Citation Nr: 21020864 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 16-58 672 DATE: April 8, 2021 ORDER A rating in excess of 30 percent for generalized anxiety disorder (GAD) and posttraumatic stress disorder (PTSD) is denied.   FINDING OF FACT The Veteran’s GAD and PTSD have manifested in no more than occupational and social impairment with occasional decreases in work efficiency and intermittent periods of the inability to perform occupational tasks. CONCLUSION OF LAW The criteria for a rating in excess of 30 percent for GAD and PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.130, Diagnostic Codes (DCs) 9400, 9411. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1966 to September 1970. The case is on appeal from a February 2016 rating decision. In May 2019, the Veteran testified at a Board hearing. Later in May 2019, the Board remanded the claim for further development. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran, his representative and those reasonably raised by the record. See Scott v. McDonald, 789 F3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). A rating in excess of 30 percent for GAD and PTSD. General Legal Criteria Ratings are based on a schedule of reductions in earning capacity from specific injuries or combination of injuries. The ratings shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations. 38 U.S.C. § 1155. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. Specific Legal Criteria 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). While Global Assessment of Functioning (GAF) scores may be included in the Veteran’s medical records, the Board will not consider GAF scores in determining the outcome of this case. See Golden v. Shulkin, 29 Vet. App. 221 (2018) (finding GAF scores to be unreliable indicators of functional impairment and not useful in rating psychological disabilities). The Veteran’s PTSD and MDD has been evaluated under the General Formula. 38 C.F.R. § 4.130, DCs 9400, 9411. A 30 percent evaluation is warranted when there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, due to such symptoms as: depressed mood; anxiety; suspiciousness; panic attacks (weekly or less often); chronic sleep impairment; and mild memory loss (such as forgetting names, directions, recent events). A 50 percent rating is warranted when there is 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 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; difficulty in establishing and maintaining effective work and social relationships. A 70 percent evaluation is warranted 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, or 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 the inability to establish and maintain effective relationships. The highest rating of 100 percent is warranted where there is 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. Analysis The Veteran is seeking an increased rating for GAD and PTSD in excess of 30 percent. At his May 2019 Board hearing, he testified that his symptoms have increased in severity, including his panic attacks, lack of motivation, anxiety, sleep problems with nightmares, poor concentration, and avoidance of crowds. He also testified that his symptoms are now affecting his family and social relationships. The Veteran was first afforded a VA examination for his increased rating claim in December 2015. The Veteran reported that he had not worked or volunteered since July 2010, and was currently receiving mental health services that included individual and group therapy, and medical prescriptions. He stated that he had been married for 45 years, with a “good” relationship with his wife, with regular contact with his daughters and grandchildren, and occasionally visited with friends over the weekend. He denied any suicidal or homicidal ideation, or mania. Symptoms identified by the examiner included: recurrent recollections and distressing dreams of traumatic events with chronic sleep impairment; persistent avoidance of distressing memories, thoughts, feelings, or external reminders; marked diminished interest in activities; detachment or estrangement with the inability to experience positive emotions; irritability; problems with concentration; difficulty falling or staying asleep; hypervigilance; exaggerated startle response; depressed mood; anxiety; panic attacks weekly or less often; and disturbances of motivation and mood. The Veteran was also found to be adequately groomed, had appropriate affect, with no evidence of psychosis. The December 2015 examiner found that the Veteran’s GAD and PTSD resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. The Veteran underwent another VA examination in November 2019 pursuant to the Board’s remand. He reported that he has remained married for 49 years, maintains close relationships with his wife and two daughters and two grandchildren (with a periodic conflict with one daughter), and enjoys spending time with his family. He continues to have a small group of close friends, dining out with them or going to each other’s homes. He retired as a postal worker in 2003, and has denied any history of occupational impairment, but is “enjoying his retirement.” He has considered getting another parttime job, but believes that his chronic insomnia and associated fatigue would interfere with performance. The Veteran reported avoiding crowds but will tolerate them if required, with rare outings to a college sports game. He reported experiencing chronic worry and difficulty controlling anxiety, chronic insomnia, varied frequency of panic attacks, daily intrusive memories, weekly episodes of irritability, and mild distractibility (“My mind drifts”). He denied any history of suicidal thoughts. The examiner noted the following symptoms: recurrent recollections and distressing dreams of traumatic events with chronic sleep impairment; persistent avoidance of distressing memories, thoughts, feelings, or external reminders; marked diminished interest in activities; detachment and estrangement; irritability; problems with concentration; difficulty falling or staying asleep; hypervigilance; exaggerated startle response; depressed mood; anxiety; panic attacks (weekly or less often); disturbances of motivation and mood; and mild memory loss (such as forgetting names, directions, or recent events). He was again found to be adequately groomed, have logical and goal-directed thought processes, and with fair insight and judgment. There was no evidence of psychosis or delusional thoughts, but his mood and affect were mildly anxious and frustrated, with intact cognition for the purposes of the assessment. The November 2019 examiner determined that he continues to suffer occupational and social impairment at a level with occasional decreases in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. VA treatment records indicate that the Veteran continues with regular mental health outpatient treatment of both individual and group therapy, and pharmacotherapy. Symptoms throughout the appeal period reflect a mood range between euthymic (neutral or tranquil) and mildly anxious and/or depressed. There is no current or past evidence of suicidal or homicidal ideation, and his hygiene has remained adequate. From October 2014 to October 2019, his psychiatrist noted improved symptoms and functioning in response to treatment, with the largest complaint of chronic insomnia with nightmares. It is noted that the Veteran began reporting some cognitive issues beginning in April 2018, complaining of brief moments of forgetting where he is while driving, and in November 2019 he reported trouble with remembering names and concentration. It was noted that he would be consulting for possible participation in a dementia study. See October 2014 through November 2019 medical CAPRI documents. Based on a holistic analysis and consideration of this evidence, the Board finds that the level of the Veteran’s GAD and PTSD is appropriately rated as 30 percent disabling during the appeal period and an increased rating is not warranted. In the December 2015 VA examination, the psychologist concluded the Veteran’s symptoms resulted in occasional decreases 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 is suggestive of a 30 percent rating. See 38 C.F.R. § 4.130, DCs 9400, 9411. The November 2019 examiner found the same level of functioning after review of the record and consideration of the Veteran’s statements at the examination. Moreover, VA treatment records show only mild symptoms of anxiety or depression, and mild memory loss. (Continued on the next page)   The Board acknowledges the severity of the Veteran’s symptoms and the social and occupational impact such symptoms have caused. As noted above, chronic sleep impairment, mild concentration and memory loss, depression, anxiety, panic attacks not more than once a week, irritability, and diminished interest and motivation has been indicated. However, overall symptomatology justifying a 50 percent rating has not been exhibited. Specifically, his symptomology does not include things such as suicidal ideation, impaired thought content, speech or judgment, neglect of personal appearance, more than weekly panic attacks, or difficulty in establishing and maintaining effective relationships. The record shows the Veteran has a long-term marriage described as “good,” continued close relationships with daughters and grandchildren, and regular contact with friends. He also described enjoying his retirement. While noting that he avoids crowds, he is still able to dine out and go to the occasional sports game. In sum, the preponderance of the evidence weighs against finding that the severity, frequency, and duration of the Veteran’s psychiatric symptoms resulted in the level of impairment required for a 50 percent rating or higher. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. Thus, an increased rating in excess of 30 percent for GAD and PTSD is not warranted. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Morford, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.