Citation Nr: 0006623 Decision Date: 03/13/00 Archive Date: 03/17/00 DOCKET NO. 97-20 351A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Muskogee, Oklahoma THE ISSUE Entitlement to a rating in excess of 50 percent for post- traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Harold A. Beach, Counsel INTRODUCTION The veteran served on active duty from October 1970 to March 1975. This case was previously before the Board of Veterans' Appeals (Board) in March 1999, at which time it was remanded for further development. Following that development, the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma, confirmed and continued the veteran's 50 percent rating for PTSD. Thereafter, the case was returned to the Board for further appellate action. FINDINGS OF FACT 1. All available evidence necessary for an equitable disposition of this appeal has been obtained by the RO. 2. The veteran's PTSD, manifested primarily by a depressed mood, a constricted affect, suicidal thoughts, and irritability, causes difficulty adapting to stress and difficulty maintaining relationships. CONCLUSION OF LAW The criteria for a 70 percent rating for PTSD have been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.102, 4.1 - 4.3, 4.7, 4.130, Diagnostic Code 9411 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION As a preliminary matter, the Board finds that the veteran's claim is plausible and thus well grounded within the meaning of 38 U.S.C.A. § 5107(a); see Proscelle v. Derwinski, 2 Vet. App. 629 (1992) (a claim of entitlement to an increased evaluation for a service-connected disability generally is a well-grounded claim). Disability evaluations are determined by comparing the manifestations of a particular disability with the criteria set forth in the diagnostic codes of the Schedule for Rating Disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4 (1999). The percentage ratings represent, as far as can practicably be determined, the average impairment in earning capacity (in civilian occupations) resulting from service-connected disability. 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall 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. In accordance with 38 C.F.R. §§ 4.1, 4.2 and Schafrath v. Derwinski, 1 Vet. App. 589 (1991), the Board has reviewed all evidence of record pertaining to the history of the service- connected disability. The Board has found nothing in the historical record which would lead to the conclusion that the current evidence of record is not adequate for rating purposes. Moreover, the Board is of the opinion that this case presents no evidentiary considerations which would warrant an exposition of remote clinical histories and findings pertaining to the disability. In this regard, where (as here) 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 the recorded history of a disability is for consideration 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). PTSD is rated in accordance with 38 C.F.R. § 4.130, Diagnostic Code 9411. A 50 percent rating is warranted when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped 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. A 70 percent rating is warranted for PTSD when there is 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 ideation; obsessional rituals which interfere with routine activities; 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. A 100 percent disability rating is warranted for PTSD when there are 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 inability 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. The evidence, dated from June 1996 to November 1998, shows that the veteran was followed in the Mental Health Clinic, in part, for PTSD. It also shows that from October to December 1998, he was hospitalized, in part, for that disorder, and that in May 1997 and October 1999, he was examined by VA to determine the extent of his PTSD. The associated records reveal that the primary manifestations of that disorder were a depressed mood, a constricted affect, suicidal thoughts, and irritability, and there was evidence in October 1998 of self-mutilating scratches. There was also evidence that PTSD caused the veteran difficulty in adapting to stress and difficulty in maintaining relationships. From June 1996 to October 1999, the veteran's global assessment of functioning score ranged from 30 to 60. (Note: GAF is global assessment of functioning which under the DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS 32 (4th ed. 1994) [DSM-IV] reflects the psychological, social, and occupational functioning of those with psychiatric disability on a hypothetical continuum of mental health- illness.) Although the report of the October 1999, VA examination shows a "current" GAF of 55, the examiner estimated the GAF during the previous year to be 41. Indeed, the majority of the GAF scores during the appellate period were 50 or below. A GAF of 50 is defined as serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in social occupational, or school functioning (e.g. no friends, unable to keep a job). Richard v. Brown, 9 Vet. App. 266, 267 (1996)). A 55-60 GAF rating indicates moderate difficulty in social, occupational, or school functioning. Carpenter v. Brown, 8 Vet. App. 240, 242 (1995). Although the evidence is generally negative for obsessional rituals, illogical speech, panic attacks, spatial disorientation, or neglect of personal appearance, and the veteran's impulses are currently controlled by medication, the manifestations of the veteran's PTSD more nearly reflect the criteria for a 70 percent schedular rating. At the very least, the evidence is in equipoise, that is, the evidence which supports the higher rating is at least equal to that which supports the lower rating. In such situations, all reasonable doubt is resolved in favor of the veteran. 38 U.S.C.A. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. In arriving at this decision, the Board has considered the possibility of a still-higher schedular rating, however, the foregoing records and reports are generally negative for evidence of gross impairment in the veteran's thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; intermittent inability 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. Accordingly, there is no schedular basis for a rating in excess of 70 percent for PTSD. The Board has considered the possibility of referring this case to the Director of the VA Compensation and Pension Service for possible approval of an extraschedular rating. The governing norm in these exceptional cases is: A finding that the case presents such an exceptional or unusual disability picture, with such related factors as marked interference with employment or frequent periods of hospitalization, as to render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321(b)(1) (1999). While the veteran states that his PTSD interferes with his job performance, he has not provided any medical or employment documents of work missed or of termination from employment due to that disorder. Rather, evidence from a recent employer shows that he abandoned his job due to unspecified reasons. Although the veteran was hospitalized on 3 occasions in late 1998, in part, for PTSD, there is no evidence of any hospitalization for PTSD during the past year or otherwise during the appellate period. In essence, the record shows that the manifestations of that disability are those contemplated by the 70 percent evaluation. It must be emphasized that disability ratings are not job-specific. They represent as far as can practicably be determined the average impairment in earning capacity as a result of diseases or injuries encountered incident to military service and their residual conditions in civilian occupations. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Absent evidence to the contrary, the Board finds no reason for referral of this case to the Director of VA Compensation and Pension purposes for a rating outside the regular schedular criteria. ORDER A rating of 70 percent for PTSD is granted, subject to the law and regulations governing the award of monetary benefits. U. R. POWELL Member, Board of Veterans' Appeals