BVA9503378 DOCKET NO. 90-17 916 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUE Entitlement to an increased rating for post-traumatic stress disorder, currently evaluated as 30 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD John R. Pagano, Counsel INTRODUCTION The veteran had active military service from July 1968 to February 1970. In December 1990, the Board of Veterans' Appeals (Board) increased the disability evaluation for the veteran's service- connected post-traumatic stress disorder from 10 percent to 30 percent. The veteran appealed to the United States Court of Veterans Appeals (Court). In January 1993, the Court vacated the Board's decision except insofar as it granted a 30 percent evaluation for post-traumatic stress disorder, and remanded the case to the Board for further proceedings consistent therewith. In February 1994, the Board remanded the case to the St. Louis, Missouri, Regional Office (RO) for further development. That was accomplished, and the case was returned to the Board in December 1994, for further appellate consideration. During January 1995, the veteran's representative raised the additional issue of the veteran's entitlement to service connection for alcoholism secondary to post-traumatic stress disorder. That issue has not been developed or certified for appeal. See 38 U.S.C.A. § 7105 (West 1991). Nor is it "inextricably intertwined" with the issue now before the Board. See Harris v. Derwinski, 1 Vet.App. 180, 183 (1991). Accordingly, it is referred to the RO for all action deemed appropriate. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that the Department of Veterans Affairs (VA) erred in granting him only a 30 percent disability evaluation for his service-connected post-traumatic stress disorder. He asserts that this disability has severely hindered his social and industrial adaptability, and, in effect, has 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 upon its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that an increased disability evaluation is warranted for post-traumatic stress disorder, and that this disorder renders the veteran unemployable. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. Symptomatology associated with the veteran's post-traumatic stress disorder includes combat-related nightmares, flashbacks, irritability, feelings of anger and hatred, alienation, outbursts of rage, anxiety, and paranoid ideation; this represents severe impairment. 3. The veteran completed two years of college, and has work experience as a marketing consultant, a letter carrier, and a general laborer. He last worked full time in 1981. 4. In addition to post-traumatic stress disorder, the veteran is service connected for residuals of a perforated left tympanic membrane and residuals of abrasions of the arms and legs, each evaluated as non compensable. 5. The veteran is unable to obtain or retain substantially gainful employment as a result of his service-connected psychiatric disorder. CONCLUSIONS OF LAW 1. Post-traumatic stress disorder is 70 percent disabling under applicable schedular criteria. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.7, 4.129, 4.130, 4.132, and Part 4, Diagnostic Code (DC) 9411 (1994). 2. The requirements for a total disability rating based upon individual unemployability due to service-connected disability have been met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341 and 4.16(c) (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS As a preliminary matter, the Board finds the veteran's claim to be well grounded; that is, it is one which is plausible and capable of substantiation. See 38 U.S.C.A. § 5107(a) (West 1991). In addition, all relevant facts have been properly developed. Accordingly, no further assistance to the veteran is required in order to comply with the duty to assist him as mandated by law. Id. I. Factual Background The veteran was first diagnosed with post-traumatic stress disorder during a VA psychiatric examination conducted in July 1980. The examiner observed that the veteran was tense, angry, depressive and anxious, and displayed memory impairment and difficulty concentrating; the veteran also complained of a constriction in his activities and interests, and sleep disturbance. At that time, he had difficulty maintaining interpersonal relationships, especially with supervisors and co- workers. Soon thereafter, his employment as a mail carrier was terminated. Symptomatology associated with post-traumatic stress disorder then increased during more recent years. Since mid-1990, the veteran was hospitalized on at least four occasions for exacerbations in symptomatology associated with post-traumatic stress disorder. The veteran's complaints were relatively consistent during that time period. During his hospitalizations, he complained of feelings of anger and hatred, diminished interest in significant activities, waking flashbacks, nightmares, and anxiety. Treating physicians observed him to be extremely hostile and irritable, and somewhat paranoid. Despite this, however, the veteran has remained fully oriented, goal- directed, and free of looseness of associations, flight of ideas, hallucinations or delusions. Hospital treatment in each instance has taken the form of both group and individual therapy sessions, the development of coping skills, and the employment of various psychotropic medications. II. Analysis Disability evaluations are based upon a comparison of clinical findings with the applicable schedular criteria. 38 U.S.C.A. § 1155. Under the provisions of VA's Schedule for Rating Disabilities, 38 C.F.R. Part 4, DC 9411 (1994), post-traumatic stress disorder will be evaluated as 30 percent disabling when it results in "definite" industrial impairment; such a disability must result in "considerable" impairment to warrant a 50 percent rating, and "severe" impairment to warrant a 70 percent rating. Totally incapacitating psychoneurotic symptoms bordering on gross repudiation of reality must be present to warrant a 100 percent rating. It is within this context that symptomatology currently associated with the veteran's post-traumatic stress disorder will first be examined. Most recent findings as evidenced in the reports of the veteran's VA hospitalizations since 1990, as well as the reports of his VA psychiatric examinations during 1994, do not demonstrate that the veteran's post-traumatic stress disorder is "totally" disabling. Id. He has remained fully oriented and free of looseness of associations and flight of ideas. In addition, he has not been delusional, hallucinatory, suicidal or homicidal. This does not depict someone who has grossly repudiated reality. His symptomatology, therefore, is less than that necessary for the assignment of a 100 percent rating. However, findings on various psychological testing recently administered, as well as other symptomatology observed by various examining and attending physicians, indicate that the veteran's post-traumatic stress disorder is of such severity and persistence that it results in "severe" impairment in his ability to obtain or retain employment. His anxiety level, outbursts of anger, emotional detachment and diminished interest in significant activities are just some of the symptoms which exemplify this. Moreover, psychological testing conducted during various VA hospitalizations in 1992 and 1993, and during a VA psychiatric examination conducted in June 1994, reflected a Global Assessment of Functioning Scale rating in the 40/50 range in each instance. Pursuant to the American Psychiatric Association's Diagnostic and Statistical Manual of Psychiatric Disorders (3rd ed. rev. 1987) (see 38 C.F.R. § 4.125 (1994)), this would indicate that the current level of the veteran's social and occupational functioning is seriously impaired. Accordingly, the Board finds that the veteran's post-traumatic stress disorder is productive of severe impairment. Given that the veteran's only compensable disability is post- traumatic stress disorder ratable at 70 percent, the additional question remains regarding whether he is unemployable thereby. See 38 C.F.R. § 4.16(c). The veteran has not worked steadily in nearly 15 years. His last full-time employment was as a mail carrier. Statements elicited from the veteran just prior to the termination of that employment indicated that he was having difficulty maintaining wholesome relationships with both his supervisors and peers. This would be consistent with symptomatology more currently demonstrated such as feelings of alienation, irritability and outbursts of anger. Given this, the veteran's completion of two years of college is of very little consequence as an occupational tool. The overriding consideration is that symptomatology associated with the veteran's post-traumatic stress disorder during recent years has been both serious enough and consistent enough in nature to prevent him from seeking and retaining gainful employment. Accordingly, a total disability evaluation is for assignment. Id. ORDER An increased rating of 70 percent for post-traumatic stress disorder is granted, as is a total rating based upon individual unemployability, subject to the laws and regulations governing the payment of monetary benefits. CHARLES E. HOGEBOOM 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.