Citation Nr: 18131254
Decision Date: 08/31/18	Archive Date: 08/31/18

DOCKET NO. 15-03 832A
DATE:	August 31, 2018
Entitlement to an initial disability rating of 70 percent for posttraumatic stress disorder (PTSD) is granted.
Entitlement to a total disability rating based on individual unemployability as a result of service-connected disabilities is granted.
1. Throughout the rating period on appeal, the Veteran’s PTSD has been manifested by occupational and social impairment with deficiencies in most areas, including work, family, and social, as a result of such symptoms as anger outbursts, irritability, emotional distancing, and hypervigilance.    
2. The Veteran’s service-connected disabilities of PTSD and left leg disabilities           render him unable to secure and maintain substantially gainful employment.
1. The criteria for a disability rating of 70 percent, and no higher, for PTSD have been met.  38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. 
2. The criteria for TDIU have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16.
The Veteran had active duty military service from August 1983 to November 1983 and from April 1987 to September 1994, including service in the Persian Gulf.
Entitlement to an initial disability rating in excess of 50 percent for PTSD
The General Rating Formula for Mental Disorders at 38 C.F.R. § 4.130 provides the following ratings for psychiatric disabilities:  
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, is assigned a 50 percent rating.
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 worklike setting); inability to establish and maintain effective relationships, is assigned a 70 percent rating.
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, is assigned a 100 percent rating.  38 C.F.R. § 4.130
At a VA examination in December 2011, the examiner stated that the Veteran’s symptoms were best characterized as resulting in occupational and social impairment with reduced reliability and productivity.  The Veteran reported that he did not like to be around people and did not feel close to anyone other than his wife and children.  His wife had friends, but he preferred not to go out or engage in recreational activities.  He had not worked since 2005 and stated that he had never been fired, although he had been counseled for being too hard on the people he supervised.  The Veteran described his symptoms as including nightmares, intrusive thoughts, detached, anhedonia, hyperarousal, exaggerated startle, anger outbursts, depressed mood, and low energy.   He reported that he had been escorted out of the Dallas VA by security after threatening people there for not doing their jobs.  The examiner listed the Veteran’s relevant symptoms as depressed mood, anxiety, suspiciousness, chronic sleep impairment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and inability to establish and maintain effective relationships.  The Veteran reported that there were a couple of days each month when he stayed in bed and neglected personal hygiene.  He described his depression and anxiety as each being at 8 ½ out of 10 in intensity and stated that he had suicidal ideation once or twice a month.
An April 2012 letter sent to the Veteran by the administration of his son’s school included a discussion of the Veteran’s inappropriate behavior.   The Veteran had been involved in several altercations on school grounds involving both students and faculty and was advised not to visit school property without prior written permission from the administration.  
At the January 2013 VA examination, the Veteran reported that he had no social network and avoided even family gatherings because he could not stand to be around people.  The Veteran reported nightmares, difficulty sleeping, concentration problems, flashbacks, and hypervigilance.  The examiner diagnosed both Chronic PTSD and a personality disorder.  The examiner distinguished the following as symptoms of chronic PTSD: nightmares, chronic sleep problems, mood disturbances, depression, flattened affect, panic attacks more than once a week, difficulty in understanding complex commands, impairment of short and long-term memory disturbances of motivation and mood, and difficulty in establishing and maintain effective work and social relationships.  The examiner listed symptoms of personality disorder as  including suicidal ideation, impaired impulse control, angry outbursts, and difficulty adapting to stressful circumstances.  It was the examiner’s opinion that the Veteran’s personality disorder was responsible for the majority of his social and occupational impairment as compared to his PTSD.    
In his Notice of Disagreement submitted in August 2013, the Veteran asserted that he met the criteria for a higher disability rating for his PTSD.  He stated that he suffered from near-continuous anxiety and depression as well as suicidal ideation. 
In April 2014, the Veteran called the VA mental health hotline and reported loneliness and suicidal thoughts.  He also expressed his anger at VA and his belief that VA was “screwing with” him.  When staff later called him back, the Veteran denied having made the call and became angry and hostile and complained of mistreatment by VA.  
