1989, but the veteran continued to prosecute his appeal, requesting a total schedular rating for his post-traumatic stress disorder, which is the sole service-connected disability. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends, in essence, that he is entitled to a total schedular rating for his service-connected post-traumatic stress disorder because his symptoms are substantially more severe than currently evaluated and have rendered him unemployable. 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 preponderance of the evidence warrants a 100 percent evaluation for post-traumatic stress disorder. FINDINGS OF FACT 1. All evidence necessary for an equitable disposition of the veteran's appeal has been obtained. 2. The service-connected post-traumatic stress disorder is productive of severe social and industrial impairment. 3. The service-connected post-traumatic stress disorder precludes the veteran from securing or following a substantially gainful occupation consistent with his education and occupational experience. CONCLUSION OF LAW The criteria 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. §§ 4.16(c), 4.132, Code 9411 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION As a preliminary matter, the Board finds that the veteran's claim is plausible and thus well grounded within the meaning of 38 U.S.C.A. § 5107(a); see Proscelle v. Derwinski, 2 Vet.App. 629 (1992) (a claim of entitlement to an increased evaluation for a service-connected disability generally is a well-grounded claim). The Board is satisfied that all relevant evidence has been obtained with respect to this claim and that no further assistance to the veteran is required in order to comply with the duty to assist mandated by statute. Service connection is in effect for post-traumatic stress disorder, and it is the veteran's sole service-connected disability. A 50 percent evaluation has been effective since February 1989. Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. In accordance with 38 C.F.R. §§ 4.1, 4.2 (1994), 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 service-connected post- traumatic stress disorder in arriving at its resolution of this appeal, although the most recent findings are of primary concern. Francisco v. Brown, 7 Vet.App. 55, 58 (1994). A 70 percent evaluation for post-traumatic stress disorder is warranted when the ability to establish and maintain effective or favorable relationships with people is severely impaired and when psychoneurotic symptoms are of such severity and persistence that there is severe impairment in the ability to obtain or retain employment. A 100 percent schedular evaluation requires that the attitudes of all contacts except the most intimate be so adversely affected as to result in virtual isolation in the community and that there be totally incapacitating psychoneurotic symptoms bordering on gross repudiation of reality with disturbed thought or behavioral processes (such as fantasy, confusion, panic and explosions of aggressive energy) associated with almost all daily activities resulting in a profound retreat from mature behavior, and the individual must be demonstrably unable to obtain or retain employment. 38 C.F.R. § 4.132, Code 9411. Although poor contact with other human beings may be indicative of emotional illness, social inadaptability is to be evaluated only as it affects industrial adaptability. 38 C.F.R. § 4.129 (1994). In those cases where the where the sole service- connected disability is a mental disorder rated at 70 percent, the psychiatric disorder may be assigned a 100 percent schedular evaluation where the veteran is precluded as a result of the disability from securing or following a substantially gainful occupation. 38 C.F.R. § 4.16(c) (1994). A review of the record shows that the veteran's symptoms of his service-connected psychiatric disorder have worsened in recent years. A VA staff psychologist in July 1993 reported that the veteran had been treated as an inpatient for post-traumatic stress disorder on numerous occasions and that he continued to have persistent symptoms of post-traumatic stress disorder. She reported that the homicidal ideation for which the veteran had initially been admitted earlier that month had somewhat subsided but that he continued to have nightmares, flashbacks, intrusive recollections of Vietnam and continued anxiety. His insomnia had been witnessed and documented by night staff personnel and continued to be a problem despite the use of a medication designed to alleviate the symptoms of sleeplessness and anxiety. She reported that he continued to participate in group therapy and received individual psychotherapy on a daily basis. A VA staff psychiatrist in September 1993 reiterated his findings contained in a statement dated in November 1992. In his September 1993 statement, he reported that he had been treating the veteran for two and a half years for symptoms of post- traumatic stress disorder. He