Citation Nr: 18142573 Decision Date: 10/16/18 Archive Date: 10/16/18 DOCKET NO. 16-19 225A DATE: October 16, 2018 ORDER Between May 24, 2015 and December 9, 2016, entitlement to an initial rating of 30 percent, but no greater, for a service-connected insomnia disability is granted. After December 9, 2016, entitlement to a rating in excess of 50 percent for a service-connected unspecified trauma disorder with insomnia (claimed as posttraumatic stress disorder (PTSD)) is denied. FINDINGS OF FACT 1. Between May 24, 2015 and December 9, 2016, the Veteran’s service-connected insomnia was manifested as occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks; occupational and social impairment with reduced reliability and productivity is not shown prior to December 9, 2016. 2. After December 9, 2016, the Veteran’s service-connected unspecified trauma disorder with insomnia was manifested as occupational and social impairment with reduced reliability and productivity; occupational and social impairment with deficiencies in most areas is not shown. CONCLUSIONS OF LAW 1. Between May 24, 2015 and December 9, 2016, the criteria have been met for an initial rating of 30 percent for the Veteran’s service-connected insomnia. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 4.1-4.14, 4.21, 4.126, 4.130, Diagnostic Code 9440 (2017). 2. After December 9, 2016, the criteria are not met for a rating greater than 50 percent for the Veteran’s service-connected unspecified trauma disorder with insomnia. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 4.1-4.14, 4.21, 4.126, 4.130, Diagnostic Code 9413 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably in the United States Army from February 2010 to May 2015. The Veteran’s certificate of release from active duty (DD214) reflects that his military specialty was wheeled vehicle mechanic (91B20), which was accompanied by multiple driver and mechanic badges. In May 2016, the Veteran perfected his increased rating claims for insomnia. Using the improper VA Form 21-0958, the Veteran adequately identified the claim(s) that he wished to appeal. Specifically, the Veteran posited that, “(t)he VA has erred in the 10% rating assigned for my insomnia due to the fact that they are evaluating it as a mental health disability and the fact that I have persistent daytime hypersomnolence. I believe that I warrant a higher rating.” The Board finds that the Veteran, while using the improper form, conveyed all the information necessary to perfect his appeal on the insomnia issues(s) addressed below. 38 C.F.R. § 20.202 (2017). In Percy v. Shinseki, 23 Vet. App. 37 (2009), the U.S. Court of Appeals for Veterans Claims (Court or CAVC) held that the 60-day period in which to file a substantive appeal is not jurisdictional, and thus, VA may waive any question of timeliness in the filing of a substantive appeal. In that case, by treating a disability rating matter as if it were part of the Veteran’s timely filed substantive appeal for more than five years, VA had waived any objections it might have had to the timeliness of the appeal with respect to the matter. In this matter, while not on the appropriate form, the AOJ accepted the May 2016 submission as a substantive appeal. Accordingly, the Board will proceed with appellate review of the case. INCREASED RATINGS Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities (Rating Schedule), which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2017). The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. If there is a question as to which evaluation to apply to the Veteran’s disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of any disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the 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, 34 (1999). The Board must also assess the competence and credibility of lay statements and testimony. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). In increased rating claims, a Veteran’s lay statements alone, absent a negative credibility determination, may constitute competent evidence of worsening, at least with respect to observable symptoms. See Vazquez-Flores v. Shinseki, 24 Vet. App. 94, 102 (2010), rev’d on other grounds by Vazquez-Flores v. Shinseki, 580 F.3d 1270, 1277 (Fed. Cir. 2009). The Veteran is uniquely suited to describe the severity, frequency, and the duration of the symptoms that accompany his service-connected insomnia. See Falzone v. Brown, 8 Vet. App. 398 (1995); Heuer v. Brown, 7 Vet. App. 379 (1995). The Board has thoroughly reviewed all the evidence in the Veteran’s claims file. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, all of the evidence submitted by the Veteran or on his behalf. See Gonzalez v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record, but does not have to discuss each piece of evidence). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claims. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the Veteran). 2. Between May 24, 2015 and December 9, 2016, entitlement to an initial rating of 30 percent, but no greater, for a service-connected insomnia disability is granted. In February 2015, while still on active duty in the United States Army, the Veteran submitted his 21-526EZ. Therein, the Veteran initiated his entitlement claim for service connection for an insomnia disorder. The Veteran separated from the military on May 23, 2015. Generally, the effective date of an award of service connection, based either on an original claim or a claim reopened after final disallowance, may not be earlier than the date of receipt of claim or, if the claim is received within one year of separation from service, the day following the date of discharge or release. 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400. Consequently, the earliest date upon which the Veteran may be compensated for his service-connected insomnia is May 24, 2015. The Veteran’s insomnia was initially rated under 38 C.F.R. § 4.130, Diagnostic Code (DC) 9440. The relevant criteria authorize a 10 percent rating for occupational and social impairment due to mild and transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication. 38 C.F.R. § 4.130. A 30 percent rating is authorized 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; mild memory loss (such as forgetting names, directions, recent events). Id. 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; difficulty in establishing effective work and social relationships. Id. When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran's capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment, rather than solely on the examiner’s assessment of the level of disability at the moment of the examination. 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. The use of the term “such as” in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). In Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013), the U.S. Court of Appeals for the Federal Circuit stated that “a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration.” “Although the veteran’s symptomatology is the primary consideration, the regulation also requires an ultimate factual conclusion as to the veteran’s level of (occupational and social) impairment.” Id. In March 2015, the Veteran’s service treatment records (STRs) were associated with his claims file. Therein, on February 3, 2015, the following notation was added to the Veteran’s STRs, “24-year-old active duty service member reported a three-year history of sleep problems consistent with insomnia in conjunction with reports snoring and excessive daytime somnolence. Symptoms recognized approximately 2 years ago. Epworth 17/24. Insomnia severity index 18/28. Primary sleep problems include moderate initiation insomnia and severe terminal insomnia.” A separate notation reported that, “(p)atient counseled on the importance of safety in light of active sleep problems with symptoms of fatigue and problems concentrating. Patient instructed to inform command of his active sleep problems so that they are aware of possible impairment. Pt given instructions about avoiding activities while drowsy/sleepy such as driving, using weapons and equipment which may lead to injury or death to self or others. (emphasis added)” In March 2015, the Veteran underwent a VA examination to address the nature and severity of any currently endured insomnia disorder. In the resultant examination report, Dr. JML confirmed the presence of an insomnia disorder that conformed to the DSM-5 criteria. At that time, Dr. JML opine that, “a mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupation and social function or to require continuous medication.” Also, Dr. JML observed that, “(the Veteran) was recently discharged from the Army and works as a janitor at a concrete plant. He has been there 3 weeks and this is his first job since he got out of the service.” Also, Dr. JML observed that, “(the Veteran) did not report problem other than insomnia during interview. He is not suicidal/depressed or anxious. He was cooperative, polite.” In November 2015, the Veteran submitted his notice of disagreement (NOD) with AOJ’s rating decision. Therein, the Veteran posited that, “VA has rated the insomnia as a symptom of my S/C Chronic Adjustment Disorder and that since I am not on medication, a 0% rating was assigned. I believe this disability should be rated as its own due to the fact that I am being treated with Temazepam by my doctor.” The Board acknowledges the Veteran’s contention, regarding a desire to be rated separately for insomnia and sleep impairment under an acquired psychiatric disability. However, the rule against pyramiding prohibits compensating a Veteran twice for the same symptoms, regardless of diagnosis. See 38 C.F.R. §§ 4.14. The Board has considered all of the Veteran’s mental health symptomatology in determining the appropriate rating for his service connected unspecific traum related disorder with insomnia. In December 2015, VA received the Veteran’s treatment notations, which were generated by the Saint Francis Health System. Therein, on October 4, 2015, Dr. GWC observed, “Long HS of significant Insomnia—for 3 yrs—army felt it was due to PTSD—gets little sleep and feels exhausted all the time and it now effecting his job. Cannot drive far or feels like he could fall asleep . . ..” At that time, Dr. GWC prescribed the Veteran Temazepam 30 mg for his insomnia symptoms. In May 2016, the Veteran perfected his appeal with a VA Form 21-0958. Therein, the Veteran posited that, “VA has erred in the 10% rating assigned for my insomnia due to the fact that they are evaluating it as a mental health disability and the fact that I have persistent daytime hypersomnolence. I believe that I warrant a higher rating.” In December 2016, the Veteran supplied sworn testimony to a decision review officer (DRO) at the Muskogee, OK Regional Office. During the DRO hearing, the Veteran revealed that, “(a)s soon as I got out of the military, I felt like it was harder for me to fall asleep, stay asleep, and get a full eight hours of sleep. It was just...it was affecting my work . . . my life, and relationships with my family. So, I knew I needed to do something about it. So, I went and saw a doctor, and I’m now on medications for...for my insomnia.” The Veteran also testified that, “I have, only just recently, just because I couldn’t fall asleep, and I was just...I was just physically exhausted. I’ve called in sick, I think, a couple times this year so far.” Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also mean statements conveying sound medical principles found in medical treatises. It would also include statements contained in authoritative writings such as medical and scientific articles and research reports or analyses. See 38 C.F.R. § 3.159 (a)(1). Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. See 38 C.F.R. § 3.159 (a)(2). Competency of evidence differs from weight and credibility. The former is a legal concept determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (“although interest may affect the credibility of testimony, it does not affect competency to testify”). After deliberate and careful consideration of the Veteran’s claims file, the board finds that a 30 percent disability rating is warranted for the Veteran’s insomnia for the period between May 24, 2015 and December 9, 2016. Importantly, in February 2015, the Veteran was directed to inform his chain-of-command about his insomnia and the danger it posed on his duties as soldier, to include driving a vehicle. In December 2015, after the Veteran separated from the Army, Dr. GWC noted a long history of insomnia, which continued to limit the Veteran’s ability to operate a vehicle. In December 2016, the Veteran competently and credibly supplied sworn testimony that his insomnia negatively impacted work and familial relationships. The Veteran also competently and credibly testified that his insomnia had resulted in employment absence. The Board finds, for the claim period between May 24, 2015 and December 9, 2016, the evidence reflects occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupation tasks. Ultimately, the preponderance of the evidence favors the Veteran’s claim for entitlement to a 30 percent disability rating for his service-connected insomnia for the period between May 24, 2015 and December 9, 2016. Accordingly, the Board will assign a 30 percent disability rating for this period. In reaching this determination, the Board acknowledges that VA is statutorily required to resolve the benefit of the doubt in favor of the Veteran when there is an approximate balance of positive and negative evidence regarding the merits of an outstanding issue. This doctrine of reasonable doubt is applicable in this case because the preponderance of the evidence favors the Veteran’s increased rating claim for the period between May 24, 2015 and December 9, 2016. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990); 38 U.S.C. § 5107(b). The Board also finds that a 50 percent rating is not warranted for the Veteran’s service-connected insomnia for the period between May 24, 2015 and December 9, 2016. After careful consideration the evidence for the applicable claim period, the Board finds that the Veteran did not demonstrate occupational and social impairment with reduced reliability and productivity. While reaching this conclusion, the Board observes that the Veteran has not demonstrated the particular symptoms necessary to warrant a 50 percent disability rating under § 4.130 criteria. See Vazquez-Claudio, 713 F.3d at 118. Notably, the March 2015 examiner did not state that the Veteran’s symptoms were productive of occupational and social impairment with reduced reliability and productivity as contemplated by a 50 percent evaluation. While the Veteran had chronic sleep impairment, the March 2015 examination report does not show that the Veteran had 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. The Board notes that the Veteran and his representative have not raised any other issues, nor have any other issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). 3. After December 9, 2016, entitlement to a rating in excess of 50 percent for a service-connected unspecified trauma disorder with insomnia (claimed as PTSD) is denied. In December 2016, the Veteran submitted his VA Form 21-526EZ. Therein, the Veteran initiated his claim for entitlement to service connection for PTSD. In a July 2017 rating decision, the AOJ updated the Veterans’ previous insomnia diagnosis to reflect a recent acquired psychiatric diagnosis for an unspecified trauma disorder with insomnia. The updated diagnosis for an unspecified trauma disorder was available because VA confirmed the stressor incident of a rocket attack while the Veteran was deployed to Camp Gary Owen, Iraq. The AOJ assigned a 50 percent rating based on the date the Veteran submitted his PTSD claim. As noted previously, under DC 4913, the currently assigned 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 complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing effective work and social relationships. Id. 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 worklike setting); inability to establish and maintain effective relationships. Id. 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. Id. Again, when evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran's capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment, rather than solely on the examiner’s assessment of the level of disability at the moment of the examination. 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. The use of the term “such as” in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan, 16 Vet. App. 436. As noted earlier, in Vazquez-Claudio, 713 F.3d at 118, the U.S. Court of Appeals for the Federal Circuit stated that “a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration.” “Although the veteran's symptomatology is the primary consideration, the regulation also requires an ultimate factual conclusion as to the veteran’s level of (occupational and social) impairment.” Id. In February 2017, VA received the Veteran’s treatment notations, which were generated by the Saint Francis Health System. Therein, in January 2016, Dr. GWC noted that, “(the Veteran) having more difficulty w/ sleep recently, despite the Temazepam . . ..” In March 2016, Dr. GWC noted that, “(h)as been having more trouble sleeping recently despite Temazepam 30mg—having trouble getting to sleep—will lay awake for long period of time occasionally . . .. If this doesn’t help, will try a different sleeping medication.” In March 2017, the Veteran underwent a VA examination to determine the nature and severity of any currently endured acquired psychiatric disability. In the resultant examination report, Dr. LV diagnosed an unspecified trauma disorder, utilizing the DSM-5 criteria. Within the occupational history, Dr. LV observed that, “(h)e served 5 years in the Army. He served a 4 month tour in Iraq in 2011. In Iraq, he was a recovery specialist. He’s currently working a cement plant, in a 4 person clean up crew. He’s been at the plant for about 2 years.” When discussing the Veteran’s stressor incident, Dr. LV reported, “in Iraq, he was hit with 3 rockets, at his FOB, one being about 200 meters from him.” Among the Veteran’s demonstrated symptoms, Dr. LV reported depressed mood, anxiety, suspiciousness, chronic sleep impairment, disturbance of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. Within the DSM-5 criteria, Dr. LV observed the following: avoidance of or efforts to avoid external remainders, markedly diminished interest or participation in significant activities, feelings of detachment or estrangement from others, irritable behaviors and angry outbursts, hypervigilance, exaggerated startle response, and sleep disturbance. Also, Dr. LV noted that the aforementioned disturbances led to “clinically significant distress or impairment in social, occupation, or other impart areas of functioning.” Ultimately, Dr. LV opined that the Veteran demonstrated “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupation tasks, although generally functioning satisfactorily with normal routine behavior, self-care and conversation.” In June 2017, the Veteran’s treatment notations from Tulsa Outpatient Clinic were associated with the electronic claims file. Therein, on April 8, 2017, a VA provider supplied a mental health note. The VA provider reported that, “(she) spent time with veteran discussing his anxiety. He continues to be highly anxious or agitated in public. He is sleeping about 3 to 4 hours of sleep. Veteran reports he is easily agitated about insignificant things which at times causes marital strife. Veteran continues to have low energy.” During the encounter, the Veteran indicated that “(t)rouble adjusting to civilian life, heath has deteriorated, and he struggles with pain management.” The VA provider also observed that the Veteran “(d)ressed casual with good hygiene. Veteran presents Alert, Oriented x 4. Attitude is cooperative. Eye contact is good. Mood is euthymic. Affect is Within normal limits. Psychomotor activity is Within normal limits. Gait Is within Normal limits. Speech is Clear. Thoughts are goal directed. Delusions are Denied. Hallucinations are Denied. Concentration is good. Abstraction is good. Intelligence is good. Comprehension is good. Memory is good. Suicidal ideation is Denied. Homicidal ideation is Denied. Insight is good. Judgment is good and he is able to participate in own treatment.” In July 2017, the Veteran’s updated treatment notations from Tulsa Outpatient Clinic were associated with his electronic claims file. Therein, on June 17, 2017, Dr. JNK generated a Mental Health Administrative Note for her first psychotherapy session with the Veteran. At that time, Dr. JNK reported a diagnosis for chronic adjustment disorder. During the encounter, Dr. JNK observed that, “Veteran presents Alert, Oriented x 4, Attitude is cooperative, Eye contact is good, Mood is irritable, Affect is mood congruent, Psychomotor activity is within normal limits, Gait Is within normal limits, Speech is clear and easily understood with normal rate and rhythm but volume tends to be somewhat increased, Thoughts are goal directed, Delusions are Denied, Hallucinations are Denied, Concentration is good, Abstraction is good, Intelligence is good, Comprehension is good, Memory is good, Insight is fair, Judgment is adequate, Motivation for treatment and treatment adherence are adequate, & he is able to be an active participant in his treatment planning and implementation.” After careful and deliberate review of the Veteran’s claims file, the Board concludes that the medical and lay evidence does not reflect that the Veteran demonstrated occupational and social impairment, with deficiencies in most areas, at any point during the claim period. The Board notes that, in February 2017, Dr. GWC indicated that the Veteran reported increased difficulty sleeping. However, the Board concludes that the evidence for the applicable claim period does not reflect that the Veteran endured deficiencies in most areas, to include work, school, family relations, judgment, thinking or mood, because of his service-connected unspecified trauma disorder with insomnia. Ultimately, the preponderance of the evidence stands counter to the Veteran’s claim for entitlement to a rating in excess of 50 percent for his service-connected unspecified trauma disorder with insomnia after December 9, 2016. The record does not show this disability is manifested by symptoms consistent with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. On the contrary, while the Veteran’s affect was noted be mildly restricted during his March 2017 examination and he was noted to have a depressed mood, anxiety, suspiciousness, and chronic sleep impairment with disturbances of motivation and mood and difficulties in establishing and maintain effective work and social relationships and adapting to stressful circumstances including work or a work like setting, he did not have symptoms typically consistent with a higher rating such 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; or inability to establish and maintain effective relationships. Overall, the Veteran’s symptomatology since December 9, 2016, is most consistent with occupational and social impairment with reduced reliability and productivity. Accordingly, the claim for a disability evaluation in excess of the presently assigned 50 percent rating from December 9, 2016, is denied. In reaching this determination, the Board acknowledges that VA is statutorily required to resolve the benefit of the doubt in favor of the Veteran when there is an approximate balance of positive and negative evidence regarding the merits of an outstanding issue. This doctrine of reasonable doubt is not applicable in this case because the preponderance of the evidence stands counter to the Veteran’s increased rating claim for the period after December 9, 2016. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990); 38 U.S.C. § 5107(b). The Board also notes that the Veteran and his representative have not raised any other issues, nor have any other issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address   issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD RLBJ, Associate Counsel