BVA9503664 DOCKET NO. 90-25 495 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Buffalo, New York THE ISSUE Entitlement to an increased evaluation for post-traumatic stress disorder, currently rated 50 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Hilary L. Goodman, Counsel INTRODUCTION The veteran had active service from February 1951 to February 1954. This appeal arises from a May 1989 rating decision which continued a 10 percent disability evaluation for post-traumatic stress disorder. In a March 1991 rating decision, the disability evaluation for post-traumatic stress disorder was increased to 50 percent. The Board of Veterans' Appeals (Board) remanded the veteran's claim for further development of the record in December 1990 and November 1992. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he has difficulty sleeping at night as he has frequent nightmares and flashbacks. He asserts that he lives alone in a forest in a heavily secured home and that he becomes nervous when anyone else is in the house and has thoughts of killing them. He further contends that, as he becomes violent and destructive at times, his children stay away from him. He avers that he can not be in a crowd, avoids going out in public, is unable to maintain any social relationships and is virtually isolated in the community. He finally contends that he has problems maintaining his business as he can not stand being around other people and that, while working, he jumps to the floor when he hears air brakes or jets. He requests that a 100 per cent disability evaluation be assigned as the Global Assessment of Functioning (GAF) score is 40, indicating an inability to perform any substantially gainful employment. 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 the veteran's claim for a disability rating of 100 percent for his service-connected post- traumatic stress disorder. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the originating agency. 2. The veteran has been granted service connection for post- traumatic stress disorder; this psychiatric disability is his only compensable service-connected disability. 3. His post-traumatic stress disorder is productive of severe impairment of social and industrial adaptability and precludes him from following a substantially gainful occupation. CONCLUSION OF LAW The criteria for a rating of 100 percent for post-traumatic stress disorder have been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.16(c), Part 4, Code 9411 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran is seeking an increased evaluation for his psychiatric disability. The Board finds that the veteran's claim is "well grounded" within the meaning of 38 U.S.C.A. § 5107(a). That is, he has presented a claim which is plausible. The Board is also satisfied that all relevant facts have been properly developed and no further assistance to the veteran is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a). A November 1985 Department of Veterans Affairs (VA) psychiatric examination report reflects that, at that time, the veteran suffered from intrusive memories of traumatic events in Korea every day. He constantly re-experienced traumatic events, had nightmares and flashbacks once a week and showed a startle reaction. He complained of emotional numbing and felt detached from other people. He indicated that this impaired his work performance as he was only able to work ten to fifteen hours per week. He expressed survivor guilt. His sensorium was clear and stream of consciousness revealed no blocking. His mood was anxious. Both insight and judgment were good. The diagnosis was post-traumatic stress disorder and the examiner noted that the veteran's adaptive functioning was quite severely impaired. The impression following a January 1986 VA Social Survey was that the veteran appeared to be a very depressed, tormented and miserable individual. It was noted that he appeared to have no support within his immediate family unit and that he appeared to lack a supportive social network as he reported no involvement with friends socially or with colleagues of his profession. By rating action in March 1986, service connection was granted for post-traumatic stress disorder and a 10 percent disability evaluation was assigned. At the time of an August 1987 VA psychiatric examination, it was noted that the veteran had a long history of verbal and physical abuse toward his wife and children. He was currently working in family counseling part-time. He reported that he had recently been violent. He was living on his own in a house in the woods and did not socialize with anyone. During the examination, the veteran started bursting into sweating and cursing while talking about his problems and then bursting into tears while relating the events of the Korean war. He became sweaty, tense and anxious while speaking about his flashbacks and dreams. He had tremors and started walking around the room and pounding on the table. The veteran, who was well oriented, alert and cooperative, denied any suicidal or homicidal ideation. His insight and judgment were fair. The diagnosis was post-traumatic stress disorder with depressive features. The findings on a VA psychiatric examination of the veteran in April 1989 included a depressed affect. He described his mood as depressed and nervous. He exhibited appropriate behavior with normal psychomotor activity. He admitted to some suicidal ideation with no definite plan and he had homicidal feelings, again with no plan. He reported periods when he had severe flashbacks about events that happened to him in Korea and also reported nightmares and waking up in the middle of the night with cold, clammy skin. He felt guilty about being alive, had no social life and lived alone. He reported periods when he got very violent and smashed property. He was well oriented and his memory for recent and remote events was intact. In January 1991, when another psychiatric examination of the veteran was conducted by the VA, the veteran was still residing by himself in the woods and continued to experience nightmares about combat and other traumatic events in Korea. He reported that he was able to work approximately ten hours a week as a self-employed family life consultant. He related that he experienced flashbacks when he heard a jet plane overhead and he showed startle reaction and would hit the floor upon hearing a loud noise, such as the air brake on a truck. He reported that he had surrounded his little house with photo-electric cells to protect him from