Citation Nr: 21014415 Decision Date: 03/12/21 Archive Date: 03/12/21 DOCKET NO. 15-06 397A DATE: March 12, 2021 ORDER Entitlement to service connection/aggravation for bilateral pes planus is denied. Prior to May 3, 2018, a disability rating higher than 50 percent for the service-connected mental disability, is denied. Since May 3, 2018, a disability rating higher than 70 percent for the service-connected mental disability, is denied. REMANDED Entitlement to a total disability rating based on individual unemployability due to service connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. Pes planus is not related to service by causation or aggravation. 2. Prior to May 3, 2018, the service-connected mental disability was manifested by occupational and social impairment with reduced reliability and productivity. 3. Since May 3, 2018, the service-connected mental disability was manifested by occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection/aggravation for pes planus are not met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2021). 2. Prior to May 3, 2018, the criteria for a rating higher than 50 percent for the service-connected mental disability were not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 9411 (2021). 3. Since May 3, 2018, the criteria for a rating higher than 70 percent for the service-connected mental disability are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 9411 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a veteran (the Veteran) who had active duty service from November 1995 to October 1998. This appeal comes before the Board of Veterans’ Appeals (Board) from an October 2012 rating decision of the RO in New Orleans, Louisiana. In May 2018, the Veteran presented testimony at a Board hearing, chaired via videoconference by the undersigned Veterans Law Judge and accepted such hearing in lieu of an in-person hearing before a Member of the Board. See 38 C.F.R. § 20.700(e) (2021). The Veteran was informed of the basis for the RO’s denial of his claims and he was informed of the information and evidence necessary to substantiate each claim. The record was held open for an additional 60 days following the hearing so that the Veteran could submit evidence. A transcript of the hearing is associated with the claims file. 38 C.F.R. § 3.103 (2021). In a decision dated in August 2018, the Board reopened the claim of entitlement to service connection for a low back disorder and denied entitlement to service connection for a low back disorder on the merits. The Board also denied entitlement to service connection for aggravation of pes planus, entitlement to service connection for a bilateral knee disorder, entitlement to a rating higher than 50 percent for the service-connected mental disability, and entitlement to an effective date earlier than January 5, 2011, for the grant of service connection for the service-connected mental disability. The Veteran appealed that decision to the Veterans Court. In an Order dated in August 2019, pursuant to a Joint Motion for Remand, the Veterans Court vacated the Board’s decision in part, and remanded these issues to the Board for additional development consistent with the Joint Motion. The parties to the Joint Motion agreed that the Board’s decision to deny service connection for a bilateral knee disorder and an effective date earlier than January 5, 2011, for the grant of service connection for the service-connected mental disability should not be disturbed. In February 2020, the Board remanded these issues to address the stipulations of the parties to the Joint Motion. The case has since been returned to the Board for further appellate action. The Board also remanded the issue of entitlement to service connection for a low back disorder. That claim was granted on remand, which constitutes a full grant of the benefit sought. The appeal is thus resolved for this claim. Service Connection—Law and Regulations VA law provides that, for disability resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service, during a period of war, or other than a period of war, the United States will pay to any veteran thus disabled and who was discharged or released under conditions other than dishonorable from the period of service in which said injury or disease was incurred, or preexisting injury or disease was aggravated, compensation, except if the disability is a result of the veteran’s own willful misconduct or abuse of alcohol or drugs. 38 U.S.C. §§ 1110, 1131 (West 2014). Entitlement to service connection on a direct basis requires (1) evidence of current nonservice-connected disability; (2) evidence of in-service incurrence or aggravation of disease or injury; and (3) evidence of a nexus between the in-service disease or injury and the current nonservice-connected disability. 38 C.F.R. § 3.303(a); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); Saunders v. Wilkie, 886 F.3d 1356 (2018). VA law provides that, for disability resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service, during a period of war, or other than a period of war, the United States will pay to any veteran thus disabled and who was discharged or released under conditions other than dishonorable from the period of service in which said injury or disease was incurred, or preexisting injury or disease was aggravated, compensation, except if the disability is a result of the veteran’s own willful misconduct or abuse of alcohol or drugs. 