Citation Nr: 21010990 Decision Date: 02/26/21 Archive Date: 02/26/21 DOCKET NO. 16-35 293A DATE: February 26, 2021 ORDER For the entire period on appeal, an increased evaluation of 70 percent, but no greater, for the Veteran’s service-connected acquired psychiatric disability, to include post-traumatic stress disorder (PTSD), as well as unspecified substance-related disorder and unspecified depressive disorder as secondary to PTSD, is granted. REMANDED Entitlement to disability rating based upon individual employability (TDIU) due to the Veteran’s service-connected disabilities is remanded. FINDING OF FACT For the entire period on appeal, the Veteran’s service-connected acquired psychiatric disability, to include post-traumatic stress disorder (PTSD), as well as unspecified substance-related disorder and unspecified depressive disorder as secondary to PTSD, is productive of a disability level that more nearly approximates occupational and social impairment with deficiencies in most areas, to include work, family relations, judgment, thinking, and mood, but does not result in total social and occupational impairment. CONCLUSION OF LAW For the entire period on appeal, the criteria for an increased evaluation of 70 percent for the Veteran’s service-connected acquired psychiatric disability, to include post-traumatic stress disorder (PTSD), as well as unspecified substance-related disorder and unspecified depressive disorder as secondary to PTSD, have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. § § 3.102, 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.126, 4.130, Diagnostic Codes 9411, 9435. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably in the U.S. Army from August 2000 to December 2006. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office/Agency of Original Jurisdiction (AOJ), which continued the Veteran’s PTSD evaluation of 50 percent, effective January 14, 2014. The Veteran’s Form 9 indicates that he did not request a Board hearing In June 2019, the Board remanded this appeal for further development, including scheduling the Veteran for a VA examination to evaluate his acquired psychiatric disability. To the extent that the directed VA examination report was procured in January 2020, the Board finds that substantial compliance with its remand directives pertaining to the Veteran’s psychiatric claim has been accomplished. See Stegall v. West, 11 Vet. App. 268, 271 (1998); see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999). The Board notes that a July 2014 rating decision increased the Veteran’s disability rating from 10 percent to 50 percent, effective January 14, 2014. However, because this award amounts to less than the maximum benefit available for the Veteran’s service-connected acquired psychiatric disability, and because the Veteran has not indicated that he is satisfied with a 50 percent disability rating, the Veteran’s increased rating claim for his service-connected acquired psychiatric disability remains on appeal. See AB v. Brown, 6 Vet. App. 35, 39-40 (1993). This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.902 (2016). See 38 U.S.C. § 7107(b) (2020). For the entire period on appeal, an increased evaluation of 70 percent, but no greater, for the Veteran’s service-connected acquired psychiatric disability, to include post-traumatic stress disorder (PTSD), as well as unspecified substance-related disorder and unspecified depressive disorder as secondary to PTSD, is granted. The Veteran’s service-connected acquired psychiatric disability, to include post-traumatic stress disorder (PTSD), as well as unspecified substance-related disorder and unspecified depressive disorder as secondary to PTSD, is currently evaluated under the criteria of Diagnostic Code 9411 as 10 percent disabling from January 22, 2010, and 50 percent disabling from January 14, 2014. See 38 C.F.R. § 4.130. The Veteran contends that the severity of his service-connected acquired psychiatric disability warrants an increased evaluation in excess of 50 percent, and for the reasons set forth below, the Board agrees that, for the entire period on appeal, the Veteran’s service-connected acquired psychiatric disability warrants an increased evaluation of 70 percent. The VA General Rating Schedule for mental disorders, including PTSD, provides for a 30 percent evaluation where there is 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 conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). See id. A 50 percent rating contemplates occupational and social impairment with reduced reliability and productivity due to such symptoms 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; impaired judgment; impaired abstract thinking; disturbance of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. See id. A 70 percent evaluation contemplates occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms 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); and inability to establish and maintain effective relationships. See id. A 100 percent evaluation contemplates 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; and memory loss for names of close relatives, own occupation, or own name. See id. The VA Secretary recently amended the portion of the Schedule for Rating Disabilities dealing with psychiatric disorders and the associated regulations to remove outdated references to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and replaced them with references to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). The DSM-V eliminated the DSM-IV’s reliance upon GAF scores, and accordingly, the Board will no longer afford GAF scores any probative value. See Golden v. Shulkin, 29 Vet. App. 221, 224-25 (2018). Evaluation under Section 4.130 is symptom-driven; therefore, symptomatology should be the primary focus when assigning a rating to a given mental health disability, and the frequency, severity, and duration of a veteran’s symptoms must play an important role in determining the appropriate disability rating. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). Significantly, the list of symptoms under the rating criteria is meant to be illustrative, not exhaustive; thus, the Board need not find all or even some of the listed symptoms in order to award a specific disability rating. See Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002). In fact, it is the level of the veteran’s occupational and social impairment that determines the appropriate disability rating under Section 4.130; accordingly, if the evidence of record demonstrates that the veteran suffers from symptoms listed in the rating criteria or symptoms of a similar severity, frequency, and duration that cause occupational or social impairment equivalent to the criteria for a particular rating, then the corresponding rating shall be assigned. See id. at 443; see also Vazquez-Claudio, 713 F.3d at 117. In addition to the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran’s capacity for adjustment during periods of remission must also be considered, and the evaluation must rest upon all the evidence relating to occupational and social impairment, not solely the examiner’s assessment of the level of disability at the moment of the examination. See 38 C.F.R. § 4.126(a). Further, when evaluating the level of disability for a mental disorder, the extent of social impairment must be considered, but the evaluation shall not be assigned solely on the basis of social impairment. See 38 C.F.R. § 4.126(b). In January 2011, the Veteran was awarded service connection for an acquired psychiatric disability, to include post-traumatic stress disorder (PTSD), with an initial evaluation of 10 percent, effective January 22, 2010. Subsequently, in July 2014, his evaluation was increased to 50 percent, effective January 14, 2014. Effective dates for disability ratings shall generally be the day following separation from active service or the date entitlement arose if the claim is received within one year of separation from service; otherwise, the effective date shall be the date of receipt of the claim, or the date the entitlement arose, whichever is later. See 38 U.S.C. § 5110; 38 C.F.R. § 3.400(b)(2)(i). When determining when the entitlement arose, an effective date for benefits can be no earlier than the date the disability at issue first manifested. See DeLisio v. Shinseki, 25 Vet. App. 45, 52 (2011). In this case, the Veteran submitted a noninitial increased rating claim on January 15, 2014; therefore, the Board has considered whether the Veteran’s service-connected psychiatric symptoms warrant an increased evaluation from January 15, 2013. The Veteran contends that his service-connected psychiatric disability warrants evaluations in excess of those currently assigned, due to the severity of his psychiatric symptoms which have been found to be caused by exposure to combat stressors during his military service in Iraq. After careful review, and for the reasons set forth below, the Board finds that, for the entire period on appeal, an increased evaluation of 70 percent for the Veteran’s service-connected acquired psychiatric disability, but no greater, is warranted. However, in so finding, the Board further finds that, for the entire period on appeal, a preponderance of the evidence of record weighs against a finding that an increased evaluation in excess of 70 percent is warranted in this case, as the manifestations of the Veteran’s service-connected acquired psychiatric disability do not more closely approximate the criteria for total social and occupational impairment. Throughout the entire period on appeal, the evidence of record reflects that the Veteran’s psychiatric symptoms included the following: depressed mood; irritability; anger; chronic sleep impairment; avoidance; social isolation; anhedonia; hypervigilance; impaired concentration; and impaired judgment. In June 2014, the Veteran was afforded a VA psychiatric examination which culminated in a report diagnosing the Veteran with PTSD related to his in-service combat stressors, as well as an unspecified other substance-related disorder involving frequent misuse of alcohol and prescribed pain medication with fairly recent onset and at least as likely as not secondary to PTSD. The June 2014 VA examination report also concludes that the Veteran’s psychiatric condition manifests the following symptoms: recurrent, involuntary, and intrusive distressing memories of the traumatic event(s); intense