Citation Nr: 1306689 Decision Date: 02/27/13 Archive Date: 03/01/13 DOCKET NO. 10-40 998 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Winston-Salem, North Carolina THE ISSUE Entitlement to an increased rating for service-connected anxiety disorder, not otherwise specified, currently evaluated as 30 percent disabling. ATTORNEY FOR THE BOARD Tanya A. Smith, Counsel INTRODUCTION The Veteran served on active duty from July 1978 to July 1981 and September 1981 to June 2005. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. FINDING OF FACT The Veteran's symptoms have no significant effect on his occupational functioning, and limited effect on his social functioning; the overall impairment caused by his symptoms is moderate. CONCLUSION OF LAW The criteria for a rating in excess of 30 percent for anxiety disorder, not otherwise specified, have not been met. 38 U.S.C.A. § 1155 (West 2002 & Supp. 2012); 38 C.F.R. §§ 4.1-4.14, 4.130, Diagnostic Code 9413 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION I. VA's 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. 2011)) 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 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; and what subset of the necessary information or evidence, if any, the VA will attempt to obtain. 38 U.S.C.A. § 5103(a) (West 2002 & Supp. 2011); 38 C.F.R. § 3.159 (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). 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). Moreover, such notice errors may instead be cured by issuance of a fully compliant notice, followed by readjudication of the claim. See Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006) (reaffirming that the issuance of a fully compliant VCAA notification followed by readjudication of the claim, such as an SOC or SSOC, is sufficient to cure a timing defect). In an October 2009 VCAA letter sent to the Veteran prior to the appealed January 2010 rating decision, the RO provided notice to the Veteran regarding what information and evidence is needed to substantiate the claim as well as what information and evidence must be submitted by the Veteran and the types of evidence that will be obtained by VA. The 2009 VCAA letter advised the Veteran how disability evaluations and effective dates are assigned, and the type of evidence that impacts those determinations. The Board finds that VA's duty to notify has been met. The record also reflects that VA has made reasonable efforts to assist the Veteran in the development of his claim. Specifically, the information and evidence that have been associated with the claims file includes VA and private treatment records. The Veteran was also afforded a VA examination in December 2009. The Board finds the VA examination report is adequate for evaluation purposes because the examiner reviewed the claims file, considered the contentions of the Veteran, and provided the information necessary to evaluate the Veteran's disability under the applicable rating criteria. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Also, there is no indication in the records or in the Veteran's statements that there has been any material change in his condition since the last VA examination. For this reason, the Board finds that there is sufficient evidence to evaluate the disability for the entire appeal period. See VAOPGCPREC 11-95 (noting that a claim need not be remanded solely because of the passage of time since an otherwise adequate VA examination was conducted); see also Palczewski v. Nicholson, 21 Vet. App. 174, 182-83 (2007) (providing that a new VA examination is not required based on the mere passage of time). The Board has also reviewed the Veteran's paperless Virtual VA claims file, a highly secured electronic repository that is used to store and review documents involved in the claims process. It does not contain any evidence not already in the paper claims folder or considered by the RO. 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, submitting statements setting forth his contentions and identifying relevant evidence. Thus, he has been provided with a meaningful opportunity to participate in the claims process and has done so. The Board finds that VA's duty to assist has been met. II. General Laws and Regulations 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). Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1 (2012). 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 (2012); resolving any reasonable doubt regarding the degree of disability in favor of the claimant, 38 C.F.R. § 4.3 (2012); 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 (2012); 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 (2012). See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider a veteran's medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31, 35 (1999). A veteran may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). The analysis in the following decision is therefore undertaken with consideration of the possibility that different ratings may be warranted for different time periods. Under the General Rating Formula for Mental Disorders, a 30 percent rating contemplates 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 mild memory loss (such as forgetting names, directions, recent events). 38 C.F.R. § 4.130, Diagnostic Code 9413 (2012). A 50 percent rating contemplates 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 compete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130, Diagnostic Code 9413 (2012). A 70 percent rating contemplates 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); inability to establish and maintain effective relationships. 