Citation Nr: 21042239 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 17-02 273 DATE: July 12, 2021 ORDER Entitlement to a rating in excess of 40 percent for a low back disability, characterized as lumbar spine degenerative disc disease, is denied. An initial rating in excess of 10 percent for right lower extremity radiculopathy, associated with a low back disability, is denied. Entitlement to a rating in excess of 30 percent for an acquired psychiatric disorder characterized as depression, associated with a left shoulder disorder, prior to September 23, 2016, is denied. Entitlement to a rating in excess of 70 percent for an acquired psychiatric disorder characterized as depression and Posttraumatic Stress Disorder (PTSD), associated with a left shoulder disorder, from September 23, 2016, is denied. FINDINGS OF FACT 1. During the period on appeal, the Veteran's low back disability has not been characterized by ankylosis or episodes of intervertebral disc syndrome (IVDS) having a total duration of at least six weeks during the past 12 months. 2. Throughout the entire period on appeal, the Veteran's right lower extremity radiculopathy disability were characterized by "mild" incomplete paralysis of the sciatic nerve. 3. During the period prior to September 23, 2016, the Veteran's an acquired psychiatric disorder characterized as depression, has not been manifested by occupational and social impairment with reduced reliability and productivity. 4. During the period since September 23, 2016, the Veteran's an acquired psychiatric disorder characterized as depression and PTSD, has not been manifested by total occupational and social impairment. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 40 percent for a low back disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.1, 4.3, 4.7, 4.71a, DC 5242. 2. The criteria for an initial rating in excess of 10 percent for a right lower extremity disability have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.6, 4.120, 4.123, 4.124, 4.124a, DC 8520. 3. The criteria for a disability rating in excess of 30 percent prior to September 23, 2016, for an acquired psychiatric disability, characterized as depression, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.7, 4.130, Diagnostic Code (DC) 9434. 4. The criteria for a disability rating in excess of 70 percent prior from September 23, 2016, for an acquired psychiatric disability, characterized by depression and PTSD, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.7, 4.130, Diagnostic Code (DC) 9434. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1966 to January 1969. These matters return to the Board of Veterans' Appeals (Board) following the issuance of a January 2019 Board remand order which directed the Regional Office (RO) to undertake additional development. Additionally, the Board notes that the Veteran's Attorney submitted a VA Form 20-0995 (supplemental claim application), in April 2021. However, the submission of this supplemental was done improperly as the ratings decisions being appealed were not initial decisions. As such, only the claims properly before the Board, those stemming from the September 2020 supplemental statement of the case, will be discussed herein. Increased Ratings Disability evaluations are determined by the application of the Schedule for Rating Disabilities, which assigns ratings based on the average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C. § 1155; 38 C.F.R. Part 4. 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. In any increased rating claim, different ratings can be assigned for different periods of time in a practice known as "staged ratings." See Fenderson v. West, 12 Vet. App. 119 (1999). When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown,8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a ; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria."). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint." In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. Considerations in evaluating a mental disorder include the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission. The evaluation must be based on all evidence of record that bears on occupational and social impairment rather than solely on an examiner's assessment of the level of disability at the moment of the examination. 38 C.F.R. § 4.126 (a). When determining the appropriate disability evaluation to assign, the Board's "primary consideration" is the Veteran's symptoms. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013). 1. Entitlement to a rating in excess of 40 percent for a low back disability, characterized as lumbar spine degenerative disc disease 2. An initial rating in excess of 10 percent for right lower extremity radiculopathy, associated with a low back disability The Veteran is seeking a higher rating for his service-connected low back disorder, characterized as lumbar spine degenerative disc disease. The Veteran contends that the currently assigned rating of 40 percent does not contemplate the severity of his disability. Additionally, the Veteran was recently assigned a 10 percent rating for right lower extremity radiculopathy. As such a disability is part and parcel to his low back disability, it will also be evaluated to determine if a higher rating is warranted in a separate section below. During the entire period on appeal, the Veteran has been assigned a 40 percent disability rating for his service-connected back disability under 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5242. Pursuant to DC 5242, a disability rating in excess of 40 percent is warranted when the evidence shows: Unfavorable ankylosis of the entire thoracolumbar spine (50 percent); or IVDS with incapacitating episodes having a total duration of at least six weeks during the past 12 months (60 percent). 38 C.F.R. § 4.71a, DC 5242. Based upon the evidence of record, a rating in excess of 40 percent is not warranted for the Veteran's back disability for the period on appeal. The Veteran's medical records do not reflect any observed or documented ankylosis or incapacitating episodes due to IVDS. While his records do indicate that the Veteran experiences pain and limitation of motion, there is no evidence to suggest that his symptoms are equivalent to having ankylosis. Additionally, the Board relies on the opinions of the VA examiners who evaluated the severity of his low back disability in January 2011 and October 2019. At the January 2011 examination, the Veteran reported pain manifesting as a dull ache at a 6 out of 10 on the pain scale. He further reported flare-ups precipitated by weather, or activities such as twisting or turning. It was noted that he could not lift more than 10 pounds, and had trouble bending, stooping, and could not sit more than 20 minutes at a time. For alleviation from those symptoms he employed the use of a heating pad, walking around, or medication such as ibuprofen or asprin. Upon examination, his flexion was measured to 30 degrees, his extension to 10 degrees, and his total combined range of motion at 100 degrees. The examiner noted that following repetition the Veteran would likely have 10 degrees more limitation of motion, and during flare-ups roughly 30 percent more limitation. There was no endorsed muscle spasm, incapacitating episodes of IVDS, or ankylosis endorsed. Additionally, the examiner did not find any associated neurological abnormalities. Next, at the October 2019 examination, the Veteran reported sharp pain with tingling that travels from his low back to his right leg. He reported weekly flare-ups that range from moderate to severe and can last all day, he indicated that they are precipitated by bending, standing, and walking. He noted the use of Gabapentin and Duloxetine for the treatment of his flare-up pain. The Veteran also stated that he can no longer bend to reach the floor. Upon examination, the Veteran displayed flexion to 40 degrees, extension to 20, and a total range of motion to 180 degrees. With repetitive use his flexion and during flare-ups was measured to 20 degrees, flexion to 10 degrees, and total to 70 degrees. The examiner noted that muscle spasms resulted in abnormal gait, but not in guarding, and endorsed no further factors contributing to the Veteran's disability. While right leg radiculopathy was endorsed there were no other associated neurological abnormalities diagnosed. The veteran was not noted to have ankylosis, muscle atrophy, or incapacitating episodes of IVDS. Further, the Veteran was noted to not be using any assistive devices for ambulation. The Board also considered whether a disability rating in excess of 40 percent thereafter is warranted on the basis of functional loss due to fatigability, incoordination, pain on movement, pain on weight-bearing, flare-ups, and weakness. 38 C.F.R. §§ 4.40, 4.45, 4.59; see Sharp, 29 Vet. App. 26; Correia, 28 Vet. App. 158; DeLuca, 8 Vet. App. 206. In this case, the Veteran has indicated that his back disability has caused him to experience pain, and causes him difficulty sitting, standing or, walking, lifting heavy objects, and climbing stairs. Although he experiences the aforementioned symptoms, overall, it does not appear that these symptoms result in additional and significant functional loss, and his complaints are adequately contemplated in the rating he currently receives. See Mitchell, 25 Vet. App. at 37-43 (2011) (pain must affect some aspect of the normal working movements of the body such as strength, speed, coordination or endurance). Indeed, the reports form the October 2019 VA examination reflect that the Veteran was able to perform repetitive use testing without any additional loss of function or range of motion and that although the examination was not conducted during a flareup, the examination was medically consistent with his statements describing functional loss during a flareup. Finally, when evaluating the extent of the Veteran's lumbar spine disability, the Board is required to consider whether a separate evaluation is warranted for any associated neurological abnormality including, but not limited to, bowel or bladder impairment, neurological impairment in the extremities or other such disorders, which are to be evaluated under the appropriate DC. See 38 C.F.R. § 4.71 (a). Initially, the Board notes that the Veteran has been granted service connection for right lower extremity sciatic radiculopathy. Next, the Board finds that the medical evidence does not reveal evidence of any other neurological abnormalities or associated neurological impairments related to his lumbar spine disability during the period on appeal. Specifically, both the report from the January 2011 VA examination reflects that the examiner determined that the Veteran did not have any neurological impairments, including radiculopathy and bowel or bladder impairments, related to his service-connected back disability that would warrant a separate rating. The report from the October 2019 VA examination reflects that although the examiner determined that the Veteran had radiculopathy of the right lower extremity (for which he has been granted service connection), they did not find the Veteran had any other neurological abnormalities such as bowel or bladder impairments, related to his service-connected back disability that would warrant a separate rating. Moreover, the Veteran's treatment records do not show that his service-connected back disability causes neurological abnormalities other than radiculopathy of the left and right lower extremities, and he has not asserted otherwise. Accordingly, additional separate evaluations are not warranted for other neurological abnormalities. As such, the Board determines that a rating in excess of 40 percent is not warranted for his low back disability at any point during the period on appeal. In reaching this conclusion, the Board has considered the statements submitted by the Veteran and his wife regarding the severity of his low back disability. In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the Veteran. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Nevertheless, while they are competent to report the observable physical symptoms of this disorder, such as pain and limitation of motion, they are not competent to determine that it has progressed. This issue is medically complex and require specialized medical education and knowledge of the interaction between multiple systems in the body as well as the ability to interpret complicated diagnostic medical testing. See Jandreau, 492 F.3d at 1377 n.4, See 38 U.S.C. § 1110. Right Lower Extremity Radiculopathy Throughout the period on appeal, the Veteran's right lower extremity radiculopathy has been assigned a 10 percent rating under DC 8520 (addressing impairment to the sciatic nerve). Under DC 8520, a rating in excess of 10 percent is warranted when there is incomplete paralysis that is "moderate" in nature. 38 C.F.R. § 4.124a. Based upon the evidence of record, the Board determines that a rating in excess of 10 percent for radiculopathy in the Veteran's right and left lower extremity is not warranted. The Veteran did not endorse any radicular pain and/or have any signs or symptoms of right lower extremity radiculopathy at his January 2011 VA examination. In fact, the Veteran did not demonstrate any abnormal reflexes, sensory, or muscle impairment. The Veteran was first diagnosed with right lower extremity radiculopathy at his October 2019 examination. The October 2019 VA examiner indicated that the severity of the Veteran's right lower extremity radiculopathy was "mild". The examiner did not diagnose the Veteran with any further neurological abnormalities due to his lumbar disability. These findings are nevertheless most consistent with a 10 percent rating. Additionally, he exhibited normal muscle strength, reflexes, and sensations in his right lower extremity. Moreover, the Veteran has not alleged a worsening of his radicular disability since service connection was granted in September 2020. As there has been no indicated change since the October 2019 examination, and based upon the examiner's findings during that examination, an initial rating in excess of 10 percent is not warranted for his right lower extremity radiculopathy. Accordingly, higher ratings are not found to be warranted for either the Veteran's low back disorder or for his right lower extremity radiculopathy. There is no evidence to indicate that the severity of the Veteran's low back and right lower extremity radiculopathy disabilities are not accurately contemplated by the ratings currently assigned. The Veteran's appeals are denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the preponderance of the evidence is against the claim, that doctrine does not apply. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. § 3.102 3. Entitlement to a rating in excess of 30 percent for an acquired psychiatric disorder characterized as depression, associated with a left shoulder disorder, prior to September 23, 2016 4. Entitlement to a rating in excess of 70 percent for an acquired psychiatric disorder characterized as depression and Posttraumatic Stress Disorder (PTSD), associated with a left shoulder disorder, from September 23, 2016 The Veteran is seeking a disability rating in excess of 30 percent for his service-connected psychiatric disability prior to September 23, 2016, and in excess of 70 percent thereafter. The Veteran contends that higher ratings are warranted as the ratings assigned do not accurately contemplate the severity of his disability. The Veteran's acquired psychiatric disability has been assigned a 30 percent rating under DC 9434 prior to September 23, 2016, and a 70 percent rating thereafter. 38 C.F.R. § 4.130, DC 9434. In order to warrant a higher rating, the evidence must demonstrate: 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 complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.(50 percent); 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 worklike setting); inability to establish and maintain effective relationships. (70 percent); or Total occupational and social impairment due to symptoms such as, but not limited to, 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/or memory loss for names of close relatives, own occupation, or own name. (100 percent). 38 C.F.R. § 4.130, DC 9434. After a review of the evidence of record, the Board determines that a disability rating in excess of 30 percent prior to September 23, 2016, and in excess of 70 percent thereafter, for the Veteran's acquired psychiatric disability is not warranted. Prior to September 23, 2016 A disability benefits questionnaire from July 2014 indicates that the treating physician endorsed a diagnosis of depression and noted that the Veteran's financial difficulties and problems with his social environment were affecting his mental health. The Veteran reported feelings of depression since he stopped working and after being turned down for a job at VA. The Veteran's symptoms were noted as anxiety, depressed mood, panic attacks at a weekly or lower rate, chronic sleep impairment, flattened affect, difficultly in maintaining relationships, difficulty in adjusting to stressful circumstances, and some issues with daily hygiene and other activities. The physician indicated that these symptoms resulted in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. The Veteran was provided with a VA examination in April 2015 to evaluate the severity of his depression. At the examination, the Veteran presented with symptoms of depressed mood, panic attacks occurring weekly or less often, chronic sleep impairment, and disturbances of motivation and mood. The examiner noted a diagnosis of depression but no other psychiatric disorders. On examination, the examiner reported that the Veteran was dressed appropriately with good hygiene and was alert, attentive, and oriented to person, place, time, situation, and maintained good eye contact. He was attentive and cooperative, with speech at a regular rate and rhythm. His thought process was coherent, and insight was good, while his mood was dysphoric. He denied suicidal ideation, or hallucinations, and reported that he had no history of mental health treatment. The examiner noted that the Veteran's BDI2 score indicated severe depression. Finally, the VA examiner reported that symptoms of depressed mood and chronic sleep impairment applied to the Veteran's service-connected acquired psychiatric disability. Based on their observations and findings, the examiner opined that the Veteran's symptoms caused social and occupational impairment with an 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 Board finds that the April 2015 VA examiner's opinion is well supported by their findings and consistent with the symptoms for a 30 percent rating. Specifically, the Board notes that the symptoms observed by the April 2015 VA examiner are not sufficient to warrant an increase to a 50 percent rating because they did not cause social and occupational impairment consistent with a higher rating. Additionally, the Veteran's treatment records prior to September 23, 2016, fail to document symptoms warranting a rating in excess of 30 percent. The Veteran's treatment records, including from April 2013, do not indicate that the Veteran experienced suicidal or homicidal ideation. In light of these clinical evaluations, the Board finds that the Veteran does not exhibit objective symptomatology that would be sufficient to warrant a rating in excess of 30 percent for the period prior to September 23, 2016. The Board notes that the Veteran's symptoms appeared to be more severe in July 2014, however, by the time of the April 2015 examination, the severity and symptoms of his depression were observed to be much less severe. Additionally, during the time prior to September 23, 2016, there were no further indications of symptoms such as flattened affect, the neglect of personal hygiene, or decreased motivation when performing daily tasks. Although such symptoms approximate circumstantial speech and disturbances of motivation and mood, which are criteria of a 50 percent rating, VA must engage in a holistic analysis in which it assesses the severity, frequency, and duration of the signs and symptoms of the Veteran's service-connected mental disorder; quantifies the level of occupational and social impairment caused by those signs and symptoms; and assigns an evaluation that most nearly approximates that level of occupational and social impairment. See Vazquez-Claudio, 713 F.3d at 115-17. In this case, the Board determines that these symptoms alone are insufficient to warrant an increased rating given the treatment records do not reflect that the Veteran exhibited flattened affect, difficulty in understanding complex commands, impaired short-term and long-term memory, impaired judgment, impaired abstract thinking, or difficulty in establishing and maintaining effective work and social relationships following the July 2014 disability benefit questionnaire. From September 23, 2016 After a review of the evidence of record, the Board determines that a rating in excess of 70 percent for an acquired psychiatric disorder, characterized as depression and PTSD, is not warranted for the period from September 23, 2016. The Veteran was provided with a VA examination in September 2019 to evaluate the severity of his depression. The examiner endorsed diagnoses of depression and PTSD, however, the Board notes that the Veteran is only service connected for depression. At the examination, the Veteran presented with PTSD symptoms of nightmares, suspiciousness of others, avoidant behavior, autonomic arousal, flashbacks. His depression symptoms were noted as, depressed mood, and intermittent inability to perform daily hygiene. Overlapping symptoms between the two diagnoses were noted as anxiety, difficulty sleep, panic attacks, difficulty in maintaining interpersonal social and occupational relationships. Overall, the examiner noted that the Veteran's symptoms result in social and occupational impairment with reduced reliability and productivity. The examiner noted that the Veteran was alert and oriented to all spheres, his mood was dysphoric with a congruent affect. Suicidal and homicidal ideation was denied. The Veteran's medical records from the period since September 23, 2016, similarly, do not demonstrate that the Veteran's symptoms due to his acquired psychiatric disorder result in total occupational and social impairment. Specifically, the Veteran's treatment notes from February 2019 indicate that while the Veteran suffers from symptoms of hypervigilance, anxiety, nightmares, depression, flashbacks, and difficulty in dealing with large groups of people; he has not experienced suicidal or homicidal ideation, his medications help with his symptoms, he has a good relationship with his family, and does not experience hallucinations or delusions. In light of these clinical evaluations, the Board finds that the Veteran does not exhibit objective symptomatology sufficient to warrant a rating in excess of 70 percent during the period since September 23, 2016. Nevertheless, VA must engage in a holistic analysis in which it assesses the severity, frequency, and duration of the signs and symptoms of the veteran's service-connected mental disorder; quantifies the level of occupational and social impairment caused by those signs and symptoms; and assigns an evaluation that most nearly approximates that level of occupational and social impairment. See Vazquez-Claudio, 713 F.3d at 115-17. Here, the Board acknowledges that the Veteran experiences symptoms due to his acquired psychiatric disorder that occasionally present as more severe. However, the Veteran's medical records and September 2019 VA examination demonstrate that while the Veteran experiences the aforementioned symptoms, occasionally to a higher degree, his overall disability picture is accurately captured in the assigned 70 percent disability rating. Other Considerations Next, although the general rating formula provides specific examples of symptoms that may result from various acquired psychiatric disabilities, the Board emphasizes that its analysis should not be limited to only these symptoms and should include consideration of any other relevant criteria outside of the rating code in order to determine the level of occupational and social impairment. Mauerhan v. Principi, 16 Vet. App. 436, 444 (2002). Thus, the Board has also considered the extent to which there are other indications of occupational and social impairment which would warrant higher ratings during either period on appeal. In this regard, it is clear that the Veteran's acquired psychiatric disorder reflects some impact on his social and occupational function during both periods on appeal. Nevertheless, the evidence does not indicate that this would necessitate higher ratings during either of those periods based upon relevant criteria outside the rating code. Specifically, during the period prior to September 23, 2016 the evidence indicates that the Veteran maintains a close relationship with his wife, daughter, and two grandchildren. Additionally, during this time, the Veteran regularly attended a language course, physical therapy, and did chores around the house. In the period since September 23, 2016, the evidence shows that the Veteran continued to maintain a close relationship with his family. And while he has not been able to partake in many of the hobbies he enjoyed in the past, he is still able to drive to the next town over or to the drug store. Additionally, he has submitted statements which indicate that most of his limitations in doing hobbies or driving stem from physical disabilities such as with his neck, back, and shoulders, and not primarily due to any mental health related disability. In this regard, it is clear that the Veteran's acquired psychiatric disability has some impact on his social and occupational functioning during both periods on appeal, exemplified by his avoidance of crowds and difficulty maintaining certain relationships. Nevertheless, the evidence does not indicate that disability ratings are warranted for either period on appeal. The evidence does not demonstrate that the Veteran experienced social and occupational impairment with reduced reliability and productivity during the period prior to September 23, 2016, or total social and occupational impairment thereafter, even when factoring in other relevant criteria outside of the rating code. See Mauerhan v. Principi, 16 Vet. App. 436, 444 (2002). In this case, the evidence does not indicate that the Veteran's disability picture, during either period on appeal, could not be adequately contemplated by the applicable schedular rating criteria discussed above. Specifically, the Board has reviewed all of the Veteran's symptoms related to his acquired psychiatric disability on appeal, including limitations with activities of daily living, and concludes that there are no symptoms that were not able to be addressed by the applicable diagnostic code. See Mittleider v. West, 11 Vet. App. 181 (1998). Moreover, as was established in Mauerhan, 16 Vet. App. at 444, a schedular rating for psychiatric disorders is not necessarily limited to the enumerated symptoms in the general rating formula, and no relevant symptoms have been excluded in the Board's analysis. Thus, the Veteran's symptoms are not so unusual that they are outside the schedular criteria. Therefore, given that the applicable schedular rating criteria are more than adequate in this case, the Board need not consider whether the Veteran's disability picture includes exceptional factors, and referral for consideration of the assignment of a disability evaluation on an extraschedular basis is not warranted. See Thun, 22 Vet. App. at 111; see also Bagwell v. Brown, 9 Vet. App. 337, 338-9 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). In considering the appropriate disability rating, the Board has also considered the statements from the Veteran that his acquired psychiatric disability is worse than the ratings assigned during the periods on appeal. In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Although the Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability of his acquired psychiatric disability according to the appropriate diagnostic codes. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). On the other hand, such competent evidence concerning the nature and extent of the Veteran's acquired psychiatric disability has been provided by the medical personnel who have examined him during the periods on appeal and who have rendered pertinent opinions in conjunction with their evaluations. The medical findings of the April 2015 and September 2019 examiners (as provided in the examination reports) and the physician that performed mental status evaluations directly address the criteria under which this disability is evaluated. Specifically, while the Veteran has asserted that the symptoms of his acquired psychiatric disability warrant higher ratings during both periods on appeal, the impact of the symptoms of his acquired psychiatric disorder were discussed and evaluated by the VA examiners in April 2015 and September 2019, and the Board finds their assessments of greater probative weight. By virtue of the foregoing, the Board concludes that a disability rating in excess of 30 percent prior to September 23, 2016, and in excess of 70 percent thereafter for the Veteran's acquired psychiatric disorder is not warranted. The Veteran's appeal is denied. 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. B.T. KNOPE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Q. Hernan, Attorney Advisor