Citation Nr: 21074709 Decision Date: 12/16/21 Archive Date: 12/16/21 DOCKET NO. 16-42 312 DATE: December 16, 2021 ORDER An initial rating of 50 percent, but no higher, is granted for other unspecified anxiety disorder. FINDING OF FACT The evidence is at least in equipoise as to whether the Veteran's other unspecified anxiety disorder has resulted in occupational and social impairment with reduced reliability and productivity. CONCLUSION OF LAW Resolving all reasonable double in favor of the Veteran, the criteria for an initial rating of 50 percent for other unspecified anxiety disorder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9410. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Marine Corps from August 2002 to August 2007. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a December 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO), which granted service connection for other unspecified anxiety disorder and assigned an initial noncompensable rating, effective August 28, 2015. In June 2016, VA received the Veteran's notice of disagreement with the initial rating assigned. In an August 2016 rating decision, the RO increased the initial rating for the Veteran's other unspecified anxiety disorder to 10 percent, effective August 28, 2015. In August 2016, the RO issued a statement of the case addressing the issue of entitlement to an initial rating in excess of 10 percent for other unspecified anxiety disorder. Later that month, the Veteran perfected a timely appeal via his submission of a VA Form 9 on which he requested a Board hearing. In June 2021, the Veteran testified at a telehearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record on appeal. At the June 2021 hearing, the Veteran was accompanied by his representative, the Military Order of the Purple Heart (MOPH), who provided argument on his behalf. In July 2021, however, that service organization notified VA that it was closing its Service Officer program and requested that VA remove recognition of its authorization to prepare, present, and prosecute claims for VA benefits. In a letter dated July 16, 2021, VA advised MOPH that it was no longer recognized as an accredited representative and that any claims preparation, presentation, and prosecution would need to be redirected to another recognized organization or accredited individual. The Veteran has not appointed a new representative nor has MOPH transferred representation to another recognized organization or accredited individual. The Veteran is advised that he may appoint a new representative at any point. In August 2021, the Board remanded the claim for a higher initial rating for anxiety disorder to the agency of original jurisdiction (AOJ) for further development. In a September 2021 rating decision, the AOJ increased the initial rating for other unspecified anxiety disorder to 30 percent, effective August 28, 2015. The Veteran has not expressed satisfaction with the increased disability rating; this matter thus remains in appellate status. See AB v. Brown, 6 Vet. App. 35, 38 (1993) (when a veteran is not granted the maximum benefit allowable under the VA Schedule for Rating Disabilities, the pending appeal as to that issue is not abrogated). 1. An initial rating in excess of 30 percent for other unspecified anxiety disorder In his June 2016 notice of disagreement (NOD) with the initial noncompensable rating assigned for other unspecified anxiety disorder, the Veteran reported he had been taking medication for chronic sleep impairment for more than one year, he struggled to remember things throughout the day, and he experienced panic attacks. He believed these symptoms warranted a compensable rating for his anxiety disorder. In his August 2016 substantive appeal and after the AOJ increased the initial rating for his anxiety disorder to 10 percent, he expressed his belief that a 30 percent evaluation was warranted for his anxiety disorder. His other unspecified anxiety disorder disability is rated under 38 C.F.R. § 4.130, Diagnostic Code 9410. Under the General Formula for Mental Disorders (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). The issue in this appeal is whether the Veteran's associated symptoms caused the level of impairment required for a disability rating of 50 percent or higher. 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. On August 28, 2015, VA received the Veteran's application to reopen a claim for service connection for an acquired psychiatric disorder, to include unspecified anxiety disorder, which had previously been denied. Earlier that August he had completed a VA inpatient treatment program for alcohol dependence; the discharge diagnosis was alcohol dependence; anxiety; depression. Discharge medications included fluoxetine (Prozac) for depression and hydroxyzine pamoate (Vistaril) for anxiety and sleep. At the end of August, he presented for an outpatient session with his VA therapist, a clinical social worker, to follow up on his inpatient treatment program and to determine the next steps for care. However, the therapist indicated the appointment was brief because the Veteran arrived intoxicated. He admitted he had not been taking his medications and reported he had stayed sober during his recent treatment but that he started drinking once he got out of treatment. He stated he had not been sleeping or eating but had been drinking most days and felt "trapped." Mental status examination findings included poor hygiene and smelling of alcohol and smoke; slightly slurred speech but with normal rate and volume; moderately anxious and depressed mood with labile affect; tangential, disorganized thought content with passive thoughts of suicide without plan or intent; linear, goal-directed thought process; poor insight and judgment; and grossly intact orientation, cognition, and memory. The social worker assessed