Citation Nr: 21006005 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 17-37 761 DATE: February 3, 2021 ORDER Entitlement to an increased rating higher than 20 percent for peripheral neuropathy of the left lower extremity is denied. Entitlement to an increased rating higher than 20 percent for peripheral neuropathy of the left upper extremity is denied. Entitlement to an increased rating higher than 20 percent for peripheral neuropathy of the right upper extremity is denied. Entitlement to an increased rating higher than 30 percent for posttraumatic stress disorder (PTSD) is denied. FINDINGS OF FACT 1. The Veteran’s peripheral neuropathy of the left lower extremity is manifest by no more than moderate incomplete paralysis. 2. The Veteran’s peripheral neuropathy of the left upper extremity is manifest by no more than mild incomplete paralysis of the middle radicular group. 3. The Veteran’s peripheral neuropathy of the right upper extremity is manifest by no more than mild incomplete paralysis of the middle radicular group. 4. The severity, frequency, and duration of the Veteran’s symptoms of PTSD do not more closely approximate occupational and social impairment with reduced reliability and productivity. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 20 percent for peripheral neuropathy of the left lower extremity are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520. 2. The criteria for a disability rating in excess of 20 percent for peripheral neuropathy of the left upper extremity are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Codes 8511-8515. 3. The criteria for a disability rating in excess of 20 percent for peripheral neuropathy of the right upper extremity are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Codes 8511-8515. 4. The criteria for a disability rating in excess of 30 percent for PTSD are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1964 to January 1971. A period of active service from June 12, 1967 to January 22, 1971 has been determined to have been under dishonorable conditions. See July 1982 Department of Veterans Affairs (VA) Administrative Decision. This appeal comes to the Board of Veterans’ Appeals (Board) from a March 2015 rating decision by a VA Agency of Original Jurisdiction (AOJ). In February 2020, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. The Board remanded this case for additional development in June 2020. The directives of the Board’s remand having been substantially complied with by the AOJ. the case is returned for appellate review. This appeal stems from an original claim for a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) that was filed in March 2012. The AOJ denied entitlement to a TDIU in the March 2015 rating decision in addition to the other claims on appeal. The Veteran did not appeal the denial of entitlement to a TDIU. Other than to note that the Veteran’s disabilities impacted his ability to work, the medical evidence and statements and testimony from the Veteran do not raise the issue of entitlement to a TDIU as part of the increased rating claims pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009). Thus, the issue of entitlement to a TDIU is not before the Board. Increased Rating 1. Entitlement to an increased rating higher than 20 percent for peripheral neuropathy of the left lower extremity The Veteran contends that he is entitled to a higher rating because he was given a walker to help him when he has to walk long distances from his car. See February 2020 Board hearing transcript, p. 15. In his March 2015 notice of disagreement, the Veteran stated that he was seeking a 40 percent rating for his peripheral neuropathy of the left lower extremity. Paralysis of the sciatic nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8520. (Neuritis and neuralgia of that group are evaluated under Diagnostic Codes 8620 and 8720.). Under these criteria, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Moderately severe incomplete paralysis is rated as 40 percent disabling. Severe incomplete paralysis, with marked muscular atrophy is rated as 60 percent disabling. Complete paralysis, with the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost is rated as 80 percent disabling. 38 C.F.R § 4.124a. The words “mild,” “moderate,” and “severe” as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. The term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at “Diseases of the Peripheral Nerves.” The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). The maximum rating which may be assigned for neuritis not characterized by organic changes will be moderately severe incomplete paralysis for sciatic nerve involvement. See 38 C.F.R § 4.123. An August 2013 VA examination report shows that the Veteran had diabetic peripheral neuropathy with numbness and tingling in his left lower extremity, as well as pain radiating from his left lumbar area. The Veteran had moderate constant pain, mild paresthesias and/ or dysesthesias, and mild numbness in the left lower extremity. Light touch/ monofilament testing was normal in the left knee/ thigh, ankle/lower leg, and foot/toes. Position sense, vibration sense, and cold sensation was normal. There was no muscle atrophy. The sciatic nerve was the nerve affected by the Veteran’s lower extremity diabetic peripheral neuropathy and had moderate incomplete paralysis. It was noted that there was superimposed radiculopathy over diabetic peripheral neuropathy of the left lower limb. The examiner found that the Veteran’s neuropathy did not impact his ability to work or prevent him from seeking and maintaining gainful employment. A November 2020 VA examination report shows the Veteran reported that his numbness and tingling got worse in the past year. He rated the pain at a 7 to 9 out of 10. He noted that he used to take gabapentin and ibuprofen but that these were discontinued; and he did not have current treatment. His symptoms in the left lower extremity included moderate intermittent pain, moderate paresthesias and/ or dysesthesias, and mild numbness. Muscle strength testing was normal. There was no muscle atrophy or trophic changes and the Veteran’s gait was normal. Reflex and sensory examination also was normal. The Veteran had mild incomplete paralysis of the left sciatic nerve. He did not use any assistive devices as a normal mode of locomotion, although occasional locomotion by other methods might be possible. The Veteran’s peripheral nerve condition impacted his ability to work in that it impacted his walking and he was a fall risk. He was retired but had worked in a steel mill and had lost about one week of work during a year. Based on the above, the Board finds that the disability is primarily manifest by pain, mild to moderate paresthesias, mild numbness, and mild to moderate incomplete paralysis in the left lower extremity. The Board also finds that the most probative evidence of record is against a finding that the disability is manifest by impairment of motor functions, trophic changes, loss of reflexes, muscle atrophy, or complete paralysis. The Board thus finds that the level of impairment is most analogous to moderate incomplete paralysis. The Board acknowledges the lay assertions that he had to use a walker for long distances because of his peripheral neuropathy. The November 2020 VA examiner also noted that the Veteran was a fall risk, which impacted his work. However, the November 2020 VA examination report noted that the Veteran did not use any assistive devices as a normal mode of locomotion and had a normal gait. The Veteran further testified about his left hip degenerative joint disease as the cause for getting the walker. See February 2020 Board hearing transcript, p. 13. Also, 38 C.F.R. § 4.120 “contemplates any impairment of motor or sensory function that would require the use of an assistive device such as a cane or walker.” Spellers v. Wilkie, 30 Vet. App. 211, 218 (2018). The Board has considered all other potentially applicable Diagnostic Codes, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves in the left lower extremity that have not already been service-connected. Therefore, a separate or higher rating under a different Diagnostic Code is not warranted. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 20 percent for peripheral neuropathy of the left lower extremity. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 2. Entitlement to an increased rating higher than 20 percent for peripheral neuropathy of the left upper extremity 3. Entitlement to an increased rating higher than 20 percent for peripheral neuropathy of the right upper extremity The Veteran contends that he is entitled to higher ratings because he has cramping, pain, and tingling in his upper extremities. See February 2020 Board hearing transcript, p. 16. He also notes that sometimes he cannot pick things up or open jars. Id. at 17. On his March 2015 notice of disagreement, he stated that he was seeking 40 percent ratings for peripheral neuropathy of the upper extremities. The Veteran’s peripheral neuropathy of the upper extremities is rated under 38 C.F.R. § 4.124a, Diagnostic Codes 8511 (middle radicular group) and 8514 (musculospiral nerve (radial nerve)). Paralysis of the middle radicular group is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8511. (Neuritis and neuralgia of that group are evaluated under Diagnostic Codes 8611 and 8711). Under these criteria, mild incomplete paralysis is rated as 20 percent for both the major and minor extremity. Moderate incomplete paralysis is rated as 40 percent for the major extremity and 30 percent for the minor extremity. Severe incomplete paralysis is rated as 50 percent for the major extremity and 40 percent for the minor extremity. Complete paralysis of the middle radicular group is rated as 70 percent for the major extremity and 60 percent for the minor extremity. Complete paralysis of the middle radicular group involves adduction, abduction, and rotation of the arm, flexion of the elbow, and extension of the wrist lost or severely affected. See 38 C.F.R § 4.124a, Diagnostic Code 8511. Paralysis of the median nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8515. (Neuritis and neuralgia of that group are evaluated under Diagnostic Codes 8615 and 8715). Under these criteria, mild incomplete paralysis is rated as 10 percent for both the major and minor extremity. Moderate incomplete paralysis is rated as 30 percent for the major extremity and 20 percent for the minor extremity. Severe incomplete paralysis is rated as 50 percent for the major extremity and 40 percent for the minor extremity. Complete paralysis of the middle radicular group is rated as 70 percent for the major extremity and 60 percent for the minor extremity. Complete paralysis of the median nerve involves the hand inclined to the ulnar side, the index and middle fingers more extended than normally, considerable atrophy of the muscles of the thenar eminence, the thumb in the plane of the hand (ape hand); pronation incomplete and defective, absence of flexion of index finger and feeble flexion of middle finger, cannot make a fist, index and middle fingers remain extended; cannot flex distal phalanx of thumb, defective opposition and abduction of the thumb, at right angles to palm; flexion of wrist weakened; and pain with trophic disturbances. 38 C.F.R § 4.124a, Diagnostic Code 8515. In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes is to be avoided when rating a Veteran’s service-connected disabilities. 38 C.F.R. § 4.14. Notwithstanding the above, VA is required to provide separate evaluations for separate manifestations of the same disability that are not duplicative or overlapping. Esteban v. Brown, 6 Vet. App. 259, 261 (1994). The words “mild,” “moderate,” and “severe” as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. The term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at “Diseases of the Peripheral Nerves.” The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). The medical evidence shows that the Veteran is right-hand dominant. See, e.g., November 2020 VA examination report. An August 2013 VA examination report shows the Veteran has mild paresthesias and/ or dysesthesias and mild numbness in the bilateral upper extremities. Strength testing and deep tendon reflexes were normal. Light touch/ monofilament testing was normal. Position sense, vibration sensation, and cold sensation was normal. There was no muscle atrophy or trophic changes. There was mild incomplete paralysis of the right and left radial nerves, right and left median nerves, and right and left ulnar nerves. A November 2020 VA examination report shows moderate intermittent pain, moderate paresthesias and/ or dysesthesias, and mild numbness of the right and left upper extremities. Muscle strength testing was normal and there was no muscle atrophy. The reflex and sensory examination also was normal. There were no trophic changes. There was mild incomplete paralysis of the right and left radial and median nerves. Based on the above, the Board finds that the disability is primarily manifest by moderate intermittent pain, mild to moderate paresthesias and/ or dysesthesias, mild numbness, and mild incomplete paralysis of the right and left radial nerves, right and left median nerves, and right and left ulnar nerves. The Board also finds that the most probative evidence of record is against a finding that the disability is manifest by impairment of motor functions, trophic changes, loss of reflexes, muscle atrophy, or complete paralysis. The Board thus finds that the level of impairment is most analogous to mild incomplete paralysis/complete paralysis. While mild incomplete paralysis of the ulnar nerves, median nerves, and radial nerves all were present, which would warrant separate ratings of 10 percent if these were the sole nerves involved, such a combination would constitute pyramiding, which is not allowed. See Diagnostic Code 8719 which indicates that combined nerve injuries should be rated by reference to the major involvement, which in this case is the middle radicular group. Moreover, as there was no more than mild involvement of any of the reported nerves, no more than a 20 percent rating would be warranted for all radicular groups under 8511, 8515, or 8516. The Board acknowledges the lay assertions that sometimes he cannot pick things up or open jars, and that he should get 40 percent ratings for peripheral neuropathy of the upper extremities. However, the Board finds the medical of evidence of record to be more probative because it shows that, at most, the Veteran has mild incomplete paralysis of predominantly the middle radicular group, which offers the highest rating of 20 percent under Diagnostic Code 8511. The Board has considered all other potentially applicable Diagnostic Codes, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves that have not already been service-connected. Therefore, a separate or higher rating under a different Diagnostic Code is not warranted. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim for ratings in excess of the currently assigned 20 percent ratings for peripheral neuropathy of the bilateral upper extremities. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 4. Entitlement to an increased rating higher than 30 percent for posttraumatic stress disorder (PTSD) The Veteran contends that he should be rated higher than 30 percent for his PTSD because he has nightmares and anxiety, and finds it difficult to function. See, e.g., February 2020 Board hearing transcript, pp. 4-5. On his March 2015 notice of disagreement, the Veteran stated that he was seeking a 100 percent rating for his PTSD. 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. The Board concludes that the Veteran’s symptoms did not cause the level of impairment required for a disability rating of 50 percent or higher. The Veteran’s symptoms more closely approximated the symptoms associated with a 30 percent rating and resulted in a level of impairment that most closely approximated the level of impairment associated with a 30 percent rating. 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. A September 2013 VA examination report shows the Veteran had occupational and social impairment due to mild or transient symptoms which decreased work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication. The Veteran was married and had four children, two surviving. He had group therapy and saw a psychiatrist and was prescribed Mirtazapine for sleep. He reported anxiety episodes about twice a week. He also was irritable, and had nightmares, as well as symptoms of insecurity, inferiority, guilt, and impaired concentration. The examiner found that the frequency and duration of the Veteran’s episodes did not impact his daily activities. A May 2016 VA treatment record noted complaints of intrusive thoughts, chronic isolation, and emotional numbing. A May 2017 VA treatment record shows that the Veteran reported that his symptoms were worse over the last year. He had decreased energy and concentration, and passive thoughts of suicide without plan. In July 2020, a VA examination report shows the Veteran had occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. The Veteran reported that since his previous September 2013 VA examination, his wife passed away in March 2020. He currently lived with his brother and got along well with him. He remained unemployed and last worked in 1998. He denied a history of psychiatric hospitalizations or suicide attempts since his previous VA examination in September 2013. He reportedly attended group therapy every other week at VA but due to his wife’s illness and subsequent death, and then COVID-19 pandemic, he had not attended in months. He was currently prescribed Mirtazapine. He reported having an occasional glass of wine with dinner but denied current use of other substances. The Veteran’s symptoms included depressed mood, anxiety, suspiciousness, and chronic sleep impairment. He presented in a euthymic mood with congruent affect. He was oriented and his speech was spontaneous and clear. His thought process was fluid and goal directed. He denied current suicidal and homicidal ideations, or auditory or visual hallucinations. He reported that his mood on most days was depressed and that he experienced intrusive, distressing memories of his experiences in Vietnam “every day.” He reported that about two to three times per month he was have nightmares of his experience in Vietnam and would thrash in his sleep. He endorsed feelings of shame and guilt related to his experiences in Vietnam and avoided talking about his combat experiences as it induced strong emotional reactions. He was reportedly easily startled and occasionally became hypervigilant in public. He denied symptoms of suicidal and homicidal ideation, auditory or visual hallucinations, and physical aggression. VA treatment records, the September 2013 and July 2020 VA examinations, and the Veteran’s lay statements show that the Veteran’s PTSD was manifested by symptoms associated with a 30 percent rating (such as depressed mood, suspiciousness, anxiety, and chronic sleep impairment), and symptoms associated with a 50 percent rating (such as disturbances of motivation and mood). He also had symptoms that are not listed with a specific rating, such as decreased energy and concentration, and easily startled. The Board finds the severity, frequency, and duration of the Veteran’s unlisted symptoms more closely approximate the symptoms contemplated by a 30 percent rating, which are less severe, less frequent, and shorter in duration than those contemplated by a 50 percent rating. See 38 C.F.R. § 4.126. While these symptoms were ongoing and chronic, decreased energy and concentration, and easy startling symptoms are similar to anxiety, panic attacks (weekly or less often), and occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, which are contemplated by the assigned 30 percent rating A May 2017 VA treatment record notes that the Veteran had passive thoughts of suicide. Suicidal ideation is contemplated by the 70 percent criteria and 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 statement describing passive suicidal thoughts in May 2017, with no further findings of suicidal ideation does not rise to the severity, frequency, and duration of suicidal ideation that is contemplated by the 70 percent or 100 percent disability ratings. The Veteran reported experiencing passive suicidal thoughts with no plan only once during a period of several years, and denied suicidal ideation in other existing treatment records, and during the September 2013 and July 2020 VA examinations. The Board also finds the level of impairment caused by the Veteran’s symptoms more closely approximates the level associated with a 30 percent rating. The Veteran experienced occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, but was generally functioning satisfactorily, with routine behavior, self-care, and normal conversation. Mental status examinations in VA treatment records dated from 2016 to 2017 and the September 2013 and July 2020 VA examinations indicate that the Veteran had occupational and social impairment ranging from mild or transient symptoms (in September 2013) to occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (in July 2020). Overall, his reported symptoms included depressed mood, sleep impairment, suspiciousness, anxiety episodes, irritability, nightmares, impaired concentration, decreased energy, at least one finding of passive suicidal thoughts with no plan, intrusive thoughts, chronic isolation, and emotional numbing. While the Veteran did experience symptoms contemplated by a 50 percent rating—disturbance of motivation and mood—the evidence overall does not demonstrate the level of impairment associated with a 50 percent rating. As noted above, the Veteran’s other remaining symptoms were either contemplated by or more consistent with a 30 percent rating. Further, while the Veteran has stated that his PTSD prevents him from working and that he should have a 100 percent rating, the September 2013 VA examiner found that the Veteran’s episodes did not impact his daily activities or prevent him from seeking and maintaining gainful employment. Socially, while he was reportedly isolated and emotionally numb as noted on a May 2016 VA treatment record, he had been married prior to his wife’s death in March 2020 and since then was getting along with his brother, with whom he lived, as noted on VA examination in July 2020. In short, the preponderance of the evidence weighs against finding that the severity, frequency, and duration of the Veteran’s symptoms resulted in the level of impairment required for a 50 percent rating. The criteria for a 50 percent or higher rating are not met and the appeal must be denied. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Sarah B. Richmond, 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.