BVA9505133 DOCKET NO. 93-13 653 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUE Entitlement to an evaluation in excess of 30 percent for post traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD G. Wm. Thompson, Counsel INTRODUCTION The veteran had active service from November 1942 to November 1945, and from September 1950 to November 1953. He was a prisoner of war (POW) of the North Korean government from February 1951 to August 1953. This appeal arises from a March 1993 Department of Veterans Affairs (VA) St. Louis, Missouri, Regional Office (RO) rating action that, in addition to other determinations, increased the rating assigned for the veteran's PTSD from 10 percent to 30 percent. Statements made by the veteran's representative in June 1993 have been construed by the Board of Veterans' Appeals (Board) as raising the issue of entitlement to a total rating based on individual unemployability due to service-connected disability. Such an issue is not intertwined with the issue on appeal, had not been developed for appeal and will not be considered by the Board at this time. The RO's attention is directed to the issue for action deemed appropriate. CONTENTIONS OF APPELLANT ON APPEAL No specific contentions have been advanced by the veteran. His representative asserts that the RO erred in not finding that the evidence of record supports an evaluation in excess of 30 percent for the veteran's PTSD. It is contended that the veteran's diminished activity, detachment and estrangement from others justify an increased rating. 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 an increased evaluation for post traumatic stress disorder. FINDINGS OF FACT 1. The service-connected PTSD is principally manifested by night mares, intrusive thoughts, detachment, and some depression and anxiety. 2. The veteran is not receiving ongoing treatment or medication, and has never been hospitalized for his psychoneurosis. 3. Overall, the disability is productive of not more than definite impairment. 4. The veteran has not submitted evidence tending to show that his PTSD is unusual, requires frequent periods of hospitalization or causes unusual interference with work other than that contemplated within the schedular standards. CONCLUSION OF LAW An evaluation in excess of 30 percent for post traumatic stress disorder is not warranted. 38 U.S.C.A. §§ 1155, 5107(a) (West 1991); 38 C.F.R. § 4.132, Diagnostic Code 9411 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. 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 Veteran Health Service and Research Administration of the Department of Veterans Affairs. It limits itself to the classification of disturbance of mental functioning. 38 C.F.R. Part 4, § 4.125. 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 disorder, 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 (1994). 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 under evaluate the emotionally sick veteran with a good work record, nor must it over evaluate 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. Ratings are to be assigned which represent the impairment of social and industrial adaptability based on all of the evidence of record. 38 C.F.R. § 4.130 (1994). In rating a psychoneurotic disorder, when the attitudes of all contacts except the most intimate are so adversely affected as to result in virtual isolation in the community, and 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 result in profound retreat from mature behavior, with demonstrably inability to obtain or retain employment, a 100 percent rating is for assignment. Where the ability to establish and maintain effective or favorable relationships with people is severely impaired, and the psychoneurotic symptoms are of such severity and persistence that there is severe impairment in the ability to obtain or retain employment, a 70 percent rating is warranted. Where the ability to establish and maintain effective or favorable relationships with people is considerably impaired, and by reason of psychoneurotic symptoms the reliability, flexibility and efficiency levels are so reduced as to result in considerable industrial impairment, a 50 percent rating is assigned. Where there is definite impairment in the ability to establish or maintain effective and wholesome relationships with people, and the psychoneurotic symptoms result in such reduction in initiative, flexibility, efficiency and reliability levels as to produce definite industrial impairment, a 30 percent evaluation is in order. 38 C.F.R. § 4.132, Diagnostic Code 9411 (1994). In Hood v. Brown, 4 Vet.App. 301 (1993), the Court of Veterans Appeals stated that the term "definite" in 38 C.F.R. § 4.132 was "qualitative" in character, whereas the other terms were "quantitative" in character, and invited the Board to "construe" the term "definite" in a manner that would quantify the degree of impairment for purposes of meeting the statutory requirement that the Board articulate "reasons or bases" for its decision 38 U.S.C.A. § 7104(d)(1)(West 1991). In a precedent opinion, dated November 9, 1993, the General Counsel of the VA concluded that "definite" is to be construed as "distinct, unambiguous, and moderately large in degree." It represents a degree of social and industrial inadaptability that is "more than moderate but less than rather large." O.G.C. Precedent 9-93, 59 Fed. Reg. 4752 (1994). The Board is bound by this interpretation of the term "definite." 38 U.S.C.A. § 7104(c). With these considerations in mind, the Board will address the merits of the claim at issue. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet.App. 55 (1994). History In January 1954, the veteran was awarded service connection for psychoneurosis. The award was based on service medical records reflecting his internment as a prisoner of war of the North Korean government, as well as the report of a VA psychiatric examination performed in December 1953, when the veteran reported marked difficulty with feelings of tension, apprehension, irritability, fainting and anxiety when he first came out of service. However, following his return to work and making marital adjustments, his nervous spells and symptoms had settled down considerably. His last fainting spell was in October 1953. He complained of reaction to loud noises, irritability with his children, and nightmares of combat and his POW experiences. Examination showed tension, mild hyperhidrosis, a tendency to tremulousness, and he was somewhat fidgety. The symptoms were considered mild. The diagnosis was psychoneurosis, anxiety reaction, mild, improving. A 10 percent rating was awarded. . A VA psychiatric examination in January 1956 revealed