Citation Nr: 1306389 Decision Date: 02/25/13 Archive Date: 03/01/13 DOCKET NO. 07-05 459 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUE Entitlement to an increased initial rating for generalized anxiety disorder, rated as 10 percent disabling for the period from May 1, 2006 to June 15, 2010, and as 30 percent disabling for the period from June 16, 2010. REPRESENTATION Veteran represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL The Veteran and his spouse ATTORNEY FOR THE BOARD N. Kroes, Counsel INTRODUCTION The Veteran served on active duty from March 1969 to March 1971. This case comes before the Board of Veterans' Appeals (Board) on appeal from a December 2006 decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina. In March 2008, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of this hearing is associated with the claims file. In May 2010, the Board remanded this issue for further evidentiary development. The requested development was completed, and the case has now been returned to the Board for further appellate action. FINDINGS OF FACT 1. Prior to December 31, 2007, the Veteran's generalized anxiety disorder was manifested by a blunted affect, anhedonia, anxiety attacks, being forgetful, and feeling nervous; this most closely approximates occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. 2. Since, December 31, 2007, the Veteran's generalized anxiety disorder is manifested by blunted affect, depressed mood, anxiety attacks, panic attacks, feeling nervous, and at least one incident of poor grooming and hygiene; this most closely approximates occupational and social impairment with reduced reliability and productivity. CONCLUSIONS OF LAW 1. The criteria for an initial disability rating of 30 percent for generalized anxiety disorder have been more nearly approximated from May 1, 2006 to December 30, 2007. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. § 4.130, Diagnostic Code 9400 (2012). 2. The criteria for a disability rating of 50 percent for generalized anxiety disorder have been more nearly approximated from December 31, 2007. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. § 4.130, Diagnostic Code 9400 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist 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 & Supp. 2012)) redefined VA's duty to assist a claimant 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) (2012). The notice requirements of the VCAA require VA to notify the claimant of any evidence that is necessary to substantiate the claim, as well as the evidence VA will attempt to obtain and which evidence he is responsible for providing. 38 C.F.R. § 3.159(b) (2012). The requirements apply to all five elements of a service connection claim: veteran status, existence of a disability, a connection between a veteran's service and the disability, degree of disability, and effective date of the disability. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). VCAA 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, the VCAA notice requirements may be satisfied if any errors in the timing or content of such notice are not prejudicial to the claimant. See Pelegrini, 18 Vet. App. at 121. In this case, in a September 2006 letter issued prior to the decision on appeal, the Veteran was provided notice regarding what information and evidence was needed to substantiate the underlying claim for service connection, as well as what information and evidence must be submitted by the Veteran and what information and evidence will be obtained by VA. The letter further advised the Veteran of how disability evaluations and effective dates are assigned, and the type of evidence which impacts those determinations. A January 2007 letter included notification regarding what information and evidence was needed to substantiate the claim for a higher rating, as well as what information and evidence must be submitted by the Veteran and what information and evidence will be obtained by VA. The claim was last readjudicated in July 2011. Moreover, the Veteran is challenging the initial evaluation assigned following the grant of service connection for generalized anxiety disorder. In Dingess, the United States Court of Appeals for Veterans Claims (Court) held that in cases in which service connection has been granted and an initial disability rating and effective date have been assigned, the typical service connection claim has been more than substantiated, it has been proven, thereby rendering section 5103(a) notice no longer required because the purpose that the notice is intended to serve has been fulfilled. Dingess, 19 Vet. App. at 490-91; see also 38 C.F.R. § 3.159(b)(3)(i) (2012). Thus, because the notice that was provided before service connection was granted was sufficient, VA's duty to notify in this case has been satisfied. See generally Turk v. Peake, 21 Vet. App. 565 (2008) (where a party appeals from an original assignment of a disability rating, the claim is classified as an original claim, rather than as one for an increased rating); see also Shipwash v. Brown, 8 Vet. App. 218, 225 (1995); see also Fenderson v. West, 12 Vet. App. 119 (1999) (establishing that initial appeals of a disability rating for a service-connected disability fall under the category of "original claims"). 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 include the Veteran's service treatment records and service personnel records, VA treatment records and examination reports, and hearing testimony. In addition, the Board notes that the case was remanded in May 2010 to obtain certain VA treatment records and provide the Veteran with an examination. The requested records were obtained and associated with the claims file and the Veteran was afforded a VA examination in June 2010. Accordingly, the requirements of the remand were ultimately accomplished and the prior remand instructions were substantially complied with. See Stegall v. West, 11 Vet. App. 268 (1998). The Veteran underwent VA examinations in December 2006 and June 2010. These examinations are found to be adequate in so far as they thoroughly and accurately portray the extent of the generalized anxiety disorder. The Veteran was interviewed during each examination and a mental status examination was performed. The examiner, who performed both examinations, included a diagnosis and assigned a Global Assessment of Functioning score on each occasion. Therefore, the Board finds that the Veteran has been provided adequate medical examinations in conjunction with his claim. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (holding that a medical opinion is adequate when it is based upon consideration of a claimant's prior medical history and examinations and describes the disability in sufficient detail so that the evaluation of the claimed disability will be a fully informed one). As discussed above, the Veteran was notified and aware of the evidence needed to substantiate his 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 by providing evidence and argument and presenting for VA examinations. Thus, he was provided with a meaningful opportunity to participate in the claims process and has done so. Any error in the sequence of events or content of the notices is not shown to have any effect on the case or to cause injury to the Veteran. Therefore, any such error is harmless and does not prohibit consideration of this matter on the merits. See Dingess, supra; see also ATD Corp. v. Lydall, Inc., 159 F.3d 534, 549 (Fed. Cir. 1998). Analysis The Veteran contends that he is entitled to higher initial disability ratings for generalized anxiety disorder. Having carefully considered the Veteran's contentions in light of the evidence of record and the applicable law, the Board finds that after resolving all reasonable doubt in the Veteran's favor his generalized anxiety disorder more nearly approximates the criteria for a 30 percent evaluation from the date of the award of service connection through December 30, 2007 and a 50 percent evaluation beginning December 31, 2007. See 38 C.F.R. §§ 4.3, 4.7 (2012). Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. § 4.1 (2012). Separate diagnostic codes identify the various disabilities. Where the claimant 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. This disability has been rated under 38 C.F.R. § 4.130, Diagnostic Code 9400, as 10 percent disabling for the period from May 1, 2006 through June 15, 2010; and as 30 percent disabling for the period beginning on June 16, 2010. Under Diagnostic Code 9400, which is governed by a General Rating Formula for Mental Disorders, disability ratings are assigned based on occupational and social impairment as a result of a mental disorder. See 38 C.F.R. § 4.130. When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation solely on the basis of social impairment. 38 C.F.R. § 4.126 (2012). The symptoms listed in 38 C.F.R. § 4.130 are not intended to constitute an exhaustive list, but rather 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). One factor for consideration is the Global Assessment of Functioning (GAF) score, which is a scale reflecting the "psychological, social, and occupational functioning in a hypothetical continuum of mental health-illness." Carpenter v. Brown, 8 Vet. App. 240, 242 (1995) (citing Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)). 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 school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, with some meaningful interpersonal relationships. Scores ranging from 51 to 60 reflect moderate symptoms (e.g., flat 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). Scores ranging from 41 to 50 reflect 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). 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 (2012). The competent medical evidence of record demonstrates that prior to December 31, 2007 the Veteran's generalized anxiety disorder was manifested by a blunted affect, anhedonia, anxiety attacks, being forgetful, and feeling nervous. These symptoms are more than transient and would likely result in an occasional decrease in work efficiency which is reflective of a 30 percent disability rating. See 38 C.F.R. § 4.130, General Rating Formula for Mental Disorders. Since December 31, 2007 the Veteran's anxiety disorder was manifested by blunted affect, depressed mood, anxiety attacks, panic attacks, feeling nervous, and at least one incident of poor grooming and hygiene. Importantly, frequent panic attacks are a symptom described as demonstrative of a 50 percent disability rating. See Id. As such, the Veteran's generalized anxiety disorder should be assigned a 30 percent evaluation from the date of the award of service connection through December 30, 2007 and a 50 percent evaluation beginning December 31, 2007. See Id. Prior to December 31, 2007, a rating in excess of 30 percent is not warranted. A 30 percent rating is warranted for 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, and/or mild memory loss (such as forgetting names, directions, recent events). 38 C.F.R. § 4.130, General Rating Formula for Mental Disorders. A 50 percent rating is warranted for 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; and/or difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130, General Rating Formula for Mental Disorders. The Veteran was afforded two VA mental disorders examinations in this case. The first took place in December 2006. During that examination, the Veteran reported feeling nervous and irritable, losing interest in himself, and being forgetful. As examples, the Veteran stated that he forgets why he went to the store or in a room, forgot to pay for gas, and forgets whether he took the garbage out. He denied forgetting daily episodes, well known phone numbers, getting lost while driving in familiar areas, leaving food on the stove to burn or leaving water running in the house. He lived with his wife and son and described their relationship as good. He was working as a city inspector in the water department and described the job as going "as good as can be expected." The examiner noted that the Veteran was capable of performing activities of daily living and did these routinely and independently. Mental status examination revealed that the Veteran was alert and oriented to person, information, and place. He provided an accurate history; his insight was adequate, affect blunted, and response latencies were normal. The Veteran demonstrated adequate attention and was not distractible. Spontaneous speech was fluent, grammatic, and free of paraphasias. He was also logical and goal directed and there was no pressured speech or grandiosity. There was no report of symptoms of depression other than low self esteem and anhedonia. The Veteran denied suicidal and homicidal ideation. He was not reporting panic disorder. There was no evidence of disorder in thought process or content. The examiner, a psychologist, entered an assessment of generalized anxiety disorder and assigned a GAF score of 60. The Veteran has also received VA outpatient treatment for his generalized anxiety disorder. Prior to December 31, 2007, the corresponding notes reflect the Veteran's complaints of feeling nervous, edgy, jittery, and anxious; arguing with his wife, having anxiety attacks, and being forgetful. Mental status examinations noted the Veteran's mood was okay, "up and down," and "the same;" and his affect was constricted or relaxed. He was dressed and groomed appropriately. He had normal speech, his thought process was linear (except on one occasion when it was described as somewhat perseverative on what he gets anxious about), and there was no evidence of suicidal ideation, homicidal ideation, or audio/video hallucinations. Cognition was intact; insight was described as fair or good; and judgment was described as good. During this period assessments included generalized anxiety disorder, anxiety disorder not otherwise specified, and rule out posttraumatic stress disorder (PTSD); GAF scores ranged from 60 to 65. Comparing the types of symptoms listed in the General Rating Formula for Mental Disorders as demonstrative of a higher 50 percent rating (this list is not exhaustive) to the evidence in this case the Board finds that the overall disability level more closely approximates a 30 percent rating during this period. During this period, the Veteran's speech has consistently been reported as normal, he was able to participate in treatment, and he was described as cooperative. Judgment was good and cognition was intact. While the Veteran reported being forgetful, he described this as forgetting why he went to the store or in a room, to pay for gas, and whether he took the garbage out. The reported memory impairment does not rise to the level of memory impairment contemplated by a 50 percent rating (e.g., retention of only highly learned material, forgetting to complete tasks). See 38 C.F.R. § 4.130, General Rating Formula for Mental Disorders. The Veteran has reported having anxiety attacks; however, the VA examiner specifically noted that he was not reporting panic disorder. Panic attacks, as opposed to anxiety attacks, are not shown. While there were some anxiety attacks during this period, a 30 percent rating contemplates weekly or less often panic attacks which would appear to be similar to more frequent anxiety attacks. See id. While the Veteran had some complaints related to anhedonia, symptoms similar to depressed mood are specifically contemplated in a 30 percent rating. See id. The Veteran worked throughout this period and by his account had a good relationship with his wife and son. The Veteran did have a constricted or blunted affect at times during this period, which can be demonstrative of a higher rating. However, when looking at the overall disability picture, his constricted affect does not elevate the severity of the disorder to the next higher level. The Board recognizes that in his December 2006 notice of disagreement, the Veteran reported having suicidal thoughts, obsessed behavior, terrible memory loss, daily panic attacks, and feeling irritable and violent for no reason. He reportedly had no friends and missed 4 to 5 days of work per month because of PTSD and anxiety. He made similar statements in his February 2007 substantive appeal. These statements are in conflict with multiple treatment reports which reflect normal behavior during observation, the ability to participate in an examination and provide background information, the Veteran's report of work going "as good as can be expected" and his denial of suicidal ideation, and are therefore afforded little probative value. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (Board can consider bias in lay evidence and conflicting statements of the veteran in weighing credibility). As explained above, after reviewing the Veteran's specific complaints related to anxiety attacks and memory loss, the symptoms are not similar to those demonstrative of a higher 50 percent disability rating. The GAF scores assigned during this period, ranging from 60 to 65, are also supportive of a 30 rather than a 50 percent disability rating. Scores in this range reflect mild to moderate symptomatology or difficulty in functioning which is in keeping with a 30 percent disability rating. See DSM-IV. Overall, the findings during this period more nearly approximate 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) than occupational and social impairment with reduced reliability and productivity. See 38 C.F.R. §§ 4.7, 4.130, General Rating Formula for Mental Disorders. It is important to note that the credible evidence during this period clearly reflects that the Veteran's behavior, self-care and conversation were normal. It appears that the Veteran was functioning satisfactorily during this period and it would not be appropriate to assign a rating reflective of more severe impairment. Since December 31, 2007, a rating in excess of 50 percent is not warranted. A 70 percent rating is warranted for 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); and/or inability to establish and maintain effective relationships. 38 C.F.R. § 4.130, General Rating Formula for Mental Disorders. Initially, the Board notes that during a VA mental health telephone encounter on December 31, 2007, the Veteran stated that he had been having more anxiety and panic attacks recently, with several a day at times. He described feeling shaky, having trouble breathing and chest pain, and wondering if he was having a heart attack. This is the first showing of symptoms similar to panic attacks more than once a week and reflects a worsening of the Veteran's symptomatology. During the Veteran's March 2008 hearing, he testified that he is nervous and has panic attacks - consisting of breathing hard, fast heart beat, and scary feeling - when he is around a crowd. Board Hearing Tr. at 4. He reported daily anxiety attacks. Board Hearing Tr. at 4. The Veteran also described depression, getting upset, forgetting where he leaves things, and occasionally having thoughts of hurting himself or someone else. Board Hearing Tr. at 4-6. The Veteran's wife testified that he has visible signs when having a panic attack, such as fussing, sweating, biting his tongue, and pushing his hands together. Board Hearing Tr. at 6. The Veteran's second VA mental disorders examination was in June 2010, and was performed by the same psychologist who examined him in December 2006. During the later examination, the Veteran reported having panic attacks consisting of an increased heart rate, shortness of breath, and feeling physically weak. He also stated that he is nervous, has no friends, is irritable and has difficulty sleeping and concentrating. He was living with his wife and described their relationship as good. He was working and reportedly was doing adequately on the job but was not able to work with others because of increased anxiety. According to the Veteran, he had excessive absences missing 20 or more days per year because he wakes up feeling anxious. The examiner noted that the Veteran was capable of performing activities of daily living but does not do these routinely. At the examination, the Veteran's grooming and hygiene were quite poor. Mental status examination revealed that the Veteran was alert and oriented. His insight was adequate and his affect blunted. Spontaneous speech was fluent, grammatic, and free of paraphasias. There was no pressured speech, grandiosity, irritability or restlessness. He was logical and goal directed. Immediate, recent and remote memories were all within normal limits. The Veteran did not report any symptoms of depression. He denied suicidal and homicidal ideation and passive thoughts of death. There was no evidence of disorder of thought process or content. The examiner's assessment was generalized anxiety disorder and he assigned a GAF score of 50. According to the examiner, the Veteran's symptoms had substantially worsened since the last time he was evaluated for compensation and pension. Currently, he was much more obsessive and experiencing periods of panic which were interfering with his ability to go out socially. The examiner stated that the Veteran's current psychiatric presentation was resulting in a moderate degree of impairment in social and occupational functioning and his overall level of disability was moderate. Since December 31, 2007, VA outpatient treatment records reflect the Veteran's complaints of feeling anxious and having anxiety and panic attacks. Mental status examinations noted the Veteran's mood was euthymic, depressed, down, anxious, and variable; his affect was reportedly normal ranged, depressed, and mildly constricted during this period. He was alert and oriented to person, place, time, and situation. His short term and long term memory was intact. He was described as being well groomed or having an adequate appearance. He had normal rate and tone of spontaneous speech, his thought process was linear and goal directed, and his thought content was appropriate. There was no evidence of suicidal or homicidal ideation. Insight and judgment were described as fair or good. Impulse control was described as good. There was no irritability or anger. The Veteran was depressed on some occasions but without depressive symptoms on others. During this period assessments included generalized anxiety disorder, rule out PTSD, recurrent major depressive disorder, and panic disorder; GAF scores ranged from 55 to 60. Comparing the types of symptoms listed in the General Rating Formula for Mental Disorders as demonstrative of a higher 70 percent rating (this list is not exhaustive) to the evidence in this case the Board finds that the overall disability level more closely approximates a 50 percent rating during this period. During this period, the Veteran has repeatedly been described as alert and oriented with normal speech. While the Veteran may have reported feeling irritable, no irritability was observed during examinations and treatment and there were no reported periods of violence. Likewise, the Veteran has not described any obsessional rituals. The Veteran does have panic attacks; however panic attacks occurring more than once a week are contemplated in a 50 percent disability rating. See 38 C.F.R. § 4.130, General Rating Formula for Mental Disorders. During his hearing, the Veteran described panic attacks when he is around a crowd. Board Hearing Tr. at 4. Near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively is not present in this case. The Veteran has testified to occasionally having thoughts of hurting himself; however, during examination and treatment he repeatedly denied suicidal ideation. Overall, suicidal ideation is not shown. Likewise, while when asked about hallucinations in September 2008, the Veteran indicated that it was like another voice talking to him, before and after this appointment he denied hallucinations on multiple occasions. Overall, the evidence reflects that the Veteran does not have hallucinations. The Veteran did have some problems with grooming and hygiene at his 2010 examination; however, VA treatment reports describe the Veteran as being well groomed or having an adequate appearance. Even if the Veteran's hygiene and grooming is poor on a regular basis, this does not negate the finding made by the examiner of only moderate symptomatology and moderate social and occupational impairment. While the Veteran may have some difficulty with relationships, the evidence does not reflect an inability to establish and maintain effective relationships. Notably, the Veteran is working and has described his relationship with his wife as good. The GAF scores assigned during this period, ranging from 50 to 60, are also supportive of a 50 rather than a 70 percent disability rating. As noted above, scores in this range reflect moderate to severe symptomatology or difficulty in functioning which is in keeping with a 50 percent disability rating. See DSM-IV. Overall, the findings more nearly approximate occupational and social impairment with reduced reliability and productivity than occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. See 38 C.F.R. §§ 4.7, 4.130, General Rating Formula for Mental Disorders. The Veteran is working, has a good relationship with his wife, is not in school, and has fair to good judgment. It is important to note that the examiner specifically noted that the Veteran's current psychiatric presentation was resulting in a moderate degree of impairment in social and occupational functioning and his overall level of disability was moderate. Moderate impairment and symptoms simply do not support a rating in excess of 50 percent for this period. The Board has also considered whether the Veteran's generalized anxiety disorder presents an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards such that referral to the appropriate officials for consideration of extra-schedular ratings is warranted. See 38 C.F.R. § 3.321(b)(1) (2012); Bagwell v. Brown, 9 Vet. App. 337, 338-39 (1996). The threshold factor for extra-schedular consideration is a finding that the evidence before VA presents such an exceptional disability picture that the available schedular evaluation for that service-connected disability is inadequate. See Fisher v. Principi, 4 Vet. App. 57, 60 (1993) ("[R]ating schedule will apply unless there are 'exceptional or unusual' factors which render application of the schedule impractical."). Here, the rating criteria reasonably describe the Veteran's disability level and symptomatology, and provide for consideration of greater disability and symptoms than currently shown by the evidence. It is noted that the symptoms listed in the rating criteria are demonstrative and not exhaustive; thus, the rating criteria actually consider many other psychiatric symptoms. See Mauerhan, 16 Vet. App. 436; see also 38 C.F.R. § 4.130. Overall, the occupational and social impairment caused by the Veteran's generalized anxiety disorder, as described above, are accounted for by the rating criteria. Thus, the assigned schedular evaluations are adequate. See Thun v. Peake, 22 Vet. App. 111, 115 (2008). Consequently, referral for extra-schedular consideration is not warranted. In reaching the conclusions above, the Board has considered the applicability of the benefit of the doubt doctrine. That doctrine is not further applicable as the preponderance of the evidence is against the Veteran's claims for ratings higher than those assigned by this decision. See 38 U.S.C.A. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). ORDER A 30 percent rating for generalized anxiety disorder is granted from May 1, 2006 to December 30, 2007, subject to the applicable laws and regulations governing the payment of monetary benefits. A 50 percent rating for generalized anxiety disorder is granted from December 31, 2007, subject to the applicable laws and regulations governing the payment of monetary benefits. ____________________________________________ Laura H. Eskenazi Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs