Citation Nr: 19136366 Decision Date: 05/10/19 Archive Date: 05/10/19 DOCKET NO. 08-18 328 DATE: May 10, 2019 ORDER 1. Increases in the staged (10 percent prior to December 14, 2017, and 20 percent, combined, from that date) ratings assigned for the Veteran’s right knee disability are denied. 2. A 30 percent rating for the Veteran’s depressive disorder from (the earlier effective date of) February 26, 2009 and a 50 percent rating from (the earlier effective date of) April 6, 2011, are granted, subject to the regulations governing payment of monetary awards; a rating in excess of 50 percent is denied. FINDINGS OF FACT 1. Prior to December 14, 2017, the Veteran’s right knee disability was manifested by mild arthritis and painful motion with flexion no worse than to 110 degrees and full extension, and subluxation or lateral instability was not shown; from December 14, 2017, the right knee disability has been manifested by arthritis with painful motion, with flexion no worse than to 110 degrees and full extension, and no more than mild recurrent subluxation or lateral instability. 2. The Veteran’s depressive disorder is reasonably shown to have been manifested by symptoms productive of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks from (the earlier effective date of) February 26, 2009, and by symptoms productive of occupational and social impairment with reduced reliability and productivity from (the earlier effective date of) April 6, 2011; symptoms productive of occupational and social impairment with deficiencies in most areas are not shown. CONCLUSIONS OF LAW 1. Increases in the staged (10 percent prior to December 14, 2017, and 20 percent, combined, from that date) ratings for the Veteran’s right knee disability are not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (Codes) 5003, 5010, 5257, 5260, 5261. 2. A 30 percent rating is warranted for the Veteran’s depressive disorder from (the earlier effective date of) February 26, 2009; a 50 percent (but no higher) rating is warranted from (the earlier effective date of) April 6, 2011; a rating in excess of 50 percent is not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R.§ 4.130, Code 9434. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a Veteran who had active duty for training (ACDUTRA) from August to December 1970. In July 2015, a Travel Board hearing was held before the undersigned; a transcript is in the record. In June 2017, the Board remanded these matters for development. Increased Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation 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. Reasonable doubt as to the degree of disability will be resolved in the veteran’s favor. 38 C.F.R. § 4.3. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, separate ratings may be assigned for separate periods of time based on the facts found. This practice is known as “staged” ratings.” Hart v. Mansfield, 21 Vet. App. 505 (2007). The relevant temporal focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from a year before the claim was filed until VA makes a final decision on the claim. Id. 1. Increases in the (10 percent prior to December 14, 2017, and a combined 20 percent from that date) staged ratings for right knee disability are denied. On March 2009 VA examination, the Veteran denied deformity, giving way, instability, or effusions, of the right knee. He reported pain, stiffness, weakness, incoordination, decreased speed of joint motion, and swelling. He denied episodes of dislocation or subluxation. He reported weekly episodes of knee locking. He reported moderate weekly flare-ups, with a duration of hours, precipitated by walking, standing, or climbing hills or stairs. He was able to stand for 15 to 30 minutes and to walk one-quarter mile. He did not use assistive devices. On physical examination, the Veteran’s gait was antalgic. Other evidence of abnormal weight bearing included callus formation on the lateral aspect of the left foot. There was no inflammatory arthritis. Right knee findings included crepitus, tenderness, and guarding of movement. Crepitation and grinding were noted; a mass behind the knee, clicks or snaps, instability, or a patellar or meniscus abnormality were not. Right knee flexion was from 0 to 120 degrees and extension was normal; there was objective evidence of pain with active motion and following repetitive motion but there were no additional limitations with repetitive motion testing. X-rays showed minimal right medial compartment narrowing and superior patellar spurring suggestive of mild degenerative changes. The diagnosis was degenerative joint disease (DJD) with bursitis. Based on this evidence, the May 2009 rating decision on appeal continued a 10 percent rating for right knee bursitis with arthralgia and limitation of motion. On April 2011 VA examination, the Veteran reported pain and decreased mobility in the knee, which buckled under him more frequently. There was no history of hospitalization or surgery to the joint. He reported symptoms of deformity, giving