BVA9503814 DOCKET NO. 93-01 846 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Sioux Falls, South Dakota THE ISSUE Entitlement to an evaluation in excess of 50 percent for post- traumatic stress disorder. REPRESENTATION Appellant represented by: Paralyzed Veterans of America, Inc. ATTORNEY FOR THE BOARD Jeffrey J. Schueler, Associate Counsel INTRODUCTION The veteran served on active duty from April 1966 to August 1971. Evidence has been received by the Board which has not been the subject of a supplemental statement of the case. In view of the ultimate disposition of this appeal, the Board need not address the applicability of 38 C.F.R. § 20.1304 (1994). In a statement dated July 22, 1993, the veteran's representative asserted that the rating decision of February 11, 1986, was clearly and unmistakably erroneous in denying service connection for post-traumatic stress disorder. At the representative's request, this matter is referred to the regional office for appropriate action. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that his PTSD disability has increased in severity so as to warrant an evaluation in excess of 50 percent disabling. He maintains that the repeated hospitalizations resulting from PTSD demonstrate more than considerable impairment and, along with examiner's statements, show that he is unemployable. DECISION OF THE BOARD The Board of Veterans' Appeals (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 in favor of a 100 percent schedular evaluation for PTSD. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the regional office (RO). 2. The veteran's service-connected PTSD is productive of severe impairment of social and industrial adaptability. 3. The veteran's only compensable service-connected disability is PTSD. 4. PTSD precludes all but marginal employment. CONCLUSION OF LAW The criteria for a 100 percent evaluation for the veteran's service-connected PTSD have been met. 38 U.S.C.A. §§ 1155, 5107(b) (West 1991); 38 C.F.R. §§ 4.1, 4.16 (c), 4.129, 4.130, 4.132, Diagnostic Code 9411 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION Initially, the Board notes that the veteran's claim is well grounded within the meaning of 38 U.S.C.A. § 5107 (West 1991), and that all relevant facts have been properly developed for this appeal. I. Background The veteran was examined in March 1989 at the Fort Meade Department of Veterans Affairs (VA) Medical Center (VAMC). The examiner recorded diagnoses of PTSD secondary to Vietnam combat, alcohol dependence in remission, and dysthymia, and noted that the veteran appeared unemployable in part due a back injury that was complicated by symptoms of post-traumatic stress disorder (PTSD), reducing the areas in which he might be able to maintain employment. During the interview, the veteran told the examining psychiatrist that he had had nearly 100 jobs since service. In a letter dated in April 1989, a VA psychiatrist stated his impression that the veteran had severe delayed PTSD. The psychiatrist noted that his current hospitalization was precipitated "by extremely intense homicidal and suicidal ideation." Service connection was granted for PTSD in a May 1989 rating decision. The RO noted that the veteran's stressors included the experience of combat as well as the deaths of several friends. The record also shows that he held numerous jobs for short periods of time, the longest being 14 months. The veteran married in 1968 but was divorced three years later, and it was found that he avoided crowds, had intrusive thoughts of Vietnam, and admitted to dream in which he wakes up hearing fire fights. A discharge summary for a period of hospitalization at the Fort Meade VAMC from March to May 1989 showed diagnoses of PTSD and alcohol dependence. The discharge summary noted that the veteran was competent but unemployable. Based on this period of hospitalization, an August 1989 rating action awarded the veteran a 100 percent evaluation from March 1, 1989, through May 31, 1989, under 38 C.F.R. § 4.29 (1994). The schedular evaluation remained at 50 percent disabling. A discharge summary for a period of hospitalization at the Fort Meade VAMC from October to November 1989 showed diagnoses of PTSD and alcohol and marijuana dependence. He was considered unemployable due to a shoulder dislocation. Based on this period of hospitalization, a March 1990 rating action assigned a 100 percent evaluation from October 3, 1989, through November 30, 1989, under 38 C.F.R. § 4.29 (1994). The schedular evaluation remained at 50 percent disabling. A discharge summary for a period of hospitalization at the Fort Meade VAMC from June to July 1990 showed that the veteran was hospitalized with a one month history of increasing depression with suicidal ideation, resumption of alcohol abuse and exacerbation of PTSD symptoms. He was considered competent but unemployable. Based on this period of hospitalization, a September 1990 rating action assigned a 100 percent evaluation from June 6, 1990, through July 31, 1990, under 38 C.F.R. § 4.29 (1994). The schedular evaluation remained at 50 percent disabling. In an August 1990 decision, the Social Security Administration determined that the veteran had not engaged in substantial gainful activity since June 10, 1988, that medical evidence established that he had severe PTSD, an anti-social personality disorder, and a substance addiction disorder, and that he was entitled to a period of disability commencing that date. A discharge summary for a period of hospitalization at the Fort Meade VAMC from April 1, 1991, to June 7, 1991, showed that the veteran was hospitalized with a three month history of increasing depression culminating in a desire to shoot himself on the day of admission. Pertinent diagnoses noted were PTSD and recurrent non-psychotic major depression. He was considered competent but unemployable. Based on this period of hospitalization, a July 1991 rating decision awarded a 100 percent evaluation under 38 C.F.R. § 4.29 from April 1, 1991, through June 1991. A discharge