BVA9500306 DOCKET NO. 91-55 688 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in New Orleans, Louisiana THE ISSUES 1. Entitlement to a compensable rating for an erectile dysfunction secondary to medication. 2. Entitlement to an increased rating for a manic-depressive illness with recourse to alcohol and drug dependence, currently evaluated as 70 percent disabling, to include the issue of entitlement to a total compensation rating. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD Thomas A. Pluta, Counsel INTRODUCTION The veteran had active service from February 1943 to March 1945. This appeal arises from a September 1990 rating action of the New Orleans, Louisiana Regional Office (RO) which denied an evaluation in excess of 70 percent for the veteran's manic-depressive illness. By decisions of June 1991 and March 1992, the Board of Veterans' Appeals (Board) remanded this case to the RO for further development of the evidence with respect to the inextricably-intertwined issue of entitlement to service connection for impotence, and for adjudication of the claim for an increased rating for a manic-depressive illness with consideration to the provisions of 38 C.F.R. § 4.16(c). By rating action of October 1992, the RO granted service connection for an erectile dysfunction secondary to medication. By decision of August 1993, the Board remanded this case to the RO for further development of the evidence and for adjudication of the inextricably-intertwined issue of entitlement to a compensable rating for an erectile dysfunction. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends, in effect, that his service-connected psychotic disorder has increased in severity and is more disabling than currently evaluated. He states that he suffers from sleep problems, is unable to tolerate crowds or loud noise, and becomes easily upset and frustrated. He asserts that prescribed medication has somewhat ameliorated his sleep problems. He states that he is totally disabled and industrially inadaptable, and requests entitlement to total disability benefits under the provisions of 38 C.F.R. § 4.16(c) (1993). He also asserts that his erectile dysfunction warrants a compensable evaluation. DECISION OF THE BOARD In accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), following review and consideration of all evidence and material of record in the veteran's claims file, 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 a compensable rating for an erectile dysfunction, but supports the assignment of a 100 percent schedular rating for a manic- depressive illness under the provisions of 38 C.F.R. § 4.16(c). FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. The veteran's erectile dysfunction secondary to medication is manifested by the ability to obtain erections on the average of once every two months, without penile deformity or total loss of erectile power shown on recent U.S. Department of Veterans Affairs (VA) evaluations, and has not resulted in marked interference with employment or required frequent periods of hospitalization. 3. The veteran's manic-depressive illness with recourse to alcohol and drug dependence is productive of severe impairment of social and industrial adaptability and precludes all forms of substantially-gainful employment. CONCLUSIONS OF LAW 1. The criteria for a compensable rating for an erectile dysfunction secondary to medication have not been satisfied. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. § 3.321(b)(1), Part 4, including §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.31, Codes 7599-7522 (1993). 2. The veteran's manic-depressive illness with recourse to alcohol and drug dependence is 70 percent disabling according to the schedular criteria, but is 100 percent disabling with application of 38 C.F.R. § 4.16(c). 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. Part 4, including §§ 4.1, 4.2, 4.7, 4.10, 4.16(c), 4.129, 4.130, Code 9206 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS We find that the veteran's claims are "well-grounded" within the meaning of 38 U.S.C.A. § 5107(a). That is, we find that he has presented claims which are plausible. We are also satisfied that all relevant facts have been properly developed, and that no further development is required to comply with the duty to assist the veteran mandated by 38 U.S.C.A. § 5107(a). I. A Compensable Rating for an Erectile Dysfunction Under the applicable criteria, disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. The VA has a duty to acknowledge and consider all regulations which are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusion. Schafrath v. Derwinski, 1 Vet.App. 589 (1991). These regulations include, but are not limited to, 38 C.F.R. §§ 4.1 and 4.2. Also, 38 C.F.R. § 4.10 provides that, in cases of functional impairment, evaluations must be based upon lack of usefulness of the affected part or systems, and medical examiners must furnish, in addition to the etiological, anatomical, pathological, laboratory and prognostic data required for ordinary medical classification, full description of the effects of the disability upon the person's ordinary activity. These requirements for evaluation of the complete medical history of the claimant's condition operate to protect claimants against adverse decisions based upon a single, incomplete, or inaccurate report, and to enable the VA to make a more precise evaluation of the level of the disability and of any changes in the condition. Schafrath, 1 Vet.App. at 594. A review of the record reflects that service connection for an erectile dysfunction secondary to medication was granted by rating action of October 1992, and a noncompensable evaluation was assigned from July 1990 under Diagnostic Codes 7599-7522 of the VA's Schedule for Rating Disabilities (38 C.F.R. Part 4), based on the possibility that medication prescribed for management of the veteran's service-connected psychiatric disorder was the cause of his erectile dysfunction, and the evidence showing that he was able to obtain erections at various times, without a showing of total impotence. Under the applicable criteria, when an unlisted condition is encountered, it will be permissible to rate under a closely- related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. Conjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diagnosis, or for those not fully supported by clinical and laboratory findings. 38 C.F.R. § 4.20. When the regulations do not provide diagnostic codes for specific disorders, the VA must evaluate those conditions under codes for similar disorders or codes that may provide a general description that may encompass many ailments. Pernorio v. Derwinski, 2 Vet.App. 625 (1992). In this case, the veteran's erectile dysfunction secondary to medication has been rated analogous to deformity of the penis with loss of erectile power. Deformity of the penis, with loss of erectile power, warrants a 20 percent evaluation. 38 C.F.R. Part 4, Code 7522. In every instance where the schedule does not provide a no percent evaluation for a diagnostic code, a no percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. After a review of the entire record, the Board concludes that a compensable rating for an erectile dysfunction secondary to medication is not warranted. VA outpatient treatment records of mid-February 1990 show the veteran's complaints of decreased erections, inability to climax, and a six-week history of impotence. The impressions were erectile dysfunction, impotence due to medication and old age. He was subsequently treated with testosterone injections. In late February, he was seen with a couple-of-year history of impotence. He stated that he had had an erection with hormone treatment, but no ejaculation. The impression was neurosis with impotence. In March 1990, the veteran was noted to have been impotent for two years. He stated that he had had better potency and climax since beginning hormone injections. The impression was nerve tension with anxiety and impotence. In April, he stated that there had been no improvement, and in May, he complained that hormone injections had not been effective for impotence, as he could not achieve an erection. The impressions were no improvement with testosterone therapy; probable psychogenic impotence. Testosterone injections were discontinued. VA outpatient treatment records of August 1990 indicate that a trial of new medication was noted to have produced successful results in treatment of the veteran's impotence. The impression was that he was doing well. In May 1991, the veteran's sexual dysfunction was noted to have responded to medication. On VA urological examination in August 1991, the veteran reported a 1- to 2-year history of impotence. He denied morning erections, and stated that he last had intercourse 1 to 2 years ago. On examination, the penis was circumcised and within normal limits. The examiner opined that the veteran's impotence was probably due to arterial insufficiency, and could not predict whether the impotence was permanent or if erectile power could be restored without diagnostic tests. There was no penile deformity. The diagnosis was impotence. On VA urological examination of April 1992, the veteran gave a three-year history of inability to achieve erections. However, he claimed that he very rarely got early morning erections. The Board notes this evidence that the veteran does not have total loss of erectile power. Prescribed medication had produced good results in the past, but it made him ill, and he was not able to continue taking it. Current examination showed a normal phallus. The impression was erectile dysfunction, possibly secondary to medications. Hypergonadism or vasculogenic etiology could not be ruled out. It was felt to be very possible that the veteran's medications could be the cause, and even if not, the veteran was convinced that they were, and changing them might alleviate the problem as a placebo effect. On VA psychiatric examination the same month, the veteran gave a three-year history of increasing difficulty having erections, and stated that he had early morning erections once or twice a month, but he claimed to be unable to have intercourse. After examination, the diagnoses included erectile dysfunction, possibly secondary to prescribed psychotropic medications. VA outpatient treatment records of June 1992 noted the veteran's complaints including impotence, which he felt was secondary to prescribed medications. Significantly, the examiner noted that the veteran did have occasional erections. In February 1993, the veteran complained of a more than four-year history of impotence. Significantly, he reported occasional morning erections. The diagnostic impression was anxiety, depression (sexual dysfunction). In August 1993, the veteran complained of complete impotence for two months with decreased libido since starting prescribed medications. The examiner explained that this was a common side-effect and that no medical intervention was needed. On VA psychiatric examination of January 1994, the veteran gave a five-year history of difficulty having erections. Significantly, he reported having a morning erection once every two months. On VA urological examination the same month, the veteran complained of having no erections for the past 2 to 3 months. He stated that he previously had had morning erections. Current examination showed no plaque on the penis or any other deformity. The diagnoses included erectile dysfunction. On that record, the Board concludes that a compensable evaluation for the veteran's erectile dysfunction is not warranted. The record clearly shows that the veteran is able to obtain an erection about once every two months. The clinical findings do not show penile deformity with loss of erectile power which would entitle the veteran to a 20 percent rating under Diagnostic Code 7522. The veteran's contentions have been considered, but the preponderance of the evidence does not warrant a compensable evaluation for an erectile dysfunction. Neither does the veteran's erectile dysfunction present such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards. The record does not reflect marked interference with employment or frequent periods of hospitalization attributable to the erectile dysfunction. Thus, the Board finds that an extraschedular evaluation for an erectile dysfunction is not warranted. II. Entitlement to an Increased Rating for a Manic-Depressive Illness With Recourse to Alcohol and Drug Dependence, Currently Evaluated as 70 Percent Disabling, to Include the Issue of Entitlement to a Total Compensation Rating As noted in the above Reasons and Bases for Findings and Conclusions with respect to the issue of a compensable rating for an erectile dysfunction, the applicable criteria are contained in 38 U.S.C.A. § 1155 and 38 C.F.R. Part 4, including §§ 4.1, 4.2, 4.7, and 4.10. The analysis mandated by the Court in Schafrath is also for application. In addition, 38 C.F.R. § 4.129 provides that social integration is one of the best evidences of mental health and reflects the ability to establish (together with the desire to establish) healthy and effective interpersonal relationships. However, in evaluating impairment, social inadaptability is to be evaluated only as it affects industrial adaptability. 38 C.F.R. § 4.130 provides that, in evaluating psychiatric disabilities, 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. An emotionally sick veteran with a good work record must not be underevaluated, nor must his condition be overevaluated on the basis of a poor work record not supported by the psychiatric disability picture. A review of the record reflects that service connection was granted for an anxiety-type psychoneurosis by rating action of March 1945, and a 30 percent rating was assigned from March 1945 based on service medical records showing aggravation of this disorder by service. By rating action of December 1953, the RO decreased the evaluation of the veteran's psychiatric disorder, an anxiety reaction, from 30 percent to 10 percent, effective February 1954, based on material improvement in psychiatric symptomatology. By rating action of August 1964, the RO increased the evaluation of the veteran's psychiatric disorder, now described as a depressive reaction, from 10 percent to 30 percent, effective April 1964, under Diagnostic Code 9405 of the VA's Schedule for Rating Disabilities (38 C.F.R. Part 4), based on increased symptomatology shown on VA examination of July 1964. By rating action of November 1971, a temporary total rating of 100 percent under the provisions of 38 C.F.R. § 4.29 was assigned for the veteran's depressive reaction from July 22 through October 1971, based on hospital treatment for that disorder; a pre-hospitalization schedular rating of 30 percent was restored from November 1971. By rating action of August 1975, a temporary total rating of 100 percent under the provisions of 38 C.F.R. § 4.29 was assigned for the veteran's depressive reaction from April 22 through July 1975, based on hospitalization for that disorder; a pre- hospitalization schedular rating of 30 percent was restored from August 1975. By rating action of November 1976, the RO increased the evaluation of the veteran's psychiatric disorder, now described as a manic-depressive illness with recourse to alcohol and drug dependence and rated under Diagnostic Code 9206, to a schedular 100 percent from January 1976, based on a finding of progression of disability to total disability. By rating action of January 1982, the RO decreased the evaluation of the veteran's manic-depressive illness from 100 percent to 70 percent, effective April 1982, based on material improvement in psychiatric symptomatology. Under the applicable criteria, a 70 percent evaluation is warranted for a manic-depressive illness (manic, depressed, or mixed bipolar disorder) with symptomatology which is less than that required for a 100 percent evaluation, but which nevertheless produces severe impairment of social and industrial adaptability. A 100 percent evaluation requires active psychotic manifestations of such extent, severity, depth, persistence or bizarreness as to produce total social and industrial inadaptability. After a review of the entire record, the Board concludes that the veteran's symptoms and the clinical findings do not warrant a schedular evaluation in excess of 70 percent. The veteran's manic-depressive illness is not 100 percent disabling according to the schedular criteria, as active psychotic manifestations of such extent, severity, depth, persistence or bizarreness as to produce total social and industrial inadaptability have not been shown. VA outpatient mental hygiene clinical records of December 1989 show that the veteran felt good and slept well. He was noted to be in excellent remission. In June 1990, he complained of not sleeping well at night. On VA psychiatric examination of October 1990, the veteran complained of disliking crowds and becoming easily upset, crying easily, being depressed most of the time, bad mood swings, and heavy drinking. He currently took prescribed medications and reported having no hobbies. On mental status examination, he was sad-looking, but coherent and relevant, with a clear sensorium. He reported one suicide attempt at an unspecified time by slashing his wrist. There were no homicidal thoughts or hallucinations, but the veteran had a very serious alcohol problem. Memory was intact and intelligence average, and the veteran appeared to be integrated. However, mood was depressed. The diagnoses were mixed bipolar affective disorder, and substance use disorder, alcohol dependence. The degree of emotional impairment was assessed to be severe. The veteran was considered competent, but the prognosis was guarded. VA outpatient treatment records of December 1990 noted that the veteran reported no change in his life or activities. He had no close friends. He complained of constant fatigue in July 1991. He complained of sleep disturbance in February 1992, and the assessment was manic depression. In March, he complained of sleep disturbance, crying, depression and sadness since he stopped taking prescribed medication which had been giving good results. The diagnosis was depression, anxiety. In April, he complained of insomnia, tenseness and nervousness, and the diagnosis was anxiety-depressive reaction. On VA psychiatric examination of April 1992, the veteran reported that his last psychiatric hospitalization occurred six years ago. He currently received outpatient treatment and treatment with prescribed medications. He lived alone, having divorced his wife 15 years ago. He reported that he last worked 15 years ago, and felt unable to work currently because of difficulty falling and staying asleep. He complained of depression most of the time, difficulty falling and staying asleep, being too nervous to drive, episodes of anger, and nightmares. He reported cutting a wrist in a suicide attempt in the 1950's. He currently denied suicidal or homicidal thoughts. On mental status examination, the veteran was cooperative, but mood was depressed, anxious, and withdrawn. However, affect was appropriate, and speech was normally productive, relevant and coherent. There were no hallucinations or illusions, and the veteran was oriented in three spheres. Knowledge, memory and recall were intact. His IQ and insight were average, and judgment was fair. Commenting on how the residual disability affected the veteran's earning capacity in job performance, the examiner noted that he had difficulty sleeping, anxiety, poor concentration, and depression which prevented him from working. Regarding how the residual disability affected normal everyday activities, the examiner noted that the veteran felt too anxious to drive most of the time or to build model airplanes, and he got headaches and backaches if he tried to work. The examiner further noted that there had been no periods of remission over the past year. The veteran was assessed to be capable of managing his own benefit payments. The diagnoses included bipolar disorder, depressed; and episodic alcohol abuse. On VA outpatient psychiatric examination of May 1992, the veteran complained of sleep disturbance, tenseness, nervousness, depression, crying spells twice a week, despondence, and sadness. He felt hopeless and preferred being alone, but denied suicidal thoughts or hallucinations. He currently attended Alcoholics Anonymous meetings and had been sober for six weeks. On mental status examination, the veteran was cooperative, but affect was blunt. Speech was monotone but coherent. Thought content showed moderate symptoms of depression. There were no suicidal thoughts or hallucinations. The veteran appeared to be of average intellect, and significantly, judgment and insight were intact. The impression was recurrent depression, major versus dysthymia, and the veteran's prescribed medications were changed and adjusted. VA outpatient mental hygiene clinical records of June 1992 indicate that the veteran was still depressed, with some sleep problems when he failed to take medication as prescribed; when he did take medication as prescribed, he slept six hours per night. He reported that he spent his time working outside his home and reading. He had no suicidal or homicidal ideation or hallucinations. The assessment was moderate depressive neurosis. In July, the veteran was noted to be depressed because of trouble with his car. He felt that he had been on a streak of bad luck for the past month, and drank nearly a case of beer last night. He reported that prescribed medication made him feel better on certain days. He was noted to be not very active socially, watching television and reading the newspaper. In September, he was noted to be sleeping and feeling better with prescribed medication, but stated that his depression was unchanged, having more "down" days than "up." He desired a hobby to keep busy, but stated that he was extremely nervous when he used to build model airplanes. On VA outpatient psychiatric examination of November 1992, the veteran reported problems sleeping for a few days, which was questionably related to a recent denial of a claim for increased disability benefits. He felt that prescribed medications were helping his depression. On mental status examination, affect was restricted, but thought process was organized. Speech was productive, and there was no overt psychosis. Significantly, judgment and insight were intact, and the impression was dysthymia. In March 1993, the veteran felt that he was not completely over his depression, and there were unresolved areas, even when he was not under stress. He reported no adverse effects from his medications, yet when he was anxious, he had a set-back. There were no hallucinations or suicidal or homicidal ideas. The assessments were depressive neurosis, organic affective disorder, alcohol dependence, by history. In June 1993, the veteran continued to have minor depression. He related some of his problems to physical complaints, and felt good with his prescribed medications. He denied suicidal or homicidal ideas, and the assessment was depressive neurosis. In August, his depression was noted to be stable. In September, he stated that his depression was better with prescribed medication. He currently appeared to be nervous, with considerable hand- wringing. Depression was noted from the veteran's low energy level, irritability, anxiety, insomnia, and bleak outlook. Mental status examination showed blunted affect and monotone speech, but thought process was coherent and there were only moderate symptoms of depression. Significantly, insight and judgment were intact. The assessment was depression. On VA psychiatric examination of January 1994, the veteran reported that his last psychiatric hospitalization was eight years ago, and that he considerably reduced his drinking of alcohol 3 or 4 months ago; his last inpatient alcohol dependence treatment program was also eight years ago. He currently received outpatient treatment and treatment with prescribed medications. He divorced 17 years ago and currently lived alone. He reported that he last worked 17 years ago, when he was forced to retire because of difficulty falling and staying asleep; he also currently felt unable to work because of this. He complained of depression most of the time, crying spells 2 or 3 times per month, mood swings with severe depression once a week when he drank, trouble falling and staying asleep, and nightmares once a week. He denied current suicidal or homicidal feelings. He complained of anger episodes and difficulty concentrating. On mental status examination, the veteran was cooperative, but mood was depressed and somewhat withdrawn. However, affect was appropriate, and speech was normally productive, relevant and coherent. No hallucinations or delusions were elicited, and he was oriented in three spheres. Knowledge, memory and recall were intact, and IQ and insight were average. Judgment was fair. Commenting on the effects of the veteran's psychiatric disability on his ordinary activity, the examiner noted that he felt too anxious to drive most of the time. Because of depression, he stayed alone and avoided people, and he felt too anxious to engage in his former hobby of building model airplanes. With regard to how the disability impaired the veteran functionally, the examiner noted that he had difficulty falling and staying asleep, and poor concentration and anxiety generated by work responsibilities, all of which impaired his ability to work. The veteran was felt to be capable of managing his benefit payments. The diagnoses were bipolar disorder, depressed, and episodic alcohol abuse. On that record, the Board concludes that the schedular requirements for a 100 percent rating for a manic-depressive illness are not present, as the veteran's symptoms do not produce total social and industrial inadaptability. In this regard, the Board notes that the clinical findings do not reflect an unremitting psychiatric disability picture, nor do they show hospitalization for long periods or that prescribed medications have not ameliorated the veteran's psychiatric symptoms. Only a severe degree of emotional impairment was assessed on VA psychiatric examination of October 1990; active psychotic manifestations productive of total social and industrial inadaptability were not indicated. Although on VA psychiatric examinations of April 1992 and January 1994 the veteran stated that he felt unable to work because of difficulty falling and staying asleep, the Board notes that the veteran did not attribute his inability to work to active psychotic manifestations of such extent, severity, depth, persistence or bizarreness such as to prevent him from associating with people or performing work functions. Although on examination of April 1992 the examiner noted that the veteran had difficulty sleeping, anxiety, poor concentration and depression which prevented him from working, that opinion is not supported by the numerous positive actual clinical findings on examination, including an appropriate affect; normally productive, relevant, and coherent speech; fair judgment; average insight and IQ; intact orientation, knowledge, memory and recall; and the lack of hallucinations or illusions. Significantly, VA outpatient examinations of May and November 1992 and September 1993 consistently show intact insight and judgment. The Board notes the June 1992 finding that the veteran's failure to take medication as prescribed contributed to his sleep disturbance, which was the major symptom he felt prevented him from working. The Board also notes that the veteran reported that he spent his time working outside his home and reading - evidence that he had some degree of industrial adaptability. Although on VA psychiatric examination of January 1994 the examiner noted that the veteran had difficulty falling and staying asleep, and poor concentration and anxiety generated by work responsibilities, all of which impaired his ability to work, the positive clinical findings on examination included appropriate affect; normally productive, relevant, and coherent speech; intact orientation, knowledge, memory and recall; average IQ and insight; fair judgment; and the lack of hallucinations or delusions. These findings on the whole do not constitute active psychotic manifestations productive of total social and industrial inadaptability. Nevertheless, considering that the veteran's sole compensable service-connected disability is a manic-depressive illness with recourse to alcohol and drug dependence assigned a 70 percent evaluation, the Board must now consider whether he is unemployable and entitled to a 100 percent schedular rating under the provisions of 38 C.F.R. § 4.16(c). The applicable criteria provide that 38 C.F.R. § 4.16(a) shall not apply to cases in which the only compensable service-connected disability is a mental disorder assigned a 70 percent evaluation, and such mental disorder precludes a veteran from securing or following a substantially-gainful occupation. In such cases, the mental disorder shall be assigned a 100 percent schedular evaluation under the appropriate diagnostic code. In this case, the Board finds that the recent clinical findings and the veteran's work history support the assignment of a 100 percent schedular rating under the provisions of 38 C.F.R. § 4.16(c) and Diagnostic Code 9206. The evidence shows that the veteran is unable to secure or follow a substantially-gainful occupation as a result of his service-connected manic-depressive illness with recourse to alcohol and drug dependence, and he is thus unemployable. As noted above, the veteran has a 10th grade education and the record contains some discrepancy as to why he held numerous jobs during his working career. In November 1953, he attributed his frequent job changes to a desire to get ahead and earn more money. However, in July 1964 he reported trouble holding jobs for many years due to difficulty getting along with other employees, especially superiors. In January 1994, he reported that he last worked as a tool-maker 17 years ago, when he was forced to retire because of difficulty falling and staying asleep; he also currently felt unable to work because of this. VA medical records from 1990 to 1994 show continuing treatment of the veteran on an outpatient basis with large doses of prescribed medications for severe manic-depressive symptoms including persistent and debilitating sleep disturbance, crying spells, significant and substantial depression, despondence, tenseness, and nervousness. On psychiatric examination in April 1992, a VA physician concluded that the veteran's difficulty sleeping, anxiety, poor concentration, and depression prevented him from working. On another psychiatric examination in January 1994, the same physician noted that the veteran stayed alone and avoided people because of depression, and commented that the veteran's difficulty falling and staying asleep, poor concentration, and anxiety generated by work responsibilities all impaired his ability to work. On that record, the Board concludes that the preponderance of the evidence shows the veteran to be unemployable as a result of his severely-disabling manic- depressive illness, and that a 100 percent schedular rating is thus warranted with application of 38 C.F.R. § 4.16(c). ORDER A compensable rating for an erectile dysfunction secondary to medication is denied. An increased rating to 100 percent for a manic-depressive illness with recourse to alcohol and drug dependence is granted, subject to the applicable regulations governing payment of monetary benefits. 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 granting less than the complete benefit, or benefits, sought on appeal is appealable to the Court 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.