Citation Nr: 18155875 Decision Date: 12/06/18 Archive Date: 12/06/18 DOCKET NO. 09-15 485A DATE: December 6, 2018 ORDER Entitlement to a higher initial rating for left knee strain with degenerative joint disease, currently evaluated as 10 percent disabling, is denied. Entitlement to higher staged initial ratings for major depressive disorder, currently evaluated as 50 percent disabling prior to January 23, 2018, and 70 percent disabling from January 23, 2018, is denied. FINDINGS OF FACT 1. During the entire rating period, the Veteran’s left knee disability has been manifested by flexion limited, at its most severe, to 70 degrees, and extension limited, at its most severe, to 0 degrees. 2. Prior to January 23, 2018, the Veteran’s service-connected major depressive disorder was manifested by symptoms productive of functional impairment comparable to occupational and social impairment with reduced reliability and productivity. 3. From January 23, 2018, the Veteran’s service-connected major depressive disorder has been manifested by symptoms productive of functional impairment comparable to occupational and social impairment with deficiencies in most areas. CONCLUSIONS OF LAW 1. The criteria for an initial disability rating in excess of 10 percent for left knee strain with degenerative arthritis have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.321, Part 4, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5010, 5260 (2017). 2. The criteria for a staged initial disability rating in excess of 50 percent for service-connected major depressive disorder, prior to January 23, 2018, have not been met. 38 U.S.C. §§ 1155, 5103A, 5107 (2012); 38 C.F.R. § 4.130, Diagnostic Code 9434 (2017). 3. The criteria for a staged initial disability rating in excess of 70 percent for service-connected major depressive disorder, from January 23, 2018, have not been met. 38 U.S.C. §§ 1155, 5103A, 5107 (2012); 38 C.F.R. § 4.130, Diagnostic Code 9434 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1972 to June 1976. These matters come before the Board of Veterans’ Appeals (Board) on appeal of November 2008 and September 2012 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania. In regard to the claim for higher staged initial ratings for service-connected left knee disability, in February 2013, the Veteran testified at a video conference hearing before a Veterans Law Judge of the Board. Thereafter, the claim was remanded in May 2013 for further development. The Veterans Law Judge who conducted that hearing is no longer employed by the Board. The Veteran testified at a Travel Board hearing in May 2017 before the undersigned Veterans Law Judge with respect to both issues on appeal. Transcripts of both hearings have been received and are associated with the claims folder. This case was previously remanded by the Board in May 2013 and November 2017. A review of the claims file shows that there has been substantial compliance with the Board’s remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). The case has been returned to the Board for review. In a June 2018 rating decision, the Agency of Original Jurisdiction (AOJ) increased the rating for the Veteran’s major depressive disorder to 70 percent, effective January 23, 2018. As the increase did not satisfy the appeal in full, the issue remains on appeal and has been characterized as shown above. See AB v. Brown, 6 Vet. App. 35 (1993). The Board is cognizant of the ruling of the United States Court of Appeals for Veterans Claims (Court) in Rice v. Shinseki, 22 Vet. App. 447 (2009). In Rice, the Court held that a claim for a total rating based on individual unemployability (TDIU) due to service-connected disability, 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. In this case, the Veteran has not argued, and the record does not otherwise reflect, that the disabilities at issue render him unemployable. Accordingly, the Board concludes that a claim for TDIU has not been raised. Increased Rating Disability ratings are determined by the application of VA’s Schedule for Rating Disabilities (Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155 (2012); 38 C.F.R. Part 4 (2017). Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings,” in all claims for increased ratings. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999). In rating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated innervation, or other pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. Pain on movement, swelling, deformity, or atrophy of disuse as well as instability of station, disturbance of locomotion, interference with sitting, standing, and weight bearing are relevant considerations for determination of joint disabilities. 38 C.F.R. § 4.45. Painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011) (holding that 38 C.F.R. § 4.59 applies to disabilities other than arthritis). However, painful motion alone is not a functional loss without some restriction of the normal working movements of the body. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). 