or prolonged psychological distress at exposure to internal or external cues; avoidance; markedly diminished interest or participation in significant activities; feelings of detachment or estrangement from others; hypervigilance; exaggerated startle response; depressed mood; anxiety; chronic sleep impairment; mild memory loss, such as forgetting names, directions or recent events; and disturbances of motivation and mood. During the course of the June 2014 VA examination, the Veteran further reported as follows: he has lives with his girlfriend and two sons; his older son lives with the Veteran’s parents during the school year; he describes his relationship with his girlfriend as “so-so,” noting that at times they argue about the Veteran’s unemployment and related financial matters; the Veteran gets along “well” with his sons and coaches his younger son’s sports teams; otherwise the Veteran spends a lot of free time on the computer and watches a lot of comedy movies to “take his mind off things;” at the time of the June 2014 VA examination, the Veteran was unemployed; in 2010, he earned an associates’ degree in computer-aided drafting, then worked full-time for two years in his field; the Veteran reported he does not think he can go back to work due to his low mood and low motivation; he further reported that he “missed a lot of days” of work from “being up all night,” and he had some difficulty with coworkers; regarding his prescription medication (citalopram), the Veteran endorsed decreased irritability but states that he still has “a lot of trouble with paranoia and sleep” and had been “drinking a lot.” In February 2016, the Veteran was afforded a second VA psychiatric examination which culminated in a report confirming the Veteran’s diagnoses of PTSD and unspecified other substance-related disorder manifested by the following symptoms: depressed mood; low motivation; low energy; fatigue; anxiety; hypervigilance; chronic sleep impairment; avoidance; anhedonia; impaired concentration; persistent and exaggerated negative beliefs; 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 worklike setting. The February 2016 VA examination report further notes the following: the Veteran reported that his relationship with his children is “great;” his relationship with his girlfriend is “so-so” due to arguments about financial issues; at the time of the February 2016 VA examination, the Veteran was unemployed and was staying at home with his children; he reported coaching his son’s sports teams and being friendly with the parents of his son’s friends, but mostly staying at home; his reluctance to socialize “frustrates” his girlfriend who prefers more social activities; the Veteran reports that he does not trust many people, and that he feels anxious with new people and new places; he does not have fun in public places due to his hypervigilance, though he is “fine with sporting venues;” at the time of the February 2016 VA examination, the Veteran was unemployed due to low mood and low motivation; he further reported that he “missed a lot of days” of work from “being up all night,” and he had some difficulty with coworkers; after working as substitute teacher, he stopped working due to his fear of school shootings and his “constant state of paranoia;” he attended just a few days of barber school but dropped out due to anxiety; he constantly worries about bad things happening, like a car-jacking or a home invasion, and believes that the “world we live in is not safe;” he checks the doors and his vehicles several times and feels anxious in crowds, fearing that “something could happen,” as he feels like “a target.” The February 2016 VA examination report also noted the Veteran’s report of the following: he lacks motivation and does not “want to do anything;” he has low energy and feels “slow” cognitively, as well as “foggy” and “distracted;” he has trouble completing lists and is forgetful; he suffers from sleep apnea and feels tired during the day due to poor quality sleep; he avoids speaking or thinking about past trauma but can experience joy with his children or “when LSU wins;” he does not do anything social or pleasurable and feels irritable most days, “likely due to not getting enough rest;” he overeats; his “paranoia” (hypervigilance) has worsened and causes him to avoid school and work; he uses alcohol and opiates to reduce his hypervigilance, otherwise, “every little creak in the house I jump up;” he states he has “a pretty good mood most days,” but little things can cause him to “snap;” he feels worthless, due to being overweight and not working, though he believes he is a good parent; he reports he sometimes has memories from war triggered by the news, and if he hears about a dead soldier or the national anthem, it triggers his own memories. In an April 2016 lay statement submitted with his Notice of Disagreement (NOD), the Veteran reported that his PTSD symptoms include the following: a constant state of “almost panic;” mood swings; substance abuse; violent behavior; severe depression; anxiety; obsessive-compulsive disorder (OCD); and neglect of personal hygiene. The Veteran’s April 2016 statement further contends that his symptoms have resulted in the following: preventing him from working or attending school; unemployment which causes his fiancée to refuse to marry him; no social life; spending the majority of time at home “doing nothing;” “no quality of life;” and his life is “completely different” from his life prior to his deployment to Iraq. In a July 2016 lay statement submitted with his substantive appeal, the Veteran reports that his PTSD symptoms have worsened and include the following: a constant state of panic and anxiety; sleep impairment due to hypervigilance, including sleeping with a firearm next to his bed; OCD-type behaviors and rituals such as always checking security, windows, and doors; auditory hallucinations; isolation; anhedonia; mood swings; irritability; anger; neglect of personal hygiene; and an “obsession with death.” The Veteran’s July 2016 statement further contends that his symptoms have resulted in the following: preventing him from leaving the house; quitting coaching; quitting school; and the abuse of alcohol and pain medication. In December 2016, the Veteran was afforded a third VA psychiatric examination which culminated in a report confirming the Veteran’s diagnosis of PTSD manifested by the following symptoms: depressed mood; anxiety; chronic sleep impairment; isolation; avoidance; anhedonia; impaired concentration; mild memory loss, such as forgetting names, directions or recent events; recurrent, involuntary, and intrusive distressing memories; recurrent distressing dreams; persistent inability to experience positive emotions; irritable behavior; angry outbursts; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; moderate to severe difficulty relating to co-workers; and difficulty in adapting to stressful circumstances, including work or a worklike setting. The December 2016 VA examination report also noted the Veteran’s report of the following: he feels angry and “on edge” most of the time; he prefers to spend time alone and not to leave his home; at the time of the December 2016 VA examination, he had been unemployed since October 2012; he had been previously hospitalized at a VA facility for psychiatric treatment due to a “nervous breakdown;” he has been treated by a VA psychiatrist on an outpatient basis and receives prescription psychiatric medication; he had previously been arrested for charges related to “domestic violence” and was required to attended “anger management” training but was not sentenced to “jail time.” In January 2020, the Veteran was afforded a fourth VA psychiatric examination which culminated in a report confirming the Veteran’s diagnosis of PTSD and unspecified substance-related disorder, as well as a new diagnosis of unspecified depressive disorder, secondary to PTSD. The January 2020 VA examination further delineated the Veteran’s PTSD symptoms as follows: sleep disturbance due to nightmares; recurring/intrusive thoughts about trauma; arousal symptoms, including hypervigilance and exaggerated startle response; irritability; angry outbursts; difficulty remembering specifics related to trauma; avoidance symptoms, including avoiding reminders of trauma; strong reactions when aspects of the trauma are encountered or experienced; and negative alterations in cognitions and mood associated with trauma. The Veteran’s depression symptoms were identified as follows: depressed mood most of the day, nearly every day; markedly diminished interest in or pleasure in all, or almost all, activities most of the day, nearly every day; significant weight loss when not dieting or weight gain (not related to physiological condition) or decrease or increase in appetite nearly every day; insomnia or hypersomnia nearly every day; psychomotor agitation or retardation nearly every day (observable to others); fatigue or loss of energy nearly every day; feelings of worthlessness or excessive or inappropriate guilt nearly every day; diminished ability to think or concentrate, or indecisiveness, nearly every day; recurrent thoughts of death (not just fear of dying); and recurrent suicidal ideation or suicidality. Overlapping symptoms between PTSD and depression were identified as follows: sleep problems; fatigue; concentration difficulties; difficulties experiencing positive emotions; feeling isolated or disconnected from others; loss of interest in previously enjoyable activities; having strong negative beliefs about oneself, the world, others; and feelings of worthlessness or excessive or inappropriate guilt nearly every day. Substance abuse symptoms were further identified as follows: alcohol/drugs taken in larger amounts or over a longer period than intended; a persistent desire or unsuccessful efforts to cut down or control drug/alcohol use; a great deal of time spent in activities necessary to obtain, use, or recover from drug/alcohol use; craving, or a strong desire or urge to use alcohol/drug; continued alcohol/drug use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol/drugs; important social, occupational, or recreational activities given up or reduced because of alcohol/drug use; recurrent alcohol/drug use in situations in which it is physically hazardous; alcohol/drug use continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol/drug use; tolerance (needing markedly