BVA9501538 DOCKET NO. 93-09 557 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Indianapolis, Indiana THE ISSUE Entitlement to an evaluation in excess of 10 percent for post- traumatic stress disorder (PTSD) from July 20, 1990, to January 25, 1994. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Alice A. Booher, Counsel INTRODUCTION The veteran had active service from January 1968 to September 1969. The veteran filed his initial claim for service connection for post-traumatic stress disorder (PTSD) in July 1990. This appeal is from a rating action by the Department of Veterans Affairs (VA) Regional Office (RO) in Indianapolis, Indiana, in February 1991 which granted service connection and assigned a 10 percent rating for PTSD from July 20, 1990, the date of his claim. A timely appeal of the decision was undertaken by the veteran. The case was certified to the Board of Veterans' Appeals (the Board). On March 3, 1994, the veteran's representative submitted a Memorandum to the Board, attaching records relating to the veteran's VA hospitalization on January 26, 1994, indicating his waiver of RO consideration under 38 C.F.R. § 20.1304(c). Prior to review of these records by the Board, the RO forwarded additional evidence relating to the veteran's condition (indicating that he has been released from hospitalization on February 25, 1994) and other clinical assessments. In a rating action in April 1994, a copy of which was forwarded to the Board in May 1994, the RO assigned a 100 percent rating for the veteran's PTSD, effective January 26, 1994. CONTENTIONS OF APPELLANT ON APPEAL In essence, it is maintained by and on behalf of the appellant that in the period from July 20, 1990, to January 25, 1994, he held many jobs, was socially isolated, and displayed symptoms of PTSD justifying a higher evaluation. It is averred that both he and his family have suffered because of his psychiatric problems, and have not led normal lives for some time. 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 is against the appellant's claim for entitlement to a rating in excess of 10 percent for PTSD. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the appeal has been obtained by the RO. 2. From .July 20, 1990, to January 25, 1994, the service- connected PTSD resulted in no more than mild social and industrial impairment. CONCLUSION OF LAW The criteria for a rating in excess of 10 percent for PTSD from July 20, 1990, to January 25, 1994, have not been met. 38 U.S.C.A. § 1155, 5107; 38 C.F.R. §§ 4.125, 4.129, 4.130, 4.132, Diagnostic Code 9411 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION The appellant's claim is well grounded, that is, it is not inherently implausible. The facts relevant to the issue on appeal have been properly developed and the statutory duty of the VA to assist the appellant in the development of his claim has been satisfied. 38 U.S.C.A. § 5107(a) (West 1991). The issue on appeal was the veteran's entitlement to an evaluation in excess of 10 percent for his PTSD. After the case was forwarded to the Board, the RO assigned a schedular 100 percent rating for PTSD, effective January 26, 1994, stating that the veteran was found to be unable to obtain or retain work because of his disability. In that rating decision, the RO cited statements by the veteran and an affidavit from his friend, while placing primary focus on clinical records and psychiatric assessments and evaluations undertaken after hospitalization in 1994. During a VA psychiatric examination in July 1989, the veteran reported that he worked odd jobs, deriving most of his income from his wife's job. He had four children. He had been employed in approximately 30 jobs since his separation from service, with his longest job lasting a year. He changed jobs frequently because he had trouble with management. He had been arrested three times for drunken disorderly, fights, and being intoxicated. He stated that he was on no medications. His only hospitalizations had been for malaria. He had never seen a psychiatrist. He went on alcoholic binges, but denied drug use. He was cooperative with the interviewer. He appeared somewhat anxious, but had a calm tone to his speech. Affect was blunted. He was logical and sequential. Insight was impaired, as was judgment -- evidenced by his problem trusting management.The diagnosis was: post-traumatic stress disorder, severe. Therapy was recommended. An October 1990 statement from a friend of the veteran was to the effect that the veteran had changed since his return from Vietnam, and that he was angry and hostile. In January 1991, the appellant underwent a VA psychiatric examination He reported having had 50 jobs since his separation from service. He had problems with authority figures. He was on no medications. He stayed away from crowds. He got along with his family. He supported himself with part time jobs in sales and