38 C.F.R. § 4.130, Diagnostic Code 9413 (2012). A 100 percent rating is warranted for 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. 38 C.F.R. § 4.130, Diagnostic Code 9413 (2012). The factors listed in the rating formula are "examples" of conditions that warrant particular ratings as the use of the term "such as" 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. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). Considerations in evaluating a mental disorder include the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and a veteran's capacity for adjustment during periods of remission. 38 C.F.R. § 4.126(a) (2012). The evaluation must be based on all evidence of record that bears on occupational and social impairment rather than solely on an examiner's assessment of the level of disability at the moment of the examination. Id. Although the extent of social impairment is a consideration in determining the level of disability, the rating may not be assigned solely on the basis of social impairment. 38 C.F.R. § 4.126(b) (2012). One factor for consideration is the GAF score, which is based on a scale reflecting the "psychological, social, and occupational functioning in a hypothetical continuum of mental health-illness." See Carpenter v. Brown, 8 Vet. App. 240, 242 (1995); see also Richard v. Brown, 9 Vet. App. 266, 267 (1996) (citing the American Psychiatric Association's DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (4th ed.), p.32.). GAF scores ranging from 61 to 70 reflect some mild symptoms (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, and has some meaningful interpersonal relationships. Scores ranging from 51 to 60 reflect more 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). When it is not possible to separate the effects of the service-connected condition and the nonservice-connected condition, VA regulations at 38 C.F.R. § 3.102, which require that reasonable doubt on any issue be resolved in the appellant's favor, dictate that such signs and symptoms be attributed to the service-connected condition. See Mittleider v. West, 11 Vet. App. 181, 182 (1998). III. Increased Rating In a July 2007 rating decision, the RO granted service connection for anxiety disorder, not otherwise specified, and assigned a 30 percent rating effective July 1, 2005, the day following the Veteran's discharge from service. The evidence considered at that time included VA treatment records dated to April 2007. The Veteran filed a claim for an increased rating in May 2008. The RO continued the 30 percent rating in an October 2008 rating decision. The evidence considered at that time included VA treatment records dated to August 2008. In September 2009, the Veteran filed a claim for service connection for posttraumatic stress disorder (PTSD). In the January 2010 rating decision, the RO denied the PTSD claim (on the bases of no confirmed diagnosis of PTSD and no verified stressor), and adjudicated and denied a rating in excess of 30 percent for the service-connected anxiety disorder. The Veteran only appealed the denial of the rating issue. In the Veteran's February 2010 notice of disagreement, he contended that because the December 2009 VA examiner and his treating physician made findings that his anxiety disorder symptoms caused moderate impairment, he was entitled to either a 70 percent or 100 percent disability rating. The Veteran maintained that the RO impermissibly disregarded the findings of the medical examiners. The Veteran noted that the VAMC had been treating him for three years, had conducted therapy with him, had a long and on-going clinical relationship with him, and had made a finding that he had moderate impairment. The Veteran referenced another Board decision in which the Board recognized the probative value of a treating physician who had a long ongoing relationship with the veteran. By way of history, the Board observes that the Veteran underwent his initial VA examination in July 2007. The examiner provided an Axis I diagnosis of anxiety disorder and assigned a GAF score of 65. The examiner indicated that the Veteran's symptoms were compatible with the criteria associated with a 30 percent rating. The examiner observed that occupationally the Veteran was doing well, and that he was more impaired socially. The Veteran's phobias included heights, high floors, being around a lot of people, and driving in any situation (unless he has to). VA treatment records dated to August 2008 indicated that the Veteran had PTSD symptoms that were evidenced by recurrent intrusive thoughts of the traumatic event experienced, recurrent nightmares, irritability, hypervigilence, and social isolation. The Veteran was also noted to have "panic disorder with agoraphobia/PTSD." The Veteran underwent another VA examination in August 2008. The VA examiner (W.B.) reported that the Veteran complained of anxiety, isolative behavior, avoidance of heights, sleep disturbances, fair concentration, sadness at times, and diminished energy and interest. His temper was somewhat better and he denied any suicide attempts or panic attacks. He claimed his medication was not helping him. He had worked full-time for the past three years at a craft shop at Fort Bragg. He had not missed any work. He was able to perform the activities of daily living and chores around the house. He had a few friends, and he liked to fish. He had a few recreational and leisure pursuits, but not many. His parents were living and were described as "nice." He had only been married once and he lived with his wife. He had three children and was close to two of them. On mental status examination, the Veteran was alert and oriented times three. He was casually and appropriately dressed. He displayed no loosened associations or flights of ideas. There was no impairment of thought processes or communication. His insight and judgment appeared to be adequate. There were no bizarre motor movements or tics. His mood was tense but cooperative and friendly, and his affect was appropriate. He had no current homicidal or suicidal ideations or intent. His memory, both remote and recent, appeared to be adequate. On Axis I, the examiner provided a diagnosis of anxiety disorder, not otherwise specified, and assigned a GAF score of 53. The examiner maintained that the Veteran had moderately severe limitation of activities, and noted that there were many specific situations that the Veteran had to avoid because of his anxiety symptoms, which greatly diminished the quality of his life. The examiner noted that the Veteran's degree of social and occupational impairment was moderately severe. In connection with the current appeal, a September 30, 2009 inquiry for updated VA treatment records generated records from September 2008 to July 2009. The Veteran was noted to have "panic disorder with agoraphobia/PTSD." He complained of feelings of "up" and "down," sleep disturbances, intermittent depression, heights avoidance, and anxiety. He denied any suicidal or homicidal ideations. On mental status examinations, he was alert and oriented to place, person, and time. He was friendly and cooperative. He was tense and did not look depressed. His affect was appropriate or showed "mild anxiety." He was negative for auditory hallucinations, thought disorder, visual hallucinations, and paranoid ideations. He exhibited good impulse control, judgment, and insight. He worked from 1 pm to 10 pm, and he went to the gym three times a week. The Veteran's PTSD symptoms continued to be evidenced by recurrent intrusive thoughts of the traumatic experience, recurrent nightmares, flashbacks, irritability, hypervigilence, and social isolation. In July 2009, the Veteran claimed that he still had panic attacks around a lot of people and traffic. The Veteran underwent a VA examination in December 2009 which was conducted by the same examiner that conducted the August 2008 VA examination. The Veteran reported that his symptoms had worsened. The Veteran complained that he did not want to go anywhere and that he had trouble remembering. He further complained of sleep disturbances, concentration problems, anxiety 85 percent of the time, short temper, and diminished interests and energy. He was not sad but he cried two to three times a week. He denied any suicide attempts or panic attacks. He went to the VAMC every three months. He claimed his medications did not help. He continued to work full time at Fort Bragg as a civil servant. He was able to perform the activities of daily living and chores around the house. He continued to live with his wife. He had one friend and limited recreational and leisure pursuits. He liked to fish. His parents remained living and he continued to describe them as "nice." He maintained that he was close to his three children. On mental status examination, the Veteran was alert and oriented times three. He was cooperative, and he was causally and appropriately dressed. He did not display any lucid dissociations or flight of ideas. There were no delusions, hallucinations, ideas of reference, or suspiciousness. There was no impairment of thought processes or communication. His insight and judgment appeared to be adequate. There were no bizarre motor movements or tricks. His mood was calm, and his affect was appropriate. He had no homicidal or suicidal ideations or intent, and no history of probation or parole. His memory, both remote and recent, appeared to be adequate. On Axis I the examiner provided a diagnosis of anxiety disorder, not otherwise specified, and assigned a GAF score of 53. The examiner maintained that the Veteran had moderate and persistent symptoms of anxiety disorder with no remissions. The examiner noted that the Veteran's psychiatric symptoms were a result of "some" impairment of social functioning. Lastly, records from Southern Regional Area Health Education dated to December 2009 show that in June 2009, on a review of systems, the Veteran denied depression and anxiety. In February, June, and December of 2009, on a review of systems, the Veteran was alert and cooperative, and had normal mood and affect, attention span, and concentration. At the outset, the Board observes that in addition to anxiety disorder, the Veteran has been noted to have PTSD, a disorder in which service connection was denied. In regard to symptoms that have been attributed to PTSD (intrusive thoughts, nightmares, flashbacks, irritability, hypervigilence, and social isolation), to the extent symptoms of irritability and social isolation may overlap with symptoms associated with the Veteran's service-connected anxiety disorder, as there is no medical evidence that separates the effects of the service-connected condition and the nonservice-connected condition, such signs and symptoms will be attributed to the