increase amount to achieve intoxication or desired effect, or markedly diminished effect with continued use of the same amount); and withdrawal. The January 2020 VA examination further notes additional psychiatric symptoms as follows: dysthymic mood, described as “tired;” flashbacks; nightmares; intense or prolonged psychological distress at exposure to internal or external cues; provocation, typically expressed as verbal or physical aggression toward people or objects; anxiety; suspiciousness; mild memory loss, such as forgetting names, directions or recent events; flattened or blunted affect; 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; neglect of personal appearance and hygiene; intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene; minor OCD behaviors; impaired judgment (fair); and impaired insight (fair). The January 2020 VA examination report further notes that the Veteran’s irritability, hypervigilance, and decreased motivation could lead to mild to moderate difficulty in a physical or sedentary work environment, with the following types of functional limitations: reduced productivity; low frustration tolerance; and difficulty working with others. The Veteran also reported daytime fatigue due to insomnia and difficulties with concentration, which the January 2020 VA examination report indicates could lead to mild to moderate difficulty with the completion of complex tasks, and that impairment would be expected to be more severe in work settings with a high degree of interpersonal interaction and less severe in settings in which the Veteran could work at his own reasonable pace, with minimal supervision (which does describe the Veteran’s current occupational situation). The January 2020 VA examination report further notes that the “potentially salubrious features” (e.g., a regular routine) and effects (e.g., improved self-esteem) of employment may also serve as a protective factors for individuals coping with mental disorders, and it is within the realm of possibility that employment could contribute to globally improved functioning (citing “The mental health benefits of employment: Results of a systematic meta-review.” Australas Psychiatry. 2016 Aug; 24 (4):331-6). The January 2020 VA examination report further concludes as follows: the Veteran’s ability to understand and follow instructions is considered to be mildly impaired; his ability to retain instructions as well as sustain concentration to perform simple tasks is considered moderately or markedly impaired; his ability to sustain concentration to task persistence and pace is considered mildly impaired; his ability to respond appropriately to coworkers, supervisors, or the general public is considered moderately impaired; his ability to accept supervision is considered mildly impaired; his ability to accept criticism is considered moderately impaired; his ability to be flexible in the work setting is considered markedly impaired; his ability to work in groups is considered markedly impaired; and his ability for impulse control in the work setting is considered moderately impaired. The Veteran further reported to the January 2020 VA examiner as follows: he continues to live in a house with his girlfriend and two of his children; his relationship with his girlfriend has lasted thirteen years, but is currently “businesslike;” she refuses to marry him because he was unemployed for five years and threatened to “kick him out if he didn’t work;” he now works repairing lawn mowers and believes he and his girlfriend are “sticking together for the kids’ sake;” he and his girlfriend sleep in different rooms due to the Veteran’s chronic sleep impairment and continued nightmares about Iraq; his relationship with his three children (ages 20, 12, and 4) is “good” and is “about the only that brings any joy into my life;” he stays in touch with his family and checks in with his father but does not communicate much with his siblings; he does not have friends; he used to be outgoing and would be “out all the time,” but now he mostly stays home; he has no hobbies other than watching tv, and he no longer has any interest in playing golf, attending sporting events, or going to the movies; he can no longer go to movie theaters due to his hypervigilance and avoidance of crowds; he is currently employed by a lawn mower repair shop, working forty hours per week for the past year; he describes his current relationship with his co-workers as “fine;” and prior to his current employment, he had been unemployed for five years. The January 2020 VA examination report further notes the Veteran’s September 2009 VA in-patient psychiatric treatment due to prior suicidal ideations, as well as his ongoing VA psychiatric treatment and current prescription medication (duloxetine), which he reports reduces his crying spells and irritability. The Veteran further reported to the January 2020 VA examiner that he has “suicidal thoughts” but “not very often” and that such thoughts are “in a joking manner” and “not serious.” The examiner further noted that the Veteran appeared “to be under- reporting [his] combat exposure.” In a November 2020 lay statement submitted by the Veteran, he reported as follows that he is currently employed in lawn mower repair, and that prior to his current employment, he was unemployed for five years. The Veteran’s November 2020 lay statement further contends as follows: his girlfriend threatened to “kick [him] out” if he remained unemployed, in which case, he would have had “nowhere to go;” his “mental health is getting worse;” his VA psychiatrist added a second psychiatric medication, but he is “still suffering;” the current “COVID” situation “is making everything worse;” his father recently passed away, and ever since then, he has been “obsessed with death;” he denies being “suicidal,” but admits that he “definitely [has] thoughts about dying;” and his three children “are the only thing that bring any joy to my life.” In light of the foregoing evidence, the Board finds that, for the entire period on appeal, an evaluation of 70 percent, but no higher, is warranted in this case, because the frequency, severity, and duration of the Veteran’s symptomatology resulted in social and occupational impairment in most areas, particularly with respect to his restricted social relationships, his hypervigilance and anhedonia, his inability to form productive working relationships or to focus on job-related tasks, and his persistent mood dysregulation. See 38 C.F.R. § 4.130 (2020). In particular, the February 2016, December 2016, and January 2020 VA psychiatric examinations all culminated in reports clearly noting that the Veteran’s psychiatric symptomatology impairs his social relationships, his motivation and mood, his ability to adapt to stressful circumstances, and his inability to establish and maintain effective relationships. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); see also Guerrieri v. Brown, 4 Vet. App. 467, 470 (1993). In addition, the Board finds the Veteran’s competent and credible testimony regarding his current psychiatric symptomatology to carry significant probative weight, including his report of his chronic sleep impairment, depressed mood, and “obsession” with death, as well as his ongoing hypervigilance and irritability. See Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017). Accordingly, in light of the foregoing lay and medical evidence, the Board finds that an evaluation of 70 percent, but no higher, during the entire period on appeal is warranted in this case, because the frequency, severity, and duration of the Veteran’s symptomatology during this period resulted in social and occupational impairment in most areas, particularly with respect to his family relations, employment, school, judgment, thinking, and mood. See 38 C.F.R. § 4.130. However, in so finding, the Board further finds that at no time during the pendency of the appeal have the criteria for a 100 percent rating for an acquired psychiatric disability been satisfied or approximated. See 38 C.F.R. § 4.130, Diagnostic Codes 9411, 9435. The Veteran’s examination and treatment records consistently reflect the absence of any reports or observations of the following: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; disorientation to time or place; or memory loss for names of close relatives, own occupation, or own name. See id. Moreover, while the Board acknowledges that the Veteran contends that his psychiatric condition has manifested an “obsession” with death, including thoughts of dying, the VA examination reports of record do not indicate the Veteran’s report of suicidal ideations. More importantly, the Board finds that the totality of the evidence of record does not warrant a finding that the Veteran’s psychiatric symptomatology more closely approximates the criteria enumerated for a 100 percent evaluation, as the competent evidence of record does establish total social or occupational impairment. First, the Board notes that the presence of a specific symptom listed in evaluation criteria is not necessarily dispositive of any particular disability level. See Bankhead, 29 Vet. App. at 22. In addition, the Board further finds that the evidence of record reflects that the Veteran has maintained employment for approximately one year, as well as close familial relationships with his current long-term girlfriend and his children, despite noting that his relationship with his girlfriend has at times been ineffective. See 38 C.F.R. § 4.130. Accordingly, in light of the foregoing, the Board finds that a preponderance of the evidence of record weighs against a finding that the Veteran’s psychiatric symptoms have resulted in total social impairment as contemplated by Section 4.130 for a total disability rating, and in so finding, the Board determines that the severity of the Veteran’s psychiatric symptomatology does not more nearly approximate the level of disability contemplated by a 100 percent rating. See Vazquez-Claudio, 713 F.3d at 117-118. As set forth above, a total disability rating under Section 4.130 requires an ultimate factual conclusion that the level of the Veteran’s psychiatric symptomatology resulted in both total occupational and total social impairment; however, the evidence in this case does not support a finding that the Veteran’s familial or social relationships were totally impaired as contemplated by a total disability rating. See 38 C.F.R. § 4.130, Diagnostic Code 9411. Therefore, the Board finds that the Veteran’s psychiatric symptomatology more nearly approximates the rating criteria contemplated by the 70 percent disability rating rather than the 100 percent rating, and a rating of 100 percent is not warranted at any point during the period on appeal. Instead, an increased evaluation of 70 percent, and no higher, during such period on appeal is warranted in this case, due to the frequency, severity, and duration of the Veteran’s symptomatology resulting in social and occupational impairment in most areas, particularly in work, school, family relations, judgment, and mood. See id. Consideration has also been given the potential application of diagnostic codes for other mental disorders, including unspecified depressive disorder. See 38 C.F.R. § 4.130, Diagnostic Code 9435. However, the Board finds no basis upon which to assign increased or additional ratings for the Veteran’s acquired psychiatric disability at any point during the period of appeal, as the totality of the Veteran’s psychiatric symptoms have been encompassed in the current evaluation. Accordingly, the Board finds that an award of additional evaluations under Section 4.130 would constitute the sort of impermissible pyramiding proscribed by VA regulations for conditions that are duplicative or overlapping with the symptomatology of another condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); 38 C.F.R. § 4.14. Thus, all potentially applicable diagnostic codes have been considered, and there is no basis to assign an evaluation in excess of the rating assigned herein for the Veteran’s disability. See Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). In addition, the Board is not required to address additional issues unless specifically raised by the Veteran or reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017). Accordingly, because neither the Veteran nor his representative has raised any other issue concerning the Veteran’s psychiatric disability, and no other issues have been reasonably raised by the record, the Board finds that, for the entire period on appeal, a disability rating of 70 percent, but no greater, for the Veteran’s service-connected acquired psychiatric disability is warranted in this case. See Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). REASONS FOR REMAND Entitlement to disability rating based upon individual employability (TDIU) due to the Veteran’s service-connected disabilities is remanded. In this case, the evidence of record indicates that the Veteran was unemployed during the period on appeal from approximately September 2013 to approximately January 2019, as the Veteran reported to the January 2020 VA examination that he had been employed as a lawn mower repair technician for approximately one year prior to the January 2020 VA examination. However, a July 2014 VA Form 8940 serves as the most recent documentation of record relating to the Veteran’s employment history. Accordingly, further development of the Veteran’s claim for entitlement to a TDIU is necessary, in order to determine the Veteran’s exact dates of unemployment, as well as the nature of his current employment. Moreover, upon remand, the severity of the Veteran’s service-connected disabilities, his employment history, his education and training, and all other factors having a bearing on the matter must be developed and considered. See 38 C.F.R. § 4.16 (2020). Accordingly, this matter is REMANDED for the following action: 1. Obtain any outstanding private or VA treatment records and associate all such records with the electronic claims file. The AOJ should undertake the appropriate efforts to obtain and associate with the claims file any outstanding service treatment records, as well as any relevant and outstanding VA or private treatment records. If any records sought are not obtained, a written statement to that effect should be incorporated into the record. 2. Send the Veteran a VCAA notice for a TDIU and any related development (such as a VA Form 21-8940). 3. After the above development and any additionally indicated development has been completed, obtain an opinion (with examination only if deemed necessary) by a vocational specialist if possible (if not possible, then by an appropriate medical provider). The entire claims folder should be made available and reviewed by the examiner. All indicated studies should be performed and all findings should be reported in detail. Based upon a review of the entire record, the examiner should identify all limitations or functional impairment caused by each of the Veteran’s service-connected disabilities. The examiner should also identify the functional impairment of the combined effects of the Veteran’s service-connected disabilities. Information such as the functional impairment in his ability to stand, walk, lift, carry, sit, concentrate, etc. as well as the impact of any medications taken for his service-connected disabilities should be indicated. The examiner must include a rationale with all opinions, citing to supporting clinical data/medical literature as appropriate. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board H. Marsdale 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.