Citation Nr: 0003055 Decision Date: 02/07/00 Archive Date: 02/10/00 DOCKET NO. 95-15 147 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Huntington, West Virginia THE ISSUE Entitlement to an increased rating for service-connected generalized anxiety disorder with headaches, currently rated as 30 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD C. Eckart, Associate Counsel INTRODUCTION The veteran had active military service from July 1967 to July 1970. This case initially came before the Board of Veterans' Appeals (Board) on appeal from a February 1995 rating decision by the Huntington, West Virginia Regional Office (RO) of the Department of Veterans Affairs (VA), which denied the veteran's claim of entitlement to a disability rating in excess of 30 percent for a service-connected generalized anxiety disorder with headaches. In June 1997, the Board remanded this case to the RO for additional development of the issue. In an August 1999 supplemental statement of the case, the RO provided notice of continued denial of an increased evaluation for an anxiety disorder with tension headaches, following additional development and consideration of the issue, as requested by the Board in its remand. The case is now returned to the Board for further appellate review. FINDINGS OF FACT The veteran's service connected anxiety disorder with headaches is manifested by depressed mood, anxiety, sleep impairment, and difficulty with concentration, as well as tension headaches up to three times a week, which decrease his work efficiency, with intermittent periods of inability to perform occupational tasks, but still able to work full time, and a Global Assessment of Functioning (GAF) score of 65 to 70. CONCLUSION OF LAW The criteria for an increased evaluation for generalized anxiety disorder with headaches have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.2, 4.7, 4.10, Part 4, Diagnostic Codes 9400 (1996), 9400 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION Factual Background Service medical records reveal that the veteran was treated inservice for anxiety, beginning in January 1968. In a March 1968 treatment record, it was indicated that the veteran had a lifetime history of mild chronic anxiety. In May 1968, he was noted to be taking Valium. An October 1969 treatment record indicates that the veteran was extremely nervous and gave a history of a nervous breakdown 18 months earlier. Post-service private treatment records from the 1970's reflect treatment for physical problems that did not include psychiatric complaints. On VA general medical examination in May 1992, the veteran reported that he was employed as a pipefitter, and had been employed as such since April 1971. On psychiatric evaluation, the veteran reported a history of a nervous breakdown during service, for which he was given medications such as Valium, Darvon and Librium. He was said to be seeing a doctor now primarily for physical complaints. He stated "I won't admit I have psychiatric problems." He noted that he was taking Restoril and Vistaril, and claimed they helped him sleep, but otherwise didn't control his "nerves." He said he felt irritable and snappy. He indicated that he thought his family pushed him too hard. He claimed the depressed feelings come and go. He gave a history of working as a clerk at a hardware store in 1970 and working at a metal company from 1971 to present, having been there for 20 years. He had been married for 17 years. He also noted that he had three children. There was no history of alcohol or drug abuse. Physical complaints were noted to include headaches, which he said had been attributed predominantly to tension. He claimed to have had the headaches for a long time, again found to be predominantly related to depression and tension, but computerized tomography (CT) scan of the head was advised. The diagnosis was chronic anxiety. By rating decision of August 1992, the Huntington, West Virginia Regional Office (RO) granted service connection for generalized anxiety disorder with tension headaches and assigned a 30 percent evaluation thereto. This evaluation has been confirmed and continued by subsequent rating decisions. In September 1994, the veteran was treated in the psychiatric ward of a private facility following an altercation with his sister in law. Since then he complained that he had been unable to sleep, concentrate and had a sense of helplessness and hopelessness along with fleeting anger, agitation and suicidal ideation. A brain CT scan from September 1994 was negative. He was neat, tidy, cooperative, talked clearly and rationally, was fairly depressed and despondent with a sense of helplessness and hopelessness prevailing with marked psychomotor agitation. He had marked anger towards the sister in law. He was oriented to time, place, date and person. He could recall six digits forwards and four backwards. No clinical evidence of organicity was noted and no evidence of psychosis or thought disorder was elicited. The diagnoses included major affective disorder, recurrent, moderately severe to severe, mixed type. Individual, group and family therapies were recommended. On VA examination in October 1994, the veteran complained about anxiety and depression and how he becomes easily irritable. He had been married for 19 years, with two children, with the relationship described as fair. Anger towards his sister in law was