Citation Nr: 18160349
Decision Date: 12/26/18	Archive Date: 12/26/18

DOCKET NO. 15-18 714A
DATE:	December 26, 2018
Entitlement to an evaluation of 50 percent for service-connected PTSD is granted.
Entitlement to an evaluation in excess of 50 percent for service-connected PTSD is remanded.
Throughout the appeal period, the Veteran’s PTSD has been productive of at least occupational and social impairment with reduced reliability and productivity due to such symptoms as depressed mood, anxiety, suspiciousness, chronic sleep impairment, and difficulty establishing relationships.  
The criteria for an initial rating of 50 percent, but no higher, for PTSD are met throughout the appeal period.  38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 3.102, 4.7, 4.130, Diagnostic Code 9411 (2017).
The Veteran had active military service from December 1968 to December 1972.  The Veteran had service in Vietnam and is in receipt of the National Defense Service Medal, Vietnam Service Medal and Vietnam Campaign Medal.  
The Veteran presented sworn testimony at a hearing before the undersigned in October 2018.  
1. Increase Rating 
Disability evaluations are determined by the application of a schedule of ratings which is based, as far as can practically be determined, on the average impairment of earning capacity.  38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2017).  Each service-connected disability is rated on the basis of specific criteria identified by Diagnostic Codes.  38 C.F.R. § 4.27 (2017).  When rating the Veteran’s service-connected disability, the entire medical history must be borne in mind.  Schafrath v. Derwinski, 1 Vet. App. 589 (1991).  Where there is a question as to which of two evaluations is to 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 (2017).
Where a claimant appeals the initial rating assigned following an award of service connection, evidence contemporaneous with the claim for service connection and with the rating decision granting service connection would be most probative of the degree of disability existing at the time that the initial rating was assigned and should be the evidence “used to decide whether an [initial] rating on appeal was erroneous....” Fenderson v. West, 12 Vet. App. 119, 126 (1999).  If later evidence obtained during the appeal period indicates that the degree of disability increased or decreased following the assignment of the initial rating, “staged” ratings may be assigned for separate periods of time based on facts found.  Id.  
The Board is charged with the duty to assess the credibility and weight given to evidence.  Madden v. Gober, 125 F.3d 1477, 148 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001).  Indeed, in Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the United States Court of Appeals for the Federal Circuit (Federal Circuit), citing its decision in Madden, recognized that that Board had inherent fact-finding ability.  Id. at 1076; see also 38 U.S.C.A. § 7104 (a).  Moreover, the United States Court of Appeals for Veterans Claims (Court) has declared that in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence.  Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). 
As a finder of fact, when considering whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility, consistency with other evidence submitted on behalf of the appellant, and the appellant’s demeanor when testifying at a hearing.  See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff’d per curiam, 78 F.3d 604 (Fed. Cir. 1996).
In making all determinations, the Board must fully consider the lay assertions of record.  A layperson is competent to report on the onset and recurrence of symptoms.  See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.  Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007).  When considering whether lay evidence is competent the Board must determine, on a case by case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent.  Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d at 1377 (Fed. Cir. 2007) (holding that “[w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board”). 
When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt shall be given to the claimant.  38 U.S.C. § 5107 (b).  When a reasonable doubt arises regarding service origin, such doubt will be resolved in the favor of the claimant.  Reasonable doubt is doubt which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim.  38 C.F.R. § 3.102. The question is whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which event the claim must be denied.  Gilbert v. Derwinski, 1 Vet. App. 49, 54 (1990).
Disabilities must be reviewed in relation to their history.  38 C.F.R. § 4.1. Other applicable, general policy considerations are: interpreting reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability, 38 C.F.R. § 4.2; resolving any reasonable doubt regarding the degree of disability in favor of the claimant, 38 C.F.R. § 4.3; where there is a question as to which of two evaluations applies, assigning the higher of the two where the disability picture more nearly approximates the criteria for the next higher rating, 38 C.F.R. § 4.7; and, evaluating functional impairment on the basis of lack of usefulness, and the effects of the disability upon the person’s ordinary activity, 38 C.F.R. § 4.10.  See Schafrath v. Derwinski, 1 Vet. App. 589 (1991).
The Veteran asserts that his PTSD is more severe this his current rating of 30 percent, and increased rating is warranted.  After a careful review of the evidence of record, the Board finds that a rating of at least 50 percent is warranted for the period on appeal.  
The Veteran’s PTSD is rated under 38 C.F.R. § 4.130, Diagnostic Code 9411, which provides for a 50 percent rating when the evidence shows 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.
Ratings are assigned according to the manifestation of particular symptoms.  However, the use of the term “such as” in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating.   Mauerhan v. Principi, 16 Vet. App. 436 (2002).  When determining the appropriate disability evaluation to assign, however, the Board’s “primary consideration” is the Veteran’s symptoms.   Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013).  In addition, in Mittleider v. West, 11 Vet. App. 181 (1998), the Court held that VA regulations require that when the symptoms and/or degree of impairment due to a Veteran’s service-connected psychiatric disability cannot be distinguished from any other diagnosed psychiatric disorders, VA must consider all psychiatric symptoms in the adjudication of the claim.
As part of his claim for a higher initial rating the Veteran was afforded a VA examination in July 2014.  He subjectively reported that he suffered from nightmares, flashbacks, irritability, insomnia, concentration loss, avoidance of trauma triggers and activities, as well as hypervigilance.  
During the examination the Veteran reported that he has been married since 2005 and he has good relationship with his wife.  They do not argue, he does not become angry with her, or have outburst.  He did report hypervigilance while shopping or out in public, he has no friends, and only spends time with his wife, his wife’s family, and his niece.  The examiner subjectively reported that the Veteran had a depressed mood, anxiety, suspiciousness, chronic sleep impairment, and difficulty establishing relationships.  At the conclusion of the examination, the examiner noted that the Veteran’s nightmares had increased in severity and as well as his dysphoric moods.  
Based on the severity of his symptoms, the Board finds that the Veteran’s disability picture and symptomatology warrants at least the criteria for a 50 percent disability rating throughout the appeal.  See Bankhead v. Shulkin, 29 Vet. App. 10 (2017).
The 50 percent rating being assigned adequately addresses his PTSD symptomatology, which more closely approximates the 50 percent criteria.  See 38 C.F.R. § 4.7.   38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49 (1990).
1. Entitlement to a rating in excess of 50 percent for service connected PTSD is remanded.
During the October 2018 Board hearing, the Veteran testified that his service-connected PTSD has worsened since his last VA examination.  As such, VA is required to afford him a contemporaneous VA examination to assess the current nature, extent, and severity of his PTSD.  See Snuffer v. Gober, 10 Vet. App. 400, 403 (1997) (VA regulations specifically require the performance of a new medical examination when evidence indicates that there has been a material change in a disability).  Thus, this claim must be remanded.
The matter is REMANDED for the following action:
1. Notify the Veteran that he may submit lay statements from individuals that have first-hand knowledge of the nature, extent, and severity of his service-connected psychiatric disability.  He should be provided a reasonable amount of time to submit this lay evidence.  
2. Schedule the Veteran for an appropriate VA psychiatric examination to determine the nature, extent, and severity of his psychiatric disability.  The claims file must be made available to and reviewed by the examiner.  
(a.) The Veteran’s spouse must be given the opportunity to accompany the Veteran to the scheduled VA examination.  
(b.) All tests deemed appropriate by the examiner should be performed.
(c.) The examiner should report all pertinent findings and comment on the severity of any social and occupational impairment related to his psychiatric disability.

Veterans Law Judge
Board of Veterans’ Appeals

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