any intruder. He did not socialize, was seclusive and did not have relations with the opposite sex. The examiner noted that it was obvious that the veteran could not maintain behavioral self management in the workplace. The veteran was observed to become progressively more agitated throughout the examination and he started pacing the floor, taking his jacket off and putting his jacket on, and looking like he was having trouble controlling aggressive feelings. The examiner stated that, if the examination were prolonged, the veteran would become belligerent. The content of thought was significant for chronic intrusive memories of traumatic events in Korea manifested also in nightmares, flashbacks and startle reaction. His sensorium was clear and stream of consciousness revealed no blocking. The examiner observed that there appeared to be a problem with impulse control. Both insight and judgment were adequate. The diagnosis was post-traumatic stress disorder and the GAF score was 40, very seriously impaired. Catherine Johnson, ACSW, in an April 1993 statement, related that the veteran had been seen by her in psychotherapy for eighty- three hours since February 1991. It was indicated that the veteran's presenting problems included feelings of rage and violent fantasies, feelings of detachment and social withdrawal most of the time, frequent flashbacks of combat experience with fears that he will be attacked or blown up at any moment, hypervigilance and extensive plans and devices for defense, guilt feelings about having survived combat and frequent exaggerated startle responses. It was noted that the veteran, in the last six to seven months, had been getting more in touch with repressed emotions associated with his combat experiences but that he was able to experience such emotions only briefly. A VA Social Survey was conducted in May 1993 and in the report it was noted that, at the beginning of the interview, the veteran chose his own spot to sit, stating that he had to sit with his back to the wall, facing the door. He was very difficult to interview and appeared angry, as though he could explode at any time. His speech was loud in tone and his thought content was rambled. Frequently, he arose from his chair and walked around the room. The interviewer reported that he was literally shocked when the veteran stated that he had a Masters Degree in Sociology from Cornell. He related that he currently was in business for himself teaching individuals and families, including sex education and communication. At the time of a December 1993 VA psychiatric examination, the veteran's complaints included a startle reaction, homicidal thoughts, fears of sleeping and feelings of isolation because of living on a mountain. It was noted that he had two mastiff dogs to protect him. All six of his children were alienated from him and he was fearful of being with them for Christmas because of his impulses to hurt them. He related that his business as a self-employed family life education teacher had dropped off badly because of his strange behavior and ideation. During the examination he moved his chair away from the doorway so that he could face the doorway. He was unable to focus on the questions asked by the examiner because he wanted to express his own agenda. The veteran was observed to be an angry man who felt very debilitated and helpless. He had homicidal and suicidal ideations. He was administered tests, including the Minnesota Multiphasic Personality Inventory (MMPI). His MMPI profile was interpreted to show a picture of a rebellious, angry, resentful man who avoids social relationships and close personal ties. He was noted to lack frustration tolerance and tended to be impulsive, compulsive and obsessively ruminative. He felt a great deal of bottled up tension and emotion and there was some suggestion of borderline psychosis. Significant critical items he endorsed on the MMPI included that he felt useless, did not go to sleep without thoughts or ideas bothering him, felt anxious almost all the time and sometimes felt that he must injure either himself or someone else. It was noted that his post-traumatic stress disorder score on the MMPI suggested that his post- traumatic stress disorder symptomatology was not quite as severe as he said. The diagnosis was post-traumatic stress disorder, severe and chronic. His GAF score was reported to be 40. The medical evidence received demonstrates a distinct worsening of the veteran's post-traumatic stress disorder, with recurrent depression, feelings of helplessness and thoughts of suicide. The veteran is socially withdrawn, violent and destructive at times and has homicidal ideations as well. The symptoms associated with his psychiatric disability are productive of severe impairment of social and industrial adaptability as contemplated by a 70 percent schedular rating. 38 C.F.R. § Part 4, Code 9411. Impairment of intellectual functions, orientation, memory and judgment, and lability and shallowness of affect of such extent, severity, depth, and persistence as to produce total social and industrial inadaptability warranting a 100 percent schedular evaluation have not been presented. However, where the veteran's only compensable service-connected disability is a mental disorder, as in this case, the provisions of 38 C.F.R. § 4.16(c) are also for consideration. In such cases, the mental disorder shall be assigned a 100 percent schedular evaluation under the appropriate diagnostic code if the mental disorder precludes the veteran from securing or following a substantially gainful occupation. In the present case, the Board notes that the VA physicians concluded in 1991 and 1993 that the veteran, as a result of his psychiatric disability, had a GAF score of 40, a score indicative of the inability to work. While the veteran was working ten hours per week, this type of employment can be regarded as only marginal. The Board concludes that the manifestations of his post-traumatic stress disorder are of such severity to prevent the veteran from substantially gainful employment. Accordingly, the requirements have been met for the assignment of a 100 percent disability evaluation for post-traumatic stress disorder. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 4.16(c), Part 4, Code 9411. ORDER Entitlement to a 100 percent schedular evaluation for post- traumatic stress disorder is granted, subject to the law and regulations governing the payment of monetary benefits. WAYNE M. BRAEUER 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.