At the Board hearing in August 2017, the Veteran testified that he struggled with anxiety on a daily basis, with nightmares, and night sweats and sleep disturbances.  He would rather be at home, but his wife was able to get him out late at night when there were very few people around.  He had a poor relationship with his family and his wife spent most of her time caring for him.  He preferred to be alone in his house, had frequent mood swings and depression, and was hypervigilant at home and in public.  He testified that the root of his PTSD was an incident in which a soldier under his command did not follow the Veteran’s instructions and was involved in an explosion.  The soldier died and the Veteran tended to be triggered by any instance in which his family and others didn’t follow the instructions he gave them.  He constantly worried that his family was in danger if they did not listen to him.  This was the source of friction in his family, particularly with his teenage daughter.  He felt detached from the world and was quite depressed to realize how much that had negatively impacted his family.  He no longer participated in mental health treatment because the counselor he trusted had left and he didn’t have a relationship with any other provider.
The Veteran’s daughter submitted a letter describing the impact of the Veteran’s PTSD on her and their family.  She said that his medication made him act like a zombie, but that he was always emotionally distant and withdrawn throughout her life.  He avoided interactions with all people and social occasions and was so psychologically absent that she had always felt rejected by him.  She felt that the Veteran’s PTSD had robbed her of a decent childhood. 
After considering all of the evidence of record, with special attention to the documents discussed above, the Board finds that the Veteran’s disability picture is more consistent with one of occupational and social impairment with deficiencies in most areas.  Specifically, the Veteran is shown to have problems with his family relationships, with his ability to interact with others, and with his mood and thinking.  Although the VA examiner ascribed the Veteran’s hostility and angry outbursts to his personality disorder rather than his PTSD, the Board finds that it is at least as much related to his PTSD.  Specifically, the record has established that the Veteran’s stressor event for his PTSD involved the death of a soldier who did not follow the Veteran’s instructions.  Many of the angry outbursts documented in the record relate to individuals resistant to the Veteran’s authority or direction.  Therefore, the Veteran’s PTSD is clearly also part of the impetus for these incidents.   They are evidence of deficiencies in judgment and thinking, in addition to the demonstrated near-continuous anxiety and depression, and his emotional detachment from others.  Based on these symptoms, the Board finds that a 70 percent disability rating is warranted.
A still higher, or 100 percent disability rating, is not warranted here because the Veteran has not shown total social and occupational impairment.  Specifically, the record shows that the Veteran is still able to handle most of the activities of daily living and maintains a relationship with his wife.  He has not shown evidence of extreme impairment such as loss of memory for his own name or incoherent speech or frequent inability to attend to personal hygiene needs.  In short, his disability picture is not consistent with one of total impairment due to PTSD.
Entitlement to TDIU 
A total disability rating may be granted where the schedular rating is less than 100 percent and the veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities.  Generally, to be eligible for a TDIU, a percentage threshold must be met.  38 C.F.R. §§ 3.340, 3.341, 4.16(a).  If there is only one service-connected disability, or two or more with the same etiology or affecting the same body system, the disability rating must be 60 percent or more.  Id.  If there are two or more disabilities, there shall be at least one disability rated at 40 percent or more, and sufficient additional disabilities to bring the combined rating to 70 percent or more.  Id.
At the August 2017 Board hearing, the Veteran testified that no one wanted to hire him because of his disabilities.  He stated that he was supposed to be taking 60 milligrams of morphine a day for his leg pain, which made it difficult for him to concentrate.  He had last been gainfully employed in 2005, when he worked for an armored car company as a vault manager.  He normally worked at night when there were few people around.  He was terminated from that job because he couldn’t get along with other people.  He was also having problems with pain in his legs and with his PTSD symptoms.  
As discussed above, the Board finds that the Veteran’s PTSD is associated with deficiencies in most areas, including occupational and social functioning.  The Board also finds that the Veteran’s hostile and angry outbursts are related at least in part to his PTSD and the underlying stressor incident in service.  The evidence regarding his angry outbursts is also clear demonstration of his inability to interact appropriately with others as would be required in a work setting.  In addition, as the Veteran has testified, he takes a significant dose of painkillers for his leg disabilities, which interfere with his ability to think clearly and to function.  Both he and his daughter have described his medications as making him act liincluke a zombie.  For all of these reasons, the Board finds that the Veteran’s disability picture warrants a grant of TDIU.

Eric S. Leboff
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	Cheryl E. Handy, Counsel 

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