BVA9500850 DOCKET NO. 93-05 682 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Des Moines, Iowa THE ISSUE Entitlement to an increased rating for schizophrenia, currently evaluated as 30 percent disabling. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD T. Reichelderfer, Associate Counsel INTRODUCTION The veteran was inducted in June 1969 and was discharged in March 1971. He had seven months and 21 days of active service. This case arises from a rating decision of June 1992 from the Des Moines, Iowa, Regional Office (RO). In December 1991, the veteran indicated that he had been hospitalized for his service-connected disability for over 30 days. There is no indication in the claims file of any adjudication action having been taken on the issue of entitlement to benefits under the provisions of 38 C.F.R. § 4.29 (1993). Accordingly, this issue is referred to the RO for appropriate action. Statements on appeal appear to raise the issue of entitlement to a total rating for compensation purposes based on individual unemployability. This issue has not been developed for appellate consideration, and is not inextricably intertwined with the issue on appeal. As such, it is referred to the RO for appropriate action. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends, in essence, that the RO erred when it denied an increased rating for schizophrenia. He specifically alleges that he is socially withdrawn, hears voices, and has confused racing thoughts which render him unable to work. He notes that he has been awarded Social Security Administration disability benefits. 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 an increased rating for paranoid schizo-phrenia. FINDINGS OF FACT 1. All evidence necessary for an equitable disposition of the veteran's claim has been developed. 2. Paranoid schizophrenia, as currently manifested by complaints of confused racing thoughts, paranoia, and depression, is productive of no more than definite industrial impairment. 3. Neither an exceptional nor an unusual disability picture has been demonstrated that would render impractical the application of the regular schedular standards. CONCLUSION OF LAW The criteria for an evaluation in excess of 30 percent for paranoid schizophrenia are not met. 38 U.S.C.A. §§ 1155, 5107(b) (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.130, Part 4, Diagnostic Code 9203 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board finds that the veteran's claim is "well grounded" within the meaning of 38 U.S.C.A. § 5107(a) (West 1991); that is, a plausible claim has been presented. The veteran has not indicated that relevant evidence of probative value may be obtained which has not already been associated with his claims folder. Accordingly, the Board finds that the duty to assist him, as mandated by 38 U.S.C.A. § 5107(a) (West 1991), has been satisfied. The veteran was granted service connection in April 1971 for "schizophrenic reaction, paranoid, competent," with a 30 percent disability rating assigned effective from the day after separation from service, in March 1971. Thereafter, the schizo- phrenia has been assigned disability evaluations ranging from noncompensable to a schedular 100 percent. The veteran has also been periodically classified as incompetent. The current 30 percent evaluation has been continued from November 1979. The veteran has also been classified as competent for VA purposes since June 23, 1978. As indicated, the veteran contends that his paranoid schizophrenia is more severe than contemplated by the 30 percent disability rating currently in effect, and that an increased rating is accordingly warranted. After a review of the record, the Board finds that his contentions are not supported by the evidence, and that an increased rating is not warranted. The severity of schizophrenia, paranoid type, is ascertained for Department of Veterans Affairs (VA) rating purposes by application of the criteria set forth in Diagnostic Code 9203 of VA's Schedule for Rating Disabilities contained in 38 C.F.R. Part 4 (1993) (Schedule). Under these criteria, the rating currently in effect contemplates a disability productive of no more than definite impairment of industrial adaptability. A rating greater than that currently assigned would be appropriate if the disability is productive of considerable impairment of industrial adaptability, based on the veteran's ability to interact on both a social and industrial level, as confirmed by current clinical findings. In this regard, however, social inadaptability is evaluated only as it affects or impairs industrial capability. A report of a private initial assessment performed in February 1990, indicates the veteran complained of being anxious and depressed. He indicated he was not employed and was concerned that his "personal functioning" might be affecting his ability to work at a steady job. He reported that over the previous month he had had extreme difficulty sleeping, felt depressed, and was beginning to become withdrawn. A history of alcohol abuse was noted. It was indicated that he lived with his wife of 11 years, and worked at various jobs. On mental status evaluation, the veteran was friendly, cooperative, and coherent with fluent, understandable speech. The examiner noted that the veteran showed signs of depression in terms of a flat affect. The veteran reportedly described feelings of anxiety, although he appeared calm to the examiner. He was oriented for time and place, and had good memory and recall. He was not on psychiatric medication. The impression was a dual diagnosis of alcohol dependence in remission, and dysthymia, as well as some indication of a personality disorder. His current level of functioning was classified as 60. Pursuant to the above initial assessment, the veteran underwent psychiatric evaluation by a private physician in August 1990. It was noted that the veteran had continued to have a drinking problem and had been admitted for hospitalization approximately one month earlier, and had been discharged on psychiatric medications after a two week stay. On mental status examination, the veteran was alert, cooperative, and reasonably friendly. His associations were intact, and his thought was goal oriented. He was not depressed, and had a bland affect. He was oriented as to time, place and person. His memory was fair and he had slow psychomotor activity. He reported that he slept well. He was on psychiatric medication. The diagnoses were alcohol abuse, by history, schizophreniform disorder, and "some elements of personality disorder." His level of