38 U.S.C. §§ 1110, 1131 (West 2014). Every veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b); see also Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004); Patrick v. Shinseki, 668 F.3d 1325, 1329 (Fed. Cir. 2011). To be “noted” within the meaning of the presumption of soundness statute, the condition must be recorded in the entrance examination report. 38 C.F.R. § 3.304(b); see also 38 U.S.C. § 1111; Crowe v. Brown, 7 Vet. App. 238, 245 (1994). Generally, lay evidence is competent with regard to identification of a disease with unique and readily identifiable features which are capable of lay observation. See Barr v. Shinseki, 21 Vet. App. 303, 311 (2007). A lay person may speak to etiology in some limited circumstances in which nexus is obvious merely through observation, such as sustaining a fall leading to a broken leg. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir 2007). Lay persons may also provide competent evidence regarding a contemporaneous medical diagnosis or a description of symptoms in service which supports a later diagnosis by a medical professional. However, a lay person is not competent to provide evidence as to more complex medical questions, i.e., those which are not capable of lay observation. Lay statements are not competent evidence regarding diagnosis or etiology in such cases. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever); Jandreau, at 1377, n. 4 (‘sometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer’); 38 C.F.R. § 3.159(a)(2). After the evidence has been assembled, it is the Board’s responsibility to evaluate the entire record. 38 U.S.C. § 7104(a) (West 2014). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (West 2014); 38 C.F.R. §§ 3.102, 4.3. A VA claimant need only demonstrate that there is an approximate balance of positive and negative evidence in order to prevail. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), Gilbert at 54. Entitlement to service connection/aggravation for bilateral pes planus. When examined, accepted, and enrolled for active duty service on July 31, 1995, examination findings for the bilateral feet were abnormal due to pes planus (Record 04/03/2014 at 20, 21). Accordingly, the presumption of soundness does not attach with respect to bilateral pes planus. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). The Veteran separated from active duty service on October 31, 1998. While a service separation examination is not of record, the Veteran entered the National Guard immediately after he was discharged. A report of medical examination performed on September 10, 2000, reveals normal clinical findings for the feet. A physical profile rating of L-1 was assigned (Record 10/21/2004 at 21). The L factor concerns the feet, legs, pelvic girdle, lower back musculature and lower spine (lower lumbar and sacral) in regard to strength, range of motion, and general efficiency. The number 1 indicates that an individual possesses a high level of medical fitness and, consequently, is medically fit for any military assignment. See 9–3(c)(1) Army Regulation 40–501, Change 35; Hanson v. Derwinski, 1 Vet. App. 512 (1991); Odiorne v. Principi, 3 Vet. App. 456, 457 (1992). A report of medical history completed by the Veteran on the same day as the examination reveals the Veteran’s account that he had no history of, or current foot trouble (Record 10/21/2004 at 25). An April 5, 2011, VA Primary Care Note reveals X-rays of the bilateral feet were normal (Record 04/17/2018 at 343). A May 13, 2011, VA Podiatry Note reveals the Veteran’s complaint of pain in both feet. On examination, the Veteran had arches present without weight bearing, but the arches collapsed with standing. The diagnoses included achilles tendonitis, plantar fasciitis, and hyperhidrosis (Record 04/17/2018 at 336). The Board denied the claim in August 2018. The parties to the August 2019 Joint Motion agreed that the Board’s analysis did not address the Veteran’s report that he would go on long marches and that left his feet aching, that these marches aggravated his pes planus, and that now he has arch supports. Therefore, remand was warranted for the Board to address this evidence and provide an adequate statement of reasons or bases for its determination. A December 2020 VA Examination reveals a diagnosis of pes planus. The examiner noted that the Veteran’s pes planus clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness. The examiner reasoned that, although the Veteran was noted as having pes planus on enlistment there is no objective care or treatment for the condition during service. The earliest noted foot care and treatment was in 2011, a 12 year gap. There was also objective evidence of other co-morbidities causing foot pain noted on July 28, 2017. Although there may have been some acute aggravation with long marches, there is no objective evidence of worsening beyond natural progression (Record 12/01/2020). After a review of all of the evidence, the Board finds that the Veteran’s pes planus existed prior to service and was not aggravated by service. The Board acknowledges that the December 2020 examiner used the incorrect standard to the extent the examiner found the Veteran’s pes planus clearly and unmistakably predated service; however, there is no prejudice to his claim, as it essentially provides more process than is actually due. The condition was noted at examination, acceptance, and enrollment into service; therefore, he is not presumed to have been in sound condition. No further finding regarding the pre-existence of pes planus is necessary. If a preexisting disorder is noted upon entry into service, the Veteran cannot bring a claim for service connection for that disorder, but the Veteran may bring a claim for service-connected aggravation of that disorder.” Wagner, 370 at 1096; see also 38 U.S.C. § 1153; 38 C.F.R. § 3.306. In such claims, the Veteran has the burden of showing that there was an increase in disability during service to establish the presumption of aggravation. See Wagner; Jensen v. Brown, 19 F.3d 1413, 1417 (Fed. Cir. 1994). If the claimant meets his burden of demonstrating an increase in service, the disability is presumed to have been aggravated in service, and the burden is on the Secretary to rebut that presumption. Horn, 25 Vet. App. at 234; 38 U.S.C. § 1153; 38 C.F.R. § 3.306. Here, the Veteran reported only experiencing symptoms during service (pain). The mere occurrence of symptoms, in the absence of an increase in the underlying disability, does not constitute aggravation of the disability. Davis v. Principi, 276 F.3d 1341, 1345 (Fed. Cir. 2002); 38 C.F.R. § 3.306(a). The normal clinical findings in September 2000, the physical profile rating of 1 for the feet, and the Veteran’s denial of a history of, or current, foot problems at that time, is persuasive evidence that there was no worsening of the condition during service. He was examined by a physician, and he reported the presence of no symptoms at that time. The Board attaches greater probative weight to the Veteran’s denial of foot trouble shortly after service than to his current contradictory account because the earlier account is consistent to the contemporary medical examination findings. The Board also notes that the point in time in which any statement was made is important. The description of an event which is closer to the time that event allegedly occurred is naturally less likely to be affected by errors in memory. See Seng v. Holder, 584 F.3d 13, 19 (1st Cir. 2009). To the extent the Veteran maintains that his feet were injured during his period of National Guard service, the Board emphasizes that the requirements for establishing service connection for disability incurred as a result of National Guard service are more strenuous than those for active duty service. The Veteran must establish not only an injury or disease, but that he became disabled during such period; and, that such disability was incurred in the line of duty. There are no line-of-duty investigations of record in this case. The Veteran has not identified any line-of-duty injuries during his National Guard Service. Accordingly, the Board finds that the Veteran did not become disabled due to injury or disease incurred in the line of duty during any duty period pertinent to his National Guard service. There is no medical opinion that purports to establish a worsening beyond natural progress of bilateral pes planus during service. The only evidence in favor of this necessary service connection element comes from the Veteran’s lay statements, which do not rise to the level of substantiating worsening. The Board finds that establishing the natural progress of pes planus, and relating post-service pes planus symptomatology to remote events of service is not the equivalent of relating a broken bone to a concurrent injury to the same body part (Jandreau, at 1377). Such an opinion requires specialized medical knowledge, and is not capable of lay observation. In light of the September 2000 examination findings, this must be considered a disability of temporally remote onset. Therefore, the onset of the disability is not a lay-observable event. Accordingly, the Veteran’s lay statements are not competent evidence of an etiologic relationship between aggravation of the claimed disability and service. In sum, the Board finds that bilateral pes planus predated service and was not aggravated by service. In light of these findings, the Board concludes that service connection, by way of aggravation or otherwise, for the claimed foot disorder, is not warranted. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. Disability Ratings – Laws and Regulations Disability ratings are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran. See 38 C.F.R. § 4.3. A disability rating may require re-evaluation in accordance with changes in a veteran’s condition. Thus, it is essential that the disability be considered in the context of the entire recorded history when determining the level of current impairment. See 38 C.F.R. § 4.1. See also Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Nevertheless, where a veteran is appealing the rating for an already established service-connected condition, his present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, when an appeal is based on the assignment of an initial rating for a disability, following an initial award of service connection for this disability, the rule articulated in Francisco does not apply. Fenderson v. West, 12 Vet. App. 119 (1999). Instead, the evaluation must be based on the overall recorded history of a disability, giving equal weight to past and present medical reports. Id. Staged ratings are appropriate for an increased-rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). In the process of evaluating a mental/mental disorder, VA is required to consider a number of pertinent factors, such as the frequency, severity, and duration of a veteran’s mental symptoms and the veteran’s capacity for adjustment during periods of remission. After consideration of these factors, and based on all the evidence of record that bears on occupational and social impairment, VA must assign a disability rating that most closely reflects the level of social and occupational impairment a veteran is suffering rather than based solely on the examiner’s assessment of the level of disability at the moment of examination. When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation solely on the basis of social impairment. See 38 C.F.R. § 4.126. The VA Secretary, acting within his authority to adopt and apply a schedule of ratings, chose to create one General Rating Formula for Mental Disorders. 38 U.S.C. § 1155; see 38 U.S.C. § 501; 38 C.F.R. § 4.130. By establishing one general formula to be used in rating more than 30 mental disorders, the VA Secretary anticipated that any list of symptoms justifying a particular rating would, in many situations, be either under- or over-inclusive. The use of the phrase “such symptoms as,” followed by a list of examples, provides guidance as to the severity of symptoms contemplated for each rating, in addition to permitting consideration of other symptoms, particular to each veteran and disorder, and the effect of those symptoms on the claimant’s social and work situation. This construction is consistent with Cohen v. Brown, 10 Vet. App. 128 (1997). See Mauerhan v. Principi, 16 Vet. App. 436, 442 (1992). The schedular criteria incorporate the American Mental Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). 38 C.F.R. §§ 4.125, 4.130. Since August 4, 2014, VA has required a diagnosis of a mental disorder that conforms with the DSM–5. For claims prior to that date, VA required a diagnosis that conformed with the DSM–IV–TR. See Schedule for Rating Disabilities: Mental Disorders and Definition of Psychosis for Certain VA Purposes, 79 Fed. Reg. 45,093, 45,093 –94 (Aug. 4, 2014 (amending 38 C.F.R. § 4.125)). The evidence considered in determining the level of impairment under § 4.130 is not restricted to the symptoms provided in the diagnostic code. Instead, the rating specialist is to consider all symptoms of a claimant’s condition that affect the level of occupational and social impairment, including, if applicable, those identified in the American Mental Association’s Diagnostic and Statistical Manual of Mental Disorders. See 38 C.F.R. § 4.126. If the evidence demonstrates that a claimant suffers symptoms or effects that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the diagnostic code, the appropriate, equivalent rating will be assigned. Mauerhan, 16 Vet. App. at 443. The Court of Appeals for the Federal Circuit has embraced the Mauerhan interpretation of the criteria for rating mental disabilities. Sellers v. Principi, 372 F.3d 1318, 1326 (Fed. Cir. 2004). Mental disorders are to be rated on the severity, frequency, and duration their respective signs and symptoms. See Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); Vazquez-Claudio v. Shinseki, 713 F.3d 112, 115 (Fed. Cir. 2013). Entitlement to an increased disability rating for the service-connected mental disability, currently rated at 50 percent prior to May 3, 2018, and 70 percent since May 3, 2018. The current appeal arises from a claim of entitlement to service connection for an acquired mental disorder, received at VA on January 5, 2011. In a September 2015 rating decision, VA granted service connection for an acquired mental disorder and assigned an initial disability rating of 50 percent under Diagnostic Code 9411, effective January 5, 2011. The rating was increased to 70 percent in a December 2020 rating decision, effective May 3, 2018, corresponding to the date of the Board hearing at which the Veteran testified that his symptoms were worsening. Pertinent to the claim on appeal, the General Rating Formula for Mental Disorders at 38 C.F.R. § 4.130 provides the following ratings for mental disabilities: A 50 percent rating is warranted if it is productive of 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 (e.g., retention of only highly learned material, forgetting to compete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating, may be assigned for 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; speech intermittently illogical, obscure, or irrelevant; 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 work-like setting); and inability to establish and maintain effective relationships. The criteria for a 70 percent rating are met if there are deficiencies in most of the areas of work, school, family relations, judgment, thinking, and mood. Bowling v. Principi, 15 Vet. App. 1, 11-14 (2001). A 100 percent rating 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; memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130, Diagnostic Code 9411. The report of a July 2015 VA PTSD Examination reveals the Veteran’s occupational history of being currently employed full time as a project analyst. He had maintained his current employment for 8 years and he denied having problems on the job. Prior to this, he worked as a truck driver. The Veteran denied a history of learning or behavioral problems. The Veteran endorsed symptoms of sleep disturbance/frequent waking, hypervigilance triggered by sounds of airplanes and fireworks, avoidance of reminders of military service, anxiety, social withdrawal, and irritability. The Veteran denied suicidal or homicidal ideation. He continued to enjoy social activities. He denied memory problems or difficulties concentrating. The examiner provided a diagnosis of PTSD and opined that his level of functional impairment was occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication (Record 07/30/2015). The report of a July 2017 VA PTSD Examination reveals that the Veteran was living alone. He had two daughters and he described his relationships with them as “OK.” They were talking a few times per week. The Veteran was keeping in touch with his mother. He had one close friend and they would talk once per week. The Veteran continued to work as a project analyst The Veteran stated that he did a good job there, but was sometimes criticized for being brusque with co-workers. He stated that the contract for the job had ended and he was given part-time work as a truck driver. That job came to an end after a three-month probationary period because of his diabetes, which was poorly controlled and prevented him from working as a truck driver. He reported that he felt anxious and jumpy when he heard loud noises while he was driving trucks. No other occupational difficulties were reported. He reported anxiety and recurrent intrusive thoughts about stressor events in response to cues such as airplane noises, anniversaries of the events, and songs from that era. He reported nightmares several times per month that disrupt his sleep. He was depressed and angry most of the time; his reported unemployment was a significant stressor that was also contributing to low mood. He felt detached from other people because he felt no one, even his family, understood his deployment experiences. He would punch or hit walls when he was angry, but avoided outbursts at other people. He was excessively watchful and got up at night to check around his home. He had difficulty initiating and maintaining sleep, even in the absence of nightmares. He denied suicidal or homicidal ideation, and denied symptoms of psychosis. Symptoms included depressed mood, anxiety, chronic sleep impairment, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. The examiner endorsed a diagnosis of PTSD and opined that the Veteran’s functional impairment was 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 (Record 07/28/2017). A November 2020 VA Mental Examination reveals the Veteran’s statement that he was single and living by himself. He had never been married but he had two daughters. He occasionally sees his daughters. He spends most of his time at home. He does not sleep at night and reports he wakes up at 2 to 3 in the morning. He occasionally cooks and cleans. He does groom himself every day. He does have some friends. He visits his children once a month. He has no other hobbies. He had job experience as a truck driver, but had not worked in 18 months. He attributed his lack of work to memories of Iraq where he served as a truck driver. Symptoms included depressed mood, anxiety, suspiciousness, chronic sleep impairment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and difficulty adapting to stressful circumstances, including work or a work like setting. His speech was limited but coherent. His mood was anxious, and affect was appropriate. His thought processes were goal directed. He denied any suicidal or homicidal ideations. He did not have any delusions or hallucinations. His memory, past, present, recall were fair. His psychomotor activity was normal. Insight and judgment were good (Record 11/10/2020). VA outpatient records can be summarized as showing symptoms of depression, anxiety, suspiciousness, hypervigilance, difficulty sleeping, irritability, social withdrawal, and difficulty concentrating. However, the Veteran has consistently presented as alert, oriented, cooperative, with normal speech, appropriate affect, coherent thought processes, with concentration, insight, and judgment that was fair to good, memory performance that was fair to good, with attention that was generally fair to good, and on 1 occasion was mildly abnormal, and without abnormal movements, hallucinations, delusions, suicidal ideation or homicidal ideation. GAF scores, when recorded, have either been in the range of 51 to 60, which is reflective of moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning, (e.g., few friends, conflicts with peers or co-workers), or in the range of 61 to 70, which is reflective of mild symptoms (e.g., depressed mood and mild insomnia) or some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships (Record 04/17/2018). After a review of all of the evidence, the Board finds that the criteria for a rating higher than 50 percent for the service-connected mental disability are not met prior to May 3, 2018; and, the criteria for a rating higher than 70 percent are not met since that date. The parties to the Joint Motion agreed that the Board did not consider evidence in the July 2017 VA examination “(July 28, 2017, VA examination report, page 4)” that there is evidence of hallucinations and delusions. The Board notes that this page contains a pre-printed “check box” list of the PTSD diagnostic criteria. The Board also notes that the words “hallucination” and “delusion” are nowhere found on the examination report, including page 4. The Veteran denied hallucinations and delusions to the November 2020 VA examiner, and he has been found to have no hallucinations or delusions by VA outpatient examiners. The parties also agreed that the Board did not adequately address evidence reflecting irritable behavior “typically expressed as verbal or physical aggression toward people or objects,” including punching or hitting walls when angry. The parties omit the next clause in that sentence despite its significance. It states:” but [he] avoids outbursts at other people.” The Board finds that impaired impulse control--a symptom example—is only probative of entitlement to a rating at that level if it results in occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (1992). Here, the examiner opined that his symptoms, presumably including angry outbursts, directed at inanimate objects, not people, were productive of 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). These are the criteria for a 30 percent rating. Any examination report, but particularly a pre-printed form, must be taken in complete context. The examiners assessment is probative evidence that the noted symptoms did not result in occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. Relevant to and supportive of this assessment are findings indicating that the Veteran was getting along at least “OK” with family members. Also significant is that he continued to work as a program analyst and truck driver until forced to stop working due to his diabetes, a nonservice-connected disorder. While he contradicted himself in November 2020, blaming this decision on “memories of Iraq,” a 70 percent is already in effect for that period. Moreover, the November 2020 examiner assessed occupational and social impairment with reduced reliability and productivity, the criteria for only a 50 percent rating. Based on this evidence, the Board finds that the July 2017 examiner’s assessment is adequately supported in the context of the entire report. The basis for the grant of a 70 percent rating was not medical evidence, but the May 2018 Board hearing, at which time, the Veteran testified that his symptoms had worsened. This is a favorable determination by VA, and will not be disturbed. The date of the worsening was not specified. Accordingly, and in light of the subsequent assessment of entitlement to only a 50 percent rating, the Board finds that it is not factually ascertainable that the disability had increased to the point warranting a 70 percent rating prior to the current effective date. Regarding entitlement to a 100 percent rating, the Board finds that there is not total occupational impairment and total social impairment at any time. The Veteran has consistently been found to be oriented, his speech is coherent, and he lives alone and is capable of self-support. Here, the Board finds that the gross impairment of behavior resulting in severe disorientation, which is contemplated by the 100 percent rating criteria, is simply not evident in this case at any time. In sum, the Board finds that the service-connected mental disability has been manifested by occupational and social impairment with reduced reliability and productivity during the period prior to May 3, 2018, and by occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood since that period. In light of these findings of fact, the Board concludes that no higher disability ratings are warranted for the service-connected mental disability. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 371 (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). REASONS FOR REMAND Entitlement to TDIU is remanded. The parties to the Joint Motion stipulated that the Board should determine whether the rating claim includes a claim for TDIU in accordance with Rice v. Shinseki, 22 Vet. App. 447 (2009). In light of the Veteran’s current unemployment, the combined rating of 80 percent, and evidence, albeit contradictory, that his lack of employment is due to his service-connected mental disorder. Accordingly, the Board finds that the matter is reasonable raised. However, in this case, the record does not contain a specific listing of dates of the Veteran’s employment, as the Agency of Original Jurisdiction (AOJ) has never adjudicated this matter. Therefore, even if the Board determined that TDIU were currently warranted, the dates of such a grant cannot be determined from the record. All portions of the period on appeal for the rating claim are before the Board in a TDIU claim. The date of the claim on appeal is January 5, 2011. Accordingly, this matter is REMANDED for the following action: 1. Send to the Veteran a VA Form 21-8940 (Veterans Application for Increased Compensation Based on Unemployability) for submission of his employment history, including the precise dates of employment. 2. Adjudicate the remanded claim. If the benefit sought on appeal is not granted, the Veteran and his representative should be provided a supplemental statement of the case and an appropriate time period for response. The case should then be returned to the Board for further consideration, if otherwise in order. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Cramp 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.