way, instability, pain, stiffness, weakness, and decreased speed of joint motion. He denied symptoms of incoordination or episodes of dislocation or subluxation. He reported locking episodes one to three times per month, repeated effusions, and swelling and tenderness. He reported weekly severe flare-ups with a duration of hours, during which he rested on the sofa or reclining chair. There were no constitutional symptoms of arthritis or incapacitating episodes of arthritis. He reported he was able to stand for 15 to 30 minutes, unable to walk more than a few yards, and that he did not he use assistive devices. On physical examination, the Veteran’s gait was antalgic. There was no evidence of abnormal weight bearing. Right knee findings included mild medial and lateral tenderness and guarding of movement; there was more pronounced tenderness at the inferior patellar area. There were no bumps consistent with Osgood-Schlatter’s disease, no mass behind the knee, clicks or snaps, grinding, instability, patellar or meniscus abnormality, or abnormal tendons or bursae. Crepitation was noted. Right knee flexion was from 0 to 110 degrees and extension was normal; there was objective evidence of pain with active motion and following repetitive motion. There were no additional limitations after repetitive use testing. There was no ankylosis. X-rays showed minimal degenerative changes. The examiner opined that the right knee disability had significant effect on the Veteran’s usual occupation and daily activities due to problems with lifting and carrying, decreased strength in the lower extremity, and pain. On July 2015 VA examination, the Veteran reported pain in the lateral patella above the knee cap and a burning sensation even when just sitting. He related that cold damp weather caused flare-ups. He stated he did not have full range of motion of the right knee. Moderate tenderness to palpation was noted at the medial aspect of the knee below the knee cap. There was no objective evidence of crepitus. There was evidence of pain with weight bearing. Range of motion testing of the knee could not be conducted (apparently due to pain during a period of acute exacerbation). It was noted that the knee was not ankylosed (there was at least some (unspecified) degree of right knee motion), and that the Veteran used a cane for ambulation because he walked with an unsteady gait (reason unspecified). There was no history of recurrent subluxation, lateral instability, or recurrent effusion; joint instability testing was normal. On December 14, 2017 VA examination, the Veteran reported aching pain in the right knee rated 5-6/10 in severity. He reported a stiff feeling to the joint that he attributed to the cold weather. Standing and walking caused pain resulting in decreased range of motion. He related that walking for 5 minutes or standing for longer than a couple of minutes caused flare-ups with increased pain, which occurred daily. Flexion of the right knee was from 0 to 110 degrees and extension was full; right hip and back pain contributed to the decreased range of motion. Passive range of motion was equivalent to active motion. Pain was noted on flexion and extension and caused functional loss. There was evidence of pain with weight bearing. There was objective evidence of crepitus. The knee was not ankylosed. Slight lateral instability of the knee was noted; there was no recurrent subluxation. The Veteran reported intermittent edema with increased activity; effusion was not noted on exam. Joint stability testing was normal. The Veteran reported constant use of a cane for gait stability/assistance for his disabilities of both knees, right hip, and low back, and regular use of a motorized scooter. X-rays showed mild degenerative changes; no fractures or other acute osseous abnormalities were identified and the soft tissues were unremarkable. Based on this evidence, a February 2019 rating decision granted a separate 10 percent rating for lateral instability of the right knee effective December 14, 2017. Additional VA treatment records show symptoms/functional impairment largely similar to that reported on the examinations discussed above. The Veteran has also submitted lay statements from his wife and himself, describing the severity of his symptoms. When evaluating a service-connected disability based on limitation of motion, the Board must take into consideration functional loss due to pain under 38 C.F.R. § 4.40 and functional loss due to weakness, fatigability, incoordination or pain on movement of a joint under 38 C.F.R. § 4.45. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see Johnson v. Brown, 9 Vet. App. 7 (1996). In DeLuca, the Court held that a diagnostic code based on limitation of motion does not subsume 38 C.F.R. §§ 4.40 and 4.45 and that the rule against pyramiding set forth in 38 C.F.R. § 4.14 does not forbid consideration of a higher rating based on a greater limitation of motion due to pain on use, including use during flare-ups. Id. A finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the veteran. 