Citation Nr: 0005802 Decision Date: 03/03/00 Archive Date: 03/14/00 DOCKET NO. 97-30 802 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Jackson, Mississippi THE ISSUES 1. Entitlement to service connection for hypertension. 2. Entitlement to service connection for headaches. 3. Entitlement to an increased rating for a panic disorder, currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD E. W. Koennecke, Associate Counsel INTRODUCTION The appellant served on active duty from November 1982 to November 1986, and from January 1989 to January 1993. This case comes before the Board of Veteran's Appeals (the Board) on appeal from February 1997 and March 1999 rating decisions of the Jackson, Mississippi, Department of Veterans Affairs (VA) Regional Office (RO). Preliminary review of the record reveals that the RO expressly considered referral of the case to the Chief Benefits Director or the Director, Compensation and Pension Service for the assignment of an extraschedular rating under 38 C.F.R. § 3.321(b)(1) (1999). This regulation provides that to accord justice in an exceptional case where the schedular standards are found to be inadequate, the field station is authorized to refer the case to the Chief Benefits Director or the Director, Compensation and Pension Service for assignment of an extraschedular evaluation commensurate with the average earning capacity impairment. The governing criteria for such an award is a finding that the case presents such an exceptional or unusual disability picture with such related factors as marked inference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards. The U. S. Court of Appeals for Veterans Claims (known as the United States Court of Veteran's Appeals prior to March 1, 1999) (hereinafter Court) has held that the Board is precluded by regulation from assigning an extraschedular rating under 38 C.F.R. § 3.321(b)(1) in the first instance, however, the Board is not precluded from raising this question, and in fact is obligated to liberally read all documents and oral testimony of record and identify all potential theories of entitlement to a benefit under the law and regulations. Floyd v. Brown, 9 Vet. App. 88 (1996). The Court has further held that the Board must address referral under 38 C.F.R. § 3.321(b)(1) only where circumstances are presented which the Director of VA's Compensation and Pension Service might consider exceptional or unusual. Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). Having reviewed the record with these mandates in mind, the Board finds no basis for further action on this question. VAOPGCPREC. 6-96 (1996). In August 1999, the appellant filed an informal claim for individual unemployability. Based on the evidence in the record, it seems that the RO has not had an opportunity to act upon the claim. The Board refers the issue to the RO to take appropriate action with respect to this claim, as the Board does not have jurisdiction over this claim. Jurisdiction does indeed matter and it is not "harmless" when the VA during the claims adjudication process fails to consider threshold jurisdictional issues. Absent a decision, a notice of disagreement, a statement of the case and a substantive appeal, the Board does not have jurisdiction of the issue. Rowell v. Principi, 4 Vet. App. 9 (1993); Roy v. Brown, 5 Vet. App. 554 (1993), Black v. Brown, 10 Vet. App. 279 (1997), Shockley v. West, 11 Vet. App. 208 (1998). An application that is not in accord with the statute shall not be entertained. 38 U.S.C.A. § 7108 (West 1991). Furthermore, this Board Member cannot have jurisdiction of this issue. 38 C.F.R. § 19.13 (1999). The veteran should be informed of any determination by separate letter that includes notification of appellate rights. 38 C.F.R. § 3.103 (1999). If there is any intent to appeal, there is an obligation to file a notice of disagreement and a substantive appeal after the issuance of the statement of the case. 38 C.F.R. § 20.200 (1999). FINDINGS OF FACT 1. Competent evidence of hypertension in service or within one year from separation from service has not been presented. 2. Competent evidence of a headache disorder has not been presented. 3. Competent evidence linking hypertension to service connected panic disorder has not been presented. 4. Competent evidence linking a headache disorder to service connected panic disorder has not been presented. 5. Panic disorder is manifested by intermittent periods of inability to perform occupational tasks due to panic attacks. CONCLUSIONS OF LAW 1. The claim of entitlement to service connection for hypertension is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 2. The claim of entitlement to service connection for headaches is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 3. Panic disorder is 30 percent disabling. 38 U.S.C.A. §§ 1155, 5107(b) (West 1991); 38 C.F.R. Part 4, § 4.130, Diagnostic Code 9412 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION Service Connection Claims The claim on appeal stems from a March 1999 rating decision wherein the RO denied service connection for hypertension, claimed as secondary to service connected panic disorder, and for headaches. In video testimony before the Board in November 1999, the appellant clarified that his claim was that his panic disorder caused both hypertension and severe headaches. Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury or disease. 38 U.S.C.A. §§ 1110, 1131 (West 1991). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1999). Disability that is proximately due to or the result of a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310 (a) (1999). Additional disability resulting from the aggravation of a non-service- connected condition by a service-connected condition is also compensable under 38 C.F.R. § 3.310(a). See Allen v. Brown, 7 Vet. App. 439 (1995). In making a claim for service connection, the appellant has the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded. 38 U.S.C.A. § 5107(a) (West 1991). A well- grounded claim is a plausible claim, one which is meritorious on its own or capable of substantiation. Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). A well-grounded claim for service connection generally requires medical evidence of a current disability; evidence of incurrence or aggravation of a disease or injury in service as provided by either lay or medical evidence, as the situation dictates; and, a nexus, or link, between the inservice disease or injury and the current disability as provided by competent medical evidence. Cohen v. Brown, 10 Vet. App. 128, 137 (1997); Caluza v. Brown, 7 Vet. App. 498 (1995) aff'd per curiam, 78 F.3d 604 (Fed.Cir. 1996) (table); see also 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303 (1998); Layno v. Brown, 6 Vet. App. 465 (1994); Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Alternatively, the nexus between service and the current disability can be satisfied by evidence of continuity of symptomatology and medical or, in certain circumstances, lay evidence of a nexus between the present disability and the symptomatology. See Savage v. Gober, 10 Vet. App. 488, 495 (1997). Establishing direct service connection for a disability that was not clearly present in service requires the existence of a current disability and a relationship or connection between that disability and a disease contracted or an injury sustained during service. Cuevas v. Principi, 3 Vet. App. 542 (1992); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). For secondary service connection claims, competent evidence linking the claimed condition to a service connected disability must be presented. Moreover, establishing a well-grounded claim for service connection requires evidence relevant to the requirements for service connection cited above and of sufficient weight to make the claim plausible and capable of substantiation. Tirpak v. Derwinski, 2 Vet. App. 609 (1992); see also Murphy, 1 Vet. App. at 81. The kind of evidence needed to make a claim well grounded depends upon the types of issues presented by the claim. Grottveit v. Brown, 5 Vet. App. 91, 92-93 (1993). For some factual issues, competent lay evidence may be sufficient. However, where the claim involves issues of medical fact, such as medical causation or medical diagnoses, competent medical evidence is required. Grottveit, 5 Vet. App. at 93. The appellant testified before the Board in November 1999. He contended that his service connected panic disorder caused hypertension and severe headaches. His blood pressure always went up when he was having a panic attack and over the years it started staying up and his doctors put him on medication for it. His blood pressure readings fluctuate on a daily basis, but get so high during a panic attack that the blood vessels in his eyes burst. He has headaches on a daily basis and with the panic attacks the headaches get very severe. A headache disorder or hypertension was not identified in service. In an enlistment examination in November 1988 the appellant denied frequent or severe headaches or high blood pressure. In June 1992 when a rule-out diagnosis of anxiety induced shortness of breath was made, his blood pressure was 150/114. On his separation examination in October 1992, his blood pressure was 120/80. The appellant denied frequent or severe headaches. The appellant received treatment for anxiety at the VA Medical Center in March 1993. A VA psychiatric examination was conducted in July 1993. The appellant reported shortness of breath, restlessness, sweating and increased heart rate during a panic attack. Panic disorder without agoraphobia was diagnosed. On general medical examination, the appellant reported occasional headaches that he related to his breathing problem. His blood pressure was 130/84 sitting and 120/76 reclining. In March 1994 he was seen for a complaint of headache accompanied by abdominal cramps. He appeared acutely ill. His blood pressure was 152/88. Viral gastroenteritis was diagnosed. The appellant was admitted to the VA Medical Center in September 1994 for a complaint of panic attacks. He reported tightness in his chest with shortness of breath. He did not report headache. During the course of his hospitalization he was started on antihypertensive medication. His discharge diagnoses included panic disorder and possible essential hypertension. In May 1996 he was seen for a complaint of headache. He reported being very stressed before the headache began. His blood pressure was 177/97. His clinical examination was unremarkable except for mild hypertension (during attack). An acute anxiety attack was diagnosed. The appellant was admitted for treatment of alcohol dependence in December 1997. His blood pressure was 