the Veteran's risk of harm to himself to be "heightened but not imminent based on current intoxication, legal problems, heartbreak over recent relationship, and occasional thoughts about taking 'the easy way out.'" He reported he had never really thought of suicide before and would not do it, but the thoughts had been there recently. In November 2015, the Veteran was afforded a VA examination. He reported that his first contact with mental health providers was in 2008 for depression, anxiety, and alcohol dependence. He stated he was not currently involved in any treatment but was taking fluoxetine and hydroxyzine for sleep, adding that it seemed "to be helping as long as I keep working out and quit drinking it usually helps." He described a lengthy history of excessive alcohol use, disclosing that he first started drinking at age 15 and that he last drank alcohol two days after he completed the inpatient treatment program in August 2015. He indicated he was currently on supervised probation through Veteran's court for DWIs in 2008 and 2014. He reported a history of periodic episodes of depression symptoms since separation from military service, including hopelessness, helplessness, worthlessness, low mood, and low appetite, when drinking heavily. He stated he had not had any symptoms in the last four months. He described worrying a lot and a history of panic attacks a few times a week, adding, "I can usually get control of it if it's not too bad." He reported having positive self-esteem and that he tries to stay positive about the future but also described his mood as "pretty blah." He described having good concentration and memory. He denied any suicidal or homicidal ideation or psychosis. Other behavioral observations included alert and oriented appearance, appropriate grooming and dress, good eye contact, inconsistent cooperation and effort at times, good social skills, fair insight, anxiety, and unremarkable speech and thought content. Following a review of the claims file, psychological testing, and examination, the diagnosis was unspecified anxiety disorder and alcohol use disorder in remission per Veteran's self-report. As to whether it was possible to differentiate what symptoms were attributable to each diagnosis, the examiner indicated that such differentiation was not applicable. Regarding the degree of impairment, the examiner indicated that although a mental disorder had been formally diagnosed, symptoms were not severe enough either to interfere with occupational and social functioning or to require continuous medication. A December 2015 individual therapy note reflects the Veteran's report that he was currently working full-time as a contract security officer at a VA facility and was no longer on daily alcohol monitoring, having been sober for more than three months. Mental status examination findings included the following: fair hygiene; cooperative and pleasant behavior; coherent, relevant speech with normal rate and volume; euthymic mood; appropriate affect with congruence to mood; no delusions elicited; linear, goal-directed thought process; fair insight and judgment; and orientation, cognition, and memory grossly intact. The Veteran denied thoughts of suicide, intent, or plan. The therapist assessed the Veteran's risk of self-harm as low because he was sober, working, and future-oriented. On the same day, the Veteran also met with his VA psychiatrist for medication management and supportive psychotherapy. He reported that his mood and anxiety had improved since increasing his fluoxetine dose, he was hopeful and future-oriented, his concentration and focus were good while at work, and he was sleeping well with the aid of hydroxyzine. Mental status examination findings were similar to those reported by the clinical social worker but also included the following: good eye contact; psychomotor activity within normal limits with no abnormal involuntary movements; "good" mood; euthymic, blunted with periods of brightening, and calm affect; linear, logical, goal-oriented thought process; no auditory or visual hallucinations or delusions; fair to good insight; good judgment; and intact attention and concentration. The Veteran again denied any suicidal or homicidal ideation. Individual therapy and psychiatric treatment records from January 2016 reflect the Veteran's reports that he had relapsed that month and had to serve a few days of jail time. He indicated his mood was "fine," his anxiety was well-controlled, and he was sleeping well at night. He continued to work as a VA security guard and agreed to start monitored Antabuse therapy as recommended by the courts. During a May 2016 psychiatry visit, the Veteran reported he continued to serve his sentence in the County Workhouse and expected to be released in October. He stated he was sad because a grandparent passed away, but his mood was otherwise good and he was sleeping well. He endorsed a low appetite due to the poor quality of food at the Workhouse. He stated that he planned to resume drinking upon release from the Workhouse and believed he could control his drinking. Mental status examination findings were similar to those reported in December 2015; however, the examiner found he had limited insight and judgment. In June 2021, the Veteran's former representative elicited testimony from the Veteran regarding his current psychiatric symptoms, the effects of his anxiety disorder on his occupational function as a welder, and his belief that his psychiatric disability had increased in severity since the last VA examination in November 2015. Specifically, in response to questions by his former representative, he affirmed that he experiences panic attacks with varying frequency, sometimes having a lot at once or none for a while, adding that he has good weeks and bad weeks. He affirmed that when he has "really bad panic