service-connected condition. See Mittleider, 11 Vet. App. at 182. The Board finds that the currently assigned 30 percent rating most closely reflects the level of social and occupational impairment caused by the Veteran's anxiety disorder. While the Veteran contends that his symptoms have worsened since the 2008 VA examination, the Board finds that this assertion is not borne out by the current medical findings. The Veteran's service-connected anxiety disorder is primarily manifested by anxiety that impedes his ability to act in specific situations (e.g., avoidance of heights, etc.); however, his symptoms have no significant effect on the Veteran's occupational functioning. The Veteran also complains of intermittent depression, bouts of crying, feeling "up" and "down," no desire to go anywhere, and diminished interests and energy, but these symptoms similarly have no significant effect on the Veteran's occupational functioning. Despite the Veteran's anxiety and depression, he works full-time and has retained such continuous employment for the past four years (since his discharge from service in 2005). The Veteran has not indicated that he misses time from work on account of his symptoms. The Veteran is able to leave his home and go to work. Thus, the Veteran is able to establish and maintain effective work relationships. As for the Veteran's social functioning, his anxiety and depression are not so severe as to preclude all recreational and leisure pursuits but rather the impact on his functioning is to limit such pursuits. The Veteran reported that he still fished, and he enjoyed going to the gym three times a week. Thus, the Veteran is able to leave home and go fish as well as be in a public place. The Veteran also reported that he had one friend. This shows that the Veteran is able to establish and maintain effective social relationships-the number of friends is irrelevant; it is the ability to establish such a relationship that is important. In addition, the Veteran's irregular reporting of the presence of panic attacks (Compare July 2009 VA outpatient treatment record (positive) with December 2009 VA examination report (negative)) suggests that these attacks occur with less frequency than the frequency associated with a higher rating. Symptoms of anxiety, including panic attacks, and depression are contemplated in the currently assigned rating. The effects of these symptoms on the Veteran's functioning do not result in a level of impairment associated with the higher disability ratings. The Veteran also complains of sleep disturbances but the impact on his occupational functioning is not cognizably significant as the Veteran has never indicated that he is habitually late to work or that the quality and quantity of his work is impacted on account of such disturbances. Rather, the Veteran has reported that he works from 1 pm to 10 pm which tends to show his reliability and productivity in the absence of affirmative complaints to the contrary. It is not just the presence of sleep disturbances but rather the effect of the symptom exhibited. The currently assigned rating contemplates chronic sleep impairment. The Veteran's symptoms as previously described do not suggest a severity greater than that contemplated by the current rating. The Veteran complains of trouble remembering. The currently assigned rating contemplates mild memory loss. The Veteran's symptoms do not suggest a severity greater than that contemplated by the current rating as the VA examiner indicated that the Veteran's memory, both remote and recent, appeared to be adequate. The Veteran complains of concentration problems. VA treatment records, private treatment records, and the 2009 VA examiner indicated that on mental status examination, no impairment of thought processes or communication was displayed. The Veteran was also noted to have a normal attention span. Thus, his symptoms clearly do not result in a level of impairment associated with a 50 percent rating or higher. The Veteran complains of a short temper. The 2009 VA examination report shows the Veteran denied being on probation or parole. (The Veteran reported the same in 2008 and no current history of violence/assaultiveness in 2007. See August 2008 and July 2007 VA examination reports.) The Veteran has also denied homicidal ideations, and the VA examiner indicated that the Veteran's judgment and insight appear to be adequate. The VA treatment records note that the Veteran exhibits good impulse control. Again, the Veteran has had continuous full employment. Thus, while the Veteran has a short temper, its degree is not severe enough to affect the Veteran's social and occupational functioning in any significant way. As noted above, the Veteran contends that he is entitled to a 70 or 100 percent rating, and he does not dispute that the degree of his impairment is moderate. Unfortunately, however, he is incorrect in regard to the appropriate rating that can be assigned in connection with such moderate impairment. The Veteran has not described and the medical evidence of record does not otherwise show impairment analogous to the type of impairment associated with these higher ratings, much less a 50 percent rating. Rather, the 2009 VA examiner indicated that the Veteran had moderate symptoms of anxiety disorder and that the Veteran's symptoms were a result of "some" impairment of social functioning. The GAF score 53 reflects moderate impairment. Here, the Board finds that the assignment of a 30 percent rating is appropriate for symptoms that result in a level of occupational and social impairment that is moderate. Accordingly, the Veteran is not entitled to a rating in excess of 30 percent for his service-connected anxiety disorder. In so finding, the Board notes that it considered all of the Veteran's complaints. The Veteran is competent to report on symptoms and credible in his belief that the severity of his symptoms warrant a higher rating. His competent and credible lay evidence, however, is outweighed by competent and credible medical evidence that evaluates the true extent of his psychiatric impairment based on objective data coupled with the lay complaints. In this regard, the Board notes that the VA examiners and treating physicians have the training and expertise necessary to administer the appropriate tests for a determination on the type and degree of the impairment associated with the Veteran's complaints. For these reasons, greater evidentiary weight is placed on the treatment records and examination findings in regard to the type and degree of impairment. The Veteran's anxiety disorder has not been shown to be manifested by greater than the criteria associated with the rating assigned under the designated diagnostic code during any portion of the appeal period. Accordingly, staged ratings are not in order and the assigned rating is appropriate for the entire period of the Veteran's appeal. Hart v. Mansfield, 21 Vet. App. 505 (2007). Consideration has also been given regarding whether the schedular evaluation is inadequate, thus requiring that the RO refer a claim to the Under Secretary for Benefits or to the Director, Compensation and Pension Service, for consideration of "an extra-schedular evaluation commensurate with the average earning capacity impairment due exclusively to the service-connected disability or disabilities." 38 C.F.R. § 3.321(b)(1) (2012); Barringer v. Peake, 22 Vet. App. 242, 243-44 (2008) (noting that the issue of an extraschedular rating is a component of a claim for an increased rating and referral for consideration must be addressed either when raised by the veteran or reasonably raised by the record). In determining whether an extra-schedular evaluation is for consideration, the Board must first consider whether there is an exceptional or unusual disability picture, which occurs where the diagnostic criteria do not reasonably describe or contemplate the severity and symptomatology of a veteran's service-connected disability. See Thun v. Peake, 22 Vet. App. 111, 115 (2008). If there is an exceptional or unusual disability picture, the Board must next consider whether the disability picture exhibits other factors such as marked interference with employment and frequent periods of hospitalization. Thun, 22 Vet. App. at 115-16. When those two elements are met, the appeal must be referred for consideration of the assignment of an extra-schedular rating. Otherwise, the schedular evaluation is adequate, and referral is not required. 38 C.F.R. § 3.321(b)(1)(2012); Thun, 22 Vet. App. at 116. The rating criteria in this case are not inadequate. An evaluation in excess of the assigned rating is provided for certain manifestations of the service-connected disability, but the evidence reflects that those manifestations are not present in this case. The Veteran primarily complains of anxiety resulting in avoidance behavior and depression resulting in a limitation of activities. These and all of the Veteran's complained of symptoms are not exceptional or unusual features of a psychiatric disability and are symptoms contemplated in the rating criteria and related regulations. As the Board finds that the Veteran's disability picture is contemplated by the rating schedule, the inquiry ends and the Board need not consider whether the disability picture exhibits other related factors such as marked interference with employment and frequent periods of hospitalization. Accordingly, referral for consideration of an extra-schedular rating is not warranted. Finally, the Board also recognizes that the Court of Appeals for Veterans Claims has clarified that a claim for a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities exists as part of a claim for an increase (whether in an original claim or as part of a claim for increased rating). Rice v. Shinseki, 22 Vet. App. 447 (2009). A TDIU claim is considered reasonably raised when a veteran submits medical evidence of a disability, makes a claim for the highest rating possible, and submits evidence of service-connected unemployability. See Roberson v. Principi, 251 F.3d 1378, 1384 (Fed. Cir. 2001). The Veteran has not specifically contended that his anxiety disorder renders him unemployable and the evidence does not otherwise suggest that this is the case. Indeed, as discussed at length above, the Veteran is employed full-time. For these reasons, the Board finds that a claim for TDIU has neither been raised by the Veteran nor by the record. In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. The preponderance of the evidence, however, is against the Veteran's claim and so that doctrine is not applicable. See 38 U.S.C.A. § 5107(b) (West 2002); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). ORDER A rating in excess of 30 percent for service-connected anxiety disorder, not otherwise specified, is denied. ____________________________________________ K. OSBORNE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs