Citation Nr: 18146739 Decision Date: 11/01/18 Archive Date: 10/31/18 DOCKET NO. 12-35 141 DATE: November 1, 2018 ORDER Entitlement to an initial disability rating of 50 percent, but no higher, for depressive disorder for the period prior to October 12, 2012, is granted. Entitlement to a disability rating in excess of 50 percent for depressive disorder for the period from October 12, 2012, to January 31, 2017, is denied. Entitlement to a disability rating of 70 percent, but no higher, for depressive disorder for the period from February 1, 2017, onward, is granted. A total disability rating based on individual unemployability (TDIU) due specifically to the service-connected disability of depressive disorder from February 1, 2017, is granted. A TDIU on a schedular basis, and referral for consideration of a TDIU on an extraschedular basis, due specifically to the service-connected disability of depressive disorder prior to February 1, 2017, is denied. FINDINGS OF FACT 1. For the period prior to October 12, 2012, the Veteran’s depressive disorder was productive of occupational and social impairment with reduced reliability and productivity; it is not shown to have been productive of 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. 2. For the period from October 12, 2012, to January 31, 2017, the Veteran’s depressive disorder is not shown to have been productive of 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). 3. For the period from February 1, 2017, onward, the Veteran’s depressive disorder has been productive of occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood; it is not shown to have been productive of 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. 4. For the period from February 1, 2017, the Veteran has been rendered unable to secure or follow a substantially gainful occupation due to his service-connected disability of depressive disorder rated 70 percent disabling. 5. Prior to February 1, 2017, the evidence does not support a finding that the Veteran’s depressive disorder (rated 50 percent disabling) rendered him unable to secure or follow a substantially gainful occupation. CONCLUSIONS OF LAW 1. For the period prior to October 12, 2012, the criteria for an initial rating of 50 percent (but no higher) for the Veteran’s depressive disorder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.130, Diagnostic Codes 9434, 9435. 2. For the period from October 12, 2012, to January 31, 2017, the criteria for a rating in excess of 50 percent for the Veteran’s depressive disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.130, Diagnostic Codes 9434, 9435. 3. For the period from February 1, 2017, onward, the criteria for a rating of 70 percent (but no higher) for the Veteran’s depressive disorder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.130, Diagnostic Codes 9434, 9435. 4. The criteria for entitlement to a TDIU due to the Veteran’s depressive disorder from February 1, 2017, onward, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. 5. The criteria for entitlement to a TDIU on a schedular basis, or referral for consideration of a TDIU on an extraschedular basis, due to the Veteran’s depressive disorder prior to February 1, 2017, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1966 to March 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina, which granted entitlement to service connection for depressive disorder, effective from July 14, 2008, and assigned an initial 30 percent disability rating. During the pendency of this appeal, the RO issued a November 2012 rating decision that awarded an increased 50 percent disability rating for depressive disorder, effective from October 12, 2012. Also during the pendency of this appeal, evidence of record (featuring a February 2017 private medical opinion) raised the issue of entitlement to TDIU based upon his service-connected depressive disorder alone, an issue that is part-and-parcel of the depressive disorder rating issue and distinct from the Veteran’s April 2017 claim for TDIU that he withdrew in December 2017. As explained below, the Board’s grant of increased ratings for depressive disorder in this case have made the Veteran newly qualified for consideration of a TDIU as part of this appeal on a schedular basis for depressive disorder alone. The Veteran testified at a Board hearing before the undersigned in February 2017. This matter was previously before the Board in August 2017, when the case was remanded for additional evidentiary development. Increased Rating and TDIU The Veteran seeks an initial disability rating in excess of the currently-assigned 30 percent for depressive disorder for the period prior to October 12, 2012, and the Veteran seeks a disability rating in excess of the currently-assigned 50 percent for depressive disorder for the period from October 12, 2012, onward. The appeal arises from the grant of service connection for depressive disorder which is effective from July 14, 2008, defining the beginning of the rating period on appeal. Disability ratings are determined by comparing a Veteran’s symptomatology during the pertinent period on appeal with criteria set forth in VA’s Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. Otherwise, the lower rating will be assigned. Id. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. Id. § 4.3. With a claim for an increased initial rating (as in this case), separate “staged” ratings may be assigned based on facts found. Fenderson v. West, 12 Vet. App. 119 (1999). In determining whether a claimed benefit is warranted, VA must determine whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107 (a); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). It is the policy of VA to administer the law under a broad interpretation, consistent with the facts in each case with all reasonable doubt to be resolved in favor of the claimant; however, the reasonable doubt rule is not a means for reconciling actual conflict or a contradiction in the evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Lay evidence may be competent to address any matter 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 layperson. 38 C.F.R. § 3.159(a)(2). However, competent medical evidence is necessary where the determinative question is one requiring medical knowledge. 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 or statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). The Board has reviewed all of the evidence in the Veteran’s claims file, with an emphasis on the evidence pertinent to the issue on appeal. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence of record. Indeed, the Federal Circuit has held that the Board must review the entire record, but does not have to discuss each piece of evidence. Gonzalez v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board’s analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim. In McGrath v. Gober, 14 Vet. App. 28 (2000), the Court held that when evidence is created is irrelevant compared to when the Veteran was actually experiencing the symptoms. Thus, the Board will consider whether the evidence of record suggests that the severity of pertinent symptoms increased sometime prior to the date of the examination reports noting pertinent findings. The Board has also considered the history of the Veteran’s disabilities prior to the rating period on appeal to see if it supports a higher rating during the rating period on appeal. The Veteran’s depressive disorder has been rated by applying the criteria in 38 C.F.R. § 4.130, Diagnostic Code 9434. The Board notes that the evidentiary record indicates some uncertainty as to whether the Veteran’s diagnosis is best characterized as major depressive disorder or another manner of depressive disorder. However, the Board notes that the rating criteria for unspecified depressive disorder under 9435 are identical to the criteria for 9434; both diagnostic codes rate the disability under the General Rating Formula for Mental Disorders. There is no suggestion that the service-connected disability on appeal is of a nature that better corresponds to a diagnostic code with rating criteria other than the General Rating Formula for Mental Disorders. The VA Schedule rating formula for mental disorders reads in pertinent part as follows: 100 percent rating (the maximum schedular rating) - Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation or own name. 70 percent - 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). 50 percent - Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g. retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. 30 percent - 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 9434. VA had previously adopted the American Psychiatric Association: Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV), for rating purposes. VA implemented DSM-5, effective August 4, 2014, and the VA Secretary determined that DSM-5 applies to claims certified to the Board on and after August 4, 2014. See 79 Fed. Reg. 45,093, 45,094 (Aug. 4, 2014). As the Veteran’s increased rating claim was originally certified to the Board after August 4, 2014, DSM-5 applies in this case. DSM-IV, including its global assessment of functioning (GAF) scale, does not apply. When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, length of remissions, and the Veteran’s capacity for adjustment during periods of remission. 38 C.F.R. § 4.126 (a). The rating agency shall assign a rating 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. Id. However, when evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign a rating solely on the basis of social impairment. 38 C.F.R. § 4.126 (b). When determining the appropriate disability rating to assign, the Board’s primary consideration is a veteran’s symptoms, but it must also make findings as to how those symptoms impact a veteran’s occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013); Mauerhan v. Principi, 16 Vet. App. 436, (2002). Because the use of the term “such as” in the rating criteria demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, the Board need not find the presence of all, most, or even some, of the enumerated symptoms to award a specific rating. Id. at 442; see also Sellers v. Principi, 372 F.3d 1318 (Fed. Cir. 2004). The Board recognizes that there is no “formula” to follow when assigning ratings. Accordingly, the evidence considered in determining the level of impairment under Diagnostic Code 9434 is not restricted to the symptoms provided in the diagnostic code. Instead, VA must consider all symptoms associated with the Veteran’s depressive disorder that affect the level of occupational and social impairment, including, if applicable, those identified in the DSM-IV/5. Id. While particular symptoms associated with a higher rating may be present during pertinent portions of the appeal period, such symptoms are exemplars to aid in characterizing the degree of social and occupational impairment. Thus, while certain symptoms might be present on isolated occasions, such symptoms must produce the contemplated levels of occupational and social impairment to provide a basis for increased rating assignments in any particular period. Nevertheless, all ratings in the general rating formula are also associated with objectively observable symptomatology and the plain language of the regulation makes it clear that the veteran’s impairment must be “due to” those symptoms; a veteran may only qualify for a given disability rating by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio, 713 F.3d at 118. At the outset of this analysis, the Board notes that after the Board’s August 2017 remand directed that this case be referred for extraschedular rating consideration, an RO Decision Review Officer (DRO) signed a memorandum in August 2018 that included the following assertion: Recommendation: Grant an extra-schedular evaluation to 50 percent disabling prior to February 1, 2017, for the entire retroactive period of the claim and to 70 percent disabling effective from February 1, 2017, the date of treatment report from [Dr. Atkinson] (Licensed Clinical Psychologist) for depressive disorder as a combined review of all the evidence as a whole supports the higher evaluations during those periods of time. The Director, Compensation Service, responded to this recommendation by finding that extraschedular ratings were not warranted, explaining: “The evidentiary record does not demonstrate that the symptomatology consistently associated with the service-connected depression is not wholly contemplated by the criteria utilized to assign the past and current evaluations for depression.” The Director’s determination did not otherwise disagree with the DRO’s finding that “review of all the evidence as a whole supports the higher evaluations during those periods of time.” However, the supplemental statement of the case (SSOC) issued in August or September 2018 (there are conflicting indications regarding the timing of the SSOC) denied any increased ratings. The Board is not bound by the findings expressed by the DRO in the August 2018 written recommendation for an extraschedular rating. However, in brief, the Board agrees with the DRO’s findings and notes that the Director, Compensation Service, did not indicate disagreement with those findings; rather, the Director merely found that the Veteran’s shown impairment was not beyond the scope of impairment contemplated by the schedular rating criteria. Accepting that the Veteran’s impairment can reasonably be considered to be contemplated by the schedular rating criteria may present a basis for denying an extra-schedular rating assignment, but it does not prevent assignment of a schedular rating. As explained below, the Board finds that the rating increases recommended by the DRO are warranted and appropriate for assignment on a schedular basis in this case. In particular, the DRO cited the February 2017 report of Dr. Atkinson. The Board finds that this report persuasively explains in thorough detail that the Veteran’s service-connected pathology is somewhat unusual and has been somewhat misunderstood and misdiagnosed in some prior mental health evaluations of record. Dr. Atkinson explains that the Veteran “is having depression secondary to the stress of having a general medical condition[,] … in my opinion this is still tinnitus which has caused the patient to become so obsessed it is almost verging on an obsessional psychosis. His impairments from that are severe ….” Dr. Atkinson noted “somewhat poor memory, [the Veteran] was constantly leaving out information in a vague manner and at times giving incorrect information that had to be repeated and changed. This was due to his psychomotor pressure and fixation upon his tinnitus to the point where he cannot think about anything else.” Additionally, the Veteran was noted to be “making some possibly illogical generalizations of his disorder at this time which have a somewhat peculiar content in their connections.” Mental status examination notes included that the Veteran was “alert but vague, restless, totally obsessed with his symptoms and disorders and constantly rambling about the disorders and their side effects.” Attention span was “short,” psychomotor activity was “increased,” speech patterns were “digressive, tangential and circumstantial.” The Veteran’s ability to abstract was “marked by fluctuation between abstract and concrete levels.” The Veteran’s affect was “[s]omewhat labile,” and he “reports mood swings” and he “does report emotional lability with crying spells.” The Veteran reported a long-term history of depression on a daily basis with avolition (“don’t want to do nothing (avolition)”), and discussed a history of suicidal ideation and “irritability.” Dr. Atkinson’s February 2017 report explains that the Veteran “is highly obsessive and preoccupied with his symptoms and having almost what used to be called an obsessive psychosis.” The report explains that “[t]he unwanted ideas are persistent and of a repetitive nature…. Morbid or pathological obsessions tend to be long lived and constituting a never ending harassment of mental functioning. They are not subject to conscious control and consist of various ideas.” The report further explains that the Veteran “is forced to think constantly of his disorder and in this case tinnitus and the brooding constitutes a severe restriction of activities within an obsessive - rumative state of tension.” Dr. Atkinson explains that the nature of the Veteran’s mental health pathology has become somewhat obscure: “... although these formulations were well known at the time that I was in school 50 yrs. ago[,] today they have largely been forgotten but one continues occasionally to see a case of this sort.” Significantly, Dr. Atkinson concluded: “... impairment from his constellation of disorders is far in excess of his rated impairments by the VA including from 7-14-08 to Oct. 12, 2012[,] at which time his disorder is continuing unabated.” Dr. Atkinson assesses: “At this time he shows deficiencies in most areas such as work, thinking and mood with obsessional preoccupation which are generalized in a[n] odd manner to other physical symptoms.” Dr. Atkinson discusses “[a] Somatic Symptoms Disorder, irritability, a very poor stress tolerance and actually I don’t feel that he is capable of any substantial or sustained employment.”   Entitlement to a disability rating of 70 percent, but no higher, for depressive disorder for the period from February 1, 2017, onward, is granted. The Board finds that the February 2017 report from Dr. Atkinson persuasively establishes that the Veteran’s depressive disorder manifests in severe disability productive of occupational and social impairment with deficiencies in most areas due to symptoms of the nature and severity contemplated by the schedular criteria for a 70 percent rating. Thus, a 70 percent rating (increased from the currently-assigned 50 percent) is warranted from February 1, 2017, onward. A further increase to a 100 percent rating is not warranted. Although the evidence featuring Dr. Atkinson’s report indicates that the Veteran may be unemployable, the evidence does not indicate that the Veteran’s depressive disorder is productive of total social impairment or impairment due to symptoms of the nature and severity contemplated by the exemplars in the rating criteria. The Board finds that the evidence does not indicate that the Veteran has experienced symptoms of the nature and severity of the level of symptoms such 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. No evidence, including the September 2017 VA mental health rating examination report, shows a greater degree of impairment or symptom severity than does the February 2017 private report. The Board notes that the September 2017 VA examiner found that the Veteran’s depressive disorder manifested in “[o]ccupational and social impairment with reduced reliability and productivity,” but not impairment in most areas and not total occupational and social impairment. The September 2017 VA examiner noted some symptomatology consistent with the nature and severity of symptomatology contemplated by a 70 percent rating, such as “[d]ifficulty in adapting to stressful circumstances, including work or a worklike setting.” The September 2017 VA examination report does not indicate the presence of impairment or symptomatology of the nature and severity contemplated by the criteria for a 100 percent rating. The Board also notes that the Veteran’s testimony at his February 2017 Board hearing described his experience of low energy level, difficulty functioning in environments with “pressure” and “noise,” increased anxiety, depression, and stress with the relatively recent development of a noisy shooting range opening next to the Veteran’s home, a history of suicidal thinking (discussed with reference to 1994 or 1995), and withdrawal from socializing and activities. The Board finds that the nature and severity of the symptoms and impairment described most nearly approximate that contemplated by the criteria for a 70 percent rating, and no higher. With consideration of all of the evidence, the Board finds that no rating in excess of the increased 70 percent rating is warranted for the period from February 1, 2017, onward. (The Board notes, however, that later in this decision the Veteran will be awarded a TDIU for this period under different criteria, as discussed below.) Entitlement to a disability rating in excess of 50 percent for depressive disorder for the period from October 12, 2012, to January 31, 2017, is denied. The Board notes that the DRO’s recommendations do not suggest any increase in the already-assigned 50 percent rating in effect for the period from October 12, 2012, to February 1, 2017. The Board has considered whether an increased rating is warranted for this period. The Board finds no contemporaneous evidence indicating that the Veteran’s depressive disorder was productive of occupational and social impairment, with deficiencies in most areas, as contemplated by the criteria for a rating in excess of 50 percent at any time prior to the February 1, 2017, report that shows such a degree of impairment. The Board has considered that the Veteran’s level of impairment shown by the February 2017 report is not shown to have necessarily had its initial onset specifically on the day of the February 2017 examination that revealed it, but the evidence does not clearly identify when that degree of occupational and social impairment with deficiencies in most areas began. The Board finds that no evidence otherwise shows that level of impairment at an ascertainable time prior to February 2017 to support a non-speculative determination of entitlement to a rating in excess of 50 percent for any period prior to February 1, 2017. The Board notes that the February 2017 opinion of Dr. Atkinson states his “opinion that the patient’s current rating should have been rated back as far as 7-14-08 as there was no way his impairments were only occasional or transient.” At the time that Dr. Atkinson authored that opinion, the Veteran’s “current rating” was the 50 percent rating assigned by the RO. The Board notes that the result of its analysis in the current decision is that the Veteran is to be awarded a 50 percent rating dating back to the July 2008 effective date for the grant of service connection for the depressive disorder. The Board’s analysis accepts and contemplates Dr. Atkinson’s assertion regarding the Veteran’s pertinent symptom history in its analysis and rating assignments in this case. The 50 percent rating contemplates that the Veteran’s symptoms were more than occasional or transient. The October 2012 VA mental health examination report indicates that the Veteran’s impairment was characterized by the competent examining expert as productive of “[o]ccupational 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.” The Board notes that this assessment is most consistent with the rating criteria language describing the level of impairment contemplated by a 30 percent rating. The Veteran has already been assigned a 50 percent rating from October 2012 to February 2017, supported by the Veteran’s particular impairment and symptom history in this period, including disturbances of motivation in mood along with irritability and passive thoughts of death discussed in the October 2012 VA examination report. The Board finds that none of the evidence concerning the period from October 2012 to February 2017 shows occupational and social impairment, with deficiencies in most areas due to symptoms of the nature and severity contemplated by a rating in excess of 50 percent for any definable portion of the period. Accordingly, the Board finds that the evidence does not provide a basis for an award of a rating in excess of 50 percent during the period from October 2012 to February 2017. Entitlement to an initial disability rating of 50 percent, but no higher, for depressive disorder for the period prior to October 12, 2012, is granted. The RO’s November 2012 rating decision found that the degree of impairment shown by the October 2012 VA mental health rating examination report most nearly approximated the degree of impairment contemplated by the criteria for a 50 percent rating. The RO’s DRO memorandum recommendation in August 2018 looked back at the evidence in the context of the entire record, including the significant February 2017 private report, and included a finding that the level of impairment for the entire rating period prior to October 12, 2012, was essentially consistent with that shown for the period from October 12, 2012, to February 1, 2017, such that a 50 percent rating was recommended for the period prior to October 12, 2012. The Board is not bound by the findings made in the DRO’s August 2018 recommendation, but the Board has reviewed the evidence and agrees with the DRO’s finding in this regard. The Board has considered the discussion in the February 2017 private report of Dr. Atkinson concerning the Veteran’s mental health history, including with regard to the difficulty presented in clinically identifying and classifying the entirety of the Veteran’s somewhat unusual pathology. Consistent with Dr. Atkinson’s thorough explanation, the June 2010 VA examination report shows that attempts to assess the Veteran’s mental health revolved around a consuming fixation upon his tinnitus symptoms. The June 2010 report indicates: “On interview the Veteran primarily related limitations due to the ringing in his ears which he reports goes on ‘24/7.’” The Veteran further reported the he perceived “pain issues and cramping when he experiences ringing in his ears,” and he also reported experiencing nightmares, an inability to achieve restful sleep, low energy level, chronically “depressed mood … due to the hearing loss and tinnitus,” and he further clarified “that everything that he is experiencing is dependent on the ringing in his ears.” Dr. Atkinson’s February 2017 thorough and detailed review of this matter led to his comment that the Veteran’s mental health impairment was “in excess of his rated impairments by the VA including from 7-14-08 to Oct. 12, 2012[,] at which time his disorder is continuing unabated.” The Board again notes that the February 2017 opinion of Dr. Atkinson states his “opinion that the patient’s current rating should have been rated back as far as 7-14-08 as there was no way his impairments were only occasional or transient.” At the time that Dr. Atkinson authored that opinion, the Veteran’s “current rating” was the 50 percent rating assigned by the RO. The Board’s analysis accepts and contemplates Dr. Atkinson’s assertion regarding the Veteran’s pertinent symptom history in its analysis and rating assignments in this case. Whereas the criteria for a 30 percent rating contemplate occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, a 50 percent rating contemplates impairment that is more than occasional or intermittent. The Board notes that the RO has already recognized the Veteran’s impairment as meeting the criteria for a 50 percent rating from October 12, 2012, on which date the Veteran’s symptoms featured depressed mood, chronic sleep impairment, disturbances of motivation and mood, irritability (without indications of violence), and passive thoughts of death (without suicidal or homicidal ideation). Although the symptoms shown in the June 2010 VA examination report are not identical to those shown in the October 2012 VA examination report, the Board finds that they are substantially similar and compatible. Both the June 2010 and October 2012 VA examination reports summarize the Veteran’s level of impairment in terminology that does not clearly match the language defining the impairment contemplated by the criteria for a 50 percent rating, but the RO has already determined that the Veteran’s particular impairment from this symptomatology most nearly approximated ‘occupational and social impairment with reduced reliability and productivity’ in assigning a 50 percent rating effective from October 2012. The Board further notes that Dr. Atkinson’s February 2017 discussion explains that the Veteran’s impairment has previously been misapprehended even by experts due to the unusual nature of the impairment arising from involuntary obsessional thinking dominated by his constant tinnitus. In light of the totality of the record, the Board finds that the degree of the Veteran’s mental health impairment for the period prior to October 12, 2012, is reasonably shown to be substantially consistent with the degree of impairment shown during the period beginning on October 12, 2012. Accordingly, resolving reasonable doubt in the Veteran’s favor, the Board agrees with the RO DRO’s August 2018 memorandum finding that the evidence supports an award of an increased 50 percent rating for the depressive disorder for the period prior to October 12, 2012. The Board finds that the evidence does not support a finding that the Veteran’s depressive disorder manifested in occupational and social impairment with deficiencies in most areas during the period prior to October 12, 2012. The thorough June 2010 VA examination report shows that the Veteran was alert and oriented with a linear thought process; euthymic affect; fair insight; speech generally fluent, grammatic, and free of paraphasias; intact attention; only mild difficulty with memory; no overt symptoms of psychosis; and no suicidal or homicidal ideation. The Veteran maintained his marriage of 30 years, participated in an amateur radio hobby, and maintained family relationships in addition to a few friendships. By the time of the October 2012 VA examination report at the end of this period, there was “[n]o change reported since last [June 2010] examination” in the Veteran’s “Relevant Social/Marital/Family history.” As discussed above, the Board finds that the level of impairment shown in October 2012 is substantially consistent with the level of impairment shown in June 2010 and generally throughout the period prior to October 12, 2012. The evidence does not indicate that the Veteran experienced occupational and social impairment, with deficiencies in most areas, during the period prior to October 12, 2012. Accordingly, the Board finds that no rating in excess of 50 percent is warranted for the Veteran’s depressive disorder for the period prior to October 12, 2012. Increased Schedular Rating Conclusion Additional references to the Veteran’s mental health are presented in other evidence of record, including VA treatment reports associated with the Veteran’s treatment. The additional evidence of record does not present findings concerning the Veteran’s mental health that significantly expand upon, revise, or contradict the findings in the most detailed evidence discussed by the Board in this decision. The Veteran is competent to report lay-observable symptoms. The Board notes that the medical evidence in this case largely reflects that medical providers have accepted the Veteran’s descriptions of his own symptomatology, and the Board has accepted the competent symptom reports in this analysis. However, questions of assessing the degree of psychiatric functional impairment and identifying underlying features of psychiatric pathology involve medical questions beyond the capability of the Veteran’s own lay observation. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). There is no evidence to demonstrate the Veteran has the training and expertise to make psychiatric assessments of functional mental impairment from the complex combinations and patterns of symptomatology featured in this case. The Board has relied upon the competent medical evidence of record with regard to such medical assessments. For the period prior to October 12, 2012, resolving reasonable doubt in the Veteran’s favor, the Board finds that a rating increase from 30 percent to 50 percent is warranted. For the period from October 12, 2012, to January 31, 2017, the Board finds that no increase in the currently-assigned 50 percent rating is warranted. For the period from February 1, 2017, onward, resolving reasonable doubt in the Veteran’s favor, the Board finds that a rating increase from 50 percent to 70 percent is warranted. The Board finds that no further increased ratings are warranted for any periods on appeal. Not only does the evidence reflect that the Veteran’s depressive disorder did not manifest in the symptoms listed as examples for the criteria for increased ratings in these stages of the appeal period, but his psychiatric symptoms are not otherwise shown to have been of similar severity, frequency, and duration as contemplated by the criteria for higher ratings. See Vazquez-Claudio, 713 F.3d at 118. The Board finds that the Veteran’s disability picture, taken as a whole and in combination with the objective psychiatric examination reports, has most nearly approximated the criteria for the ratings assigned by the Board in this decision at the pertinent periods for those assignments. The Board finds that the psychiatric disability picture has not manifested in such severity to warrant any additional or further increased ratings during any portions of the period on appeal. Hart v. Mansfield, 21 Vet. App. 505 (2007). In reaching this conclusion, the Board has considered the benefit-of-the-doubt rule. However, as the preponderance of the evidence is against the award of further increased ratings, that doctrine is not applicable to this extent. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Extraschedular Rating Consideration for Depressive Disorder The Board’s August 2017 remand included instructions for the RO to take steps to determine whether the Veteran may be entitlement to increased ratings for depressive disorder on an extraschedular basis. As discussed above, the DRO’s recommendation for increased ratings on an extraschedular basis was rejected by the Director, Compensation Service, but the Board has now determined that the recommended increased ratings can be granted through application of the schedular rating criteria. The Board has considered whether the Veteran is entitled to a further increased level of compensation on an extraschedular basis for the psychiatric disability on appeal. An extraschedular disability rating is warranted when there is a finding that the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization that would render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321(b)(1); see Fanning v. Brown, 4 Vet. App. 225, 229 (1993). Under Thun v. Peake, 22 Vet. App. 111 (2008), there is a three-step inquiry for determining whether a Veteran is entitled to an extraschedular rating. First, the Board must determine whether the evidence presents such an exceptional disability picture that the available schedular ratings for that service connected disability are inadequate. Second, if the schedular rating does not contemplate the claimant’s level of disability and symptomatology and is, thus, found inadequate, the Board must determine whether the claimant’s disability picture exhibits other related factors such as those provided by the regulation as “governing norms.” Third, if the rating schedule is inadequate to evaluate a Veteran’s disability picture and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether the Veteran’s disability picture requires the assignment of an extraschedular rating. The rating formula for mental disorders allows for them to be rated based on the level of occupational and social impairment. While the code lists examples to be considered, the Veteran’s psychiatric disability symptoms have been considered, whether or not they are listed among the examples. The ratings are based on the severity of the Veteran’s symptoms and the code allows for various ratings based on levels of symptoms from mild or transient to those causing total impairment. Thus, regardless of whether the actual related symptom is listed in any criteria, it is still considered based on its severity. The Board has found that application of the schedular rating criteria in this case supports the award of the increased ratings discussed above; the schedular ratings awarded by the Board in this case match the ratings the DRO recommended awarding on an extraschedular basis. The Board finds that the applied rating criteria are not inadequate. In any event, the Board notes that this case has already been referred for extraschedular consideration at the Agency of Original Jurisdiction. The Board finds that the only suggestion of impairment in this case beyond that contemplated by the applied rating criteria is the statement from Dr. Atkinson in February 2017 opinion that the Veteran is unemployable, but without indications of the full manner of impairment and symptomatology contemplated by a 100 percent disability rating. The Board finds that the indication that the Veteran is unemployable due to his depressive disorder clearly raises a claim of entitlement to TDIU as part-and-parcel of the increased rating claim, and the Board is granting a schedular TDIU in this case from the date of the February 2017 opinion, onward, as discussed below. See Rice v. Shinseki, 22 Vet. App. 447 (2009). The Board finds no other manner of psychiatric impairment in this case beyond the scope of the applied rating criteria for the ratings assigned. Hence, further consideration of an extra-schedular rating is not warranted. Thun v. Peake, 22 Vet. App. 111 (2008).   TDIU Based Upon Depressive Disorder A claim for TDIU, either expressly raised by the Veteran or reasonably raised by the record, involves an attempt to obtain an appropriate rating for a disability and is part of the claim for an increased rating. Rice v. Shinseki, 22 Vet. App. 447 (2009). In this appeal, the only disability for which a rating appeal has been properly within the Board’s jurisdiction is the Veteran’s depressive disorder. The Board need not consider any disability other than the service-connected depressive disorder in adjudicating the TDIU component of the Veteran’s claim for an increased disability rating for depressive disorder. This form of TDIU claim is known as a Rice TDIU, because it was raised during the administrative appeal of the Veteran’s claim for an increased rating for his service-connected depressive disorder and it is, therefore, a component of that claim for benefits related solely to that disability. See Rice v. Shinseki, 22 Vet. App. 447, 454-455 (2009). Such a claim is limited to the question of whether a veteran is unemployable exclusively due to the service-connected disability (or disabilities) on appeal. VA will grant a total rating for compensation purposes based on unemployability when the evidence shows that the Veteran is unable, by reason of his service-connected disabilities, to secure or follow a substantially gainful occupation consistent with his education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. A threshold requirement for eligibility for a TDIU under 38 C.F.R. § 4.16(a) is that, if there is only one such disability, it must be rated at 60 percent or more; and if there are two or more disabilities, at least one disability must be rated at 40 percent or more, and sufficient additional disability must bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). For the above purpose of identifying one 60 percent disability, or one 40 percent disability in combination, disabilities resulting from common etiology will be considered as one disability. However, even where the Veteran does not meet these schedular requirements, 38 C.F.R. § 4.16(b) codifies VA’s policy under which all veterans who are unable to secure a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. It is the policy of VA that all Veterans who are unable to secure and follow a substantially gainful occupation due to service connected disability shall be rated totally disabled. 38 C.F.R. § 4.16(b). Thus, if a Veteran fails to meet the schedular requirements above, an extraschedular rating is for consideration where the Veteran is nonetheless unemployable due to service connected disability. Id.; see also Fanning v. Brown, 4 Vet. App. 225 (1993). The Board may not grant a TDIU on an extraschedular basis in the first instance. Rather, the matter must be referred to the Director of the Compensation and Pension Service (Director) for extraschedular consideration. Bowling v. Principi, 15 Vet. App. 1, 10 (2001). A TDIU due specifically to the service-connected disability of depressive disorder from February 1, 2017, is granted. In April 2017, the Veteran filed a claim of entitlement to TDIU specifically claimed as due to his tinnitus. In August 2017, the RO adjudicated the TDIU with consideration of all of the Veteran’s service-connected disabilities and denied entitlement to service connection at that time, finding that the Veteran did not meet the schedular requirements for TDIU at that time. The Board’s current decision on his depressive disorder rating has found entitlement to an increased 70 percent rating for depressive disorder effective from February 1, 2017, now clearly meeting the schedular requirements for a possible TDIU on the basis of the depressive disorder. Significantly, the February 2017 report of Dr. Atkinson raised the issue of entitlement to a Rice TDIU specifically due to the depressive disorder: Dr. Atkinson asserted that in light of the details of the Veteran’s service-connected psychiatric symptomatology “I don’t feel that he is capable of any substantial or sustained employment.” However, the Board’s decision now results in increases in the Veteran’s depressive disorder rating, of which the Rice TDIU claim was part-and-parcel, such that a 70 percent rating is now in effect from February 1, 2017; the Veteran now meets the schedular criteria for the Rice TDIU from February 1, 2017. The Board finds that the question of entitlement to a Rice TDIU based upon depressive disorder has been raised such that the Board shall address the matter at this time. In accordance with the Board’s discussion of the depressive disorder rating assignments, above, the Board finds that the February 2017 private medical opinion indicating that the Veteran is unemployable due to his depressive disorder is competent probative evidence informed by direct examination of the Veteran and review of the claims-file. The February 2017 private medical opinion includes discussion of the Veteran’s educational history featuring a Certificate of High School Equivalency / GED, and also includes discussion of the Veteran’s work history consistent with that reported on his April 2017 VA Form 21-8940. The Board notes that the Veteran’s work history features varied work as a mechanic, an electrician, and a driver, with his highest annual earnings reported to be $16,800. The Veteran reportedly last worked in 2000. The Board finds that no evidence of record persuasively contradicts the February 2017 medical opinion asserting unemployability with regard to the period from February 1, 2017, to the present. The Board notes that an October 2017 VA medical opinion agrees that the Veteran’s depressive disorder “diagnosis impacts both physical and sedentary employment tasks.” Although the September 2017 VA mental health examination report and October 2017 VA medical opinion do not go as far as to state that the Veteran is rendered unemployable by his depressive disorder, the Board does not find that any content of these reports or the other evidence in the period persuasively contradicts Dr. Atkinson’s competent probative opinion that the Veteran’s depressive disorder renders him incapable of any substantial or sustained employment. Resolving reasonable doubt in the Veteran’s favor, the Board finds that a TDIU for the period from February 1, 2017, to the present is warranted. A TDIU on a schedular basis, and referral for consideration of a TDIU on an extraschedular basis, due specifically to the service-connected disability of depressive disorder prior to February 1, 2017, is denied. Also in accordance with the Board’s discussion of the depressive disorder rating assignments, above, the Board has determined that the Veteran’s depressive disorder manifested in impairment approximating occupational and social impairment with reduced reliability and productivity for the period prior to February 1, 2017. The October 2012 VA examination report characterized the Veteran’s impairment at that time as featuring occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. The February 2017 private opinion from Dr. Atkinson disputed the contemporaneous October 2012 characterization, opinion that “there was no way his impairments were only occasional or transient.” The Board has accepted that the Veteran’s impairments were not occasional or transient during the periods prior to February 1, 2017, but that finding is contemplated in the assigned 50 percent rating for disability approximating occupational and social impairment with reduced reliability and productivity. The Veteran’s depressive disorder symptoms prior to February 1, 2017, featured depressed mood, chronic sleep impairment, disturbances of motivation and mood, irritability (without indications of violence), and passive thoughts of death (without suicidal or homicidal ideation). The Board has found that these symptoms were productive of occupational and social impairment with reduced reliability and productivity. The Board does not find that the evidence shows that these symptoms and their associated impairment rendered the Veteran unable to secure or follow a substantially gainful occupation consistent with his education and occupational experience. The October 2012 VA examination report indicates that the Veteran did not have any significant symptomatic cognitive impairments, he did not have symptomatic “[d]ifficulty in adapting to stressful circumstances, including work or a worklike setting,” and he did not have symptomatic “difficulty establishing and maintain[ing] effective relationships.” The Board observes that the October 2012 VA examiner found that the Veteran’s depressive disorder did not cause “[t]otal occupational impairment.” The Board finds that the October 2012 VA examination report is competent and probative medical evidence indicating that the Veteran’s PTSD did not manifest in impairment rendering him unable to secure or follow a substantially gainful occupation consistent with his education and occupational experience at that time. The Board finds that there is no contrary evidence that persuasively indicates that the Veteran’s depressive disorder impairments were of such severity as to render the Veteran unemployable for the period on appeal prior to February 1, 2017. Accordingly, referral for consideration of a TDIU on an extraschedular basis is not warranted with regard to that period. Prior to February 1, 2017, the Veteran does not meet the schedular criteria for TDIU when considering his depressive disorder alone. Further, given the competent evidence in this case, the Board finds that the preponderance of the evidence is against a finding that the Veteran was unable to secure and follow a substantially gainful occupation due solely to his service-connected depressive disorder for the periods prior to February 1, 2017. Accordingly, referral to the Director of Compensation for consideration of extraschedular TDIU prior to February 1, 2017, is not warranted. Conclusion Neither the Veteran nor his representative has raised any other issues associated with the depressive disorder ratings, nor have any other issues been reasonably raised by the record in connection with the depressive disorder ratings. See Doucette v. Shulkin, 28 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). In summary: (1) an increased 50 percent initial rating, but no higher, is warranted for depressive disorder for the period prior to October 12, 2012; (2) no increase in the currently-assigned 50 percent rating is warranted for depressive disorder for the period from October 12, 2012, to January 31, 2017; (3) an increased 70 percent rating, but no higher, is warranted for depressive disorder for the period from February 1, 2017, onward; (4) a TDIU due specifically to depressive disorder is   warranted from February 1, 2017, onward; and (5) a referral for consideration of an extraschedular TDIU due specifically to the service-connected disability of depressive disorder prior to February 1, 2017, is not warranted. M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Barone, Counsel