reported that the veteran had daily nightmares of being overrun by North Vietnamese soldiers and auditory hallucinations consisting of voices from two of his closest friends in his unit calling his name. He further reported that the veteran experiences flashbacks during the day of being ambushed and olfactory hallucinations of diesel gas and dead bodies and that he avoided any reminders of Vietnam. The treating psychiatrist was of the opinion that the veteran's current symptomatology was severe, that it caused him to lose touch with reality and that, as a result, he was unable to work and was occupationally disabled. It is notable that when the veteran was examined by VA for compensation purposes in May 1993, he was said to exhibit all the symptoms of post-traumatic stress disorder, which the examiner felt to be moderate to severe. The examiner added that the veteran was totally disabled by his post- traumatic stress disorder symptoms. Although multiple substance abuse was diagnosed, it was felt to be in remission for the previous year and a half. The record shows that the veteran was admitted to a VA medical center in October 1993 with worsening symptoms of flashbacks, nightmares, violent behavior, paranoia with withdrawal and nervousness of many years' duration. The veteran gave a history of having had symptoms of post-traumatic stress disorder immediately following his separation from service but of not being familiar with the diagnosis until much later. He reported that he had tried to cover his post-traumatic stress disorder symptoms with heavy drug and alcohol abuse. It was further reported that he was withdrawn, very suspicious and nervous and that he carried a pistol with him and became startled with any noise outside his apartment. A mental status examination showed that the veteran was hypervigilant, restless, affectively decreased in range and increased in intensity, and anxious, depressed and perplexed. His speech centered on Vietnam and how the memory of Vietnam was interfering with his daily living. Although he had good cognitive function, he exhibited perceptual disturbances. Although he had fair insight and judgment, it was reported that his judgment could become transiently impaired in the presence of stresses, nightmares and flashbacks. It was reported that the veteran felt lonely and reported survivor guilt. Despite multiple medications, the veteran had nightmares and flashbacks at discharge. The pertinent diagnosis at discharge from the hospital was chronic, severe post-traumatic stress disorder with acute exacerbation; antisocial personality features were noted on Axis II. He was referred to individual psychotherapy at a VA mental health clinic. Although competent to handle his funds, he was considered unemployable. About a week following discharge from the VA facility, the veteran was privately hospitalized after overdosing on multiple medications in a suicide attempt. The veteran's history of multiple substance abuse complicates his disability picture, as does his history of depression and the antisocial personality features noted when the veteran was hospitalized at a VA medical center in October and November 1993. However, there is some indication in the record that he drank alcohol to relieve the symptoms associated with his post- traumatic stress disorder, and disassociating symptoms of depression from the service-connected psychiatric disorder is, in the circumstances of this case, problematical at best. It is significant that VA examiners have noted the veteran's history of multiple substance abuse but have still found his post-traumatic stress disorder symptoms to be severe. The Board is of the opinion that the evidence of record reflects symptomatology that more nearly approximates the severe level of social and industrial impairment contemplated by a 70 percent evaluation. 38 C.F.R. § 4.7. The record indicates that the veteran has an general equivalency diploma. He testified at the RO in February 1994 that he had not worked since December 1986. For the previous several years, he testified that he had worked with paraplegics at a VA hospital. He added that he was unable to work anymore. Although the record indicates that his substance abuse is a significant cause of his frustrated job efforts, VA examiners have found him to be totally disabled and unemployable based on his post-traumatic stress disorder symptoms alone. The Board therefore finds that symptoms of the service- connected post-traumatic stress disorder are sufficient, by themselves, to render the veteran unable to secure or follow a substantially gainful occupation. The Board thus concludes that the preponderance of the evidence warrants a 100 percent rating on a schedular basis. ORDER A 100 percent evaluation for post-traumatic stress disorder is granted, subject to controlling regulations governing the payment of monetary awards. ROBERT E. SULLIVAN 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.