Citation Nr: 0815665 Decision Date: 05/13/08 Archive Date: 05/23/08 DOCKET NO. 04-12 081 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Pittsburgh, Pennsylvania THE ISSUES 1. Whether the reduction of a 100 percent evaluation for residuals of prostate cancer was proper. 2. Entitlement to an evaluation in excess of 40 percent for residuals of prostate cancer from January 1, 2004. 3. Entitlement to an initial evaluation in excess of 10 percent for an adjustment disorder with depressed mood. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Saira Sleemi, Associate Counsel INTRODUCTION The veteran served on active duty from November 1966 to April 1971. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an October 2003 rating decision of the Regional Office (RO) that reduced the evaluation assigned for adenocarcinoma of the prostate from 100 percent to 40 percent, effective January 1, 2004. The veteran also filed a filed a timely substantive appeal from a January 2004 rating decision that granted service connection for an adjustment disorder with depressed mood as secondary to his service-connected residuals of prostate cancer, and assigned a 10 percent evaluation for it. FINDINGS OF FACT 1. A December 2002 rating decision assigned a 100 percent evaluation for adenocarcinoma of the prostate, effective October 21, 2002. 2. The veteran underwent a prostatectomy for adenocarcinoma of the prostate in November 2002, and a June 2003 VA examination report demonstrated the absence of prostate cancer with an undetectable PSA. 3. Following appropriate due process, an October 2003 rating decision reduced the 100 percent evaluation assigned for the veteran's adenocarcinoma of the prostate to 40 percent, effective January 1, 2004. 3. Prior to February 13, 2007, the veteran's postoperative residuals of prostate cancer resulted in urinary frequency and leakage requiring no more than 4 pads a day. 5. As of February 13, 2007, the veteran's postoperative residuals of prostate cancer include urinating every hour to avoid additional incontinence and urinary leakage requiring the use of pads a minimum of 4 times a day with relatively poor urinary control. 6. The veteran's adjustment disorder with depressed mood is manifested by mild symptoms and the use of medication, with a Global Assessment of Functioning score of 75. CONCLUSIONS OF LAW 1. The reduction of the assigned 100 percent evaluation for residuals of prostate cancer was proper. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.105(e), 4.115b, Diagnostic Code 7528, Note (2007). 2. The criteria for an evaluation in excess of 40 percent for residuals of prostate cancer have not been met for the period of January 1, 2004 to February 12, 2007. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 4.115a, 4.115b, Diagnostic Code 7527 (2007). 3. The criteria for an evaluation of 60 percent for residuals of prostate cancer have been more nearly approximated effective February 13, 2007. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 4.7, 4.115a, and 4.115b, Diagnostic Code 7527 (2007). 4. The criteria for an initial evaluation in excess of 10 percent for an adjustment disorder with depressed mood have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 & Supp. 2007); 38 C.F.R. § 4.130, Diagnostic Code 9440 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSION Veterans Claims Assistance Act The Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (Nov. 9, 2000) (codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, and 5126 (West 2002) redefined VA's duty to assist the veteran in the development of a claim. VA regulations for the implementation of the VCAA were codified as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a) (2007). The notice requirements of the VCAA require VA to notify the veteran of what information or evidence is necessary to substantiate the claim; what subset of the necessary information or evidence, if any, the claimant is to provide; what subset of the necessary information or evidence, if any, the VA will attempt to obtain; and a general notification that the claimant may submit any other evidence he has in his possession that may be relevant to the claim. Sanders v. Nicholson, 487 F.3d 881 (Fed. Cir. 2007). The requirements apply to all five elements of a service connection claim: veteran status, existence of a disability, a connection between the veteran's service and the disability, degree of disability, and effective date of the disability. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). Such notice must be provided to a claimant before the initial unfavorable decision on a claim for VA benefits by the agency of original jurisdiction (in this case, the RO). Id; see also Pelegrini v. Principi, 18 Vet. App. 112 (2004). However, insufficiency in the timing or content of VCAA notice is harmless if the errors are not prejudicial to the claimant. Conway v. Principi, 353 F.3d 1369, 1374 (Fed. Cir. 2004) (VCAA notice errors are reviewed under a prejudicial error rule); see also Sanders, supra. The appeal arises from a reduction in evaluation for prostate cancer and following the award of an initial evaluation for adjustment disorder. A June 2003 letter advised the veteran of his due process rights concerning the proposal of reduction in his prostate cancer evaluation and an October 2003 letter advised the veteran of the evidence necessary to establish service connection for his adjustment disorder. After the case was remanded by the Board for additional notice and development of the case, the Appeals Management Center (AMC) sent a letter in January 2007 informing the veteran of what is required to establish a claim for an increased rating, as well as what