attacks or the depression, [he] can't really function independently or appropriately," "can't drive," and "can't work or do anything for days because [he] can't get out of bed." He affirmed he has trouble "maintaining and establishing" work and social relationships and has "trouble adapting to stressful circumstances." He affirmed he has "disturbances of motivation and mood," sometimes causing him to "have trouble doing things." He affirmed he has "the inability to perform daily routines" and is "disoriented to time sometimes." When asked about suicidal ideation, he testified that "it's been there in the past." He testified that he had used alcohol for years to cope with his symptoms but "now I'm on medication and it seems to be helping a lot." Regarding the effects of his anxiety disorder on his occupational function as a welder, the Veteran affirmed he had chosen his particular field because he did not have to interact with others. Still, he affirmed he had missed 15 days from work since he started his job eight months earlier, including four days missed in the last week due to depression. He testified that his employer had been very helpful with his job so far and that a letter from his VA doctor had asked the employer to "give [the Veteran] a little bit of a break." The representative summarized the Veteran's psychiatric symptoms that were contemplated by 30 percent, 50 percent, and 70 percent rating criteria and indicated there were outstanding VA treatment records since 2016 that had not been associated with the claims file. In compliance with the Board Remand directives, the AOJ obtained ongoing VA treatment records dating from May 2016 to July 2021 and arranged for a fee-basis examination to evaluate the current severity of the Veteran's anxiety disorder. The VA treatment records reflect that he consistently denied any suicidal or homicidal ideation. He was discharged from the Veterans Justice Outreach (VJO)-County Veterans Court around September 2016 and completed the remainder of his sentence at a county Workhouse on work release status from the jail. During a January 2017 psychiatric visit, he reported he stopped taking fluoxetine and hydroxyzine when he left the Workhouse. He described his mood as "pretty good," his energy was sufficient to get through the day in his job working construction, His sleep was fair, and his anxiety was well-managed. He continued to engage in "moderate to heavy alcohol use on the weekends but had poor insight into the fact this could lead to additional legal and physical problems." He denied any suicidal ideation. Mental status examination findings were similar to those reported in December 2015. A December 2017 psychiatry note indicates he was started on gabapentin for intermittent bouts of anxiety and to potentially help reduce alcohol cravings. In 2018, the Veteran failed to appear for several scheduled psychiatry appointments. In November 2019, he sought emergency care for back pain and received a doctor's note excusing him from work for three days. In July 2020, the Veteran presented for a psychiatry visit after having last been seen in December 2017. He reported that he finished college in December 2019. Then, in May 2020, he ended a long-term relationship, had trouble sleeping, stopped going to work as a result, developed money problems, then developed anxiety and near-daily panic attacks. He indicated he re-started his medication three weeks earlier and had noticed some reduced anxiety with fewer panic attacks along with improved sleep. In addition, his boss offered him his old welding job back. In October 2020, he endorsed improved mood and lifting of depression symptoms since increasing fluoxetine on his last visit. He reported he enjoyed his new job and was working overtime, he started exercising, and he maintained interest in activities. During an April 2021 psychiatry visit, the Veteran described his state of mental health as "pretty good" overall, but earlier in the week, he had "freaked out" due to a mix of depression, panic, and anxiety and slept for two days, not wanting to get out of bed. He could not think of any triggers for his symptoms, adding that he liked his job, and he denied that alcohol had been an issue. He described his current alcohol consumption and believed naltrexone had helped him reduce his alcohol use. Mental status examination findings were consistent with those previously reported. The assessment included anxiety, depression, and panic that were problematic a few days per month despite the maximum dose of fluoxetine with symptoms causing sufficient impairment to make the Veteran miss work. The psychiatrist remarked it was interesting that the Veteran "typically misses work on Mondays and/or Tuesdays but denied missing work due to drinking, which typically including a pint of liquor at the bar on Fridays and Saturdays. An addendum note includes a letter from the psychiatrist explaining that the Veteran "has a relapsing and remitting medical condition [that] may cause him to miss work approximately one or two days per month" and requesting that his employer excuse him from work during times of medical need. The Veteran's next psychiatry appointment in June 2021 was "scheduled to assist [him] in writing a letter in support of service connection for depression." (He and his former representative mentioned this letter and symptoms reported during this psychiatry visit at his Board hearing, which was held the following day). He reported a low mood over the last week resulting in four days of missed work, low motivation, and low appetite. The psychiatrist observed he remained hopeful, future-oriented, and denied suicidal thoughts. The letter, which the psychiatrist mailed to the Veteran, indicated that his current diagnoses included recurrent major depressive disorder and alcohol use disorder and that historically he had diagnoses of panic disorder and unspecified trauma and stressor-related disorder. The psychiatrist detailed that "[d]epression symptoms have included insomnia, anhedonia, guilt, worthlessness, low energy, poor concentration, hopelessness, and helplessness." "Anxiety symptoms have included restlessness, feeling on edge, and muscle tension." He had "also experienced panic attacks." The psychiatrist also noted in the letter that the Veteran "had a psychiatric hospitalization in April 2011 due to depression leading to alcohol intoxication." (In fact, the VA treatment records from that hospitalization show he had been admitted from Urgent Care after binging on alcohol for the past week, drinking 24 beers and a fifth of Crown Royale per day. Upon admission, his blood alcohol level was reported as .316. He disclosed he began drinking at age 12 and had his first in-patient treatment for alcohol abuse or dependence at age 16. The discharge diagnosis in April 2011 was alcohol dependence). The psychiatrist also reported the Veteran attended a residential treatment program for management of mental illness and chemical dependence in August 2015. The psychiatrist summarized that the Veteran's chronic depression symptoms had led to difficulty maintaining stable employment and he had been terminated from jobs due to his inability to reliably show up to work due to depression symptoms such as low mood, staying in bed all day for several days in a row, excessive sleeping, and low appetite. The psychiatrist related that this "issue remains problematic as recently as the last few weeks." During a July 2021 VA psychiatry visit, the Veteran reported that the medication dose increase at his last visit had been beneficial for depression, anxiety, and panic, adding that he had not "missed any work due to depression (as was problematic in the past)." He indicated he got back together with his girlfriend and the relationship was going well, he bought a car, and he had no recent severe panic attacks. He continued to drink a pint of liquor on Fridays and Saturdays. Mental status examination findings were similar to those previously reported; however, his insight and judgment were presently fair to good. In September 2021, the Veteran presented for a VA fee-basis examination to evaluate the current severity of his service-connected other unspecified anxiety disorder. He indicated he had worked as a full-time welder for a company for about a year and his job was going well but he used to take a lot of time off; he denied any reprimands "other than attendance." He indicated he continued to drink one liter of liquor each of two weekend nights and was trying to control his drinking; he reported his longest period of sobriety being one week. He described his current stress level as "medium," which he attributed to relationships, more so in the past. He reported having good relationships with his mother, sister, and brother; having several acquaintances; and having a few close friends, including some from high school. Regarding his mood, he acknowledged having bouts of depression in the past during which he might stay down for two weeks at a time, not wanting to do anything. He denied generalized feelings or hopelessness or helplessness. He indicated his energy had been decent, his appetite was good, his weight was stable, and he denied having suicidal thoughts. He reported being prone to anxiety with manifestations that included sweating, shaking, and sometimes an upset stomach. He stated that he last had a panic attack six months ago. He considered himself easily distracted by external factors and reported having trouble with birthdays and names. He reported having trouble getting to sleep because his "mind just keeps wandering." Symptoms associated with the Veteran's anxiety disorder included the following: depressed mood, anxiety, panic attacks that occur weekly or less often, chronic sleep impairment, and mild memory loss. Other behavioral observations included logical, coherent, and reserved interactions; speech normal for rate and volume; reduced range of affect; average insight; and alert and oriented to person, place, and time. Following a review of the claims file and examination, the examiner concluded that the symptoms from the Veteran's moderate alcohol use disorder could not be differentiated from his service-connected anxiety disorder, explaining that there is often a bidirectional relationship between alcohol use disorder and other mental health disorders. The examiner indicated differentiation of symptoms was particularly challenging in this case because the Veteran's longest period of going without drinking was reportedly only one week, and while a person is actually drinking, "it is nearly impossible to differentiate what might be coming from what." The examiner concluded that the Veteran's anxiety disorder resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although he generally functioned satisfactorily with normal routine behavior, self-care, and conversation. Having considered the medical and lay evidence of record, the Board concludes the evidence is at least in equipoise as to whether the Veteran's anxiety disorder has more nearly approximated the criteria for a 50 percent disability rating since service connection was established. Accordingly, the Board resolves all reasonable doubt in the Veteran's favor and finds that an initial 50 percent rating is warranted for other unspecified anxiety disorder. VA treatment records, the VA and fee-basis examination reports, and/or the Veteran's lay statements indicate that the Veteran's anxiety disorder was manifested by symptoms associated with a 30 percent rating (chronic sleep impairment, panic attacks occurring weekly or less often, periodic episodes of depressed mood and anxiety, and mild memory loss); symptoms associated with a 50 percent rating (impaired judgment, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships); symptoms associated with a 70 percent rating (neglect of personal appearance and hygiene, near-continuous panic or depression affecting the ability to function independently or appropriately, and difficulty in adapting to stressful circumstances); and symptoms associated with a 100 percent rating (intermittent inability to perform activities of daily living and disorientation to time). The evidence also indicates he had symptoms that are not listed with a specific rating, such as poor appetite. The Board resolves reasonable doubt and finds the severity, frequency, and duration of the Veteran's listed and unlisted symptoms more closely approximate the criteria 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. A higher 70 or 100 percent rating is not warranted, however, for the Veteran's anxiety disorder because the symptoms associated or consistent with these criteria are shown to have occurred infrequently and/or for a relatively brief duration. For example, the Board notes the Veteran expressed suicidal ideation, which is contemplated by the 70 percent criteria, whether passive or active and without required suicidal intent, plan, or preparatory behavior. Bankhead v. Shulkin, 29 Vet. App. 10, 20 (2017). Here, he reported experiencing passive thoughts of suicide without plan or intent once during this appeal in August 2015 when he presented intoxicated for his therapy visit with a VA social worker. Subsequent VA treatment records and the November 2015 and September 2021 examination reports reflect he consistently denied having suicidal ideation. In other words, the severity, frequency, and duration of the Veteran's suicidal ideation has not risen to a level contemplated by the 70 percent rating criteria. Moreover, as the evidence of record reflects that he endorsed passive thoughts of suicide without plan or intent on one occasion during the pendency of the appeal and treatment records document his risk of self-harm was low, it logically follows that the criteria for a maximum 100 percent rating based on persistent danger of hurting self or others are not met. Similarly, the single instance during which the Veteran was observed to have poor hygiene also occurred in August 2015 when he presented for a scheduled therapy appointment intoxicated after having just completed an inpatient treatment program for alcohol dependence. This limited instance of neglect of personal appearance and hygiene is insufficient to warrant a higher, 70 percent rating because it occurred in the context of alcohol intoxication and the evidence shows he otherwise maintained adequate self-care. Notably, subsequent treatment records and examination reports documented adequate hygiene and appropriate attention to his appearance. Considering the reported symptoms of near-continuous panic or depression affecting the ability to function independently or appropriately and difficulty in adapting to stressful circumstances, the Board recognizes that during a July 2020 psychiatry visit, the Veteran reported he ended a relationship in May 2020, had trouble sleeping, stopped going to work, and then developed "anxiety and near-daily panic attacks" until he restarted his medications and his symptoms improved. Further, although the Veteran described missing work to his VA psychiatrist in June 2021 due to depression symptoms and testified the following day about missing four days of work, his subsequent statements to his psychiatrist and the September 2021 fee-basis examiner reflect that his inability to reliably perform his occupational tasks was intermittent and temporary. After reportedly missing four days of work in June 2021 due to depression symptoms, he stated at his next appointment that he had not missed any further days of work. Here, the evidence shows the Veteran's symptoms of anxiety, panic attacks, and depression have generally been more episodic, consistent with occupational and social impairment with reduced reliability and productivity. Finally, although the Veteran affirmed upon questioning during the June 2021 hearing that he is sometimes disoriented to time and experiences an intermittent inability perform activities of daily living (such as maintaining minimal personal hygiene), the corresponding medical evidence, which includes mental status examination reports by his former therapist, current psychiatrist, and the November 2015 and September 2021 examiners, does not support that assertion. The mental status examination reports document that he has consistently been fully oriented to person, place, and time and the records do not identify difficulties completing activities of daily living. In summary, the Board finds the level of impairment caused by the Veteran's anxiety disorder symptoms does not more closely approximate the level associated with a 70 percent rating. Instead, the evidence appears to be more consistent with occupational and social impairment with reduced reliability and productivity, consistent with the 50 percent rating granted herein. In short, the preponderance of the evidence weighs against finding that the severity, frequency, and duration of the Veteran's anxiety disorder symptoms resulted in the level of impairment required for a higher initial rating than the 50 percent rating granted herein. As the preponderance of the evidence is against the Veteran's claim for a higher rating than that assigned for other unspecified anxiety disorder, the benefit-of-the-doubt doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. The criteria for a 70 percent or higher rating are not met and the appeal for a rating higher than 50 percent must be denied. K. Conner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Laura Kirscher Strauss 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.