functioning was designated as 45, and characterized as fair to poor. A medical history report from a private hospital, dated in June 1991, indicates that the veteran was admitted with an impression of brief reactive psychosis and/or organic brain syndrome, alcoholism, and mixed personality type. He reportedly was confused and had difficulty functioning. He was not able to follow coherent conversation, but stated he had drank beer and taken Antabuse on the day of admission. The discharge summary from this hospitalization indicates that he has a long history of alcoholism and a personality disorder with difficulty dealing with significant stress without resorting to alcohol or having psychotic breakdown. The summary also indicates that he was treated with psychiatric medications and supportive counseling with emphasis on reality orientation. He improved to the point of being able to carry on a conversation. The report notes that his response to treatment was fair and his prognosis was poor. He was continued on medication and transferred to a private health care facility. The final diagnoses on transfer were grief reactive psychosis, improved, alcoholism, by history, and personality disorder, mixed type. A report of private psychiatric evaluation in July 1991 noted the veteran had been hospitalized for being severely depressed, and hearing and seeing things. He had not been drinking. He had been maintained in the mental health side of a private health care facility for approximately two months. On mental status evaluation, he was pleasant with good eye contact. It was noted that he had shown "considerable improvement" since his treatment at the private health care facility. There had been no psychosis noted. His recent and remote memory remained intact. He denied that he had hallucinations or that he was depressed. He denied suicidal thoughts and had not had any suicide attempts. The diagnoses were chronic undifferentiated type schizophrenia, and continuous alcohol dependence. His global assessment of functioning was designated as "about 60." Continued psychiatric medication and therapy were recommended. A report of social history from a private hospital, dated in January 1992, indicates that the veteran was referred to a partial hospitalization program and was diagnosed with a personality disorder and organic brain syndrome. Records from the medication clinic of a private facility, dated from January 1992 to October 1992, indicate that he receives psychotropic medications, that there was an incident of thoughts racing, and that he had tried to work for three days but was unable to continue. When seen for 15 minutes at a private medication clinic in January 1992, the veteran was noted to have an appropriate affect, and a clean and appropriate appearance. He described his mood as depressed once in a while. He denied that he was currently suicidal, depressed, paranoid, or hostile, and denied that he currently had hallucinations or delusions. He reported that he was anxious. The examining physicians noted that the veteran was not psychotic. When seen monthly, thereafter, he was repeatedly noted to be not psychotic and not depressed. The report of a VA examination, dated in June 1992, indicates that he complained of racing thoughts, confusion, and difficulty being around others. He indicated that on a typical day he stayed around home, rode an outdoor bike, and visited his mother. He denied any marital problems and reported good relations with his siblings. He was on psychiatric medication. On mental status examination he was alert and cooperative. There was no pressured speech noted. He acknowledged occasional periods of depression. He had had suicidal ideation two months earlier, with no actual attempt. He denied any current hallucinations. He indicated he had difficulty trusting others. Mild paranoia symptoms were noted. He was fully oriented as to time, place and person, and indicated he slept well and had a good appetite. The examiner indicated that the veteran did not show acute signs of a schizophrenic process and that his symptoms are assumed modified by medications. The diagnoses were chronic paranoid schizophrenia, with partial remission, and alcohol addiction. The veteran presented testimony at a personal hearing at the RO in October 1992. The transcript of that hearing shows that he testified that he had not worked for three years, and that he had tried to work for his cousin in roofing for one day but was not continued. He also testified that he had been hospitalized for schizophrenia in the last three years on two occasions for five and seven weeks, and that he is on medication. He also testified that he receives Social Security benefits, that he stays at home during the day, and prefers not to be around people. The Board notes that the VA examination in June 1992 indicates that the veteran's chronic schizophrenia is in partial remission, and that he has not recently required frequent hospitalization. Additionally, the medication reports from January 1992 to October 1992 do not show significant symptoms of his schizophrenia. Therefore, while the evidence notes improvement in his schizophrenia to the point that it is in partial remission due to medication, he still receives continuing treatment and has symptoms which interfere with his industrial ability. This is contemplated in his current disability rating. Accordingly, the Board finds that the evidence, including the clinical symptomatology and his continuing treatment, indicates the presence of no more than definite industrial impairment. Therefore, the veteran is entitled to his current 30 percent rating for his paranoid schizophrenia. 38 U.S.C.A. §§ 1155, 5107(b) (West 1991); 38 C.F.R. Part 4, Diagnostic Code 9203 (1993). The veteran has testified that his schizophrenia prevents him from being employed. However, the provisions of 38 C.F.R. § 4.130 (1993) require that clinical symptomatology and examiner's reports be considered when evaluating the degree of impairment from mental disorders, and as discussed above, the symptomatology indicates that his schizophrenia is productive of no more than definite industrial impairment. Additionally, the Board does not find that his schizophrenia presents such an unusual disability picture due to marked interference with employment or frequent periods of hospitalization that would render the application of the regular schedular standards impractical. 38 C.F.R. § 3.321(b)(1). ORDER An increased rating for paranoid schizophrenia is denied. U. R. POWELL 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.