BVA9504174 DOCKET NO. 93-09 739 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Milwaukee, Wisconsin THE ISSUE Entitlement to an increased rating for post-traumatic stress disorder, currently rated as 70 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Michael Martin, Counsel INTRODUCTION The veteran had active service from August 1969 to May 1971. This matter came before the Board of Veterans' Appeals (Board) on appeal from a decision of April 1992 by the Department of Veterans Affairs (VA) Milwaukee, Wisconsin, Regional Office (RO). CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that the RO made a mistake by not assigning a rating higher than 70 percent for his service-connected post- traumatic stress disorder. He asserts that the disorder renders him unemployable. 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 evidence supports the veteran's claim for a 100 percent rating for post-traumatic stress disorder. FINDINGS OF FACT 1. All evidence necessary for an equitable resolution of the veteran's claim has been obtained. 2. The symptoms of the veteran's post-traumatic stress disorder render him demonstrably unable to obtain or retain employment. CONCLUSION OF LAW The criteria for a 100 percent rating for post-traumatic stress disorder are met. 38 U.S.C.A. §§ 1151, 5107 (West 1991); 38 C.F.R. §§ 4.16, 4.132 Diagnostic Code 9411 (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board has found that the veteran's claim is "well-grounded" within the meaning of 38 U.S.C.A. § 5107 (West 1991). That is, the veteran's claim is not inherently implausible. The Board is also satisfied that all relevant facts have been properly developed. All evidence necessary for an equitable disposition of the veteran's claim has been obtained. The Board does not know of any additional relevant evidence which is available. Therefore, no further assistance to the veteran with the development of evidence is required. The Board has considered the full history of the veteran's post- traumatic stress disorder. The veteran's DD 214 shows that his awards and decorations included the Combat Infantryman Badge. In October 1984, the veteran filed a claim for disability compensation for disorders including "nerves". The veteran was afforded a special psychiatric examination by the VA in March 1985. The report shows that following examination the diagnosis was post-traumatic stress disorder. Subsequently, in a rating decision of May 1985, the RO granted service connection for post- traumatic stress disorder and assigned a 10 percent disability rating. In January 1990, the veteran requested increased disability compensation. A VA hospital discharge summary dated in February 1990 was obtained and revealed that the veteran had been hospitalized for treatment of post-traumatic stress disorder and alcoholism. In a rating decision of April 1990 the RO assigned a temporary total disability rating based on the portion of the hospitalization attributable to treatment for post-traumatic stress disorder. The veteran was again hospitalized in May 1990. He was not discharged until July 1990. In a decision of September 1990, the RO again assigned a temporary total disability rating based on the hospitalization, with the rating subsequently returning to 10 percent. The veteran filed a notice of disagreement with that decision, and subsequently perfected this appeal. A hearing officer subsequently increased the rating to 70 percent, however, the veteran has continued his appeal. Disability evaluations are determined by the application of a schedule of ratings which is based on the average impairment of earning capacity in civil occupations. See 38 U.S.C.A. § 1155 (West 1991). Separate diagnostic codes identify the various disabilities. Under Diagnostic Code 9411, a 100 percent rating is warranted (1) when the attitudes of all contacts except the most intimate are so adversely affected as to result in virtual isolation in the community; (2) 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; or (3) where the veteran is demonstrably unable to obtain or retain employment. The three diagnostic criteria in Diagnostic Code 9411 for a 100 percent rating are each independent bases for granting a 100 percent rating. See Johnston v. Brown, No. 93-89 (U.S. Vet. App. Sept. 28, 1994). In other words, a 100 percent rating may be granted if any one of the three criteria are met. After considering all of the evidence of record, it is the judgment of the Board that the schedular criteria for a 100 percent rating are met as the veteran's post-traumatic stress disorder has caused him to be unable to obtain or retain employment. The VA hospital discharge summary dated in February 1990 shows that the veteran had been hospitalized for treatment of post- traumatic stress disorder and alcoholism. The veteran was again hospitalized in May 1990. He was not discharged until July 1990. Upon admission, he had multiple complaints including problems with an inability to relax, anger/rage, problems with interpersonal relationships, isolation, and problems with insomnia and nightmares. During the hospitalization, he underwent the post-traumatic stress program. The primary diagnosis was post-traumatic stress disorder. On discharge, the treating physician noted that the veteran was unemployable. A disability determination bureau medical questionnaire response dated in October 1990 which was prepared by a VA physician shows that the examiner treated the veteran on a monthly basis. The diagnoses were PTSD, major depression, and panic disorder. The symptoms reportedly included intrusive thought, flashbacks and nightmares of Vietnam. He also had agitation and restlessness. He also had chronic loss of control, palpitations, rage, and fearfulness in crowds. The veteran's ability to relate to others was described as being extremely poor. The psychiatrist concluded that the veteran was 100 percent permanently and totally disabled and unemployable. At a personal hearing held in February 1991, the veteran testified regarding the symptoms and severity of his post- traumatic stress disorder. He stated that he did not do much socialization outside of his house aside from visiting a girlfriend and a daughter. He stated that since his separation from service, he had had about 40 or 50 jobs. He said that his longest job had been working as a roofer for about a year and a half. The veteran was afforded a psychiatric examination by the VA in April 1991. Following examination, the diagnosis was post- traumatic stress disorder, with diffluency (stuttering). The examiner concluded that the veteran's behavior was severely impaired and his judgment was impaired secondary to severe anger and rage. He was clearly unable to function in almost all areas. He had no family contact. He was described as unemployable. He had no social contacts, and led an isolated lifestyle. He lived in a remote cabin without running water. His companions were his dogs. There was some suicidal preoccupation. Global assessment of functioning during the prior year was rated as 30. He was described as being marginally competent for VA purposes. A decision by the Social Security Administration dated in September 1991 shows that the Social Security Administration concluded that, as a result of post-traumatic stress disorder and a substance addiction disorder, the veteran was disabled within the meaning of Social Security regulations. Outpatient treatment records dated in 1991, 1992 and 1993 show that the veteran has continued to experience symptoms of post- traumatic stress disorder. A VA medical record dated in May 1992 shows that the veteran reported that he was having increased anxiety, that he was not sleeping, and that he was withdrawing from family and friends. He also said that he was having feelings of hopelessness. The assessment was PTSD with increased anxiety. A VA mental health clinic record dated in July 1992 shows that the veteran's post-traumatic stress disorder symptoms continued to be at an exacerbated level and were affecting his daily functioning. A VA mental health clinic record dated in October 1992 shows that the veteran's PTSD was at a severely exacerbated level and was impairing his life at every level. He reportedly was extremely isolated in his home, and was not able to tolerate any type of competitive situation. He was reportedly coping at a very marginal level. A report of a January 1993 post-traumatic stress disorder examination conducted by the VA shows that the examiner concluded that the veteran had severe impairment of social and industrial functioning. The diagnosis was post-traumatic stress disorder, chronic (with dysfluency since 1984). The Board finds that the medical evidence is consistent in showing that the veteran is unemployable. Several physicians have concluded that the veteran is not employable, while no physician has expressed an opinion that the veteran is employable at the present time. For these reasons, the Board concludes that the criteria for the assignment of a 100 percent rating for post- traumatic stress disorder are met. ORDER A 100 percent disability rating for post-traumatic stress disorder is granted, subject to the law and regulations applicable to the payment of monetary benefits. WARREN W. RICE, JR. 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.