information and evidence must be submitted by the veteran, what information and evidence will be obtained by VA, and the need for the veteran to advise VA of or submit any further evidence he has in his possession that pertains to the claim. The letter further advised the veteran of the evidence needed to establish the level of disability, including evidence addressing the impact of his conditions on employment and the severity and duration of his symptoms, as well as examples of the types of evidence which would show such. See Vazquez-Flores v. Peake, 22 Vet. App. 37 (2008). The letter further advised the veteran of the evidence needed to establish an effective date. The Board further points out that both statements of the case, issued in March 2004, included the diagnostic criteria for an increased rating for each of his service-connected disabilities. The case was last readjudicated August 2007. The record also reflects that VA has made reasonable efforts to obtain relevant records adequately identified by the veteran. Specifically, the information and evidence that have been associated with the claims file includes the veteran's multiple contentions, employment records, private medical records and VA examination reports. As discussed above, the VCAA provisions have been considered and complied with. The veteran was notified and aware of the evidence needed to substantiate this claim, the avenues through which he might obtain such evidence, and the allocation of responsibilities between himself and VA in obtaining such evidence. The veteran was an active participant in the claims process, providing numerous statements regarding the level of his disability and its impact on his employment, as well as submitting medical evidence and employment information. The veteran's actions reflect actual knowledge of the types of evidence to submit to substantiate his claim. He was provided with a meaningful opportunity to participate in the claims processes and has done so. Any error in the sequence of events or content of the notice is not shown to have affected the essential fairness of the adjudication or to cause injury to the claimant. See Sanders, supra. Thus, any such error is harmless and does not prohibit consideration of this matter on the merits. See Conway, supra; Dingess, supra; see also ATD Corp. v. Lydall, Inc., 159 F.3d 534, 549 (Fed. Cir. 1998). Analysis The Board has reviewed all the evidence in the appellant's claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the appellant or obtained on his behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate each claim and what the evidence in the claims file shows, or fails to show, with respect to each claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); See Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Under the applicable criteria, disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. 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 apply, assigning a 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 disabilities upon the person's ordinary activity, 38 C.F.R. § 4.10. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). 1. Residuals of Prostate Cancer The veteran underwent a radical retropubic prostatectomy on November 27, 2002. In December 2002, the RO granted service connection for adenocarcinoma of the prostate and assigned him a 100 percent evaluation. After a June 2003 VA examination, the veteran was assigned a 40 percent evaluation for residuals of prostate cancer. The veteran takes issue with the rating assigned when his service-connected adenocarcinoma of the prostate was reduced from 100 percent to 40 percent. This issue essentially involves two questions. First, was the reduction in the 100 percent evaluation proper; and second, if the reduction was proper, was the assignment of a 40 percent disability evaluation proper. (a) Whether the reduction of a 100 percent evaluation for residuals of prostate cancer was proper. The evaluation of 100 percent was provided under 38 C.F.R. § 4.115b, Diagnostic Code 7528, for malignant neoplasms of the genitourinary system. The note following this Diagnostic Code indicates that, following the cessation or surgery, chemotherapy, or other therapeutic procedure, the rating of 100 percent shall continue with a mandatory VA examination at the expiration of six months. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of 38 C.F.R. § 3.105(e). If there has been no local reoccurrence or metastasis, then the veteran's cancer is rated based on residuals as voiding dysfunction or renal dysfunction, whichever is the predominant disability. Id. Pursuant to 38 C.F.R. § 3.105(e) where a reduction in the evaluation of a service-connected disability is considered warranted and the lower evaluation would result in a reduction or discontinuance of compensation payments currently being made, a rating proposing the reduction or discontinuance will be prepared setting forth all material facts and reasons. The beneficiary will be notified at his or her latest address of record of the contemplated action and furnished detailed reasons therefor, and will be given 60 days for the presentation of additional evidence to show that compensation payments should be continued at their present level. Final rating action will reduce or discontinue the compensation effective the last day of the month in which a 60-day period from the date of notice to the beneficiary of the final rating action expires. 38 C.F.R. § 3.105(e). The evidence reveals that the veteran underwent a radical prostatectomy in November 2002. Thereafter, no additional chemotherapy or other therapeutic procedures were undertaken to treat the prostate cancer. In addition, private medical reports from January 2003 and April 2003 revealed the veteran's prostatic specific antigen (PSA) was less than 0.1 and noted to be undetectable. Also, in the June 2003 VA examination report, the examiner commented that there was no chemical evidence of a recurrent disease. The Board notes incidentally that regulatory provisions normally applicable to reductions from 100 percent, and for rating reductions in general, are not applicable where, as here, the reduction is mandated by provisions set in the rating schedule. Rossiello v. Principi, 3 Vet. App. 430 (1992); cf. 38 C.F.R. §§ 3.343, 3.344 (2007). Based on a review of the procedural history, it appears that the RO complied with all of the requirements of 38 C.F.R. § 3.105(e). The veteran was notified of his rights and was given an opportunity for a hearing and time to respond by way of a June 2003 letter. An October 2003 letter notified the veteran of the final reduction, and the reduction was made effective no sooner than permitted by current law and regulations ("the last day of the month in which a 60-day period from the date of notice to the beneficiary of the final action expires"). 38 C.F.R. § 3.105(e) (2007). Thus, the Board finds that the reduction from 100 percent was proper. (b) Entitlement to a disability rating in excess of 40 percent for prostate cancer from January 1, 2004. Where 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. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation during the course of the appeal. Hart v. Mansfield, 21 Vet. App. 505 (2007). Under Diagnostic Code 7528, malignant neoplasms of the genitourinary system are to be rated as voiding dysfunction or renal dysfunction, whichever is predominant. See 38 C.F.R. § 4.115b. Under Diagnostic Code 7527 postoperative prostate residuals are to be rated as voiding dysfunction or urinary tract infection, whichever is predominant. The Board notes that the veteran is currently rated at 40 percent, which is greater than or equal to the maximum ratings assignable for urinary tract infection, obstructed voiding or urinary frequency. Moreover, there is no indication of any renal dysfunction related to his prostate cancer or surgery. See 38 C.F.R. § 4.115a. Thus, the appropriate criteria for consideration in this case are those pertaining to urine leakage. Urine leakage (continual urine leakage, post-surgical urinary diversion, urinary incontinence, or stress incontinence) requiring the wearing of absorbent materials which must be changed 2 to 4 times per day warrants a 40 percent rating. Leakage requiring the use of an appliance or the wearing of absorbent materials which must be changed more than 4 times per day warrants a 60 percent rating. A January 2003 private report noted the veteran's PSA was less than 0.1, urinalysis was negative on a dipstick, pathology revealed moderately differentiated adenocarcinoma Gleason 6 with small focus on the left lobe, resection margins and seminal vesicles were negative for carcinoma and no angiolymphatic invasion was noted. The veteran's pre- operative PSA was noted to be 3.1. The physician listed adenocarcinoma of the prostate, stage T2A, with an undetectable PSA of less than 0.1 following radical prostatectomy. In an April 2003 private examination, the physician reported the veteran's urinary incontinence continued to improve, he wore 1 light pad a day and was voiding with a reasonable stream. He did not report any erectile dysfunction. The veteran's PSA was less than 0.1, noted undetectable, and a urinalysis was negative on the dipstick. The private physician listed an impression of carcinoma of the prostate with an undetectable PSA following radical prostatectomy, mild stress incontinence and symptoms of urinary frequency. In a June 2003 VA examination report, the examiner noted findings made by the veteran's private physician that after surgery, the veteran was incontinent, requiring 1-2 pads a day and perhaps one at night, and that his PSA was reported undetectable as of March 2003 when it was drawn. The examiner concluded that the veteran is still incontinent and there was no chemical evidence of recurrent disease. Private medical reports from August 2003 and September 2003 reflect the veteran continued to have problems with incontinence. In an August 2003 private report, the physician noted that the veteran had severe incontinence requiring 2 to 3 absorbent pads a day. In September 2003 the veteran complained of problems with microhematuria (microscopic blood in the urine), and when he urinated he felt like a plug had come out first, with no pain on urination. The private physician scheduled a sonography of the kidneys, ureter and bladder. An October 2003 private operative report reflects the veteran underwent surgery for a bladder neck contracture and a small bladder calculus. The private physician reported that on a follow up examination after his radical retropubic prostatectomy, the veteran was noted to have a microscopic hematuria with a diminished urinary stream. A preoperative renal ultrasound was normal but an outpatient cytoscopy revealed findings of a bladder neck contracture and a small calculus at the bladder neck. After this surgery was performed, the veteran did not have any tumors or erythematous areas and the ureteral orifices were in the normal position effluxing clear urine. A private medical report in October 2003 following the surgery noted the veteran was unable to urinate after this procedure. In an October 30, 2003 statement, the veteran reported being on a catheter following his bladder neck surgery on October 28, 2003, which was removed on October 30. He stated that he was able to urinate after this procedure but had been changing pads at least 6 times a day, although he expected the incontinence to lessen. He reported that there was less blood on the pads but holding urine was difficult. He further stated that he would continue to change his pads 3 times a day if his urinary difficulty continued. A March 2004 private treatment note apparently from his primary care provider noted complaints of depression and erectile dysfunction, but no problem with the bowel or bladder. In a December 2006 private medical report, testing results reflected trace amounts of blood in the veteran's urine and a PSA screening was less than 0.1. In a private medical report on February 13, 2007, the veteran complained of urinary frequency about 15 times a day and that he changed his pads 4 times a day at a minimum with occasional aching in the pubic area. In a June 2007 VA examination, the examiner reported the veteran had urinary incontinence, generally wearing 4 pads a day, urination approximately every hour during the daytime to avoid as much incontinence as possible and nocturia 2 to 3 times a night. The examiner also noted that the most recent PSA was undetectable and there was no evidence of bladder contracture. The veteran also reported having no significant erections on his own with no response to Viagra and he took injections but did not get a significant erection. The examiner concluded that there was no cancer recurrence but the veteran had relatively poor urinary control as he still requires 4 pads per day on average; however, there was no need for dilation or catheterization. The evidence demonstrates that the veteran did not require more than 4 pads a day prior to February 13, 2007, other than on the day the catheter was removed following his bladder neck surgery. The preponderance of the evidence notes that prior to February 13, 2007, the veteran reported changing his pads 3 times per day. Thus, the weight of the evidence is against a finding that the veteran's service connected residuals of prostate cancer meets or more nearly approximates the criteria for an evaluation in excess of 40 percent for the period of January 1, 2004 to February 12, 2007. However, the competent medical evidence of record from February 13, 2007 and thereafter reflect the veteran's service-connected residuals of prostate cancer more nearly approximates the criteria for a rating of 60 percent, as he voids every hour during the daytime to specifically reduce the amount of incontinence, but still requires changing his pads a minimum of four times a day. After resolving all doubt in favor of the veteran, the Board finds that an evaluation of 60 percent, but no higher, is more nearly approximated for the residuals of prostate cancer, as of February 13, 2007. Finally, the Board acknowledges the veteran's continuing complaints of erectile problems. However, the veteran already receives special monthly compensation for the loss of use of a creative organ. 2. Adjustment disorder with depressed mood As stated above, the RO granted service connection for adjustment disorder with depressed mood and assigned a 10 percent rating effective September 25, 2003. Where the appellant has expressed dissatisfaction with the assignment of an initial rating following an initial award of service connection for that disability, separate ratings can be assigned for separate periods of time based on the facts found - a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999). 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 due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication, warrants a 10 percent rating. Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events), warrants a 30 percent rating. 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, warrants 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, warrants 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, warrants a 100 percent rating. 38 C.F.R. § 4.130. One factor for consideration is the Global Assessment of Functioning (GAF) score, which is a scale in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV) reflecting the "psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness." See Richard v. Brown, 9 Vet. App. 266 (1996); Carpenter v. Brown, 8 Vet. App. 240, 242 (1995). A GAF score of 51 to 60 indicates moderate symptoms (e.g., flattened affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers). A GAF score of 61 to 70 indicates some mild symptomatology (e.g., depressed mood and mild insomnia) or some difficulty in social, occupational, or social functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, with some meaningful interpersonal relationships. A GAF score of 71 to 80 indicates that if symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g. difficulty concentrating after family argument) or no more than slight impairment in social, occupational, or school functioning (e.g. temporarily falling behind in schoolwork). While the Rating Schedule does indicate that the rating agency must be familiar with the DSM IV, it does not assign disability percentages based solely on GAF scores. See 38 C.F.R. § 4.130 (2007). The veteran contends that he suffers from symptoms warranting a higher evaluation for his psychiatric disorder. Private medical reports reflect that the veteran first addressed issues of depression in September 2003, following his prostatectomy. The veteran initially stated that he was not suicidal but was down and out sometimes because of his diagnoses of what he had been through recently and did not feel that he was depressed. In a follow-up examination later that same month, the veteran admitted to being mildly depressed and agreed to try medication, Lexapro, for his depression. The veteran's physician also noted that he had problems with his memory although this was not mentioned as being linked to his depression. A VA examination report in December 2003, notes the veteran was concerned about his future, fears the return of his prostate cancer and is struggling with other complications which include persistent erectile dysfunction, fatigue and urinary leakage. He was on Lexapro at the time of the examination and reported some improvement with sleep pattern, level of irritability, and sexual interest, but continued to have sadness, an occasional feeling of wanting to cry, and irritability. He did not feel as though he needed counseling. He noted he was employed as a salesman for a heavy duty fan equipment company. He stated there have been some difficulties with his job lately, in that he was being pressed to become an independent contractor along with his co-worker before his surgery ensued. As a result of the surgery, his company was allowing him to remain an employee rather than pressing the issue of independent contract for fear he would lose his insurance for the pre-existing prostate condition. As a result of this, however, he has lost some of the territory that has gone to his co-worker which has caused some financial losses. He also reported feeling fatigued and having trouble with concentration and short-term memory, which he is unsure whether it is due to depression, oxygen deprivation or pulmonary arrest while he was in surgery. A mental status evaluation reveals the veteran was alert, oriented in all three spheres and conversation was relevant, coherent, organized and goal-directed. In addition the veteran's mood was found to be euthymic with a responsive and reasonably well-modulated affect that had no signs of flattening. Also there were no indications of suicidal ideation, intent or plans. His memory and intellect appeared to be intact and well-above average capacity. Finally, there were no impairments of insight or judgment noted. The examiner concluded that the veteran met the criteria for a diagnosis of an adjustment disorder with depressed mood secondary to cancer and other medical problems that was mild and assigned a GAF score of 75. A private medical report in March 2004 reflects the veteran was taking medication for his depression, Lexapro, and reported feeling more relaxed on it. His physician assessed him with depression. In a June 2007 VA examination, the veteran reported no current psychiatric treatment, hospitalizations or therapy. He was prescribed Lexapro that helped with his depression. He reported being employed and working 45-50 hours a week. It was also noted that the veteran had a good relationship with his family, socializes with friends and neighbors, bowls in a league, and golfs. He complained of fatigue during the day. He stated that he feels the depression, anxiety and sleep disruption are due to urinary frequency. A mental status evaluation revealed the veteran was neatly dressed and groomed. His affect and mood were noted as appropriate. He was animated, calm, interacted appropriately and maintained good eye contact. There was no obvious depression or anxiety noted. The veteran's thought processes were goal directed, logical and coherent with no indications of thought disorders, hallucinations or delusions. There was no homicidal or suicidal ideation noted. The examiner also noted that the veteran was unable to specifically cite in detail the psychiatric symptoms that have increased in severity. No symptoms consistent with major depression or mania were noted. He had fair insight and good judgment. The examiner concluded that there was no indication of an increase in severity of his symptoms and that the veteran was employed full time and fully employable. He was assigned a GAF score of 75. Based on the evidence of record, the Board finds that the veteran's symptoms for adjustment disorder with depressed mood do not meet the criteria for an evaluation higher than 10 percent. The clinical findings do not reflect an occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as suspiciousness, panic attacks (weekly or less often), chronic sleep impairment and mild memory loss (such as forgetting names, directions, recent events), that would justify a higher evaluation. While the veteran has reported subjective complaints of memory loss, depression, and anxiety, such was not objectively noted on VA examinations. Moreover, his sleep problems are noted to be resulting from getting up to urinate at night. Further, while he has reported a decrease in sales contracts since his surgery, the December 2003 examination noted that he lost part of his territory at work because he could not become an independent contractor. In summary, the objective findings on the examinations reveal only mild symptoms controlled by medication, which do not interfere with occupational or social functioning. Accordingly, the Board finds that the preponderance of the evidence does not support a rating in excess of 10 percent for adjustment disorder with depressed mood. ORDER The reduction of the 100 percent evaluation for residuals of prostate cancer was proper, and restoration of the 100 percent evaluation is denied. An evaluation in excess of 40 percent for residuals of prostate cancer for the period from January 1, 2004 to February 12, 2007, is denied. A 60 percent evaluation for residuals of prostate cancer is granted, effective February 13, 2007, subject to the applicable criteria governing the award of monetary benefits. An initial evaluation in excess of 10 percent for adjustment disorder with depressed mood is denied. ____________________________________________ K. A. BANFIELD Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs