Citation Nr: 18146335 Decision Date: 11/01/18 Archive Date: 10/31/18 DOCKET NO. 12-33 798 DATE: November 1, 2018 Entitlement to a disability rating more than 50 percent from October 29, 2008 forward for generalized anxiety disorder and dysthymic disorder. ORDER Entitlement to a disability rating of 70 percent from October 29, 2008 forward for generalized anxiety disorder and dysthymic disorder is granted. FINDING OF FACT Throughout the period on appeal, the Veteran’s generalized anxiety disorder and dysthymic disorder were manifested by occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood, and impaired impulse control. Total occupational and social impairment has not been met or approximated as a result of these psychiatric manifestations. CONCLUSION OF LAW The criteria for a disability rating of 70 percent, but no higher, for generalized anxiety disorder and dysthymic disorder have been met or approximated. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.10, 4.130, Diagnostic Code 9411 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from October 1951 to September 1953. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in New Orleans, Louisiana. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a September 2014 travel Board hearing. A transcript of that hearing has been associated with the record. This matter was last before the Board in November 2016. In a March 2018 Memorandum Decision, the United States Court of Appeals for Veterans Claims (the Court) set aside the Board’s November 2016 decision and remanded this matter back to the Board for readjudication. The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107 (2012); 38 C.F.R. §§3.102, 3.156(a), 3.159, 3.326(a) (2017). The Veteran in this case has not referred to any deficiencies in either the duties to notify or assist; therefore, the Board may proceed to the merits of the claim. See, Scott v. McDonald, 789 F.3d 1375, 1381 (Fed.Cir. 2015, cert denied, U.S.C. Oct.3, 2016) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board....to search the record and address procedural arguments when the [appellant] fails to raise them before the Board"); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to an appellant's failure to raise a duty to assist argument before the Board). The Board has reviewed all of the evidence in the Veteran's claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See, Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-130 (2000). Entitlement to a disability rating in excess of 50 percent from October 29, 2008 forward for generalized anxiety disorder and dysthymic disorder. The Veteran contends that he is entitled to a disability rating in excess of 50 percent from October 29, 2008 forward for service-connected generalized anxiety disorder and dysthymic disorder. Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321 (a), 4.1. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1 (2016); Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). That said, higher evaluations may be assigned for separate periods based on the facts found during the appeal period. See, Fenderson v. West, 12 Vet. App. 119, 126 (1999). This practice is known as staged ratings. Id. If the evidence for and against a claim is in equipoise, the claim will be granted. 38 C.F.R. § 4.3 (2017). A claim will be denied only if the preponderance of the evidence is against the claim. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). Any reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. 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. 38 C.F.R. § 4.126. The rating agency shall assign an evaluation based upon all the evidence of record that bears on occupational and social impairment, rather than solely upon the examiner's assessment of the level of disability at the moment of the examination. Id. 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. Id. The Veteran’s generalized anxiety disorder and dysthymic disorder are rated under Diagnostic Codes (DC) 9433-9413. 38 C.F.R. § 4.130. Generalized anxiety disorder and dysthymic disorder are rated using the General Rating Formula for Mental Disorders (General Formula). Under the General Formula, a 30 percent rating is assigned 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). A 50 percent rating is assigned 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, impaired judgment, impaired abstract thinking, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent disability rating is contemplated 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 worklike setting); inability to establish and maintain effective relationships. Id. A 100 percent disability rating is contemplated 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. The "such symptoms as" language means "for example," and does not represent an exhaustive list of symptoms that must be found before granting the rating of that category. Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). The list of examples provides guidance as to the severity of symptoms contemplated for each rating. Id. However, this fact does not make the provided list of symptoms irrelevant. See, Vasquez-Claudio v. Shinseki, 713 F.3d 112, 116-117. The Veteran must still demonstrate either the particular symptoms associated with the rating sought, or other symptoms of similar severity, frequency, and duration. Id. at 118. The Board is required to assess the credibility and probative weight of all relevant evidence, and may consider factors such as facial plausibility, bias, self-interest, and consistency with other evidence of record. McClain v. Nicholson, 21 Vet. App. 319, 325 (2007) (Greene, J., concurring in part and dissenting in part) (noting that the Board has the duty to assess credibility and probative weight of evidence); see, Jandreau v. Nicholson, 492 F.3d 1372, 1376 (Fed. Cir. 2007) (affirming that the Board retains discretion to make credibility determinations and otherwise weigh the evidence submitted, including lay evidence); Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). The Board has the authority to "discount the weight and probity of evidence in the light of its own inherent characteristics and its relationship to other items of evidence." See, Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998). In evaluating the probative value of competent medical evidence, the Court has stated that the probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion that the physician reaches. See, Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Effective August 4, 2014, VA amended the portion of the Schedule for Rating Disabilities dealing with mental disorders to remove outdated references to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), and replaced them with references to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). See 79 Fed. Reg. 149, 45094 (August 4, 2014). The provisions of the interim final rule apply to all applications for benefits that are received by VA or that were pending before the Agency of Original Jurisdiction (AOJ) on or after August 4, 2014. This appeal was pending long before August 4, 2014. Although DSM-IV applies to this appeal, it is worth noting that, according to the DSM-5, clinicians do not typically assess GAF scores. The DSM-5 introduction states that it was recommended that the GAF be dropped from DSM-5 for several reasons, including its conceptual lack of clarity (i.e., including symptoms, suicide risk, and disabilities in its descriptors) and questionable psychometrics in routine practice. In reviewing the evidence of record, the Board will consider the assigned GAF score; however, the Board is cognizant that GAF scores are not, in and of themselves, the dispositive element in rating a disability. Rather, GAF scores must be considered in light of the actual symptoms of the Veteran's disorder, which provide the primary basis for the rating assigned. See 38 C.F.R. § 4.126(a). GAF scores, which reflect the psychological, social, and occupational functioning of an individual on a hypothetical continuum of mental health, can be useful indicators of the severity of a mental disorder. See Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (DSM-IV). GAF scores ranging between 61 to 70 reflect 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 indicate that the individual is functioning pretty well, and has some meaningful interpersonal relationships. Scores between 51 to 60 are indicative of 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). GAF scores between 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). Scores between 31 to 40 indicate some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) or major impairment in several areas, such as work or school, family relations, judgment, thinking or mood (e.g., depressed man avoids friends, neglects family, and is unable to work). The Veteran was afforded a VA mental disorders examination on October 29, 2008. Diagnoses of generalized anxiety disorder and dysthymic disorder were noted. It was noted that the veteran has some friends but rarely sees them and had no leisure pursuits other than walking. The Veteran reported feeling lonely and stated that he fought with his wife of 42 years who, the examiner noted, stayed with their daughter. The examiner further noted that the Veteran’s laughter “easily turns to tearing” when he talks about his wife becoming angry when he calls her. The Veteran reported a “consistent history” of nightmares, insomnia, being easily startled at night, loneliness, ease of crying, persistent sadness, worrying, feeling hopeless most days, and feelings of worthlessness. The Veteran’s appearance was described as casual, his psychomotor activity noted as unremarkable, his speech was hesitant and slow but with appropriate affect and his mood was dysphoric. The veteran was noted as being easily distracted and having a short attention span. He could not perform serial 7’s or spell a word forward and backward. The Veteran denied being suicidal. It was noted that the Veteran has not driven a car since 1953 and that this was due to psychological reasons. The Veteran further reported that at times he felt as though someone were following him and he would look for them. The Veteran’s memory was described as mildly impaired but was found to be competent to manage his financial affairs. A GAF score of 51 was noted. Exaggerated startle response, hypervigilance and poor concentration and attention were noted. A May 2010 VA treatment record notes the Veteran reported seeing things in his sleep. The Veteran denied suicidal or homicidal ideation. A May 2010 VA treatment record notes the Veteran reported being depressed sometimes, but denied suicidal or homicidal ideation. In a July 2010 Report of General Information, the Veteran reported nightmares and hallucinations of fires, roaches and dead people. The Veteran was afforded a VA PTSD examination in September 2010. It was noted that the Veteran had been receiving mental health treatment from VA “for at least the past 15 years or so.” The Veteran reported irritability and “get[ting] angry at times with his family.” The Veteran further reported that he spends time with friends, watches sports, walks, regularly attends church and goes out to eat. The Veteran denied a history of suicide attempts. The Veteran denied hallucinations and no delusions were noted. The Veteran denies suicidal or homicidal ideation. The Veteran’s memory was described as normal. Noted symptoms of PTSD were recurrent and intrusive thoughts, nightmares, avoidance, hypervigilance, exaggerated startle response, difficulty falling and staying asleep and difficulty concentrating. It was noted that the Veteran “continues to be impaired by symptoms of anxiety which affect his personal and social functioning.” A diagnosis of generalized anxiety disorder was noted, as was a GAF score of 55. The Veteran was afforded a VA TBI examination in April 2011. The Veteran was diagnosed with a TBI from 1952 while serving in Korea. The Veteran was described as a poor historian. The Veteran reported psychiatric symptoms of mood swings, anxiety and depression. The Veteran further reported mild memory impairment and difficulty with executive functions. The examiner noted that he “could not state without speculation which symptoms are related to TBI and which are PTSD.” The Veteran was noted as having mildly impaired judgment and being occasionally disoriented. It was further noted that the Veteran has “[o]ne or more neurobehavioral effects that do not interfere with workplace interaction or social interaction. The veteran was able to communicate both by spoken and written word, as well as able to understand. A May 2011 VA treatment record notes the Veteran was well dressed, alert, awake and oriented to time, place and person. An August 2011 letter from a VA psychiatrist notes the Veteran was under his care at the New Orleans VAMC and “suffers from disabling symptoms such as nightmares, insomnia, extreme anxiety, depressed mood, irritability, cries easily, hypervigilance and jumpiness.” An April 2013 VA treatment record notes the Veteran called VA and stated that he was "just going to jump from a bridge". The Veteran stated that he was having a reaction to his medication. VA called the Veteran's wife who stated that he makes these comments all the time. VA was able to call the Veteran back who did admit to making the statement often, but denied suicidal ideation and stated that he "just meant it to show how frustrated [he is]." The Veteran then stated that his anxiety level is always high. A May 2013 VA treatment record notes the Veteran reported sleeping well, however he was also noted as being "[v]ery anxious and depressed." He denied suicidal or homicidal ideation. An August 2013 VA treatment record notes the Veteran reported sleeping fine with fewer nightmares. Additionally, the Veteran reported lessened depression and anxiety, but still cries easily. He denied suicidal or homicidal ideation. No anhedonia or hopelessness were noted. An August 2013 VA PTSD screen notes the Veteran reported nightmares, but denied avoidance hypervigilance, being easily startled or feeling detached from others. A June 2014 VA depression screen notes the Veteran denied feeling little interest or pleasure in doing things. The Veteran further denied feeling down, depressed or hopeless. The Veteran was afforded a VA TBI examination in August 2014. A diagnosis of TBI was noted. The Veteran reported suffering a head injury in Korea and stated he has a headache almost every day and says he has been getting them for the last 2-3 years but denied that there is any problem due to this head injury that has stayed with him over all these years since the head injury. The Veteran reported no complaints of impairment of memory, attention, concentration or executive functions and his judgment was described as normal. The Veteran was further described as always oriented to person, time, place and situation and able to communicate by and comprehend spoken and written language. The Veteran testified at the September 2014 Board hearing that his emotions are all over the place and if he’s watching something sad on television he cries. The Veteran denied ever yelling at his wife and stated that he “does pretty good with friends”, walks every day and sometimes takes the bus to go grocery shopping, but doesn’t do much else other than staying in his house. The veteran stated that other than his daughter he doesn’t have many friends come to the house. The Veteran stated that he didn’t have any friends presently because he “moved around so much”. The Veteran stated that he doesn’t go to therapy and doesn’t talk to anybody other than a VA physician. The Veteran then stated that he sometimes discusses with his wife, depending on how he feels. The Veteran denied having problems with small groups of people but stated he is “overactive sometimes.” The Veteran stated that he had been having nightmares for years and stated that if he’s walking he has to look back because he thinks somebody is following him. The Veteran indicated that only his physical disabilities and age prevented him from working and not his mental disorders. A May 2015 VA treatment record notes the Veteran reported less crying and no anhedonia or hopelessness. However, the Veteran reported that he had been "extremely jumpy" and not sleeping well with recurrent nightmares. The Veteran denied suicidal ideation. He stated his 9-year-old granddaughter visits him weekly which he enjoys. The Veteran was afforded a VA mental disorders examination in October 2015. A diagnosis of other specified anxiety disorder was noted. The Veteran’s previously diagnosed TBI was noted, but the examiner stated that the symptoms and impairment discussed in the examination are attributable to his mental health disorder. Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. It was noted that the Veteran lives with his wife of 50 years and described the relationship as “all right.” It was further noted that the Veteran keeps in touch with his sister and brother, but has no close friends and spends most of his time at home watching television, only occasionally going grocery shopping or other activities with his wife or daughter. The Veteran reported Korean war related nightmares and stated that he often wakes up upset or sweaty. The Veteran further reported crying at sad movies and avoiding thinking about the war, though without any associated impairment. The Veteran denied irritability or reckless behavior. The Veteran did endorse an exaggerated startle response to loud noises and stated that when he leaves his home he often feels as if other people are following him and he will look around to see if this is the case. The Veteran denied anhedonia and suicidal or homicidal ideation. Anxiety, chronic sleep impairment, disturbances of motivation and mood and difficulty in establishing and maintaining effective work and social relationships were noted. In its March 2018 decision to set aside and remand, the Court found that the reasons and bases for the Board’s November 2016 decision were inadequate in that it failed to explain the frequency and duration of the Veteran’s psychiatric symptoms only with respect to his ability to establish and maintain effective relationships. See, Decision at 6. The Court also found that the Board “failed to address numerous psychiatric symptoms that may suggest a greater degree of occupational and social impairment.” See, Decision at 7. Finally, the Court found that the Board did not expressly assess whether the Veteran had deficiencies in the areas of occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking or mood, which are necessary for a 70 percent evaluation. See, Decision at 7. In the now set aside November 2016 decision, the Board found “that the Veteran arguably has suicidal ideation” and impaired impulse control. See, BVA decision at 14. The Board based this finding on an April 2013 VA treatment record which notes the Veteran called VA and stated that he was "just going to jump from a bridge". The Board acknowledges that this VA treatment record further notes that the Veteran explained that he was having a reaction to his medication. VA called the Veteran's wife who stated that he makes these comments all the time. VA was able to call the Veteran back who did admit to making the statement often, but denied suicidal ideation and stated that he "just meant it to show how frustrated [he is]." The Veteran then stated that his anxiety level is always high. However, as listed above, the surrounding VA treatment records overwhelmingly show that the Veteran consistently denies suicidal ideation. These records were not noted in the November 2016 decision. As such, the Board finds that the weight of the evidence of record shows the Veteran does not have suicidal ideation and that the April 2013 threat to “jump from a bridge” was not a sincere threat of suicide, as explained by the Veteran, but rather, a histrionic outburst, indicative of poor impulse control. Furthermore, as the Veteran’s wife told VA staff that the Veteran makes this ‘threat’ all the time, the Board finds that this poor impulse control is a persistent symptom. Considering the totality of the evidence, the Board finds that throughout the relevant period on appeal, the Veteran's disability picture more nearly approximates that contemplated by the 70 percent rating. See 38 C.F.R. § 4.7. Throughout that period, the Veteran’s PTSD was characterized by occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood, and impaired impulse control. In its March 2018 decision to set aside and remand, the Court notes that the Board found that the Veteran exhibited paranoid thoughts and a persistent danger of hurting himself. See, Decision at 6. In the now set aside November 2016 decision, the Board found that the Veteran “has evidenced persistent danger of hurting himself.” See, BVA decision at 16. However, as explained above, the Veteran overwhelmingly denies any suicidal ideation and the Board has found that his April 2013 threat to “jump from a bridge” was not a sincere threat of suicide, as evidenced by not only the overwhelming weight of the evidence but also by the Veteran’s own admission regarding his desire to show frustration. As such, while the Board has conceded that this histrionic outburst shows an impairment in impulse control, it does not show any danger of self harm, persistent or otherwise. In the now set aside November 2016 decision, the Board found that the Veteran “has reported that he believed people followed him”. See, BVA decision at 16. In its March 2018 decision to set aside and remand, the Court characterized this belief as “paranoid thoughts”. See, Decision at 6. The Board notes that the Veteran has repeatedly stated that when he leaves his house or is out walking, he feels as though there is someone following him and turns around to see if anyone is doing so. However, the board notes that, although persistent, there has been no evidence presented as to how this has affected the Veteran in any manner other than causing him to turn around and look when he leaves his house. As noted above, the Veteran doesn’t drive and going for walks is one of his only remaining leisure pursuits. There has been no evidence presented, nor have the Veteran or his counsel argued, that this symptom, admittedly an unfortunate one, has caused any impairment to the Veteran. Indeed, the evidence demonstrates the Veteran still goes on walks. As such, the Board finds that the Veteran’s belief that he is being followed while going for walks is not of such a severity to result in total occupational and social impairment. Finally, and as noted above, the Court also found that the Board “failed to address numerous psychiatric symptoms that may suggest a greater degree of occupational and social impairment.” See, Decision at 7. Namely, the Court found that the Board did not discuss evidence of speech impairment, attention disturbances, inability to do serial 7s or spell a word forward and backward, crying episodes, fear of driving, difficulty with executive functions, impaired judgment, social inappropriateness, disorientation, and mild psychomotor agitation. The Veteran was afforded a VA mental disorders examination on October 29, 2008. The Veteran’s appearance was described as casual, his psychomotor activity noted as unremarkable, his speech was hesitant and slow but with appropriate affect and his mood was dysphoric. The veteran was noted as being easily distracted and having a short attention span. He could not perform serial 7’s or spell a word forward and backward. The Veteran denied being suicidal. It was noted that the Veteran has not driven a car since 1953 and that this was due to psychological reasons. The Veteran was afforded a VA PTSD examination in September 2010. The Veteran’s appearance was described as clean and casual with restless motor activity. The Veteran’s speech was unremarkable and his attitude was noted as cooperative and attentive. The Veteran was afforded a VA TBI examination in April 2011. The Veteran was diagnosed with a TBI from 1952 while serving in Korea. The Veteran was described as a poor historian. The Veteran reported psychiatric symptoms of mood swings, anxiety and depression. The Veteran further reported mild memory impairment and difficulty with executive functions. The examiner noted that he “could not state without speculation which symptoms are related to TBI and which are PTSD.” The Veteran was noted as having mildly impaired judgment and being occasionally disoriented. It was further noted that the Veteran has “[o]ne or more neurobehavioral effects that do not interfere with workplace interaction or social interaction. The veteran was able to communicate both by spoken and written word, as well as able to understand. The Veteran was afforded a VA TBI examination in August 2014. The Veteran reported no complaints of impairment of memory, attention, concentration or executive functions and his judgment was described as normal. The Veteran was further described as always oriented to person, time, place and situation and able to communicate by and comprehend spoken and written language. The Veteran was afforded a VA mental disorders examination in October 2015. A diagnosis of other specified anxiety disorder was noted. Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. Some mild psychomotor agitation was observed. The Board finds that while there is some evidence of inability to perform serial 7s or spell a word forward and backward, crying episodes, fear of driving, difficulty with executive functions, impaired judgment, social inappropriateness, disorientation, and mild psychomotor agitation, there has been no evidence put forward that any of these has caused total occupational and social impairment. While the evidence does show the Veteran has few friends, it also shows that he lives with his wife of several decades and maintains good relationships with his children and granddaughter. The Board finds that at no time during the period on appeal does the evidence indicate that the Veteran’s symptoms resulted in 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. As such, the Board finds that the preponderating weight of the evidence demonstrates that the Veteran’s generalized anxiety disorder and dysthymic disorder do not meet any of the criteria for a rating higher than 70 percent and that his symptoms are substantially less than those reflective of a 100 percent rating. Consequently, the Veteran does not more nearly meet or approximate the criteria for a 100 percent rating. See 38 C.F. R. § 4.7. Neither the Veteran nor his/her representative has raised any other issues, nor have any other issues been reasonably raised by the record. See, Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (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). Michael Pappas Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. P. Keeley, Associate Counsel