Citation Nr: 21004046 Decision Date: 01/25/21 Archive Date: 01/25/21 DOCKET NO. 17-13 298 DATE: January 25, 2021 ORDER The August 10, 2020 Board decision denying an initial rating in excess of 30 percent for unspecified anxiety disorder is vacated. Entitlement to a 50 percent rating for unspecified anxiety disorder from October 29, 2015 to December 20, 2019 is granted. Entitlement to a 70 percent rating for unspecified anxiety disorder from December 21, 2019 is granted. FINDINGS OF FACT 1. The August 10, 2020 Board decision was issued but did not identify and discuss a February 2020 Mental Disorders Disability Benefits Questionnaire (DBQ). 2. Prior to December 21, 2019, the severity, frequency, and duration of the Veteran’s symptoms more closely approximated occupational and social impairment with reduced reliability and productivity but not occupational and social impairment with deficiencies in most areas. 3. From December 21, 2019, the severity, frequency, and duration of the Veteran’s symptoms more closely approximated occupational and social impairment with deficiencies in most areas but not total occupational and social impairment. CONCLUSIONS OF LAW 1. The criteria for vacatur of the Board’s August 10, 2020 Board decision have been met. 38 U.S.C. § 7104(a); 38 C.F.R. § 20.904. 2. The criteria for a 50 percent disability rating from October 29, 2015 to December 20, 2019 for unspecified anxiety disorder were met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9413. 3. The criteria for a 70 percent disability rating for unspecified anxiety disorder have been met since December 21, 2019. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9413. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from January 2006 to January 2010. These matters come to the Board of Veterans’ Appeals (Board) on appeal from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). In February 2019, the Board, in pertinent part, denied the increased initial rating claim for unspecified anxiety disorder and the service connection claim for low back disorder. In December 2019, the United States Court of Appeals for Veterans Claims (CAVC) granted a Joint Motion for Partial Remand (JMPR) filed by both parties that vacated and remanded the part of the February 2019 Board decision that denied the increased rating claim for unspecified disorder and the service connection claim for low back disorder. In August 2020, the Board remanded the claim for service connection for a low back disorder and again denied entitlement to an increased rating for unspecified anxiety disorder. As discussed below, the August 2020 Board decision is vacated in part as it pertains to the claim for an increased rating for unspecified anxiety disorder. Order to Vacate 1. The August 10, 2020 Board decision denying an initial rating in excess of 30 percent for unspecified anxiety disorder is vacated. The Board may vacate an appellate decision at any time upon request of the appellant or his or her representative, or on the Board’s own motion, when an appellant has been denied due process of law. 38 U.S.C. § 7104(a); 38 C.F.R. § 20.904. In December 2020, the Veteran submitted a motion requesting that the Board vacate the August 10, 2020 Board decision because the Board failed to consider the February 2020 VA examination report. The Board acknowledges that it failed to identify and discuss the February 2020 Mental Disorders DBQ and apologizes for the oversight. As the Veteran was denied full due process, the August 10, 2020 Board decision is vacated. 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. Part IV. If two evaluations are potentially applicable, 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. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. Therefore, the Board has considered the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the veteran’s disability in reaching its decision. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). In deciding this appeal, the Board has considered whether separate ratings for different periods of time, based on the facts found, are warranted, a practice of assigning ratings referred to as “staging the ratings.” See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2008). The Veteran contends that he is entitled to a rating greater than 30 percent for his service-connected unspecified anxiety disorder, previously rated as primary insomnia, which is rated under 38 C.F.R. § 4.130, Diagnostic Code 9413 using the General Formula for Mental Disorders (General Formula). Under the General Formula, the Board must conduct a “holistic analysis” that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). Under the General Formula, a noncompensable rating is assigned when a mental condition has been formally diagnosed, but symptoms are not severe enough to either require continuous medication, or to interfere with occupational and social functioning. A 10 percent rating is assigned when mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of occasional stress, or symptoms controlled by medication cause occupational and social impairment. A 30 percent