Citation Nr: 21009094 Decision Date: 02/18/21 Archive Date: 02/18/21 DOCKET NO. 15-26 776 DATE: February 18, 2021 ORDER Entitlement to a rating in excess of 70 percent for acquired psychiatric disorder, diagnosed as a depressive disorder and anxiety, is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected acquired psychiatric disorder, diagnosed as a depressive disorder and anxiety, for the period from August 21, 2013, onward, is granted. FINDINGS OF FACT 1. Throughout the rating period on appeal, the Veteran’s acquired psychiatric disorder, diagnosed as a depressive disorder and anxiety, is not shown to have been productive of total occupational and social impairment. 2. Throughout the period from August 21, 2013, onward, the Veteran’s service-connected acquired psychiatric disorder, diagnosed as a depressive disorder and anxiety, rated 70 percent disabling, rendered the Veteran unable to secure or follow a substantially gainful occupation. CONCLUSIONS OF LAW 1. Throughout the rating period on appeal, the criteria for a rating in excess of 70 percent for the Veteran’s acquired psychiatric disorder, diagnosed as a depressive disorder and anxiety, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.130, Diagnostic Code 9434. 2. Throughout the period from August 21, 2013, onward, the criteria for entitlement to a TDIU based upon the Veteran’s service-connected acquired psychiatric disorder, diagnosed as a depressive disorder and anxiety, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1974 to July 1974. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a March 2017 rating decision (assigning the effective date and initial rating for the award of service connection for psychiatric disorder) of a Department of Veterans Affairs (VA) Regional Office (RO). The Board issued a decision in December 2016 that granted a claim of entitlement to service connection for a psychiatric disorder, leading eventually to the Veteran’s appeal of the AOJ’s subsequent assignment of an effective date and initial disability rating in the processing of that award. In June 2019, the Veteran’s appeal for a higher initial rating assignment for the award of service connection for the psychiatric disorder came before the Board, and the Board remanded the issue to the Agency of Original Jurisdiction (AOJ) for additional development of the evidence. The directed development has been completed, and the matter has now returned to the Board for further appellate review. In March 2019, the Veteran claimed entitlement to TDIU during the pendency of her claim of entitlement to an increased rating for the service-connected psychiatric disability. Items of record have further raised the issue of entitlement to a TDIU due to her service-connected psychiatric impairment in particular, including evidence discussed below. The Veteran’s appeal thus includes a form of TDIU claim known as a Rice TDIU, because it was raised during the administrative appeal of the Veteran’s claim for an increased rating for a particular service-connected disability and it is, therefore, a component of that claim for benefits related to that disability. See Rice v. Shinseki, 22 Vet. App. 447, 454-455 (2009). Increased Ratings Disability ratings are determined by comparing a Veteran’s symptomatology during the pertinent period on appeal with criteria set forth in VA’s Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings shall be applied under a particular diagnostic code, the higher rating will be assigned if the disability picture more nearly approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. An exception to this rule applies when the rating criteria are successive. In such a case, all the requirements of the lower levels must be met before a higher level is awarded, and 38 C.F.R. §§ 4.7 and 4.21 do not apply. Johnson v. Wilkie, 30 Vet. App. 245 (2018). After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. With a claim for an increased initial rating, separate staged ratings may be assigned based on facts found. Fenderson v. West, 12 Vet. App. 119 (1999). In a claim for increase in a previously established rating, the present level of disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, where the evidence contains factual findings that demonstrate distinct time periods when the service connected disability exhibited diverse symptoms meeting the criteria for different ratings during the course of the appeal, staged ratings are to be considered. See Hart v. Mansfield, 21 Vet. App. 505 (2007). In determining whether a claimed benefit is warranted, VA must determine whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107 (a); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). It is the policy of VA to administer the law under a broad interpretation, consistent with the facts in each case with all reasonable doubt to be resolved in favor of the claimant; however, the reasonable doubt rule is not a means for reconciling actual conflict or a contradiction in the evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Lay evidence may be competent to address any matter not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a layperson. 38 C.F.R. § 3.159(a)(2). However, competent medical evidence is necessary where the determinative question is one requiring medical knowledge. Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also mean statements conveying sound medical principles found in medical treatises or statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). The Board has reviewed all of the evidence in the Veteran’s claims file, with an emphasis on the evidence pertinent to the issues on appeal. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, all contents of the extensive evidence of record. Indeed, the Federal Circuit has held that the Board must review the entire record but does not have to discuss each piece of evidence. Gonzalez v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board’s analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim. In McGrath v. Gober, 14 Vet. App. 28 (2000), the Court held that when evidence is created is irrelevant compared to when the Veteran was actually experiencing the symptoms. Thus, the Board will consider whether the evidence of record suggests that the severity of pertinent symptoms increased sometime prior to the date of the examination reports noting pertinent findings. The Board has also considered the history of the Veteran’s disabilities prior to the rating period on appeal to see if the history supports a higher rating during the rating period on appeal. Additional references to the Veteran’s service-connected disabilities are presented in evidence of record beyond that discussed below, including in VA medical reports associated with the Veteran’s treatment. The additional evidence of record does not present findings that significantly expand upon, revise, or contradict the findings in the most detailed evidence discussed by the Board in this decision. 1. Entitlement to a rating in excess of 70 percent for acquired psychiatric disorder, diagnosed as a depressive disorder and anxiety, is denied. The Veteran contends that she is entitled to a higher rating for her service-connected acquired psychiatric disorder, diagnosed as a depressive disorder and anxiety, asserting that the impairment is more severe than the assigned 70 percent rating reflects. The Veteran’s psychiatric disorder has been rated under 38 C.F.R. § 4.130, Diagnostic Code 9434, for major depressive 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’s service-connected psychiatric disorder is currently rated 70 percent disabling from the initial date of the award of service-connection: August 21, 2013. The entire period of the award of service-connection is before the Board on appeal in this case. The issue in this appeal is whether the Veteran’s associated symptoms have caused the level of impairment required for a disability rating of 100 percent (the next-highest rating in the rating schedule). The Board concludes that the Veteran’s symptoms have not caused the level of impairment required for a disability rating of 100 percent. The Veteran’s symptoms have more closely approximated the symptoms associated with a 70 percent rating, and have resulted in a level of impairment that most closely approximates the level of impairment associated with a 70 percent rating. The General Formula presents the following rating provisions: 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 February 2017 VA mental health compensation examination report shows that the Veteran reported that “she has struggled with depression and anxiety since sustaining her back injury while in the military.” The February 2017 VA examination report’s inventory of the Veteran’s symptoms featured: depressed mood; anxiety, panic attacks more than once a week; chronic sleep impairment; 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; and obsessional rituals which interfere with routine activities. The February 2017 VA examiner characterized the Veteran’s overall level of impairment as “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.” This characterization clearly matches the description of impairment contemplated by the rating criteria for a 50 percent rating. The shown symptoms feature items matching the exemplars for impairment contemplated by the rating criteria for up to a 70 percent rating, and no higher rating. A December 2017 VA mental health compensation examination report shows that the VA examiner’s inventory of the Veteran’s symptoms featured: depressed mood; anxiety; 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; and difficulty in adapting to stressful circumstances, including work or a work like setting. The VA examiner assessed that the Veteran was “an INCREASED but not current imminent risk” with regard to “harm to... herself,” and this was explained to indicate “no current plan or intent to take action.” The Board finds that this represents no greater impairment than contemplated by the listed 70 percent rating exemplar of “suicidal ideation,” and the report does not indicate impairment approximating a “persistent danger of hurting self or others” as contemplated in the listed exemplar for a 100 percent rating. The December 2017 VA examiner characterized the Veteran’s overall level of impairment as “Occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood.” This characterization clearly matches the description of impairment contemplated by the rating criteria for a 70 percent rating. The shown symptoms feature items matching the exemplars for impairment contemplated by the rating criteria for up to a 70 percent rating, and no higher rating. An October 2020 VA mental health compensation examination report shows that the VA examination report’s inventory of the Veteran’s symptoms featured: depressed mood; anxiety; 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 work like setting. Further discussion of the Veteran’s symptoms additionally noted: sadness; concern of past failure; self-dislike; sleep problems; agitation; irritability; concentration problems; feelings of worthlessness; nervousness; inability to relax; feelings of losing control; fear of dying; and fear of the worst happening. The VA examiner also noted “physical effects of anxiety” such as: hot flashes; dizziness/lightheadedness; numbness or tingling; difficulty breathing; and feeling shaky/unsteady. The October 2020 VA examiner characterized the Veteran’s overall level of impairment as “Occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood.” This characterization clearly matches the description of impairment contemplated by the rating criteria for a 70 percent rating. The shown symptoms feature items matching the exemplars for impairment contemplated by the rating criteria for up to a 70 percent rating, and no higher rating. The October 2020 VA examination report shows some symptoms that are not exact matches for exemplars listed in the rating criteria. The Board finds that these more closely approximate the symptoms and impairment contemplated by a 70 percent rating, not a 100 percent rating. The Board finds that the “physical effects of anxiety” are generally contemplated by the listed exemplar of “anxiety” contemplated by the rating criteria, and each of unlisted symptoms reported is essentially compatible with the level of impairment contemplated by listed exemplars such as anxiety, depression, panic attacks, disturbances of motivation and mood, impaired impulse control (irritability), and impaired abstract thinking. The Board finds that the adequate and probative VA examination reports discussed above, informed by interview / examination of the Veteran and review of the pertinent history, show that the service-connected psychiatric disorder has been manifested by symptoms associated with a 70 percent rating (such as suicidal ideation; difficulty in adapting to stressful circumstances, including work or a worklike setting; and obsessional rituals which interfere with routine activities), but not symptomatic impairments meeting the criteria for a 100 percent rating. The Board notes that the evidence discussed above includes a suggestion of some concern regarding suicidal risk, which may be 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 VA examination report evidence, consistent with the other evidence of record including VA treatment reports, shows that the Veteran’s suicide risk has not exceeded the level of occasional suicidal ideation, at most. 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 December 2017 VA examiner assessed that there was -not- any “current imminent risk,” and the Veteran described that “she doesn’t want to die because she has ‘three beautiful grandchildren.’” All three of the pertinent VA examination reports indicate that the Veteran denied “suicidal ideation,” and this is generally consistent with the indications of the VA treatment reports. The Board finds that the evidence does not show a persistent danger of self-harm. The Board finds the level of impairment caused by the Veteran’s symptoms more closely approximates the level associated with a 70 percent rating. The Veteran has experienced occupational and social impairment with reduced reliability and productivity with deficiencies in most areas. All of the VA examination reports provide assessments of the Veteran’s impairment that specifically match the rating criteria for ratings no higher than 70 percent. The Board finds that the evidence of record does not show total occupation and social impairment. The record’s depictions of the Veteran’s considerable difficulties maintaining relationships do not indicate total social impairment. For instance, the October 2020 VA examination report shows that the Veteran “sees her brother and neighbors,” and “sees her grandchildren,” although she was having difficulty “get[ting] along” with her daughter. The December 2017 VA examination report shows that the Veteran reported family visits to see her grandchildren “several times per week.” The Board notes that the assigned 70 percent rating contemplates “deficiencies in … family relations,” and a higher 100 percent rating requires “total … social impairment.” The Board finds that the evidence reflects the Veteran’s significant social difficulty from deficiencies interfering with her social functioning and relationships, as contemplated by the 70 percent rating, but the evidence does not indicate total social impairment. The Veteran’s symptoms most closely approximate occupational and social impairment with deficiencies as contemplated by the criteria for a 70 percent rating, and not total occupational and social impairment as contemplated by the criteria for a 100 percent rating. As discussed above, to the extent that some of the Veteran’s symptoms described in the evidence may not exactly match the exemplars listed with a specific rating, the Board finds the severity, frequency, and duration of the Veteran’s 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. The Board finds that the evidence indicates that the Veteran’s symptoms are productive of occupational and social impairment with deficiencies in most areas, and -not- total occupational and social impairment. The Veteran’s symptomatology is not shown to include symptoms of comparable severity, frequency, and duration as the listed exemplars for a 100 percent rating: 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 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 100 percent rating. The criteria for a 100 percent rating are not met, and the appeal must be denied. The Board finds that the preponderance of the evidence is against entitlement to an increased rating. 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 a TDIU due to service-connected acquired psychiatric disorder, diagnosed as a depressive disorder and anxiety, for the period from August 21, 2013, onward, is granted. In March 2019, the Veteran claimed entitlement to TDIU during the pendency of her claim of entitlement to an increased rating for the service-connected psychiatric disability. Items of record have further raised the issue of entitlement to a TDIU due to her service-connected psychiatric impairment in particular, including evidence discussed below. The Veteran’s appeal thus includes a form of TDIU claim known as a Rice TDIU, because it was raised during the administrative appeal of the Veteran’s claim for increased ratings for a particular service-connected disability and it is, therefore, a component of that claim for benefits related to that disability. See Rice v. Shinseki, 22 Vet. App. 447, 454-455 (2009). A claim for TDIU, either expressly raised by the Veteran or reasonably raised by the record, involves an attempt to obtain an appropriate rating for a disability and is part of the claim for an increased rating. Rice v. Shinseki, 22 Vet. App. 447 (2009). In light of the above-discussed procedural history, the Veteran’s Rice TDIU arises as part of the Veteran’s appeal for higher compensation for her service-connected psychiatric disorder. The rating period for consideration spans back to August 21, 2013, the date that marks the beginning of the rating period on appeal for the service-connected psychiatric disorder. VA will grant a total rating for compensation purposes based on unemployability when the evidence shows that the Veteran is unable, by reason of his or her service-connected disabilities, to secure or follow a substantially gainful occupation consistent with his or her education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. A threshold requirement for eligibility for a TDIU under 38 C.F.R. § 4.16(a) is that, if there is only one such disability, it must be rated at 60 percent or more; and if there are two or more disabilities, at least one disability must be rated at 40 percent or more, and sufficient additional disability must bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). For the above purpose of identifying one 60 percent disability, or one 40 percent disability in combination, disabilities resulting from a common etiology will be considered as one disability. However, even where the Veteran does not meet these schedular requirements, 38 C.F.R. § 4.16(b) codifies VA’s policy under which all veterans who are unable to secure a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. Thus, if a Veteran fails to meet the schedular requirements above, an extraschedular rating is for consideration where the Veteran is nonetheless unemployable due to service connected disability. Id.; see also Fanning v. Brown, 4 Vet. App. 225 (1993). The Board may not grant a TDIU on an extraschedular basis in the first instance. Rather, the matter must be referred to the Director of the Compensation and Pension Service (Director) for extraschedular consideration. Bowling v. Principi, 15 Vet. App. 1, 10 (2001). In Ray v. Wilkie, 31 Vet. App. 58 (2019), the Court defined the term “unable to secure and follow a substantially gainful occupation” in § 4.16(b) to include two components: one economic and one noneconomic. The economic component means an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. The non-economic component includes consideration of: the Veteran’s history, education, skill, and training; whether the veteran has the physical ability to perform the type of activities required by the occupation at issue; and whether the veteran has the mental ability to perform the activities required by the occupation at issue. In determining whether the Veteran is entitled to a TDIU, neither nonservice-connected disabilities nor age may be considered. Van Hoose v. Brown, 4 Vet. App. 361 (1993). The Court has held that the central inquiry in determining whether a Veteran is entitled to a TDIU is whether service-connected disabilities alone are of sufficient severity to produce unemployability. Hatlestad v. Brown, 5 Vet. App. 524 (1993). The Board notes that the scope of the Rice TDIU in this case begins with consideration of the impairment associated with the Veteran’s service-connected psychiatric disorder; that disability has a rating of 70 percent effective throughout the rating period, meeting the criteria for consideration of a TDIU under 38 C.F.R. § 4.16(a). See 38 C.F.R. § 4.25. The Veteran’s March 2019 filing of a VA Form 21-8940 shows that she reported that she was last employed in 2008. She reported a completed high school education, and that she last worked as a supervisor at a car part store. This information, including the indication that the Veteran’s last employment concluded significantly prior to the rating period for consideration in this case, is essentially consistent with the discussion of the Veteran’s history presented in VA medical records, including the VA psychiatric examination reports discussed earlier in this Board decision. The evidence regarding the Veteran’s potential entitlement to a TDIU for the rating period under review is not unequivocally clear. However, the Board has carefully considered potentially favorable evidence, particularly that presented by the VA psychologist who authored the October 2020 VA examination report and the associated “Individual Unemployability Statement.” The October 2020 VA psychologist’s “Individual Unemployability Statement” presents a list of conclusions regarding the Veteran’s “difficulties in each area due only and specifically to the mental health diagnosis,” and features: “Individual has difficulty attending to or is easily distracted from the task at hand,” “Individual has difficulty maintaining concentration and focus on work over a period of time, tends to skip from one task to another without completing the prior task,” “Individual has significant difficulty remembering instructions and details of work assignments,” “Individual has significant difficulty functioning around other people, has difficulty functioning as a team member, and feels uncomfortable around others,” and “Individual’s sleep is so disrupted that [s]he has difficulty sustaining energy and motivation to complete assignments at work.” Again, the evidence is not unequivocally clear with regard to the Veteran’s entitlement to a TDIU during the period on appeal. However, resolving reasonable doubt in the Veteran’s favor, the Board can conclude that the Veteran has been impaired by her service-connected psychiatric disorder to a degree that has caused her to be unable to secure or follow a substantially gainful occupation consistent with her education and occupational experience during this period. The Board finds that the evidence reasonably shows entitlement to a TDIU throughout the rating period on appeal; this TDIU can be awarded on the basis of the Veteran’s mental health / psychiatric disorder alone. The Board notes that the Veteran’s psychiatric disorder has been evaluated by VA at the same disability rating throughout the entire rating period on appeal, and the Board finds no persuasive indication of record that the Veteran’s impairment was significantly lesser in 2013 than it was at the time of the pertinent October 2020 expert assessment. Based on detailed review of the foregoing, resolving reasonable doubt in the Veteran’s favor, the Board finds that the Veteran’s service-connected mental health / psychiatric disorder has precluded her from all forms of substantially gainful employment consistent with her educational background and occupational experience throughout the period from August 21, 2013, onward. To this extent, the appeal is granted. (No earlier effective date is available for this award as service-connected status is not in effect for any disability prior to August 21, 2013.) The Veteran and her representative have not raised any other issues in connection with the issues on appeal, nor have any other issues been reasonably raised by the record in connection with these matters. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Barone, 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.