38 C.F.R. § 4.40; Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Nonetheless, a rating higher than the minimum compensable rating is not assignable under any diagnostic code relating to range of motion where pain does not cause a compensable functional loss. Rather, the “pain must affect some aspect of ‘the normal working movements of the body’ such as ‘excursion, strength, speed, coordination, and endurance,’” before a higher rating may be assigned. See Mitchell v. Shinseki, 25 Vet. App. 32, 37 (2011). The criteria for rating knee disabilities are found in Codes 5256 to 5263. Code 5256 provides for ratings from 30 to 60 percent for ankylosis of a knee. Under Code 5003, degenerative arthritis established by X-ray findings is rated based on limitation of motion under the appropriate Codes for the specific joint involved. When the limitation of motion of the specific joint involved is noncompensable under the appropriate Codes, a 10 percent rating is warranted for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added, under Code 5003. Under Code 5257, a 10 percent rating is warranted for slight recurrent subluxation or lateral instability, a 20 percent rating is warranted for moderate recurrent subluxation or lateral instability, and a 30 percent rating is warranted for severe recurrent subluxation or lateral instability. Code 5258 provides for a 20 percent rating for dislocated semilunar cartilage with frequent episodes of “locking”, pain, and effusion into the joint. Under Code 5259, a (maximum) 10 percent rating is warranted for cartilage, semilunar, removal of, symptomatic. Under Code 5260, limitation of knee flexion to 60 degrees or more warrants a 0 percent rating, to 45 degrees warrants a 10 percent rating, to 30 degrees warrants a 20 percent rating, and to 15 degrees warrants a 30 percent rating. Under Code 5261, limitation of knee extension to 5 degrees warrants a 0 percent rating, to 10 degrees warrants a 10 percent rating, to 15 degrees warrants a 20 percent rating, to 20 degrees warrants a 30 percent rating, to 30 degrees warrants a 40 percent rating, and to 45 degrees warrants a 50 percent rating. Code 5262 provides for ratings for impairment due to malunion or nonunion of the tibia and fibula. Code 5263 provides for a 10 percent rating for acquired (traumatic) genu recurvatum. 38 C.F.R. § 4.71a. [Codes 5256, 5258, 5262, and 5263 have no applicability here, as the pathology or manifestations in the rating criteria for those Codes (ankylosis, dislocated (or symptomatic postoperative)semilunar cartilage, malunion or nonunion of tibia or fibula, or genu recurvatum) are not shown. 38 C.F.R. § 4.71a.] The instant claim for increase was received February 26, 2009. The 10 percent rating assigned for the right knee disability for limitation of motion throughout the appeal period is based on limitation of motion/flexion or painful motion due to X-ray confirmed degenerative arthritis (under Code 5010). To warrant an increase in the rating, the evidence would have to show limitation of knee flexion to 30 degrees, compensable limitation of extension (at 10 degrees), instability or subluxation, dislocated semilunar cartilage, or symptomatic removal of semilunar cartilage. The evidence of record does not show that any such manifestations prior to December 14, 2017. At no time prior to that date is the Veteran’s right knee flexion shown to have been limited to 30 degrees; was there compensable limitation of extension; was instability or subluxation shown. While a 2015 examiner indicated that pain caused functional limitation, such was not shown to exceed the impairment reflected by the 10 percent rating assigned, and symptoms of the right knee disability did not approximate the criteria for a compensable rating under any other applicable Code for rating knee disability. Consequently, the Board finds that a rating in excess of 10 percent for the right knee was not warranted prior to December 14, 2017. The combined 20 percent rating assigned for the right knee disability from December 14, 2017 is based on a 10 percent rating for arthritis with limitation of motion combined with a 10 percent rating for slight instability (under Code 5257). To warrant an increase in the combined rating, the evidence would have to show limitation of knee flexion to 30 degrees, compensable limitation of extension (at 10 degrees), moderate instability, or dislocated semilunar or symptomatic removal of semilunar cartilage. The evidence of record does not show such manifestations. At no time during the relevant period was right knee flexion shown to be limited to 30 degrees; was there compensable limitation of extension; or was there more than slight instability. Consequently, a combined rating in excess of 20 percent is not warranted for the right knee at any time. The preponderance of the evidence is against the claim, and the appeal in the matter must be denied. 