construction. He reported that he had received no psychiatric treatment whatsoever, and was on no medications. On objective examination, he appeared mildly anxious. He was cooperative and displayed above-average intelligence. He described some self- control problems. Insight and judgment were good. The examiner diagnosed PTSD, mild to moderate in severity, noting that this caused the veteran problems with relations with others, and in maintaining consistent employment. Outpatient therapy was recommended. During the April 1992 VA psychiatric examination, the veteran reported that he was employed and had no problems with his job. He enjoyed such things as working at home, and had a friend with whom he socialized. During the interview, he was guarded but cooperative. His affect was constricted. His thought processes were clear, logical, and sequential. He had a moderate capacity for insight, but no judgmental impairment. The diagnosis was PTSD, mild to moderate. The examiner remarked that the veteran displayed the capacity to work full-time. During his VA hospitalization in January 1994, the veteran related that, except for VA examinations, he had received no inpatient or outpatient care. Essentially, he denied having had clinical care for his PTSD in the interim between 1990 and his voluntary VA hospitalization in January to February 1994. Based on the evidence, the RO, in May 1994, awarded the veteran a schedular 100 percent rating for PTSD, effective January 26, 1994. The issue remains: Did the service-connected PTSD undergo an increase in the underlying pathology from July 20, 1990, to January 25, 1994? In making a determination, the following regulations must be considered: General considerations. The field of mental disorders represents the greatest possible variety of etiology, chronicity and disabling effects, and requires differential consideration in these respects. These sections under mental disorders are concerned with the rating of psychiatric conditions, specifically psychotic and psychoneurotic disorders and psychological factors affecting physical conditions as well as organic mental disorders. Advances in modern psychiatry during and since World War II have been rapid and profound and have extended to the entire medical profession a better understanding of and deeper insight into the etiological factors, psychodynamics, and psychopathological changes which occur in mental disease and emotional disturbances. The psychiatric nomenclature employed is based upon the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM - III), American Psychiatric Association. This nomenclature has been adopted by the Veterans Health Services and Research Administration of the Department of Veterans Affairs. It limits itself to the classification of disturbances of mental functioning. To comply with the fundamental requirements for rating psychiatric conditions, it is imperative that rating personnel familiarize themselves thoroughly with this manual (American Psychiatric Association Manual, 1980 Edition) which will be hereinafter referred to as the APA manual. 38 C.F.R. § 4.125 (1993) Social inadaptability. Social integration is one of the best evidences of mental health and reflects the ability to establish (together with the desire to establish) healthy and effective interpersonal relationships. Poor contact with other human beings may be an index of emotional illness. However, in evaluating impairment resulting from the ratable psychiatric disorders, social inadaptability is to be evaluated only as it affects industrial adaptability. The principle of social and industrial inadaptability as the basic criterion for rating disability from the mental disorders contemplates those abnormalities of conduct, judgment, and emotional reactions which affect economic adjustment, i.e., which produce impairment of earning capacity. 38 C.F.R. § 4.129 (1993) Evaluation of psychiatric disability. The severity of disability is based upon actual symptomatology, as it affects social and industrial adaptability. Two of the most important determinants of disability are time lost from gainful work and decrease in work efficiency. The rating board must not underevaluate the emotionally sick veteran with a good work record, nor must it overevaluate his or her condition on the basis of a poor work record not supported by the psychiatric disability picture. It is for this reason that great emphasis is placed upon the full report of the examiner, descriptive of actual symptomatology. The record of the history and complaints is only preliminary to the examination. The objective findings and the examiner's analysis of the symptomatology are the essentials. The examiner's classification of the disease as ``mild,'' ``moderate,'' or ``severe'' is not determinative of the degree of disability, but the report and the analysis of the symptomatology and the full consideration