120/74. The appellant did not report headaches. He was diagnosed with alcohol dependence, panic disorder by history and hypertension. In January 1998 treatment records the appellant's blood pressure was 154/108. He reported that he had not taken his blood pressure medication for 3 days as he had wanted to determine if he needed it. Hypertension and a history of a panic disorder were diagnosed. In April 1998 the appellant reported experiencing headaches with his panic attacks and that the frequency of the attacks had increased. He had hypertension and had self-discontinued his antihypertensive medications but had to resume taking them due to persistent blood pressure elevation. In a later April 1998 note, his blood pressure was 150/100. His headaches had decreased with medication. Hypertension was diagnosed. In June 1998 treatment records, his blood pressure was 147/98. The appellant indicated he felt strongly that his anxiety attacks had a bearing on his blood pressure control. The examiner did not comment. Later in June 1998 he was seen for treatment of hypertension, anxiety and alcohol dependence. He denied significant headache. He was seen again in June for complaints of chest tightness, arm numbness and headache. His blood pressure was 152/104. Anxiety was diagnosed. In July 1998 his blood pressure was 126/88. He reported that headache, dizziness and blurred vision occurred with the anxiety attacks. A computed tomography scan of his head was normal. His blood pressure was said to be normal with compliance on his medications. Anxiety disorder, alcohol dependence and hypertension were diagnosed. On October 6, 1998 a panic attack and hypertension were diagnosed. On October 8, 1998 his blood pressure was 160/106 and the appellant admitted to not taking his medications at all. He denied headaches. Anxiety disorder, dysthymia and hypertension with noncompliance were diagnosed. On October 9th his blood pressure remained elevated and he reported feeling better. His blood pressure was 122/74 in November 1998 with consistent compliance with his medication regime. He reported that he had no headaches. A VA examination was conducted in December 1998. The appellant reported elevated blood pressure readings associated with his panic attacks. Hypertension was diagnosed. The examiner opined that his panic attacks did not cause hypertension. His blood pressure might be elevated during a panic attack which was a normal response to fight or flight. In this case, it is not contended nor is there any evidence that connects the appellant's current hypertension or headaches to disease or injury during service. Neither hypertension nor a headache disorder was identified in service and no competent examiner has linked these conditions to service. The claim for service connection for hypertension or a headache disorder on a direct basis is not well grounded. Similarly, there is no competent evidence of hypertension to a compensable degree of 10 percent within 1 year of separation from service. Rather, the appellant claims that his service-connected panic disorder has led to the development of hypertension and headaches, or that he exhibits hypertension and headaches during panic attacks. Service connection may be granted for a disability which is proximately due to and the result of a service-connected disease or injury. In a secondary service connection claim, the question centers on the relationship of one condition to another. Such a relationship is not susceptible to informed lay observation and thus, for there to be credible evidence of such a relationship, medical evidence is required. See, e.g., Reiber v. Brown, 7 Vet. App. 513, 516 (1995). An appellant's own conclusion, stated in support of his claim, that his present disability is secondary to his service-connected disability is not competent evidence as to the issue of medical causation. The evidence that a current disease is connected to a service- connected disability must come from a physician or other trained medical source. Grivois v. Brown, 6 Vet. App. 136 (1994). Further, any additional impairment of earning capacity resulting from an already service-connected condition, regardless of whether or not the additional impairment is itself a separate disease or injury caused by the service connected condition, shall be compensated. Thus when aggravation of a nonservice-connected condition is proximately due to or the result of a service connected condition, such veteran shall be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. Allen, 7 Vet. App. at 439, 448. This is clearly a question of the interaction of disabilities and presents a medical question requiring evidence from a trained medical source. Grottveit, 5 Vet. App. at 93. a. Hypertension In this case, there is evidence of a current disability. Hypertension was first identified and treated in September 1994. The appellant is service connected for panic disorder. However, the claim is not well grounded because there is no evidence from a competent source which demonstrates that hypertension is due to or the result of the panic disorder. Furthermore, no competent source has stated that hypertension is aggravated in any degree by the panic disorder. The Board has noted the March 1996 statement that the appellant exhibited mild hypertension during an acute anxiety attack. However, this is not the equivalent