2. A 30 percent rating is granted for the Veteran’s depressive disorder from (the earlier effective date of) February 26, 2009; and a 50 percent rating is granted from (the earlier effective date of) April 6, 2011; a rating in excess of 50 percent is denied. On April 2009 VA examination, the Veteran reported participating in medication management sessions approximately every 3 months. He served as a bookkeeper for the high school basketball team and had retired in 2005 due to eligibility by age or duration or work. He reported sleep impairment due to caring for his father who lived with him, with frequent awakening at night. The examiner opined that this was a situational sleep disturbance and not a diagnosable sleep disorder. On mental status examination, the Veteran was neatly groomed and his psychomotor activity and speech were unremarkable. His attitude was cooperative, friendly, and relaxed. His affect was normal and his mood was mildly dysthymic. His attention was intact and he was fully oriented. His thought process and content were unremarkable. There was no evidence of delusions of hallucinations. His judgment and insight were intact. He did not have inappropriate behavior, obsessive/ritualistic behavior, panic attacks, homicidal thoughts or suicidal thoughts. His impulse control was good with no episodes of violence. He had no problem with activities of daily living. His memory was normal. The diagnosis was dysthymic disorder. The examiner noted that the Veteran felt frustrated and discouraged because his physical conditions did not permit him to do activities he wanted to do, and he was disappointed that his granddaughter had “disowned” him”; the examiner opined that these situational stressors led to his dysthymia. The examiner opined that there was occasional decrease in work efficiency with intermittent periods of inability to perform occupational tasks due to mental disorder signs and symptoms, but with generally satisfactory functioning. The examiner opined that ongoing mild depressive symptoms could interfere with optimal productivity and efficiency sometimes but the Veteran generally functioned quite well. Based on this evidence, the May 2009 rating decision on appeal continued a 10 percent rating for depressive disorder. On April 6, 2011 VA examination, it was noted that the Veteran was receiving VA treatment for depression with worsening of chronic depressive symptoms reported. He reported depressed mood for most of the day, more often than not, of moderate severity with appetite disturbance, hypersomnia, and low energy/fatigue. On mental status examination, his speech and psychomotor activity were unremarkable. His attitude was cooperative. His affect was normal and mood was depressed. His attention was intact and he was fully oriented. His thought process and content were unremarkable. No delusions or hallucinations were noted. His judgment was adequate. He did not have inappropriate behavior. He reported sleep impairment and recurrent checking behaviors which resulted in ineffectual use of time and impaired family relationships/interactions. He reported panic attacks irregularly during the week in association with stressors. He denied homicidal or suicidal thoughts. His impulse control was good, with no episodes of violence. His memory was normal. The examiner opined that there was reduced reliability and productivity due to mental disorder symptoms, noting that the Veteran reported increased isolation to deal with his depressed mood, with resultant decrease in social activities and family interactions; he noted estrangement from his daughter, difficulty articulating his worsening of mood, and effect on his life; his wife noted that he demonstrated increased withdrawal and decreased participation in family and social activities as well as worsening anhedonia. On July 2015 private examination, the Veteran reported that he has been treated by a VA psychiatrist but had no other mental health treatment. He had been married to his second wife for 8 years and the marriage was going fairly well. On mental status examination, he was described as terse and impatient, with attitude toward the examination tentative. His concentration was within normal limits and his attention span was “tenacious”. His psychomotor activity was increased. His speech patterns were relevant, coherent and appropriate but somewhat sparse. His ability to abstract and calculate were within normal limits. His affect was generally normal and his mood was “not so good”; he denied any wide mood swings, mostly feeling apathetic, and denied any emotional lability. He reported feeling depressed on a constant basis daily. He denied any intent or plan to harm himself. He reported a low energy level and chronic fatigue. He denied mania, hypomania, agitation, psychomotor pressure, free floating anxiety, panic attacks, phobias or fears. He reported constantly feeling irritable with others. He denied obsessions, compulsions, paranoid ideas or hallucinations. He reported he had no friends and that he was always reserved, possibly due to his early home life. His judgment and insight were good. His memory was broadly intact and his stream of thought was normal. The examiner opined that the Veteran’s major depressive disorder, apathetic type with melancholia, caused reduced reliability and productivity with flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining work and social relationships, apathy, melancholia, and hypersomnia. On August 25, 2015 VA examination, the Veteran reported an “ok” relationship with his wife but described conflict and feeling depressed that he could not do things he was able to do when they were first married. He reported distant relationships with his daughter and adult granddaughter. He was not a member of any social organizations; his interests included watching sports; he did not regularly go out to socialize or go shopping, spending most of his time at home. He used to coach children’s sports teams but no longer did so. He reported that he had become more isolated and avoidant of social situations, which reinforced his negative perceptions and interactions. He reported frustration due to his physical limitations. He denied suicidal or homicidal ideation. His symptoms included depressed mood, disturbances in motivation and mood, difficulty establishing and maintaining effective work and social relationships, and difficulty adapting to stressful circumstances. On mental status evaluation, the Veteran made appropriate eye contact and was initially hesitant but became slightly more relaxed and engaged. His psychomotor behavior was normal. His speech rate and rhythm were normal. His mood and affect were dysthymic, blunted, and congruent. His cognition was unimpaired and his thought patterns were coherent, logical and responsive. The diagnosis was major depressive disorder, moderate. The examiner opined that the Veteran’s psychiatric disability results in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. On June 29, 2017 VA examination, the Veteran reported that he felt like a burden to his wife, his grandson, and to everybody. He reported infrequent contact online with his daughter, who lived nearby. He reported having occasional contact with others via social media, and that he had acquaintances in the athletic community due to his work. He enjoyed attending football and basketball games occasionally when he is able. He reported that he held office in his county political party but could not do anything in his position due to his physical issues. He played Facebook sports games online, collected sports cards, and watched Westerns on television. He denied suicidal or homicidal ideation. He reported feeling worthless and helpless and losing interest in some activities, and that he experienced crying spells at times. He denied suspiciousness or panic attacks. He reported mild memory loss at times, difficulty getting out of bed some days, and lack of motivation. He reported problems in his family relationships and that he had also lost contact with friends except through social media. He became easily frustrated, and had occasional verbal outbursts. His wife reported that he neglected his hygiene. On mental status evaluation, the Veteran was attentive and fully oriented. His mood was dysthymic with a restricted range of affect. His speech was within normal limits and thought processes were clear and coherent. The examiner opined that the psychiatric disability resulted in 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 examiner opined that the Veteran’s mental health symptoms likely have a moderate impact on his daily functioning. Based on this evidence, a July 2017 rating decision granted a 20 percent rating for the Veteran’s depressive disorder effective August 25, 2015 and a 40 percent rating effective June 29, 2017. Following the Board’s October 2017 remand, a February 2019 rating decision granted a 30 percent rating for the Veteran’s depressive disorder effective August 25, 2015, and a 50 percent rating effective June 29, 2017. Additional VA treatment records throughout show symptoms for the most part similar to those found on the examinations described above. The Veteran has also submitted lay statements describing his difficulties due to his psychiatric disability. Psychiatric disability is rated under the General Rating Formula for Mental Disorders. A 10 percent rating is warranted when there is occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication. A 30 percent rating is warranted when there is 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). A 50 percent rating 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; difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is warranted when there is occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. A 100 percent rating is warranted 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; memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130, Code 9434. The use of the phrase “such symptoms as,” followed by a list of examples, provides guidance as to the severity of symptoms contemplated for each rating, in addition to permitting consideration of other symptoms, particular to each veteran and disorder, and the effect of those symptoms on the claimant’s social and work situation. Mauerhan v. Principi, 16 Vet. App. 436, 443 (2002). Because “[a]ll nonzero disability levels [in § 4.130] are also associated with objectively observable symptomatology,” and the plain language of this 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 under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration.” Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). “[I]n the context of a 70[%] rating, § 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas.” Id. at 117. Although a veteran’s symptoms are the “primary consideration” in assigning a rating under § 4.130, the determination as to whether the veteran is entitled to a 70% disability evaluation “also requires an ultimate factual conclusion as to the veteran’s level of impairment in ‘most areas.’” Id. at 118. When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran’s capacity for adjustment during periods of remissions. 38 C.F.R. § 4.126(a). The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner’s assessment of the level of disability at the moment of the examination. 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 an evaluation on the basis of social impairment. 38 C.F.R. § 4.126(b). The Board finds that from the filing of this claim for increase (in February 2009), symptoms and functional impairment reported by the Veteran, and noted by VA examiners and treatment providers, reflect 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). On April 2009 VA examination, he reported symptoms that meet, or at least approximate, the criteria for a 30 percent rating. The April 2009 examiner opined that there was occasional decrease in work efficiency with intermittent periods of inability to perform occupational tasks due to mental disorder signs and symptoms, but with generally satisfactory functioning. Progress notes reflect a level of functioning consistent with occasional decrease in efficiency since the filing of the claim for increase. Accordingly, the Board finds that the criteria for a 30 percent rating were met from since then, and that such rating is warranted from February 26, 2009. From the April 6, 2011 VA examination date, the symptoms and functional impairment reported by the Veteran and noted by VA examiners and treatment providers (such as flattened affect; memory impairment; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships) reflect occupational and social impairment with reduced reliability and productivity. On both the April 2011 and the August 2015 examinations, the Veteran reported symptoms of a nature and severity similar to those he reported in his July 2015 hearing testimony, on private examination, and on the June 2017 examination (findings on which were the basis for the assignment of the 50 percent “stage” in the ratings). Notably, the April 2011 VA examiner and the July 2015 private examiner each opined that the Veteran’s psychiatric disability results in occupational and social impairment with reduced reliability and productivity. Progress notes reflect a level of functioning that has been consistent throughout since April 6, 2011. Accordingly, the Board finds that the criteria for a 50 percent rating were met from that date, and that such rating is warranted from (the earlier effective date of) April 6, 2011. The evidence of record does not show that symptoms that meet (or approximate) the criteria for a 70 percent rating were manifested at any time under consideration. While he has on occasion self-reported symptoms of greater severity (obsessional rituals, neglect of personal hygiene), the record does not show that such symptoms resulted in deficiencies in most areas. No examiner, VA or private, has opined that the depressive disorder symptoms result in deficiencies in most areas. The Veteran has maintained important family relationships and participation in community activities, as his physical limitations allow, e.g., he has participated in county to the extent his physical disabilities permit, and while being unable to maintain friendships in person due to physical limitations, has indicated he does so on social media. The record does not show that he requires assistance tending to finances or with activities of daily living due to his depressive disorder. Impairment in cognition is not alleged or shown, and his judgment has consistently been intact. He worked until 2007 (when he retired due to age or duration of work). The Board also notes the lay statements submitted by the Veteran in support of this claim, describing problems flowing from his depressive disorder symptoms. The levels of functioning impairment described are encompassed by ratings assigned, and do not reflect deficiencies in most areas. Deficiencies in most areas are not shown, and a rating in excess of 50 percent is not warranted. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Schechner, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.