1. Entitlement to Higher Staged Initial Ratings for Left Knee Disability The Veteran seeks a higher staged initial ratings for his service-connected left knee strain with degenerative arthritis. The Veteran’s service-connected left knee disability is rated as 10 percent disabling under 38 C.F.R. § 4.71a, Diagnostic Code 5010-5260. The applicable rating period is from June 2, 2008, the effective date for the award of service connection for the left knee disability, through the present. See 38 C.F.R. § 3.400. The record shows that the Veteran has been diagnosed with osteoarthritic changes of the left knee, as confirmed by X-Ray imaging. See March 2011 VA examination report. The Veteran’s service-connected left knee disability may be rated under 38 C.F.R. § 4.71a, DCs 5003, 5257, 5260, and 5261. Under 38 C.F.R. § 4.71a, Diagnostic Code 5003, evaluation shall be on the basis of limitation of motion under the appropriate Diagnostic Codes for the specific joint or joints involved. If noncompensable limitation of motion is demonstrated, a 10 percent rating is assigned for each major joint or group of minor joints affected. In the absence of any limitation of motion, a 10 percent rating is warranted for involvement of two or more major joints or two or more minor joint groups, and a 20 percent rating is warranted for involvement of two or more major joints or two or more minor joint groups with occasional incapacitating exacerbations. 38 C.F.R. § 4.71a, Diagnostic Code 5003. For the purpose of rating disability from arthritis, the knee is considered a major joint. 38 C.F.R. § 4.45. Under 38 C.F.R. § 4.71a, Diagnostic Code 5260, a 10 percent rating is warranted for flexion of the knee limited to 45 degrees; a 20 percent rating is warranted for flexion limited to 30 degrees; and a 30 percent rating is warranted for flexion limited to 15 degrees. Under 38 C.F.R. § 4.71a, Diagnostic Code 5261, a 10 percent rating is warranted for extension of the knee limited to 10 degrees; a 20 percent rating is warranted for extension limited to 15 degrees; a 30 percent rating is warranted for extension limited to 20 degrees; a 40 percent rating is warranted for extension limited to 30 degrees; and a 50 percent rating is warranted for extension limited to 45 degrees. Normal range of motion of the knee is 0 degrees of extension to 140 degrees of flexion. See 38 C.F.R. § 4.71a, Plate II. Separate ratings may be awarded under Diagnostic Codes 5260 and 5261. See VAOPGCPREC 9-2004. In addition, even if a veteran did not have limitation of motion of the knee meeting the criteria for a compensable rating under Diagnostic Code 5260 or 5261, a separate rating could be assigned if there was evidence of full range of motion “inhibited by pain.” Lichtenfels v. Derwinski, 1 Vet. App. 484, 488 (1991). Other impairment of the knee, recurrent subluxation or lateral instability, that is slight in degree warrants a 10 percent rating. For moderate impairment, a 20 percent rating is assigned. For severe impairment, a 30 percent rating is assigned. 38 C.F.R. § 4.71a, Diagnostic Code 5257. Turning to the relevant evidence of record, the VA treatment records relevant to the rating period reflect that the Veteran has reported left knee pain, limited left knee motion and that he wears a brace on his left knee. However, the VA treatment records do not include range-of-motion measurements, indications of ankylosis of the left knee, or other information pertinent to the relevant rating criteria. The Veteran was provided a VA examination in September 2008. The Veteran complained of severe constant pain of his left knee. The Veteran wore a left knee brace and stated he uses a cane. The Veteran stated he has difficulty with prolonged standing and walking. Upon examination, the Veteran’s left knee flexion was to 90 degrees and left knee extension was to 0 degrees. The Veteran displayed mild to moderate pain of the left knee from 80 degrees to 90 degrees. The Veteran was able to perform repetitive use testing without additional loss of range of motion. The Veteran denied flare-ups of the left knee. Additionally, there was no instability of the left knee noted. The Veteran was provided a VA examination in September 2010. The Veteran stated that he experiences left knee pain all day every day. He stated he has problems standing for more than three minutes at a time, walking more than one block, and squatting and bending. Upon examination, the Veteran demonstrated mild erythema and swelling. His left knee extension was to -10 degrees with pain from -15 to -10 degrees. His left knee flexion was to 70 degrees with pain from 65 degrees to 70 degrees. He was able to perform repetitive use testing without additional loss of range of motion. The Veteran was provided a VA examination in March 2011. The VA examiner reviewed the record, interviewed the Veteran and conducted an in-person examination. The Veteran stated he has constant left knee pain with swelling, stiffness and occasional locking. He stated he has difficulty standing for more than three minutes, walking more than one block, squatting or bending. Upon examination the Veteran demonstrated left knee extension to -10 degrees with pain from -15 to -10 degrees and left knee flexion to 70 degrees with pain from 65 degrees to 70 degrees. The Veteran was able to perform repetitive use testing without additional loss of range of motion. At the February 2013 Board hearing, the Veteran testified that he has left knee swelling. He further testified that his left knee locks and feels unstable. The Veteran was provided a VA examination in December 2013. The VA examiner reviewed the record, interviewed the Veteran and conducted an in-person examination. The Veteran reported chronic left knee pain of a ten out of ten. He further reported that he has to stand every half hour for two to three minutes to reduce pain. The Veteran did not report flare-ups. Upon examination, the Veteran demonstrated left knee flexion to 90 degrees with objective evidence of painful motion at 90 degrees. He demonstrated left knee extension to 0 degrees with no objective evidence of painful motion. The Veteran was able to perform