that the veteran had shown abatement of his anxiety symptoms, replaced by psychophysiologic gastrointestinal reaction. Psychiatric examination by the VA was next performed in September 1988. At that time the veteran's physical problems, included dizziness, fainting, and wheezing. He did not describe anxiety or mood symptoms. He reported seeing a psychiatrist once or twice many years before. He was not receiving psychiatric treatment, or medication and felt no need for it in many years. He emphasized that shortness of breath was the main reason that he had to retire. The veteran was preoccupied with his pulmonary disease and was without nervousness, mood and emotional behavioral or thought disorder types of symptoms. The diagnosis was psychoneurosis by history. The examiner did not feel that there was sufficient criteria to support a diagnosis of PTSD. The veteran underwent a VA POW protocol examination in April 1989. A social work service report in April noted references to startle reaction, fainting spells, sexual dysfunction, recurrent nightmares, survivors guilt, emotional numbing and labile mood. He reported arthritic problems which limited his mobility and frustrated and depressed him, and that he had less stress since retirement in 1984. He had lost contact with a private psychiatrist, seen monthly until 5 years earlier. His symptoms of inability to relate, and feelings of loss of control especially at work, had been unrelenting and did not seem to have worsened or abated since retirement in 1984. No emergent social symptoms were elicited and while the veteran denied vegetative depression he clearly was frustrated, angry, and saddened by limitations imposed by physical condition and PTSD symptoms. He refused referral for ongoing therapy. Psychiatric examination was also apparently conducted in April 1989. At that time the veteran reported panic attacks, starting in service, resulting in syncope and continuing to the present. It was reported that fear of fainting kept him from driving. He had startle reaction, sexual dysfunction, and periods of dysphoria with increased irritability. No persistent neurovegetative symptoms were found. The diagnosis was post traumatic stress disorder. By rating action in July 1989, the veteran's acquired psychiatric disorder was redefined as post traumatic stress disorder and the 10 percent rating was continued. When examined by the VA in January 1993, the examiner noted recurrent and intrusive recollection of traumatic events, nightmares, avoidance, diminished interest in significant activities, feeling of detachment, restrictive affect, exaggerated startle response, hypervigilance and increased arousal. The veteran reported sleeping in twin beds because of his nightmares and lack of sexual interest. He reported doing little physically but enjoyed seeing his grand children. The examiner reported that the veteran had post-traumatic stress disorder, chronic anxiety and depression. It was added that he had a history of labile mood with irritability, loss of temper, difficulty in personal relations with his wife and others, feelings of loss of control, signs of vegetative depression and also being frustrated, angry, saddened, emotional instability but apparently no serious suicidal ideations, plans or attempts. Summary The record shows that the veteran maintained his marital relationship after he returned home from Korea, and he and his wife continued raising a family. While reference has been made to the veteran's sexual disinterest, the Board notes that he had 2 children when examined in December 1953, 3 children when examined in January 1956, and when hospitalized for active pulmonary tuberculosis (TB) in June 1958, it was noted that he had 4 children. In the social report of April 1989 it was recorded that when the veteran was hospitalized with TB he completed high school, having previously quit school in the eighth grade. It was also reported in April 1989 that the veteran owned a home on a sizable piece of land, lived comfortably and reported no social problems. He enjoyed the companionship of his family and grandchildren. The veteran was able to work steadily until his retirement in 1984, at age 60, and when examined in 1988 he reported that his retirement was due to shortness of breath. Subsequent reports of difficulty on the job have been given appropriate consideration but the fact remains that the veteran did retire, and the currently reported PTSD symptoms cannot be considered a limitation on industrial adaptability because of his retirement and advancing age. The veteran's main PTSD symptoms are startle response, nightmares, and recollection of traumatic events, with some depression and anxiety. In addition to these symptoms are his frustrations with his physical limitations, manifested by social limitations and feelings of loss of control, with some depression and anxiety. However, the record does not show that the veteran is isolated in the community, unable to maintain family ties and relationships, or is unable to handle the everyday vagaries of living. His social integration is not poor. (38 C.F.R. § 4.129) The reports of the veteran seeing a psychiatrist in the past are conflicting in regard to the duration and frequency but the record does indicate that he stopped seeing the psychiatrist about the time he stopped working, in 1984. In April 1989 it was reported that there had been no change in the veteran's symptoms since 1984. He has never had any psychiatric hospitalization, and the record does not show that he is receiving ongoing treatment or medication for his service- connected psychoneurosis. With respect to impairment in initiative, flexibility, efficiency and reliability levels, his 30-plus year employment in the same occupation stands as an example of his industrial adaptability. While there is some impairment in the veteran's ability to maintain effective and favorable relationships with people, overall his psychoneurotic symptoms are productive of not more than definite impairment. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.132, Diagnostic Code 9411. Finally, we have considered whether the veteran's overall disability picture warrants an extraschedular evaluation under the provisions of 38 C.F.R. § 3.321(B)(1). However, the evidence fails to document any marked interference with employment, frequent periods of hospitalization, or any other exceptional or unusual disability picture results from the veteran's service- connected disability which would render the application of the regular schedular standards impractical. Id. ORDER An increased evaluation for post traumatic stress disorder 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.