of the whole history by the rating agency will be. In evaluating disability from psychotic disorders it is necessary to consider, in addition to present symptomatology or its absence, the frequency, severity, and duration of previous psychotic periods, and the veteran's capacity for adjustment during periods of remission. Repeated psychotic periods, without long remissions, may be expected to have a sustained effect upon employability until elapsed time in good remission and with good capacity for adjustment establishes the contrary. Ratings are to be assigned which represent the impairment of social and industrial adaptability based on all of the evidence of record. (See § 4.16 regarding the issue of individual unemployability based on mental disorder.) Evidence of material improvement in psychotic disorders disclosed by field examination or social survey should be utilized in determinations of competency, but the fact will be borne in mind that a person who has regained competency may still be unemployable, depending upon the level of his or her disability as shown by recent examinations and other evidence of record. 38 C.F.R. § 4.130 (1993) Psychoneurotic Disorders - 9411 Post-traumatic stress disorder The attitudes of all contacts except the most intimate are so adversely affected as to result in virtual isolation in the community. Totally incapacitating 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. Demonstrably unable to obtain or retain employment........ 100 Ability to establish and maintain effective or favorable relationships with people is severely impaired. The psychoneurotic symptoms are of such severity and persistence that there is severe impairment in the ability to obtain or retain employment....... 70 Ability to establish or maintain effective or favorable relationships with people is considerably impaired. By reason of psychoneurotic symptoms the reliability, flexibility and efficiency levels are so reduced as to result in considerable industrial impairment....... 50 Definite impairment in the ability to establish or maintain effective and wholesome relationships with people. The psychoneurotic symptoms result in such reduction in initiative, flexibility, efficiency and reliability levels as to produce definite industrial impairment....... 30 Less than criteria for the 30 percent, with emotional tension or other evidence of anxiety productive of mild social and industrial impairment....... 10 There are neurotic symptoms which may somewhat adversely affect relationships with others but which do not cause impairment of working ability....... 0 Note (1). Social impairment per se will not be used as the sole basis for any specific percentage evaluation, but is of value only in substantiating the degree of disability based on all of the findings. Note (2). The requirements for a compensable rating are not met when the psychiatric findings are not more characteristic than minor alterations of mood beyond normal limits; fatigue or anxiety incident to actual situations; minor compulsive acts or phobias; occasional stuttering or stammering; minor habit spasms or tics; minor subjective sensory disturbances such as anosmia, deafness, loss of sense of taste, anesthesia, paresthesia, etc. When such findings actually interfere with employability to a mild degree, a 10 percent rating under the general rating formula may be assigned. 38 C.F.R. § 4.132 (1993) In applying the criterion to the facts of the case, it is noted that in evaluating impairment resulting from the ratable psychiatric disorders, social inadaptability is to be evaluated only as it affects industrial adaptability. 38 C.F.R. § 4.129. While the veteran does not have many friends, he gets along with his family, and does spend time with a friend. In order for a 30 percent rating to be assigned, definite social and industrial impairment must be demonstrated. The medical findings noted above include indications that he was logical and sequential; was cooperative and displayed above-average intelligence, that his judgment and insight were good; he had a moderate capacity for insight, but no judgmental impairment. The examiner remarked that the veteran displayed the capacity to work full-time. Clearly, his ability to cooperate, addresses his initiative and flexibility in the work environment, just as a lack of judgmental impairment addresses his reliability in making work-related decisions. Based on the findings, it does not appear that from July 20, 1990, to January 25, 1994, the veteran displayed evidence of PTSD productive of more than mild impairment of working ability. For that time period, an increased rating is not warranted. ORDER Entitlement to an evaluation in excess of 10 percent for post- traumatic stress disorder (PTSD) from July 20, 1990, to January 25, 1994, is denied. RENÉE M. PELLETIER 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.