BVA9505033 DOCKET NO. 92-02 352 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUES 1. Entitlement to an increased evaluation for paranoid schizophrenia, evaluated as 70 percent disabling. 2. Entitlement to a total disability evaluation based on individual unemployability due to service-connected disabilities. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL The appellant and his mother ATTORNEY FOR THE BOARD James A. Frost, Associate Counsel INTRODUCTION The veteran served on active duty from April 1972 to December 1973. This appeal arises from a rating decision in June 1991 by the Department of Veterans Affairs (VA) Regional Office (RO) in Los Angeles, California. In July 1993 the Board of Veterans' Appeals (the Board) remanded this case to the RO for evidentiary development. The case was returned to the Board in January 1995. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he is unable to secure and retain substantially gainful employment because of his service connected disabilities. 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 record supports an allowance of the veteran's individual unemployability claim. FINDINGS OF FACT 1. The veteran is 41 years of age; he has work experience as a janitor, clerk and a cashier; he last worked in 1990. 2. Service connection is in effect for schizophrenia, paranoid type, evaluated as 70 percent disabling, and for residuals of a fracture of the left third metatarsal, evaluated as 10 percent disabling, with a combined rating of 70 percent. 3. The veteran's service connected disorders preclude substantially gainful employment. CONCLUSION OF LAW The veteran is unemployable by reason of service-connected disabilities. 38 U.S.C.A. § 5107 (West 1991); 38 C.F.R. §§ 3.340, 3.341, 4.16 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION Initially, the Board notes that the veteran's claims are "well- grounded" within the meaning of 38 U.S.C.A. § 5107(a). That is, he has presented claims which are plausible. The Board is also satisfied that all relevant facts have been properly developed. No further assistance to the veteran is required to comply with the duty to assist the veteran mandated by 38 U.S.C.A. § 5107(a). The service medical records disclose that in July 1973 in Korea the veteran began to withdraw from other people. He stopped working. He began to talk in grandiose terms, saying that he could make it rain. He stated that he was God. He tried to stowaway on an airplane. He stated that his mother was talking to him and telling him to come home. He was admitted to a service department hospital; he had auditory hallucinations and delusions of grandeur; he stared at the wall with fixed gaze. His affect was inappropriate. At a psychiatric examination in September 1973 the veteran was sad and very suspicious. His speech was pressured. He had many loose associations and felt persecuted by his commanding officer. He thought he could make it rain and control other people. He did not know which month it was. His recent memory was impaired. During hospitalization he was treated with Thorazine and group therapy, and his condition improved. The diagnosis was schizophrenia, paranoid type, acute, moderate, treated, improved, manifested by ambivalence, loose associations, persecutory and grandiose delusions, referentiality, visual and auditory hallucinations, suspiciousness and seclusiveness. In November 1973 a Physical Evaluation Board found the veteran unfit for further military service by reason of schizophrenic reaction, paranoid type, and recommended his separation from service, which was accomplished in December 1973. A rating decision in February 1974 granted service connection for schizophrenia, paranoid type. Thereafter, the veteran was repeatedly hospitalized for psychiatric treatment and had a sporadic work history. A rating decision in January 1990 assigned a 70 percent disability evaluation for the veteran's psychiatric disorder. In January 1994 the Chief of the Schizophrenic Treatment Unit at a VA medical center reported that the veteran had been under his care for several years. The veteran suffered from chronic paranoid schizophrenia, which was unresponsive to treatment. His condition had not gone into even partial remission and completely precluded any competitive employment. His symptoms of auditory hallucinations and delusions of persecution had not responded to medication, and he had repeatedly required rehospitalization during acute exacerbations. The VA physician stated his opinion that the veteran was totally and permanently disabled from employment by reason of his psychiatric disability. In February 1994 a social and industrial survey was completed by a VA social worker, who interviewed the veteran. On mental status examination the veteran admitted to having auditory hallucinations. His thought content had ideas of reference and paranoid ideation. He had attempted to work at various positions in postservice years, including jobs at a VA medical center and with the United States Postal Service, but had been unable to maintain employment due to mental illness. The social worker found that the veteran's industrial adjustment was "markedly inadequate" and would not improve, due to his psychiatric condition. The veteran was "essentially unemployable, for all practical purposes". In May 1994 the veteran underwent testing at a VA psychology service. The results were consistent with the diagnosis of schizophrenia, paranoid type, and showed evidence of ongoing visual and auditory hallucinations, ideas of reference, paranoid delusions and problems with concentration and racing thoughts. Individuals with the veteran's profile are socially isolated and easily decompensate under stress. The veteran's Global Assessment of Functioning score was 40, representing major impairment in social, psychological, and occupational functioning. In July 1994 the veteran was evaluated by a board of two VA psychiatrists, who confirmed the diagnosis of chronic paranoid schizophrenia and stated their opinion that, because of auditory hallucinations and paranoid ideas, the veteran's ability to compete in the open job market had been "severely compromised". He needed continued treatment and should continue as a patient at the schizophrenic research of the VA medical center. In September 1994 a VA clinical psychologist reported that the veteran had participated in a research protocol from November 1993 to March 1994, during which time he received Clozapine. Although he had experienced some improvement, his condition was unstable. He regularly experienced psychotic symptoms, which rendered him unemployable. Total disability will be considered to exist when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. Total disability ratings for compensation may be assigned where the schedular rating is less than total and the disabled person is unable to secure or follow a substantially gainful occupation as a result of a service-connected disability. 38 C.F.R. § 4.16(a). In the veteran's case, the evidence is overwhelming that he cannot work because of his service connected disorders, and primarily because of his major mental disorder. The findings of the VA psychologists, psychiatrists and social worker compel the conclusion that psychiatric symptomatology essentially precludes the veteran's ability to secure and retain substantially gainful employment. A total disability evaluation based on individual unemployability due to service-connected disability will therefore be assigned. 38 C.F.R. §§ 3.340, 3.341, 4.16. The Board finds that the veteran's claim for an increased schedular rating for his psychiatric disability is thus moot. ORDER A total disability evaluation based on individual unemployability due to service-connected disabilities is granted, subject to governing criteria for the payment of monetary awards. ALBERT D. TUTERA 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.