Citation Nr: A24010476 Decision Date: 03/05/24 Archive Date: 03/05/24 DOCKET NO. 201007-113043 DATE: March 5, 2024 ORDER Entitlement to an initial rating in excess of 70 percent for posttraumatic stress disorder (PTSD) is denied. FINDING OF FACT The Veteran's PTSD symptoms do not result in or approximate total occupational and social impairment. CONCLUSION OF LAW The criteria for an initial rating in excess of 70 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.130, Diagnostic Code (DC) 9411. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 2003 to March 2005. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In the October 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the April 2020 agency of original jurisdiction (AOJ) decision, which was subsequently subject to higher-level review. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. Entitlement to an initial PTSD rating in excess of 70 percent. The Veteran contends that a higher 100 percent rating is warranted for his PTSD because a private examiner endorsed the 100 percent rating box on a disability benefits questionnaire (DBQ). Psychiatric disorders, however diagnosed, are rated under the General Rating Formula for Mental Disorders. Under the General Rating Formula for Mental Disorders, a 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; 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 worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. Id. A 100 percent rating is warranted when there is 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 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. Id. Under the Formula the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). Upon a review of the record, the Board finds that the Veteran's PTSD symptoms do not warrant a total schedular rating, the only available higher rating. Initially, the Board observes that available treatment records do not reveal any symptoms associated with the 100 percent rating, nor has the Veteran endorsed such aside from that discussed below. Specifically, the Veteran has not been shown to have (nor has he reported) gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; disorientation to time or place; or memory loss for names of close relatives, his own occupation, or his own name. Indeed, while the Veteran reports the intermittent inability to perform activities of daily living, such is not supported by the record which indicates he runs his own investment counseling business, has never been noted to lack personal hygiene, and has instead been noted to be appropriately attired (to include during both a private and VA examination). Moreover, even if the Veteran's reports of the inability to perform activities of daily living are accurate, such clearly has not resulted in total social or occupational impairment as the Veteran has maintained both a marriage and employment throughout the appeal - meaning he was not totally socially and occupationally impaired. Further, one only needs to read the Veteran's well-organized, typed, timely, and coherent submissions to deduce he is not suffering from the type of symptoms imagined by the 100 percent criteria like forgetting his own name or occupation or experiencing persistent delusions. Turning to the crux of the Veteran's argument for a higher rating is the probative value of a DBQ submitted by E.S. Initially, the Board observes that in the October 2019 submission, E.S. relied on outdated criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), which has not been used by VA since August 4, 2014, as it is outdated. Instead, VA applies the updated DSM-5. Furthermore, it is unclear from the examination report how E.S. conducted the interview, but the Veteran reported to the December 2019 VA examiner that such was conducted via teleconference. The VA examination was conducted face-to-face where the examiner could truly assess important criteria related to the 100 percent rating, specifically, personal hygiene, that could be ascertained through more than one sense (olfactory and visually). Finally, E.S.'s report did not include findings consistent with the 100 percent rating. To the contrary, it documents the Veteran's marital and employment status - married and working, which does not support a total rating under the criteria. Further, he did not endorse symptoms of memory loss for names of close relatives, own occupation, or own name; gross impairment in thought processes or communication; persistent delusions or hallucinations; persistent danger to others; hallucinations; delusions; or any other symptoms that approximate the dramatic psychologic symptoms that are present in those that are totally socially and occupationally impaired due to psychiatric disturbance. On the other hand, the December 2019 VA examiner applied the appropriate medical standards (DSM-5), interviewed the Veteran face-to-face, and documented findings supporting the suggested 70 percent rating. As such, the Board affords great probative weight to the findings of the VA examiner. Ultimately, the December 2019 examination findings, the Veteran's own submissions, and the medical records of evidence significantly outweigh the probative value of the DBQ from E.S. Thus, the Board finds a rating in excess of 70 percent for PTSD is not warranted and the appeal is denied. Nathaniel Doan Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Sosna, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.