repetitive use testing without additional loss of range of motion. The VA examiner noted that the Veteran’s service-connected left knee disability causes less movement than normal, pain on movement, disturbance of locomotion and interference with sitting, standing and weight-bearing. The Veteran demonstrated normal joint stability tests. The Veteran was provided a VA examination in October 2014. The VA examiner reviewed the record, interviewed the Veteran and conducted an in-person examination. The Veteran stated he has several monthly flares of his left knee that cause minimal functional loss. Upon examination, the Veteran demonstrated left knee flexion to 90 degrees with objective evidence of painful motion at 85 degrees. He demonstrated left knee extension to 0 degrees with no objective evidence of painful motion. The Veteran was able to perform repetitive use testing without additional loss of range of motion. The Veteran demonstrated normal joint stability testing. The Veteran was provided a VA examination in April 2017. The VA examiner reviewed the record, interviewed the Veteran and conducted an in-person examination. The Veteran reported constant left knee pain of ten out of ten. He further reported weekly severe flare-ups that restrict his ability to walk very far. Upon examination, the Veteran demonstrated left knee flexion to 90 degrees and left knee extension to 0 degrees. The Veteran demonstrated pain on flexion and extension. He was able to perform repetitive use testing with no additional loss of range of motion. The Veteran did not demonstrate ankylosis. At the May 2017 Board hearing, the Veteran stated that he is unable to sit for long periods of time and that he wears a brace on his left knee. The Veteran was provided a VA examination in January 2018. The VA examiner reviewed the record, interviewed the Veteran and conducted an in-person examination. The Veteran reported constant left knee pain with swelling and stiffness. He further reported difficulty going up and down hills and trouble with prolonged walking and standing. Upon examination the Veteran demonstrated left knee flexion to 90 degrees and left knee extension to 0 degrees. The Veteran was able to perform repetitive use testing without additional loss of range of motion. The VA examiner noted that pain, weakness, fatigability or incoordination does not significantly limit functional ability with flare-ups. The Veteran did not demonstrate joint instability. For the entire period on appeal, the Veteran’s left knee disability was manifested by flexion limited, at its most severe to 70 degrees. Such limitation is noncompensable under Diagnostic Code 5260, and therefore warrants a rating of 10 percent, and no higher, under Diagnostic Code 5003. Thus, at no time during the rating period did the Veteran’s left knee disability warrant a disability rating in excess of 10 percent based on limited flexion. In addition, for the entire period on appeal, the Veteran’s left knee disability was manifested by extension limited, at its most severe to 0 degrees. Such limitation is noncompensable under Diagnostic Code 5261, and therefore the Veteran is not entitled to a separate rating under Diagnostic Code 5261. The Board further finds that the record does not reflect that the Veteran’s left knee condition warranted a separate compensable disability rating based on recurrent subluxation or lateral instability under Diagnostic Code 5257 at any time during the rating period. Specifically, the Veteran has not demonstrated recurrent subluxation or lateral instability of the left knee at any time during the rating period. Although, the Veteran has reported experiencing instability of his knee; the only joint stability testing of record was at the VA examinations and showed no instability. While the Veteran may experience a feeling that his left knee may give way or is unstable, the medical findings regarding instability, dislocation, and subluxation are more probative as to the actual presence of these conditions. Notably, there are specific medical tests that are designed to reveal instability and laxity of the joints. These tests were administered by the medical professionals in this case and revealed no instability or laxity. Hence, the evidence is against a separate rating for the left knee under Diagnostic Code 5257. 38 C.F.R. § 4.71a. The Board additionally finds that a higher rating of 20 percent was not warranted under Diagnostic Code 5003 at any time during the rating period because the record does not demonstrate that the Veteran had occasional incapacitating exacerbations of the left knee. Rather, the record shows that the Veteran continues to be independent in his activities of daily living, and has not required hospitalization or been prescribed bed rest due to the left knee disability. The Board has considered whether the Veteran is entitled to a higher or separate rating under the other diagnostic codes relating to disabilities of the knees and legs. However, there is no indication of ankylosis of the left knee, dislocation or removal of the semilunar cartilage, impairment of the tibia and fibula, or genu recurvatum. Therefore, no higher or separate rating is warranted under those diagnostic codes. See 38 C.F.R. § 4.71a, Diagnostic Codes 5256, 5258, 5259, 5262, and 5263. The Board has further considered whether the Veteran is entitled to a higher rating based on additional functional loss or impairment under 38 C.F.R. §§ 4.40, 4.45, and 4.59. See DeLuca, 8 Vet. App. 202, Burton v. Shinseki, 25 Vet. App. 1 (2011). At the VA examinations, the Veteran reported flare-ups in