Citation Nr: 0003037 Decision Date: 02/07/00 Archive Date: 02/10/00 DOCKET NO. 99-05 931 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUE Entitlement to an increased rating for post-traumatic stress disorder (PTSD), currently evaluated as 70 percent disabling. REPRESENTATION Appellant represented by: Kenneth Carpenter, Attorney ATTORNEY FOR THE BOARD Milo H. Hawley, Counsel INTRODUCTION The veteran had active service from January 1966 to January 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 1998 decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri, that continued a 50 percent evaluation for the veteran's service-connected PTSD. A May 1999 RO decision granted an increased evaluation to 70 percent for PTSD from October 23, 1995. In communications from the veteran's representative, received at the Board in November 1999 and January 2000, it is indicated that a notice of disagreement, with the effective date assigned for the 70 percent evaluation for the veteran's PTSD, has been filed at the RO. A copy of the filed notice of disagreement was not included with the communications nor does the record before the Board contain a notice of disagreement filed at the RO with respect to the effective date assigned for the 70 percent for the veteran's PTSD. Therefore, on the basis of the current record the Board does not have jurisdiction of the issue of entitlement to an earlier effective date for the assignment of a 70 percent evaluation for PTSD and this matter is referred to the RO for its consideration. In the communication received from the veteran's representative in January 2000, it was indicated that a claim for total disability based on individual unemployability had been filed in December 1999. With consideration of the decision herein it would appear that this claim is moot. VAOPGCPREC 6-99 (June 7, 1999). FINDINGS OF FACT 1. The claim of entitlement to an increased rating for PTSD is plausible and all relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained. 2. The veteran's PTSD is manifested by nightmares, flashbacks, social isolation, suicidal ideation, lack of concentration, and depression of such a degree as to result in total occupational and social impairment. CONCLUSIONS OF LAW 1. The claim for an increased rating for PTSD is well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 2. The criteria for a 100 percent evaluation for PTSD have been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, Part 4, Diagnostic Code 9411 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS As a preliminary matter, the Board finds that the veteran's claim for an increased rating is plausible and capable of substantiation and thus, well grounded within the meaning of 38 U.S.C.A. § 5107(a). When a veteran submits a well- grounded claim, VA must assist him in developing facts pertinent to that claim. The veteran has been afforded multiple VA examinations. The Board is satisfied that all available relevant evidence has been obtained regarding the claim, and that no further assistance to the veteran is required to comply with 38 U.S.C.A. § 5107(a). In accordance with 38 C.F.R. §§ 4.1, 4.2 and Schafrath v. Derwinski, 1 Vet. App. 589 (1991), the Board has reviewed the service medical records and all other evidence of record pertaining to the history of the veteran's service-connected disability. The Board has found nothing in the historical record that would lead to the conclusion that the current evidence of record is not adequate for rating purposes. The Board is of the opinion that this case presents no evidentiary considerations, except as noted below, that would warrant an exposition of the remote clinical history and findings pertaining to the disability at issue. Disability evaluations are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule), found in 38 C.F.R. Part 4. The Board attempts to determine the extent to which the veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, and the assigned rating is based, as far as practicable, upon the average impairment of earning capacity in civil occupations. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 4.1, 4.10. Regulations require that where there is a question as to which of two evaluations is to be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. 38 C.F.R. Part 4, Diagnostic Code 9411 of the Rating Schedule, provides that occupational and social impairment with reduced reliability and productivity due to such symptoms as: Flattened affect; circumstantial, circumlocutory, or stereotype speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships, warrants a 50 percent evaluation. Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: Suicidal ideations; obsessional rituals which interfere with routine activity; speech intermittently illogical, obscure, or irrelevant; near continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships, warrants a 70 percent evaluation. Total occupational and social impairment due to such symptoms as: Gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name, warrants a 100 percent evaluation. The report of an August 1998 VA psychological evaluation reflects that the veteran reported that he had only worked two days since March. He reported nightmares and flashbacks on a daily basis with intermittent insomnia. He had a depressed mood and was socially withdrawn. He was occasionally forgetful. He denied suicidal thoughts or homicidal ideations. He was very anxious. He neglected his personal hygiene. The diagnosis included PTSD and major depression and the Global Assessment of Functioning (GAF) was approximately 30. It was felt by the examiner if the veteran would comply with medication his GAF would considerably improve. The report of an April 1999 VA psychological evaluation reflects that the veteran continued to have nightmares and flashbacks. He reported suicidal ideation. His concentration was impaired. He also had anxiety and depression. The assessment was PTSD with dysthymic disorder and major depression. Psychological testing indicated that PTSD was present and extremely severe. His social and industrial adaptability were severely impaired and his ability to establish and maintain effective or favorable relationships was so severely impaired that he could no longer work. It was noted that the dysthymia began at approximately the same time as the PTSD and stemmed from the PTSD, with the major depressive disorder stemming from the PTSD and dysthymia. The diagnosis included PTSD, dysthymic disorder, and major depression with the GAF being 45 during the prior year and 40 at the time of the examination. The Diagnostic and Statistical Manual of Mental Disorders, 4th Ed., (DSM-IV), indicates that a GAF score of 21 to 30 reflects that behavior is considerably influenced by delusions or hallucinations or serious impairment in communication or judgment or inability to function in almost all areas, e.g., no job, home, or friends. GAF of 31 to 40 reflects some impairment in reality testing or communication or major impairment in several areas such as work, e.g., unable to work. A GAF of 41 to 50 reflects serious symptoms or any serious impairment in social, occupational, or school functioning, such as no friends or unable to keep a job. With consideration of the symptoms reported by the veteran, including daily nightmares and flashbacks, social isolation, suicidal ideation, depression, anxiety, and lack of concentration, as well as the assigned GAF scores, the Board concludes that the evidence supports a finding that the veteran's PTSD has resulted in total occupational and social impairment. Accordingly, a 100 percent evaluation for PTSD is warranted. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.30, Diagnostic Code 9411. ORDER An increased rating of 100 percent for PTSD is granted, subject to the laws and regulations governing the payment of monetary benefits. U. R. POWELL Member, Board of Veterans' Appeals