rating is assigned when symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events), cause 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 normal conversation). A 50 percent rating is assigned when symptoms such 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; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; 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); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name. Factual Background A December 2015 VA examination report shows the Veteran reported anxiety, which the examiner found was a progression of his previously diagnosed insomnia. He lived with his wife and had a good relationship with her. His relationship with his mother was “ok” while his relationship with his father was stronger. He had frequent contact with his seven siblings. He was working, had his master’s degree, and was a part-time student working towards his MBA. His symptoms included anxiety and mild memory loss. The examiner observed that the Veteran was alert and oriented to his surroundings, casually dressed, and appropriately groomed. His speech, eye contact, and gait were within normal limits. He was logical, coherent, and cooperative. The Veteran’s affect was euthymic, and his mood was “all right” with medication. The Veteran endorsed persistent anxiety and irritability, teeth grinding, and chronic physical symptoms of anxiety such as muscle tension and heart palpitations. He denied significant feelings of depression. He reported having a good energy level and “all right” sleep, with an average sleep time of 5 to 6 hours per night. His concentration was diminished, and he was forgetful. He also reported having poor focus at times. He denied feelings of worthlessness or hopelessness, and he denied suicidal ideation. The examiner did not observe signs of thought disorder, hallucinations, or delusions. The examiner found that the Veteran’s disability caused 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 medication. Private treatment records from BHSI, dated in October and November 2016, show treatment for panic disorder. In October 2016, the Veteran reported that he had his first panic attack in 2013 and that he had not experienced panic attacks for some time. He took medication when he felt panic or stress building up. He indicated that he experienced anxiety, fidgetiness, and difficulty concentrating sporadically. Medication made him feel normal when he felt panicked, and when he ran low on medication, he cut pills in half or drank alcohol to achieve a relaxed, calm feeling. He reported trouble sleeping as he had trouble “winding down.” He noted that he had been prescribed Lexapro but that the medication was not effective. He felt increased suicidal ideation on the medication. He denied suicidal ideation, intent, and plan, as well as homicidal ideation, delusions, and hallucinations. The provider observed that the Veteran lived with his spouse and 8 month old daughter. He had good exercise habits and was running 3 to 4 times a week. He was working towards his MBA. The provider noted that his symptoms included anxiety. The Veteran was oriented to time, place, and person, and his memory and judgment were not impaired; however, he drank 2 to 3 alcoholic beverages daily and occasionally as anti-anxiety agent. The Veteran’s mood was anxious, and his affect was congruent with mood and not easily distracted. The provider stated that the Veteran had low risk of assault or suicide. In November 2016, the Veteran reported reduced use of alcohol. A December 2016 depression assessment shows the Veteran indicated that in the last 2 weeks, he had several days of having little interest or pleasure in doing things; had several days of feeling down, depressed, or hopeless; had trouble with sleep and feeling tired or having little energy nearly every day; had poor appetite or overeating more than half of the days; had trouble concentrating nearly every day; moved or spoke so slowly that other people could have noticed on more than half of the days; and had thoughts that he would be better off dead or hurting himself on several days. He indicated that his problems made it somewhat difficult to work, take care of things at home, and get along with others. During his appointment, the provider noted that the Veteran’s affect was fair and sometimes irritable. The Veteran was not aware of any triggers with panic attacks. The Veteran stated that he had passive thoughts of death for years and that he had them at night. He had no suicidal intent or plan. He also noted intrusive homicidal thoughts but no homicidal ideation. A December 2016 VA psychiatric report shows the Veteran described a long history of chronic generalized anxiety and periods when he felt overwhelmed, on edge, and irritable. He had some panic attacks over time, but his generalized worry and anxiety remained the most problematic on a daily basis and impacted his ability to function. The Veteran drank more alcohol than recommended and drank too much caffeine. His symptoms included non-restful sleep, low energy, decreased concentration, chronic excessive