BVA9504372 DOCKET NO. 93-09 606 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Pittsburgh, Pennsylvania THE ISSUE Entitlement to an increased rating for dissociative reaction, evaluated 10 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Robert A. Leaf, Counsel INTRODUCTION The veteran served on active duty from March 1943 to December 1946 and from August 1950 to February 1952. A June 1992 rating decision of the Pittsburgh, Pennsylvania Regional Office (RO) of the Department of Veterans Affairs (VA) denied an increased rating for dissociative reaction. This appeal to the Board of Veterans' Appeals (Board) stems from that action. Received at a hearing in October 1992 was a newspaper clipping indicating that psychological distress can play a role in heart disease. The Board believes that the veteran may be seeking service connection for heart disease as secondary to his service- connected psychiatric disability. This matter has not been adjudicated, and has not been developed for appellate review. Therefore, it is referred to the RO for any action deemed appropriate. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he is short-tempered with his wife; that he is incapable of close relationships with anyone; and that he is suspicious and distrustful of his neighbors. He maintains that he had to take early retirement from the post office because of his nervous condition and missed approximately five weeks from work per year because of problems with his nerves. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against the claim for an increased rating for dissociative reaction. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. Dissociative reaction is manifested primarily by some anxiety, depression, sleep problems and somatic preoccupations; mental clarity is well-preserved. 3. The disability is productive of no more than mild to moderate social and industrial impairment. CONCLUSION OF LAW A rating in excess of 10 percent for dissociative reaction is not warranted. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. § 3.321(b)(1), Part 4, Code 9401 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board notes that the appellant's claim is "well-grounded" within the meaning of 38 U.S.C.A. § 5107(a). That is, he has presented a claim which is plausible. The Board is also satisfied that all relevant facts have been properly developed and that no further assistance to the appellant is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a). Service medical records disclose that the veteran was found to have dissociative reaction. The assessment in March 1951 was that dissociative reaction was manifested by loss of consciousness and repressive mechanisms of defense, anxiety, hostility and headaches, superimposed on a basically schizoid personality. A VA psychiatric examination was conducted in March 1953. The veteran remarked that he had been employed as a machine operator for a bronzing company since 1942; after leaving the service in 1952, he had returned to the same concern where he had been employed to date; he commented that he got along well on the job and had lost no time from work. He remarked that social life was limited. On mental status examination, the veteran's memory and concentration were adequate; he was well-oriented in all spheres; sensorium was clear. He indicated that he felt depressed at times. Mood was one of dejection and hostility and affect was somewhat blunted. The diagnosis was dissociate reaction, chronic, mild with conversion features. The veteran was examined at a VA medical facility in December 1977 for the purpose of psychiatric observation and evaluation. He noted that he was employed as a machine operator. He admitted to sleep problems and depression at times. Mental status examination revealed that he was in good contact and oriented in 3 spheres. Retention and recall were adequate. Affect was appropriate. Mood was calm and comfortable. The impression was adjustment reaction of adulthood with some elements of a personality disorder evident. No industrial impairment was noted. Limited social life was noted, and social impairment was described as mild. On VA psychiatric examination in November 1978, the veteran stated that he had worked at a bronzing company since 1942 and felt that in the last three years he had lost almost a year from work. No records from his employer or state workers' compensation authority are associated with the claims folder to document the claimed prolonged absence from work. Mental status examination showed that the veteran's thinking and affect appeared organized. Recent and remote memory appeared intact to gross testing. The diagnosis was mild to moderate anxiety neurosis. A February 1979 rating decision implemented a January 1979 Board decision which granted service connection for dissociative reaction effective December 1952, upon a determination that a rating decision of April 1953 was clearly and unmistakably erroneous in denying service connection for a neurosis; a 10 percent evaluation was assigned. A February 1981 rating decision assigned a 10 percent evaluation effective February 1952, and that evaluation has remained in effect since that time. An October 1979 statement from Raymond V. Seniow, M.D., indicates that the veteran had been under the physician's care for the past ten years. The physician remarked that, due to a nervous condition, the veteran had been forced to take an early retirement from a company for which he had worked for thirty years. Dr. Seniow provided no clinical records of the veteran's treatment for a nervous disorder. Reports were received in May 1980 from St. Francis Hospital and in June 1980 from Jameson Memorial Hospital. They reflect the veteran's treatment on various occasions from 1972 to 1979 for liver and gallbladder disease, diabetes, and tachycardia. They make no reference to a psychiatric disorder. An April 1981 statement from Donal A. Warde, M.D., the veteran's cardiologist, reveals that the veteran complained of palpitations which had been recurring for about the past 10 years with episodes of paroxysmal atrial tachycardia. The assessment was that the veteran's premature ventricular contractions were in large measure related to his anxiety which apparently had been a chronic problem since his discharge from service. A hearing was held before the RO in May 1981. The veteran testified that he had worked full-time at the post office for the past two years. He indicated that he experienced acute nervous symptoms 4 or 5 times per month, while at work, for which he took Valium and left his duties briefly to relax in a "break" room. He reported that he used his vacation time when he found it especially difficult to cope with his nervous condition, but denied that absences from work were charged to his record because of nervousness. He stated that he was unable to cope with crowds and did not participate in social activities. His spouse testified that the veteran became very withdrawn when he was upset and that he rubbed the skin of his hands raw from nervousness. A July 1982 statement from Dr. Warde refers to the veteran's evaluation and treatment for tachycardia. A history of anxiety neurosis was also noted. A VA psychiatric examination was performed in September 1982. The veteran related that he worked at the post office where he felt under pressure. He stated that he loaded sacks on a conveyer belt. He described feeling tense and indicated periods of depression. Mental status evaluation showed that thinking was organized and that affect was appropriate. Recent and remote memory appeared grossly intact. The diagnosis was anxiety neurosis, chronic, moderate. A November 1988 statement from Dr. Warde notes the veteran's long history of tachycardia. Also noted was a history of chronic anxiety neurosis and degenerative joint disease involving the knees, hips and back. His back problems had grown progressively more severe and he had developed spinal stenosis. He had developed coronary artery disease and had undergone successful bypass grafts. The veteran also received treatment for diabetes. The physician commented that the veteran would probably require a decompressive laminectomy over the next several years because of spinal stenosis. This would cause him to take a premature retirement from the postal service the next year. On VA psychiatric examination in December 1988, the veteran denied psychiatric hospitalizations, as well as any outpatient psychiatric treatment. It was noted that he had worked for 36 years at a bronzing company and for 10 years at a post office. History indicated that the bronzing company had gone out of business when the veteran became 55 years old; however, he had already sought employment elsewhere when he saw that the company was going to fold. He had married in 1951; the family was close knit. He worried excessively about his children and their adjustment to adulthood. He had no social outlet other than his family. The veteran remarked that he had continued to be treated for anxiety by his cardiologist. He had used tranquilizers sporadically since 1951 and had been prescribed them steadily since 1979. Current symptoms of anxiety included shutting out noise around himself and listening intently for his heartbeat. He indicated that he was irritable when not using Serax. He referred to difficulty falling asleep and to restless sleep. He noted difficulties with memory and concentration; the examiner observed that no organicity was evident during the interview. The veteran remarked that he felt keyed up; that he tired easily; and that he was emotionally labile, and it was observed that he cried during the interview. He stated that he continued to work at a post office, but was planning to retire in March 1989 because of chronic back pain and the exacerbation of his pain caused by anxiety. Mental status examination disclosed that the veteran was very anxious. He was friendly and cooperative. Speech was logical, coherent and goal-directed. Judgment and insight were good. The diagnosis was generalized anxiety disorder, moderate. The examiner commented that anxiety disorder had not caused any industrial impairment, but had caused social impairment. A November 1990 statement from Dr. Warde discloses that the veteran remained stable on his current regimen of medication. There had been no substantial change in his cardiac, diabetic or other medical problems including spinal stenosis. Received in April 1992 was a copy of a record of a service department medical board. It was determined that the veteran had moderately severe disability from dissociative reaction considered to be 30 percent in accordance with the standard schedule of ratings then in current use by the Veterans Administration. A VA psychiatric examination was performed in May 1992. In relating the veteran's history, the examiner described the veteran's work record as excellent, noting that the veteran had spent 36 years at a bronzing company and 10 years at the post office. It was indicated that he had retired in 1989 due to his worsening physical condition. He had been married for 41 years without significant reported conflict. Mental status examination revealed that the veteran appeared anxious. There was mild psychomotor agitation seen overtly, but no other motor abnormalities were noted. He admitted to feeling depressed and on edge all the time. Affect was consonant with reported mood disturbance. He referred to some insomnia, but denied appetite changes. The examiner found no unusual absence of psychological mindedness or any other symptoms consonant with dissociation. The veteran reported no recent dissociative experiences or conversion symptoms. The examiner reported that the veteran's somatic concerns were appropriate to his medical conditions. The veteran reported continued interest in his everyday activities and hobbies, especially his workshop and gardening activities. It was indicated that he socialized just a little bit, but was not particularly reclusive. He reported no marital tensions. He had a few memory complaints centering on names, times and places, all of which appeared to be normal variants for his age group. He was found to be fully oriented with good expressive and receptive language. The diagnosis was generalized anxiety disorder. The examiner commented that the veteran had led a reasonably stable life with a sound marriage and good industrial history for over 40 years. It was noted that the veteran continued to suffer from lifelong anxiety and somatization which were alleviated only somewhat by long-term pharmacotherapy with benzodiazepines. His prognosis for stable functioning in the future was considered good. A hearing was held before a VA hearing officer in October 1992. The veteran testified that his nervous condition produced episodes of trembling, nightmares; and numbness of the hand. He stated that he took medication for anxiety. An October 1992 statement from Dr. Warde recounted previously mentioned details about the veteran's medical history. It was stated that the veteran's chronic affective symptoms were controlled with Serax. Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity resulting from specific service-connected disabilities. 38 U.S.C.A. § 1155. Separate diagnostic codes identify the various disabilities and the criteria that must be shown for specific ratings. Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity resulting from specific service-connected disabilities. 38 U.S.C.A. § 1155. Separate diagnostic codes identify the various disabilities and the criteria that must be shown for specific ratings. Dissociative reaction may be rated on the basis of psychogenic amnesia; psychogenic fugue; or multiple personality, according to the criteria specified for evaluation of psychoneurotic disorders. A 10 percent rating is provided for dissociative reaction where there is emotional tension or other evidence of anxiety productive of mild social and industrial impairment. A 30 percent rating is warranted where there is definite impairment in the ability to establish or maintain effective and wholesome relationships with the people. The psychoneurotic symptoms result in such reduction in initiative, flexibility, efficiency and reliability levels as to produce definite industrial impairment. 38 C.F.R. Part 4, Code 9401. In Hood v. Brown, 4 Vet.App. 301 (1993), the Court of Veterans Appeals stated that the term "definite" in 38 C.F.R. § 4.132 (1993) was "qualitative" in character, whereas the other terms were "quantitative" in character, and invited the Board to "construe" the term "definite" in a manner that would quantify the degree of impairment for purposes of meeting the statutory requirement that the Board articulate "reasons or bases" for its decision. 38 U.S.C.A. § 7104(d)(1) (West 1991). In a precedent opinion, dated November 9, 1993, the General Counsel of the VA concluded that "definite" is to be construed as "distinct, unambiguous, and moderately large in degree." It represents a degree of social and industrial inadaptability that is "more than moderate but less than rather large." O.G.C. Prec. 9-93 (Nov. 9, 1993). The Board is bound by this interpretation of the term "definite." 38 U.S.C.A. § 7104(c). With these considerations in mind, the Board will address the merits of the claim at issue. A review of the record discloses that the veteran has experienced longstanding nervous symptoms, including anxiety, depression, somatization and sleep disturbances. At the same time, his dissociative symptoms have been inactive during the several decades since his separation from service. While he has received medication for anxiety from his cardiologist for several years, he has not sought treatment by a psychiatrist. There have been no postservice hospitalizations for his nervous condition, and the veteran has also denied outpatient psychiatric treatment. Although the veteran claims that his nervous condition causes him to be short-tempered with his wife, he has provided psychiatric examiners with a history of a stable, long-term marriage, free of significant marital tensions. In addition, while asserting that he is incapable of close relationships with anyone, he has related a history of close knit family life and has expressed concern over the welfare of his children. Further, while maintaining that he is suspicious and distrustful of neighbors, no suspicious behavior was reported by mental status examiners and he was described as friendly and cooperative on the two most recent psychiatric examinations. At any rate, the evidence suggests that the veteran's social relationships beyond the family have been rather restricted and may, to some degree, have impaired his functioning with others in the workplace. However, in evaluating impairment resulting from ratable psychiatric disorders, social inadaptability is to be evaluated only as it affects industrial adaptability. The principle of social and industrial inadaptability as the basic criterion for rating disability from mental disorders contemplates those abnormalities of conduct, judgment, and emotional reactions which affect economic adjustment, i.e., which produce impairment of earning capacity. 38 C.F.R. § 4.129 (1993). The Board finds it significant that the veteran worked for one employer for over 35 years and a second employer for about 10 years. Accepting as true the veteran's statement that he took a considerable amount of vacation time to cope with symptomatic episodes of his nervous condition, he has nevertheless acknowledged that he did not lose any appreciable time from work charged to sick leave. Interestingly, when the veteran's job in the bronzing trade was terminated because his former employer went out of business, the veteran displayed noticeable flexibility and adaptability in making a transition to his subsequent employer, the postal service, where he worked as a mail handler. The veteran, who retired at age 65, has made statements conceding that his retirement was prompted not only by nervous symptoms, but by severe back disability as well. Furthermore, his treating physician attributed the veteran's then impending retirement exclusively to the disabling effects of spinal stenosis. On this record, dissociative reaction is not shown to be productive of definite impairment so as to warrant assignment of a 30 percent evaluation. The Board acknowledges a service department medical board's determination, made over 40 years ago, that assignment of a 30 percent evaluation was warranted for dissociative reaction on the basis that the disability was found to be moderately severe according to VA criteria. It should be emphasized that an examiner's classification of a psychiatric disorder as "mild," "moderate" or "severe" is not determinative of the degree of disability; rather, the analysis of the symptomatology and the whole recorded history are the determinative factors in evaluating the extent of disability. 38 C.F.R. § 4.130 (1993). In this case, the entire evidence of record supports a determination that dissociative reaction has been, at most, only mildly to moderately disabling throughout the years. The record does not demonstrate social and industrial inadaptability which is "more than moderate but less than rather large." We emphasize the statements of the psychologist and psychiatrist during the May 1992 VA examination that although the veteran has had lifelong anxiety, he has had a stable family life for many years and a good industrial history for over 40 years, and that his prognosis for stable functioning in the future was good. In reaching its decision, the Board has considered the complete history of the disability in question as well as the current clinical manifestations and the effect the disability may have on the earning capacity of the veteran. 38 C.F.R. §§ 4.1, 4.2 (1993). Furthermore, the Board does not find that the evidence presents such an exceptional or unusual disability picture as to render impractical the application of the regular schedular criteria, so as to warrant the assignment of an extraschedular evaluation under 38 C.F.R. § 3.321(b)(1) (1993). In this regard, there is no evidence of frequent periods of hospitalization or marked interference with employment due exclusively to dissociative disorder. There is not an approximate balance of positive and negative evidence as to the issue on appeal as to warrant application of the doctrine of benefit of doubt. 38 U.S.C.A. § 5107. ORDER An increased rating for dissociative reaction is denied. D. C. SPICKLER Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.