Citation Nr: 21007178 Decision Date: 02/08/21 Archive Date: 02/08/21 DOCKET NO. 18-40 168 DATE: February 8, 2021 ORDER Entitlement to a disability rating of 100 percent for generalized anxiety disorder is granted. FINDING OF FACT The severity, frequency, and duration of the Veteran’s symptoms more closely approximate total occupational and social impairment. CONCLUSION OF LAW The criteria for a disability rating of 100 percent for generalized 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 9400. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from May 1969 to December 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in October 2017 by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at a hearing in December 2020. 1. Entitlement to a disability rating of 100 percent for generalized anxiety disorder The Veteran asserts that he is entitled to a 100 percent disability rating for his generalized anxiety disorder. 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 Veteran is currently service connected for general anxiety disorder with a 50 percent rating. 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. In VA treatment records from March 2017, the Veteran’s treating physician documented that he gets very anxious when he’s in crowded situations and starts sweating, shaking, and having shortness of breath. The Veteran reported that he enjoyed staying in his group home but feels anxious whenever he has to do anything outside of his normal routine. He also reported having an anxiety attack while at the DMV requiring assistance from the security guard. The Veteran also reported that he was having insomnia and was only able to sleep 2 hours a night. Further, the Veteran stated that he was feeling anxious but was not feeling depressed and has never felt suicidal or homicidal. In VA treatment records from April 2017, the Veteran’s mood was documented as being significantly anxious about his living circumstances. In May 2017, the Veteran reported that his anxiety was worse at night but found that medication helped to ease his symptoms. The Veteran appeared for a VA examination in August 2017 to determine the nature and etiology of his anxiety disorder. The examiner noted that the Veteran had multiple psychiatric disorders and detailed that the symptoms of anxiety; chronic sleep impairment; difficulty in adapting to stressful circumstances; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships are most likely attributable to the Veteran’s anxiety disorder. The examiner also documented symptoms of depressed mood and mild memory loss. The Veteran underwent a second VA examination in July 2020. The examiner determined that the Veteran exhibited occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking, and mood. The examiner documented that the Veteran’s concentration problems could be from his anxiety disorder or his mild neurocognitive disorder (due to reoccurring strokes) and thus it was not possible to differentiate all of his symptoms without resorting to speculation. The Veteran reported symptoms of anxiety; suspiciousness; panic attacks that occur weekly or less often; chronic sleep impairment; mild memory loss; impairment of short and long term memory; difficulty in understanding complex commands; impaired judgment; impaired abstract thinking; disturbances in motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances; and inability to establish and maintain effective relationships. The Veteran denied any suicidal ideations and has no history of suicide attempts. The Veteran appeared for a hearing before the Board in December 2020. During his hearing the Veteran testified about the difficulty of living with and managing his anxiety disorder symptoms. Specifically, the Veteran reported having memory loss and the inability to make rational decisions. Additionally, the Veteran reported delusions of hearing voices at night. He stated that he had been hearing voices for approximately 6 months prior to the hearing The Veteran reported that any change in his routine causes severe anxiety to the point where he is unable to sleep at night. He stated that his anxiety builds up to the point where he has to call his treating physician for assistance. The Veteran stated that his high levels of anxiety result in him having panic attacks, composed of sweating, shaking, and his heart pounding, in addition to experiencing high blood pressure, heart attacks, and strokes. The Veteran also reported that his memory loss is a daily struggle. He requires assistance every week with taking his medications and follows a schedule every day to keep him on track. Any deviation from this schedule triggers his anxiety. The Veteran also stated that the last time he was employed was 1990 due to his anxiety disorder. Upon reviewing all of the pertinent evidence of record, the Board finds that the Veteran’s general anxiety disorder more nearly approximates the level of impairment required for a disability rating of 100 percent. VA and private treatment records, the July 2020 VA examination, and the Veteran’s lay statements show that the Veteran’s anxiety disorder was manifested by symptoms associated with a 100 percent rating. In this regard, the Veteran experienced symptoms of gross impairment of thought process or communications; persistent delusions; memory loss; and intermittent inability to perform activities of daily living. The Veteran is unable to sleep at night; hears voices; and is unable to deviate from his routine schedule without triggering a severe anxiety attack warranting assistance from those around him. Additionally, his memory loss makes him unable to keep up with his own affairs unassisted. Specifically, he must keep a schedule in his phone and must rely on a nurse to make sure that he has and takes the appropriate medications. In terms of occupational and social impairment, the Veteran reported that he has been unable to maintain employment for the past 30 years due to his symptoms. In terms of social impairment, the Veteran is not married or dating, maintains minimal contact with his family and others, and reported that he mostly stays at home. The Board finds that the Veteran’s occupational and social impairment most closely approximates the total impairment required for a 100 percent rating. In summary, the Board finds that the Veteran’s service-connected psychiatric disorder manifests in severe symptoms equaling or approximating those described by the 100 percent rating, and that these symptoms have resulted in total occupational and social impairment. The Board further finds that these symptoms have been relatively consistent over the course of the entire appeal period, such that the grant of this increased rating should be applied to the entire period on appeal. For these reasons, the Board determines that an increased, 100 percent rating for the Veteran’s generalized anxiety disorder is warranted for the entire period on appeal. Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. K. Hall, 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.