summary for a period of hospitalization at the Fort Meade VAMC from June 17, 1991, to July 23, 1991, reveals that the veteran was hospitalized for multiple ailments, including PTSD. He was considered competent and employable, and was discharged to Aberdeen, South Dakota, where he reportedly had a job managing rental property. A discharge summary for a period of hospitalization at the Fort Meade VAMC from May to July 1992 showed pertinent diagnoses of major depression, PTSD, and history of alcohol dependence in remission. The summary contained a current Axis V Global Assessment of Functioning Scale score of 30 and 50 for the past year, and noted that the veteran was considered unemployable. It was noted that he complained of decreased mood and increased irritability, anger, "isolativeness," and suicidal thoughts. Based on this period of hospitalization, a July 1992 rating action awarded the veteran a 100 percent evaluation from May 26, 1992, through July 31, 1992, under 38 C.F.R. § 4.29 (1994). The schedular evaluation remained at 50 percent disabling. In an August 1992 rating decision, the RO denied the veteran's claim for an evaluation in excess of 50 percent for PTSD. The RO stated that it was not demonstrated that the veteran's current unemployment was solely due to his service- connected disability nor that his ability to establish favorable relationships with people was more than considerably impaired. A discharge summary for a period of hospitalization at the Palo Alto, California, VAMC from January to May 1993 showed pertinent diagnoses of PTSD, major depressive disorder in remission, and alcohol abuse and dependence. The examiner assigned a Axis V Global Assessment of Functioning Scale score of 50. The history recorded included a notation that the veteran was an unemployed trucker, and it was noted that at the time of discharge he appeared improved, was becoming more socially involved and effective, and was ready to return to pre-hospital activities. VA progress notes during the remainder of 1993 reflect continuing psychiatric symptomatology, including depression and suicidal ideation. II. Analysis Disability evaluations are determined by application of a schedule of ratings based on average impairment of earning capacity. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4 (1993). PTSD is rated under Diagnostic Code 9411. 38 C.F.R. § 4.132 (1993). A 50 percent rating may be assigned where the veteran's ability to establish or maintain effective or favorable relationships with people is considerably impaired and that by reason of psychoneurotic symptoms the reliability and efficiency levels are so reduced as to result in considerable industrial impairment. A 70 percent evaluation may be assigned where it is demonstrated that 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 100 percent evaluation may be assigned where the attitudes of all contacts except the most intimate are so adversely affected as to result in virtual isolation in the community, where there are 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, and where the veteran is demonstrably unable to obtain or retain employment. 38 C.F.R. § 4.132 (1993). Impairment of one's social and industrial skills indicates an inability to adapt to various social and industrial environments. In evaluating the veteran's social and industrial adaptability, we must look to "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). See also 38 C.F.R. § 4.1 (1993) ("The percentage rating represents as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupation."). Social inadaptability, reflecting the ability to establish healthy interpersonal relationships, is evaluated only as it affects industrial adaptability. 38 C.F.R. § 4.129 (1993). The Board must take care, however, not to underevaluate an emotionally sick veteran with a good work record. Emphasis is placed on the full report of the examiner, descriptive of actual symptomatology. 38 C.F.R. § 4.130 (1993). The evidence of record shows that the veteran has had multiple hospitalizations for treatment of PTSD with awards of total schedular benefits for those periods under 38 C.F.R. § 4.29 (1994). The hospitalization reports supporting these 100 percent ratings show that the physicians caring for the veteran frequently found him to be unemployable. While the January to May 1993 discharge summary seemed to show some improvement, it seems clear that the improvement cannot be sustained outside the controlled environment of the hospital. It seems abundantly clear from the veteran's reported work history and the clinical data that he is unquestionably unemployable. There is some uncertainty as to the effect that alcohol has played in his overall disability. The existing record, however, does not permit a conclusion that his post- traumatic stress disorder by itself has not led to severe impairment. The multiple and lengthy VA hospitalizations followed by awards under section 4.29 have been accorded substantial weight. The veteran's disability thereby meets the criteria for a 70 percent schedular evaluation under Diagnostic Code 9411. Where the only compensable service-connected disability is a mental disorder assigned a 70 percent evaluation and such mental disorder precludes a veteran from securing or following a substantially gainful occupation, the mental disorder shall be assigned a 100 percent schedular evaluation under the appropriate diagnostic code. 38 C.F.R. § 4.16 (c)(1994). Based on these regulatory provisions and for essentially the same reasons that have been outlined in the preceding pages, it is the determination of the Board that the veteran's PTSD causes severe impairment and excludes him from all but marginal employment. In reaching this assessment, the Board has been unable to conclude that the preponderance of the evidence is against the veteran on any material issue. ORDER Entitlement to a 100 percent schedular evaluation for post- traumatic stress disorder is granted. JOHN E. ORMOND 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.