present. A recent history of him having become depressed with fleeting suicidal and homicidal ideation was given following an altercation with the sister in law, with a history of hospitalization as a consequence. Subjective complaints included irritability towards his children to the point where he throws them out if they make noises nearby him. He described himself as losing his temper easily. His wife described him as getting extremely explosive. Objective findings at the time of the October 1994 VA examination revealed him to be neat tidy and cooperative. Speech was clear, appropriate and rational. His mood was appropriate, having improved from before. He complained of an inability to sleep in addition to his temper problems. He was oriented to time, place, date and person. He could recall six digits forwards and four backwards. No clinical evidence of organicity was noted and no evidence of psychosis or thought disorder was elicited. His relationship with his wife was described as fair, although she was somewhat scared of his aggressive and explosive behavior. The assessment rendered included major affective disorder, recurrent, moderate to moderate-severe in nature with paranoid behavior and generalized anxiety disorder, history of tension headaches and Axis II, mixed type with explosive features. The examiner indicated that the veteran was in need of continued outpatient psychiatric treatment. In April 1995, the veteran underwent a VA social work assessment for his service connected anxiety disorder, with a history given of psychiatric treatment for the past three years. He said he had always had trouble controlling his temper, but that it had worsened in the past three years. He complained of nervous problems like "hollering and carrying on." He was noted to be employed full time as a maintenance man, but said he becomes very anxious when working alone on a job. He said he was released from work for two to three weeks to attend a day program. He reported no alcohol in 20 years, no smoking for 14 years, and never used illegal drugs. He claimed that it is difficult to remember things at work. He said his family and employer were very understandings and supportive. He was noted to reside with his wife and three children and worked as a maintenance man. He said that he lets little noises bother him. In the April 1995 social work assessment, he reported getting angry at his wife and children over the smallest things. He reported a past history of alcohol abuse, but not having drank for 20 years. He indicated he gets along with his children except for his outbursts of anger. He denied being angry for any specific reason, and didn't know where his anger comes from. He denied arguing about money with his wife. On mental status examination of the April 1995 social work assessment, his conversation was relevant and guarded. His affect was blunted. Mood and effect were congruent. Speech was slurred. He denied hallucinations and delusional thoughts. His thoughts were appropriate and slow. He reported poor concentration and confused thoughts. Insight and judgment were limited. The primary presenting problem was generalized anger towards family members, again with no specific reason given. He reported being unable to work alone at his job without becoming anxious. He was aware that this was affecting his family, but that he was powerless to stop it. He was reluctant to have a family session with his wife, and saw himself as the problem. He viewed medication as the only thing that ever worked for him. At the time of an April 1995 individual therapy intake VA report, the veteran reported a history of depression with psychotic episodes. He reported a loss of concentration and an inability to retain information. His affect was flat, and mood was depressed. He underwent individual therapy, family therapy and group therapy from April 1995 through May 1995. An April 1995 treatment record from indicated that the veteran continued to do fair, but still had bouts of depression and anxiety and was admitted to the day program because of relapse of depression. He was on Prozac and Lithium, and claimed that it helped him, but that he was extremely erratic. His personal hygiene was extremely poor, he was becoming extremely violent. Various investigations were essentially normal. The axis I diagnosis was major affective disorder, recurrent, moderate to moderate severe in nation and explosive behavior under stress. A May 1995 treatment record from Group therapy revealed that he demonstrated insight into problem solving techniques. Another group therapy note from May 1995 noted that he was attentive during education on anger and family education. During a family therapy treatment session from May 1995 the veteran claimed that he had no friends or nobody he can relate his feelings to. The wife agreed that the marriage was at a critical juncture. During another May 1995 family therapy session he admitted hitting his children and wife. The frequency of this varied, but he admitted to hitting or choking his wife since they were married. Sleep difficulties such as jerking and waking up choking were complained of in an individual therapy treatment note. By the middle of May 1995, progress was discussed, and it was determined that he needed one more week of treatment. By his discharge date of May 19, 1995 the veteran indicated in a group and individual sessions