his left knee symptoms including constant pain. At the October 2014 VA examination, the Veteran reported minimal functional loss due to flare-ups. However, there is no indication in the record that any increase in symptoms during flare-ups caused additional functional loss such that the left knee condition manifested in a severity more closely approximating that contemplated by the criteria of a higher disability rating. In addition, the Veteran did not demonstrate additional functional loss upon repetitive use testing at any of the VA examinations, and none of the VA examiners opined that the Veteran would have additional functional loss upon repetitive use over time. Thus, the record does not show that the Veteran is additionally limited by pain, fatigability, incoordination, pain on movement, or weakness during flare-ups or on repetitive use over time such that a higher rating for the left knee was warranted at any time during the rating period. The Board finds that the Veteran’s pain and any functional loss are encompassed by the initial rating provided. Therefore, a higher rating is not warranted at any time during the rating period under the provisions of 38 C.F.R. §§ 4.40, 4.45, and 4.59, and DeLuca, 8 Vet. App. 202. In making its determinations in this case, the Board has carefully considered the Veteran’s contentions with respect to the nature and severity of his service-connected left knee disability at issue, and notes that his lay testimony is competent to describe certain symptoms associated with this disability. The Veteran’s history and symptom reports have been considered, including as presented in the medical evidence discussed above, and are noted to be contemplated by the criteria for the disability rating for which the Veteran has been found entitled by the Board. Moreover, the competent medical evidence offering detailed specific findings pertinent to the rating criteria is the most probative evidence with regard to evaluating the pertinent symptoms of the service-connected disability at issue. As such, while the Board accepts the Veteran’s statements with regard to the matters he is competent to address, the Board relies upon the competent medical evidence with regard to the specialized evaluation of functional impairment, symptom severity, and details of clinical features of the service-connected condition at issue. The Board therefore finds that the criteria for a rating in excess of 10 percent for the Veteran’s service-connected left knee disability have not been met at any time during the rating period. Accordingly, there is no basis for staged ratings of the Veteran’s left knee disability pursuant to Fenderson, 12 Vet. App. at 126-27, and a higher rating must be denied. As the preponderance of the evidence is against the assignment of a higher rating, the benefit-of-the-doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107 (b); see also Gilbert v. Derwinski, 1 Ver. App. 49 (1990). Neither the Veteran nor his representative has 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). 2. Entitlement to Higher Staged Initial Ratings for Major Depressive Disorder The Veteran seeks higher staged initial ratings for his service-connected major depressive disorder. The Veteran’s service-connected major depressive disorder is rated as 50 percent disabling prior to January 23, 2018 and 70 percent disabling from January 23, 2018 under 38 C.F.R. § 4.130, Diagnostic Code 9434. The applicable rating period is from June 2, 2008, the effective date for the award of service connection for major depressive disorder, through the present. See 38 C.F.R. § 3.400. Under Diagnostic Code 9434, for rating major depressive disorder, a 50 percent evaluation is warranted when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130, Diagnostic Code 9434. A 70 percent evaluation is warranted where there is objective evidence demonstrating occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to 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, or effectively; impaired impulse control, such as unprovoked irritability with periods of violence; spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances, including work or a work-like setting; and the inability to establish and maintain effective relationships. A maximum 100 percent evaluation is for application when there is 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; and memory loss for names of close relatives, own occupation, or own name. Id. The Veteran was provided a VA examination in June 2012. The VA examiner reviewed the record, interviewed the Veteran and conducted an in-person examination. The Veteran reported that he has been in a relationship for the past eight years and that he spends times with his significant other’s grandchildren. He further reported that he has friends. The Veteran reported symptoms of depressed mood, suspiciousness, chronic sleep impairment, mild memory loss and impairment of short and long-term memory, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stress circumstances, inability to establish and maintain effective relationships, persistent delusions or hallucinations and neglect of personal appearance and hygiene. Upon examination, the Veteran was appropriately dressed and had adequate hygiene. The Veteran’s speech was fast and normal and his affect was anxious and suspicious. His thought process was logical, linear and goal-directed. He denied suicidal or homicidal ideations. The Veteran was alert and oriented to person, place and time. His memory and concentration were intact, his judge was fair, and his abstraction was intact. The