worry, muscle tension, and frequent irritability without violence. He denied suicidal and homicidal ideation. The provider observed that the Veteran was anxious with restricted affect but reactive, nonlabile. His mood was “stressed.” VA treatment records include a January 2017 mental health progress note. The Veteran described his panic attack in 2013. He attempted to use self-taught coping skills, medication, and exercise to improve his anxiety. He ran when training for marathons and tended to run to the point of extreme exhaustion. During a January 2017 VA examination, the Veteran endorsed continued good relationships with his wife, child, parents, and siblings. He had two good friends, attended church, played broomball, and liked running. He stated that his job was stressful and that he had some minor difficulty performing his job duties. He sometimes felt overwhelmed with the complexity of the work. He denied having disciplinary problems or reprimands. He was still working towards his MBA and he was doing well with his classes. He noted that he took medications for his anxiety and reduced his alcohol intake. His symptoms included anxiety and panic attacks that occurred weekly or less. He described his mood as frustrated and irritable, which he attributed to reducing his alcohol consumption and new medications. He said his energy was low and his sleep sporadic. He had problems falling asleep. He reported having adequate concentration and memory. He had passive suicidal ideation but no plan or intent. The examiner found that the Veteran’s disability caused 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 medication. A January 2017 VA treatment record shows the Veteran reported improved sleep and less intense anxiety; however, he found himself more irritable and acting on that irritability, to include aggressively commenting on strangers’ behavior in public. He did not report homicidal or suicidal thoughts. His reported symptoms included panic attacks, chronic worry or rumination, tension, and agitation. See also VA treatment records, February 2, 2017 and February 16, 2017. During a February 2017 psychiatric evaluation, the Veteran reported that generalized worry and anxiety remained the most problematic on a daily basis and impacted his daily ability to function. He avoided tasks because thinking about them caused anxiety. He had problems sleeping and drank too much alcohol and caffeine. He denied current excessive worry, muscle tension, irritability, and homicidal and suicidal ideation. He only exercised when preparing for marathons. In May 2017, the Veteran attended another VA examination. The Veteran reported continued good relationships with his wife, child, parents, and siblings. He had two good friends. His social life could be better, but he liked his alone time. He was employed and had good attendance at work, but had been told that he could be distracted and may have errant priorities. He was scheduled to complete his MBA in the fall of 2017. The examiner noted anxiety, panic attacks that occur weekly or less, and chronic sleep impairment. The examiner observed that the Veteran was oriented to person, place, and time. He interacted in a logical, coherent, and very cooperative fashion. His affect was even-keeled and not overly distressed or anxious. He did not come across as depressed. His speech was normal for rate and volume and he was reasonably open. The Veteran reported that his medications helped reduce his symptoms and that he had a better sense of control. He stated that his focus was better as he used to be highly restless, which affected his work. The examiner found that the disability caused 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. A January 2018 VA treatment record indicates that the Veteran was doing well. He denied having depressive symptoms and excessive anxiety. His sleep was still restless. He denied having excessive worry, muscle tension, irritability, violence, and suicidal or homicidal ideation. See also VA treatment record, July 13, 2018. In January 2019, the Veteran reported anxiety and some irritability. His concentration was dulled at times and he had a difficult time being around others. The Veteran had muscle tension and frequent irritability without violence. He denied having suicidal or homicidal ideation. The provider noted that the Veteran’s mood was “pretty good” with full decreased intensity, nonlabile affect. In February 2019, the Veteran reported concerns about his anger and ongoing symptoms of anxiety. He said he had a short fuse and described his anger as going from a 0 to 10 at home. He denied physical violence but stated that he yelled or raised his voice, which causes problems with his wife. The provider noted that the Veteran’s mood was “okay” with normal to anxious affect. The Veteran denied current or history of suicidal and homicidal ideation, intent, or plan. He denied impulsive behavior other than some anger and yelling. On March 18, 2019, the Veteran reported increased work stress due to an employee giving notice and his wife’s postpartum anxiety. He stated that anger usually followed his anxiety. Other symptoms were the same as noted in February 2019. A subsequent March 2019 treatment record shows the Veteran described several recent events when he lost his temper and raised his voice at his wife and child. He also threw a toy and scared his child. He had some remorse but primarily expressed anger. The provider observed that his mood was “okay” with normal to irritable affect. The Veteran denied current or history of suicidal and homicidal ideation, intent, or plan. He denied impulsive behavior other than some anger and yelling. Similar symptoms were reported throughout 2019. Private treatment records show a worsening of the Veteran’s mental health in December 2019. On December 21, 2019, he was admitted to UMMC for suicidal thoughts. He reported having increased suicidal ideation and anxiety. He told one provider that he did not want to commit suicide and that he did not have a plan. However, another note completed at admission shows he reported being actively suicidal. He reported stress from work and family, but that he was confident at his place of employment and felt he would keep his job. He was admitted for a 72 hour hold. The next day, the Veteran reported feeling increasingly depressed in the last two months. He rated his depression as high. He had difficulty sleeping, low energy, impairment of memory and concentration, and increased appetite. He reported increased irritability and daily anxiety. He had extreme worries, racing thoughts, muscle tension, and felt “edgy.” His last panic attack was about a year prior. The provider observed depressed mood with congruent affect. His thought content was negative for suicidal and homicidal ideation. The diagnoses included major depressive disorder, generalized anxiety disorder, and restless leg syndrome. In January 2020, the Veteran was treated for major depression. A January 9, 2020 mental health progress note indicates that the Veteran was hospitalized for an increase in depression symptoms. He reported having a new full-time job and worked from home. He remained married and had two children. He did not have social support outside of his family. He went to church on occasion and would work at the church to get out of the house. He continued to run excessively to wear himself down. He told the provider that he showered for the first time that day in five days because his wife prompted him to do so. The Veteran’s mood was depressed with mild irritability and anxiety. His affect was blunted and at times, flat. The Veteran said he “always felt angry.” He endorsed having suicidal thoughts without intent or plan. The thoughts could be intrusive or cyclical. His risk factors for suicide included recent suicidal thoughts, psychiatric hospitalization in December, access to firearms (not presently), irritability, anger, and limited social support. The provider diagnosed major depression and generalized anxiety disorder with panic attacks. The Veteran was deemed a heightened or intermediate risk. The January 17, 2020 treatment record shows the Veteran had suicidal thoughts and had engaged in preparatory behaviors, such as looking at websites discussing death and glamorizing suicide. He acknowledged the impact that his death would have on his family. The provider observed that his mood was depressed with mild irritability and blunted and at times flat affect. The Veteran reported having limited social support in his community, sleep problems, suicidal thoughts without intent or plan, which could be intrusive or cyclical. His suicide risk factors included recent suicidal thoughts, history of preparatory behavior, psychiatric hospitalization in December 2019, access to firearms (not presently), irritability, anger, and limited social support. The Veteran was deemed an intermediate risk. A subsequent January 2020 record shows the Veteran referenced significant difficulty with isolation. He worked from home and struggled to focus. His mood was depressed, and his affect was flat with some embarrassment. He had suicidal thoughts without intent or plan. His thoughts could be intrusive or cyclical. His suicide risk factors included recent suicidal thoughts, history of preparatory behavior, psychiatric hospitalization in December 2019, access to firearms (not presently), irritability, anger, and limited social support. The Veteran was deemed an intermediate risk. In February 2020, the Veteran had a VA examination. The examiner indicated that the Veteran had unspecified anxiety disorder and unspecified depressive disorder and that she could not differentiate the symptoms attributable to each diagnosis. The Veteran reported fleeting suicidal ideation without plans or intent. He noted an increase in masturbation to “numb out” and feel something. He also indicated that he would not shower for a few days and his wife would have to remind him to shower. The Veteran reported that his relationship with his wife was good and non-confrontational. She had been more understanding since his hospitalization. Prior to this, she was unaware of his mental health issues. He had good relationships with his children. He was easily irritated at home and when driving. He tended to drive fast, tailgate, and honk at other drivers. He did not engage in any other risky or problematic behaviors. He continued to drink alcohol a few times per week but stated that his consumption had lessened. The Veteran continued to work full time from home, which helped his anxiety but worsened his depression. He stated that he was behind on his job tasks but that he had not been written up. He did not feel attentive at work. He noted that he completed his MBA in December 2018 with a 3.0 GPA. He denied having issues during school. Socially, the Veteran had good relationships with his extended family. He had no local friends. He went to church regularly but had been having difficulty finding enjoyment in things over the past 6 months. Prior to this, he enjoyed running and video games. He preferred to be at home during his free time as he felt safe there. The examiner noted the following symptoms: depressed mood; anxiety; panic attacks that occur weekly or less; chronic sleep impairment; mild memory loss, such as forgetting names, directions, or recent events; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances, including work or a worklike setting; suicidal ideation; neglect of personal appearance and hygiene. Other symptoms included rumination, decreased energy and fatigue, increased appetite, decreased interest, attention and concentration difficulties, decreased self-confidence, loneliness, restlessness, difficulty relaxing, and mild irritability. The Veteran’s mood was slightly down with restricted affect. He was adequately groomed. The examiner found that the Veteran’s symptoms resulted in occupational and social impairment with reduced reliability and productivity. In March 2020, the Veteran reported that he had to keep his kids home due to the pandemic. Other than a recent outburst when he punched a wall at home, he was managing well. He stated that he found himself feeling threatened and would react defensively with aggression. The provider stated that his mood was stable, with episodic moments of anxiety, agitation, and aggression. The assessment was major depression, recurrent-severe, with some stability in mood due to having increased responsibilities at home with his wife and kids being home full time. His anxiety had increased since COVID-19 outbreak. He continued to have suicidal thoughts without intent or plan. Similar symptoms were noted throughout 2020, along with compulsive eating and increased vigilance. In addition to the medical records, the Board has considered the Veteran’s lay statements. In his March 2020 statement, the Veteran reported that he had severe to mild panic attacks. Almost daily he had sudden symptoms of being lightheaded, feared losing control, had hot flashes, grinds his teeth, and had heart pains. To cope with his symptoms, he ran to exhaust himself mentally and physically. The Veteran also stated that he became angry with people over nothing, especially when driving, so he stayed home. He was often irritable and felt regret when it was directed at his children, so he preferred isolation to social activities. He also had intrusive thoughts of saying and doing things associated with suicide, which contributed to his hospitalization in December 2019. He reported continued loss of interest in activities, extreme fatigue, feelings of guilt and hopelessness, sadness more days than not, and sleep disturbance. His symptoms caused difficulty in concentration and persistence, difficulty maintaining social functioning, and restriction of daily activities. He mixed up words, combing two words when talking and forgetting the correct word for the context, and had to continually correct these errors. The Veteran reported difficulty performing his professional responsibilities out of fear of making critical mistakes. He also indicated that participating in professional employment exacerbated his stress and caused panic attacks, stress, and depressive episodes, which resulted in self-sabotaging behaviors. He had difficulties with concentration, persistence, and often failed to complete tasks in a timely fashion. He would withdraw from situations when there was no possibility of escape, or when he was uncomfortable. There were many days when he felt completely overwhelmed and panicked about not being able to “make it”. In a March 2020 statement from his wife, C.S., she stated that the Veteran transformed from an extrovert to an introvert due to his anxiety. She said he had not made a new friend since 2014 and had problems keeping stable relationships. She described his trouble sleeping and the impact of his insomnia on his daily living. She also noted his suicidal thoughts.   Analysis 2. Entitlement to a 50 percent rating for unspecified anxiety disorder from October 29, 2015 to December 20, 2019 is granted. Based on a review of the evidence, the Board finds that the frequency, severity, and duration of the Veteran’s symptoms from October 29, 2015 to December 20, 2019 warrant a 50 percent rating based on panic attacks occurring less than once per week, persistent anxiety, persistent irritability without violence, impairment of concentration and memory, sleep disturbance, disturbances of mood, difficulty establishing and maintaining effective social relationships, reports of minor difficulties with work tasks, and passive thoughts of death. While the majority of the Veteran’s symptoms are listed under the criteria for a 30 percent rating, the Board finds that the overall impact of the Veteran’s listed and unlisted symptoms, with significant consideration to his reports of passive suicidal ideation, resulted in functional impairment equivalent to occupational and social impairment with reduced reliability and productivity, warranting the 50 percent rating. A rating greater than 50 percent is not warranted for this period. The Board acknowledges that the Veteran endorsed having passive thoughts of suicide. While suicidal ideation is a symptom listed under the criteria for a 70 percent rating, the Board must consider whether the frequency, severity, and duration of this symptom, with consideration of all other symptoms, resulted in occupational and social impairment with deficiencies in most areas. In this case, the Board finds that they did not. The evidence clearly shows during this period that the Veteran was able to maintain a full-time job with only minor difficulties completing work tasks, attend school part-time while maintaining good grades, graduate from his schooling, and maintain relationships with his immediate and extended family. Consequently, while the Veteran endorsed suicidal ideation during this period, the symptom did not result in overall functional impairment equivalent to occupational and social impairment with deficiencies in most areas. As noted above, the Board finds the severity, frequency, and duration of the Veteran’s listed and unlisted symptoms more closely approximate the symptoms contemplated by a 50 percent rating, which are less severe, less frequent, and shorter in duration than those contemplated by a 70 percent rating. See 38 C.F.R. § 4.126. Accordingly, the Board finds that a 50 percent rating is warranted from October 29, 2015 to December 20, 2019, and to this extent, the appeal is granted. 3. Entitlement to a 70 percent rating for unspecified anxiety disorder from December 21, 2019 is granted. Based on a review of the evidence, the Board finds that the frequency, severity, and duration of the Veteran’s symptoms from December 21, 2019 warrant a 70 percent rating. As noted above, the Veteran was hospitalized on December 21, 2019 due to a worsening of his anxiety symptoms, including a worsening of his suicidal ideation. In addition to symptoms listed under the criteria for lower ratings as discussed above, since December 21, 2019, the Veteran’s symptoms have also included suicidal ideation with heightened risk, impaired impulse control, neglect of personal appearance or hygiene, and difficulty in adapting to stressful circumstances, which the Board finds have been of the frequency, severity and duration to cause occupational and social impairment with deficiencies in most areas. Briefly, the Board considered the Veteran’s March 2020 lay statement and statements to medical providers indicating that his mental health started to decline in the months before his hospitalization; however, treatment records do not show worsening symptoms until December 21, 2019. A higher rating is not warranted for this period as the frequency, severity, and duration of the Veteran’s listed and unlisted symptoms more closely approximate the symptoms contemplated by a 70 percent rating, which are less severe, less frequent, and shorter in duration than those contemplated by a 100 percent rating. See 38 C.F.R. § 4.126. Significantly, the Veteran has not argued that his disability results in total occupational and social impairment. Moreover, the records show he continues to work, though with some difficulties, and maintains relationships with his family. Further, none of the Veteran’s symptoms are listed under the criteria for a total rating and none of his unlisted symptoms have been of equivalent severity to cause total occupational and social impairment. The Board notes that the Veteran expressed suicidal ideation, which is similar to persistent danger of self-harm, which is contemplated by the 100 percent criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017). However, the severity, frequency, and duration of the Veteran’s suicidal ideation has not risen to the level contemplated by the 100 percent disability rating. The Veteran regularly denied thoughts, intent, or a plan involving self-harm in existing treatment records, and during the February 2020 VA examination report. Thus, the Board concludes that the Veteran’s symptoms did not cause the level of impairment required for a disability rating of 100 percent. Accordingly, the Board finds that a 70 percent rating is warranted from December 21, 2019, and to this extent, the appeal is granted. Amanda G. Alderman Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Norwood, Associate 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.