that it was his last day of therapy, expressed appreciation to the counselors and doctors and expressed that he had learned new ways of dealing with the group program. VA treatment records from November 1995 through 1997 revealed ongoing treatment for his psychiatric disorders. In November 1995, he was said to be doing fairly well on Depakote, and was ready to go back to work. In February 1996 he was doing fair, and his wife said he was doing much better. His major affective disorder, recurrent and bipolar in nature with explosive behavior and paranoid ideations was assessed to be in partial remission. In May 1996, he was doing "marginally well" but was running out of Lithium, and had some headaches and mood swings. The assessment in May 1996 was major affective disorder, recurrent, moderate to moderate-severe, with paranoid ideation and explosive behavior, especially under stress. In August 1996 he continued to do rather poorly, and was having bouts of agitation, having run out of Valproic acid and did not bother to get it filled. It was advised that Depakote and Lithium be increased and counseling be continued. All lethal weapons were recommended to be removed from his reach, especially when he gets explosive and it was advised to increase his physical and social activities and to deal with anger in socially acceptable means. By November 1996 he continued to do marginally well, Lithium level being well and he still had bouts of explosive behavior, under better control. Firearms were removed from the house. His wife indicated he was doing fair under the circumstances. Additional VA treatment records show that in April 1997 he was doing rather poorly, saying that for the past couple weeks he had become extremely irritable and felt that he may be slipping back. He was getting irritable and snappy. He denied any precipitating factors. He said he took a week off to "cool down." He showed some paranoia. In May 1997 he was doing fairly well since Risperdal was added, and that he has been sleeping a little excessively. The paranoia was under much better control, and he was advised to continue the Risperdal and ease off the Valium. The major affective disorder, possibly bipolar in nature with explosive behavior, especially under stress, was in remission, with paranoid ideation. In July 1997, he continued to do fair, saying he was working hard, having been working for 25 years and said he was "hanging in." He was advised to continue medication same as before, and was noted to have headaches, said to be apparently due to tension. The major affective disorder was assessed to be in partial remission. The report from an April 1998 VA examination indicated the history of recurrent anxiety and depression. The veteran was noted to have previously received treatment for the same, and continued to receive treatment. He was noted to be working for the same company for 25 years. He complained that he had problems concentrating and remembering to put things back. He also was said to have problems with interpersonal relationships with other employees. He said he gets along with a few people and did not like working on his own. He was noted to be married for 23 years, and this was his first and only marriage. He had three children all adolescents. Subjective complaints included being very argumentative and that it was hard to get along with family and coworkers. He said he had run-ins at work all the time. The veteran reported that he was very nervous, anxious and edgy. He noted that everything bothered him. He stated that he gets depressed and had some hopeless and helpless feelings. He indicated that he felt tired and run down. He stated that he easily becomes irritable and did not like being around people, but did not like working alone. He said there are only a few people he could get along with. He felt like nobody had any need for him and that he felt like he had been left out of life. Sleep was restless and appetite was alright. He denied any out of the ordinary feelings and denied drug or alcohol problems, having quit drinking 20 years prior. He denied legal difficulties and said he mostly goes to work and minds his own business. He also complained of recurrent headaches, mostly diagnosed as tension headaches. He said they are like a band around his head at which time he would become nauseated. The veteran noted that he gets them about two or three times a week. He denied any visual symptoms, photophobia or hallucinatory experiences during the headaches. Regarding daily activities, he was able to dress and wash himself, and worked from 8:00 to 4:00. He denied any specific interests or hobbies, but attended church twice a week. Objective findings noted the veteran to be casually dressed and appropriately groomed. He appeared to be very nervous, anxious, edgy and somewhat depressed. He was oriented to time, place and person. There was no evidence of any active hallucinations or delusions. Attention and concentration were normal. He was able to do mental calculations and serial sevens, and able to give the days of the week in reverse order. His memory and recall for certain events was slightly impaired and he could recall two out of three objects after five minutes. There was no evidence of looseness of association, flight of ideas or pressured speech. His fund of knowledge was appropriate for his educational level. There were no obsessive thoughts or compulsive actions. He denied suicidal or homicidal ideations. The Axis I diagnosis rendered was generalized anxiety disorder; there was no Axis II diagnosis. Axis III diagnosis included recurrent tension headaches. The severity of psychosocial stressors were moderate. The highest level of adaptive functioning currently appeared to be 70 on the GAF scale. The commentary included the opinion that the veteran has had problems with chronic generalized anxiety disorder with some symptoms of depression, mostly related to his irritability, upset and poor anger control, that has persisted ever since service. His anxiety problems were said to appear to be of a moderate extent, and appeared to be affecting him socially and industrial on an occasional basis. He had been working at a consistent job over the last several years. He had some problems with interpersonal relationships but otherwise he was functioning reasonably well. The report from a claims file review from February 1999 included the opinion that the veteran's anxiety problems cause occupational and social impairment with occasional decrease in work efficacy and without affecting his abilities to care for his daily needs or to interact with people. He was said to have problems with depressed mood and sleep impairment, and occasional problems with concentration and memory. There was no indication that his service-connected problems have increased in severity. The examiner opined that the other difficulties are related to ongoing personality difficulties and other issues. The examiner expressed that this service connected psychiatric disability met the criteria for a 30 percent evaluation. The report from an April 1999 VA examination revealed the veteran to still be employed as a maintenance man at the same plant he worked in for 27 years. He was living with his wife, and was married for 24 years. He said his wife has threatened to leave him because of his irritable, angry and being nervous constantly. He had three children ranging in age from 13 to 20. He indicated that he is able to dress, clean and wash himself. He worked from 8:00 to 4:00 during the week and sometimes worked weekends. The veteran noted that outside of work he did not have too many activities. He stated that he watched television and attended church a couple times a week and no specific hobbies or interests. He said he was currently receiving treatment at the VA medical center. He described feeling nervous, anxious and edgy inside. He said every time he is given a new job he gets panicky, especially if he works by himself. He also said he is also very uncomfortable around people and that it is hard for him to make decisions. He claimed he eats okay and sleeps all right. He indicated he had some family stressors because he gets very argumentative and upset. He gave a history of quitting drinking for 18 years. He denied problems with blackouts, nightmare or night sweats. He said that he gets occasionally depressed and had some hopeless and helpless feelings. He described feeling tired and run down. He denied any auditory or visual hallucination or delusions. He denied drug use or trouble with the law. On objective examination, he was casually dressed, generally pleasant and cooperative with the proper flow and content of his conversation. He was oriented to time, place and person. His attention and concentration were normal. He could do mental calculations and serial 7's. He was able to give the days of the week in reverse order. His memory and recall for certain events were slightly impaired and he could recall two out of three objects after five minutes. There was no evidence of looseness of association, flight of ideas or pressured speech. His fund of knowledge was appropriate for his educational level. There were no obsessive thoughts or compulsive actions. He denied suicidal or homicidal ideations. The Axis I diagnosis rendered was generalized anxiety disorder; there was no Axis II diagnosis. The severity of psychosocial stressors were moderate. The highest level of adaptive functioning currently appeared to be 75 on the GAF scale. The commentary included the opinion that the veteran has had problems with chronic generalized anxiety disorder. He was noted to be in active treatment through the VA hospital and was apparently handling it okay. His anxiety was said to have affected him occasionally, socially, as well as industrially. He was again felt to meet the criteria for a 30 percent disability for his service connected anxiety disorder. The report from an August 1999 VA examination also noted a long-term employment history of 27 years at the same plant, and a 24-year marriage. Their marriage was described as having its ups and downs. He indicated they get into arguments, but denied major problems. The veteran indicated that he is capable of dressing and washing himself, but that there are days when he does not want to get out or clean or wash. He worked an 8-hour day. He said outside of work he did not have many interests or activities and stayed in the house most of the time. He sometimes watched television. He attended church once a week. Regarding his symptoms, he said that he had been letting things bother him more and more lately. He was still in outpatient treatment at the VA medical center. He said a lot of things bother him. He described feeling nervous, depressed, tired and rundown. Sleep was variable. His appetite was okay. He described having "giving up" thoughts but denied active suicidal or homicidal ideation. He denied problems with drugs or alcohol. He denied hallucinations or delusions. He stated that he had a bad temper and had been more irritable, upset and angry. He described headaches which felt like a band around his head, and said they occur about two or three times a week. He denied photophobia or stomach upset. He felt uncomfortable around people. He had episodes of depression, lack of energy, lack of interest in anything and just worked and came home. On objective examination he was oriented to time, place and person and had no evidence of hallucinations or delusions. Attention and concentration was normal. He could do mental calculations and serial 7's. He was able to give the days of the week in reverse order. His memory and recall for certain events was slightly impaired and he could recall two out of three objects after five minutes. There was no evidence of looseness of association, flight of ideas or pressured speech. Judgment was intact. There were no obsessive thoughts or compulsive actions. He denied suicidal or homicidal ideations. The Axis I diagnosis was generalized anxiety disorder and dysthymic disorder; there was no Axis II diagnosis. Axis III diagnosis included tension headaches. The severity of psychosocial stressors were moderate. The highest level of adaptive functioning currently appeared to be 65 to 70 on the GAF scale. The commentary again noted that his psychiatric impairment has decreased his work efficiency, with intermittent periods of inability to perform occupational tasks, but that he was able to work full time. He had had depressed mood, anxiety, sleep impairment, and difficulty with concentration. Analysis 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; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities and the criteria that must be shown for specific ratings. 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. The severity of disability is based upon actual symptomatology, as it affects social and industrial adaptability. Two of the most important determinants of disability are time lost from gainful work and decrease in work efficiency. Great emphasis is placed upon the full report of the examiner and descriptive of actual symptomatology. The record of the history and complaints is only preliminary to the examination. The objective findings and the examiner's analysis of the symptomatology are the essentials. 38 C.F.R. § 4.130. In considering the severity of a disability it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41 (1999). The regulations pertaining to rating psychiatric disabilities were revised effective November 7, 1996. The Court has held that where the law or regulation changes after a claim has been filed or reopened but before the administrative or judicial appeal process has been concluded, the version most favorable to the appellant will apply. Karnas v. Derwinski, 1 Vet. App. 308, 313 (1991). According to the General Rating Formula for Mental Disorders in effect since November 7, 1996, a 50 percent evaluation is warranted for the following symptoms: 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. A 30 percent evaluation is warranted for the following symptoms: Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). Under the "old" regulations pertaining to psychiatric disabilities in effect prior to November 7, 1996, a 50 percent evaluation required the ability to establish or maintain effective or favorable relationships with people be considerably impaired and where the reliability, flexibility and efficiency levels are so reduced by reason of psychoneurotic symptoms as to result in considerable industrial impairment. A 30 percent evaluation required definite impairment in the ability to establish or maintain effective and wholesome relationships with people and psychoneurotic symptoms resulting in such reductions in initiative, flexibility, efficiency and reliability levels as to produce definite industrial impairment. In Hood v. Brown, 4 Vet. App. 301 (1993) the Court held that the term "definite" in 38 C.F.R. § 4.132 was "qualitative" in character, whereas the other terms were "quantitative" in character, and invited the Board to "construe" the term "definite" in a manner which quantifies the degree of impairment for purposes of meeting the statutory requirement that the Board articulate its "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 the term "definite" is to be construed as "distinct, unambiguous, and moderately large in degree." It represents a degree of social and industrial inadaptability which is "more than moderate but less than rather large." O.G.C. Prec. 9-93 (Nov. 9, 1993). Regarding the term "considerable," in the same precedent opinion, the General Counsel of VA (among other things) employed "rather large in extent or degree" as a description of the considerable impairment that would warrant an evaluation of 50 percent for a psychiatric disability. VAOPGCPREC 9-93 (O.G.C. Prec. 9-93). The Board is bound by precedent opinions issued by VA General Counsel. 38 U.S.C.A. § 7104(c) (West 1991). Consequently, the Board will address the merits of the veteran's claim for an increased evaluation of his service-connected generalized anxiety, in relation to the regulations in effect prior to November 7, 1996, with these interpretation of "definite" and "considerable" in mind. The Board notes here that the RO has also reviewed the veteran's claim under the provisions of the "new" diagnostic criteria as evidenced by a supplemental statement of the case issued in August 1999. However, the RO determined that a rating in excess of the current 30 percent is not warranted under the "new" criteria as well as the "old" criteria. While the regulations require review of the recorded history of a disability by the adjudicator to ensure a more accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings. Where an increase in the disability rating is at issue, the present level of the veteran's disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The veteran's disability is presently classified as generalized anxiety disorder with tension headaches. When a single disability has been diagnosed both as a physical condition and as a mental disorder, the rating agency shall evaluate it using a diagnostic code which represents the dominant (more disabling) aspect of the condition (see § 4.14). 38 C.F.R. § 4.126 (1999) See also 38 C.F.R. § 4.132 General Rating for Psychoneurotic Disorders note 4 "When two diagnoses, one organic and the other psychological or psychoneurotic, are presented covering the organic and psychiatric aspects of a single disability entity, only one percentage evaluation will be assigned under the appropriate diagnostic code determined by the rating board to represent the major degree of disability. When the diagnosis of the same basic disability is changed from an organic one to one in the psychological or psychoneurotic categories, the condition will be rated under the new diagnosis." 38 C.F.R. § 4.132, Part 4, Diagnostic Code 9400, Note 4 (1996). In this case, the major degree of disability is due to the psychological/mental disorder rather than the physical complaints of tension headaches. Tension headaches are purely subjective complaints, and would warrant no more than a 10 percent evaluation and would not be combinable with other evaluations, even in the instance of head trauma, absent multi infarct dementia. See Diagnostic Code 8045: "purely subjective complaints such as headache, dizziness, insomnia, etc., recognized as symptomatic of brain trauma, will be rated 10 percent and no more under Diagnostic Code 9304. This 10 percent rating will not be combined with any other rating for a disability due to brain trauma. Ratings in excess of 10 percent will not be assigned in the absence of multi-infarct dementia associated with brain trauma." Upon review of the foregoing, the Board finds the preponderance of the evidence is against a grant of increased evaluation for the veteran's service connected anxiety disorder. Specifically, the findings from the most recent VA examinations from 1998 and 1999 repeatedly reveal the level of disability from the service connected anxiety disorder to be consistent with the currently assigned 30 percent evaluation, either the old criteria or the criteria currently in effect. The symptomatology of record is noted to produce occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, most dramatically illustrated in the episodes wherein the veteran was required to take time off from work to attend treatment programs, such as the time between April and May of 1995. However he is noted to generally be functioning satisfactorily, with routine behavior, self-care, and conversation normal, with a GAF of 65-70 on most recent examination. This is consistent with a 30 percent evaluation under the regulations pertaining to psychiatric disabilities in effect since November 7, 1996. The evidence likewise demonstrates a "definite" impairment in the ability to establish or maintain effective relationships with people, and a reduction of initiative, flexibility and reliability levels, consistent with a 30 percent evaluation according to the regulations in effect prior to November 7, 1996. The evidence shows that his symptoms do not rise to the level warranting a 50 percent evaluation under either the "old" or "new" regulations. His symptoms are not shown to arise to the level 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 complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships that would warrant a 50 percent evaluation under the "new" regulations in effect since November 1996. Nor does the evidence demonstrate that his symptoms attributable to anxiety rise to the level that they have considerably impaired his ability to establish or maintain effective or favorable relationships with people, nor are the veteran's reliability, flexibility, and efficiency levels so reduced by reason of psychoneurotic symptoms as to result in considerable industrial impairment, consistent with a 50 percent evaluation under the "old" regulations. Moreover, since the veteran is shown to be able to continue his employment over 27 years and a marriage for 24 years strongly suggests that his anxiety symptoms, while a "definite" impairment are not a "considerable" impairment. Consideration has been given to the doctrine of reasonable doubt as to this issue, but the preponderance of the evidence is against the claim. As such, the claim is denied. 38 U.S.C.A. § 5107; Gilbert, supra. ORDER The veteran's claim for an increased rating for a service connected anxiety disorder, with headaches is denied. A. BRYANT Member, Board of Veterans' Appeals