VA examiner summarized the Veteran’s level of 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. The Veteran was provided a VA mental disorders examination in October 2014. The VA examiner reviewed the record, interviewed the Veteran and conducted an in-person examination. The Veteran reported that he has lived with his significant other for the past ten years and that he has a strong relationship with her daughters. He further reported that he maintains contact with his brother, sister, and extended family. He reported being currently employed and enjoyed working with Veterans. The Veteran reported that he can perform all personal care needs. The VA examiner noted symptoms of depressed mood, anxiety, chronic sleep impairment, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and difficulty in adapting to stress circumstances. Upon examination, the Veteran presented as oriented and his thought processes were clear and goal directed. His affect was flat and his mood was somewhat depressed. The Veteran reported no suicidal ideations, plans or intentions to self-harm. He presented with no evidence of psychosis or paranoid ideations. The Veteran’s memory and cognitive skills were intact and his intellectual functioning appeared to be above average. The Veteran reported he is able to attend work and school and finds enjoyment in both. The VA examiner summarized the Veteran’s occupational and social impairment as with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. An August 2017 psychotherapy report, reflects that the Veteran felt overwhelmed at work. No suicidal risk was reported. Upon examination, the Veteran was well groomed. His mood was anxious and irritable. He did not express delusions or paranoid ideations. The Veteran was oriented times three and denied suicidal and homicidal ideations. His insight and judgment were fair. The Veteran was provided a VA examination in January 2018. The VA examiner reviewed the record, interviewed the Veteran and conducted an in-person examination. The Veteran stated that he was in constant contact with his surviving siblings. He further stated that he has lived in a common law relationship for the past fourteen years. The Veteran further stated that he has friends and that he socializes with his friends and family. The Veteran reported problems with people in the workplace and that he occasionally misses time at work due to emotional issues. The Veteran reported being irritable and short tempered. He reported problems falling and staying asleep and that he has attacked his girlfriend. The VA examiner noted symptoms of depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, near-continuous panic or depression, chronic sleep impairment, mild memory loss, circumstantial, circumlocutory or stereotyped speech, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and difficulty in adapting to stressful circumstances, including work or a worklike setting. Upon examination, the Veteran was casually dressed and his speech was coherent. He was oriented time three with no hallucinations or delusions. The Veteran did not report suicidal or homicidal ideations and his reasoning and judgment were adequate. His insight was limited and memory intact. The VA examiner summarized the Veteran had occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. After a detailed review of the claims file, the Board finds that the preponderance of the evidence is against an initial rating in excess of 50 percent, prior to January 23, 2018, and in excess of 70 percent from January 23, 2018, for his service-connected major depressive disorder. For the rating period prior to January 23, 2018, the Veteran’s 50 percent evaluation contemplated functional impairment comparable to occupational and social impairment with reduced reliability and productivity due to psychiatric symptoms. 38 C.F.R. § 4.130, Diagnostic Code 9434. The Veteran demonstrated psychiatric symptoms including, sleep disturbance, hallucinations, decrease in personal hygiene, and increased depression. The medical evidence reflects that, prior to January 23, 2018, there was no evidence of psychosis, and there was no agitation or excessive motor activity. The Veteran’s speech was within normal limits and his judgment, insight and impulse control were good. The Veteran maintained relationships with family members and had friends. He did not display inappropriate behavior and upon examination there was no indication of short-term or long-term memory loss. Additionally, the June 2012 and October 2014 VA examiners summarized the Veteran had occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. The Board acknowledges that the June 2012 VA examiner noted that the Veteran reported persistent delusions or hallucinations. However, the VA examinations and VA treatment records consistently reflect that the Veteran did not report delusions or hallucinations prior to or after the June 2012 VA examination. After a thorough review of the evidence of record, the Board concludes that, prior to January 23, 2018, the preponderance of the evidence is against a finding that the Veteran’s psychiatric disability is manifested by symptoms productive of functional impairment warranting a 70 percent or higher evaluation at any time, as the evidence does not show functional impairment comparable to occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. In that regard, the evidence does not demonstrate that the Veteran’s psychiatric disability results in deficiencies in family relations, judgment, or thinking. See 38 C.F.R. § 4.130, Diagnostic Code 9434; Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013). The evidence shows that the Veteran still maintained a close relationship with his girlfriend, siblings and family members. Additionally, thought processes were logical and coherent, and thought content was normal, and there was no evidence of suicidal or homicidal ideations. Judgment was unimpaired and insight was good. “[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.” Vazquez-Claudio, 713 F.3d at 116-17. Here, the preponderance of the evidence shows that, prior to January 23, 2018, the Veteran did not experience symptoms as listed for a 70 percent rating, or other symptoms of a similar severity, frequency, or duration, but rather that his symptoms were all reasonably contemplated by the symptoms set forth in the rating criteria for a rating of no more than 50 percent. See Fenderson v. West, 12 Vet. App. 119 (1999). From January 23, 2018, the Veteran’s 70 percent evaluation contemplates functional impairment comparable to occupational and social impairment with deficiencies in most areas. 38 C.F.R. § 4.130, Diagnostic Code 9434. The Veteran demonstrated psychiatric symptoms including, sleep disturbance, panic attacks that occur weekly or less often, near-continuous depression, mild memory loss and disturbances in mood and motivation. The medical evidence reflects that, from to January 23, 2018, there was no evidence of psychosis, persistent delusions or hallucinations, grossly inappropriate behavior or persistent danger of hurting self or others. The Veteran maintained relationships with family members and had friends. He did not display inappropriate behavior or an inability to perform activities of daily living. Additionally, the January 2018 VA examiner summarized the Veteran had occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. After a thorough review of the evidence of record, the Board concludes that, from January 23, 2018, the preponderance of the evidence is against a finding that the Veteran’s psychiatric disability is manifested by symptoms productive of functional impairment warranting a 100 percent evaluation at any time, as the evidence does not show functional impairment comparable to total occupational and social impairment. In that regard, the evidence does not demonstrate that the Veteran’s psychiatric disability results in deficiencies in family relations, judgment, or thinking. See 38 C.F.R. § 4.130, Diagnostic Code 9434; Vazquez-Claudio, 713 F.3d at 112. The evidence shows that the Veteran still maintained a close relationship with his girlfriend, siblings and family members. The Veteran has friends that he socializes with and continues to be employed. Additionally, thought processes were logical and coherent, thought content was normal, and there was no evidence of suicidal or homicidal ideations. Judgment was unimpaired and insight was good. “[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.” Vazquez-Claudio, 713 F.3d at 116-17. Here, the preponderance of the evidence shows that, from January 23, 2018, the Veteran did not experience symptoms as listed for a 100 percent rating, or other symptoms of a similar severity, frequency, or duration, but rather that his symptoms were all reasonably contemplated by the symptoms set forth in the rating criteria for a rating of no more than 70 percent. See Fenderson v. West, 12 Vet. App. 119 (1999). The Board acknowledges the Veteran’s assertions that his major depressive disorder is more severe than evaluated. His endorsements are admissible and have been taken into consideration. See Layno v. Brown, 6 Vet. App. 465 (1994). The Veteran is not, however, competent to identify a specific level of disability of his major depressive disorder according to the appropriate diagnostic code. He has not been shown to have the requisite knowledge or training in this regard. Such competent evidence concerning the nature and extent of the Veteran’s major depressive disorder has been provided by the VA examiners who objectively examined him. The medical findings directly address the criteria under which his major depressive disorder is evaluated. The Board finds these clinical records to be competent, objective, and probative evidence of record, and is therefore accorded greater weight than the Veteran’s subjective complaints of increased symptomatology for his major depressive disorder. For these reasons, the Board finds that the Veteran is not entitled to an initial rating in excess of 50 percent, prior to January 23, 2018, and in excess of 70 percent from January 23, 2018, for his major depressive disorder. In making this determination the Board considered the application of “staged” ratings, but found no additional distinctive periods where the Veteran’s service-connected major depressive disorder met or nearly approximated the criteria for a higher evaluation. In reaching this decision the Board considered the doctrine of reasonable doubt, however, to the extent the preponderance of the evidence is against ratings higher than that already assigned for major depressive disorder, the doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49 (1990) Neither the Veteran nor his representative has 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).   VA’s Duty to Notify and Assist With respect to the Veteran’s claims herein, VA has met all statutory and regulatory notice and duty to assist provisions. See 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326 (2017); see also Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015). U. R. POWELL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. G. LeMoine, Associate Counsel