of medical evidence linking the two, but merely an observation of concurrent findings. The Board's conclusion in this regard is supported by the VA examination in December 1998 which concluded that the appellant's panic attacks did not cause hypertension and an elevated blood pressure reading during a panic attack was normal. Consequently, lacking a competent medical opinion that either states that hypertension is proximately due to service connected panic disorder or that service connected panic disorder aggravates hypertension, the claim is not well grounded. b. Headaches Although there are documented complaints of headaches that are associated with complaints of panic attacks, no competent evidence of a headache disease or injury has been presented. No headache disorder has been diagnosed either alone or secondary to panic disorder. A service-connection claim generally must be accompanied by evidence that establishes that the claimant currently has the claimed disability. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). A medical examination or other medical evidence that shows that the veteran currently has a claimed disability is a fundamental prerequisite for establishing service connection, either on a direct basis or secondary basis. Pain alone, without a diagnosed or identifiable underlying malady or condition, does not in and of itself constitute a disability for which service connection may be granted. Sanchez-Benitez v. West, No. 97-1948 (U.S. Vet. App. Dec. 1999). No evidence has been presented showing that a headache disorder was proximately caused by panic attacks or that service connected panic disorder aggravates a nonservice connected headache disorder. At this time, the evidence reflects that the veteran has complained of headaches. However, there is no competent evidence that there is underlying disease or injury producing headache and there is no competent evidence that links the complaints of headache to service-connected disability. Consequently the claim is not well grounded. Additional Considerations The service personnel records show service in Southwest Asia, however there is no evidence that the appellant served in combat, therefore the provisions of 38 U.S.C.A. § 1154 (West 1991) do not apply. Regardless, since the veteran has not claimed an inservice onset, the provisions of section 1154 are not applicable. During the videoconference, the appellant and his representative were advised to submit evidence linking hypertension and headaches to his service connected disability. The appellant alleged that there was additional information and he was informed to submit that evidence. The file was held open for 60 days. No additional evidence was submitted. The Board's actions at the time of the videoconference in addition to the Statement of the Case issued by the RO in March 1999 fulfilled VA's duty in accordance with 38 U.S.C.A. 5103 (West 1991) and complied with 38 C.F.R. § 3.103 (1999). When the veteran has not met the burden of submitting a well grounded claim, VA has no further duty to assist him in developing facts pertinent to his claim, including no duty to provide him with another medical examination. See Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992); Robinette v. Brown, 8 Vet. App. 69 (1995); Franzen v. Brown, 9 Vet. App. 235 (1996). See also Epps v. Brown, 9 Vet. App. 341 (1996); Wood v. Derwinski, 1 Vet. App. 190 (1991) (VA's duty is just what it states, a duty to assist, not a duty to prove a claim). The Board has considered the doctrine of reasonable doubt and the doctrine of doubt. 38 C.F.R. § 3.102 (1999); 38 U.S.C.A. § 5107(b). However, in this case, without the presence of competent evidence to support the appellant's contentions, there is no approximate balance of positive and negative evidence so as to apply these doctrines. Panic Disorder Service connection was granted for a panic disorder without agoraphobia in August 1993. A noncompensable evaluation was assigned. In October 1994 the evaluation was increased to 10 percent. The claim on appeal stems from a February 1997 rating decision wherein the RO confirmed and continued a 10 percent evaluation for panic disorder. The claim is well grounded. 38 U.S.C.A. § 5107(a) (West 1991). This finding is based on the appellant's contentions that his panic disorder is more disabling than currently evaluated. Proscelle v. Derwinski, 2 Vet. App. 629 (1992). The VA has met its duty to assist the appellant in the development of his claim under 38 U.S.C.A. § 5107 (West 1991). Records were obtained from all identified treatment sources. The appellant offered testimony before the RO and the Board. During the November 1999 videoconference the appellant and his accredited representative stated that they would submit Social Security Administration records to the Board. Both also indicated that they would submit additional VA Medical Center treatment records to support an increased rating. The file was held open for 60 days and no additional evidence was submitted. VA's duty is just what it states, a duty to assist, not a duty to prove a claim, and such a duty does not relieve a claimant entirely from assisting himself. Wood, at 1 Vet. App. 190. The Board instructed the appellant to submit the evidence and this complies with 38 C.F.R. § 3.103 (1999). Disability evaluations are determined by the application of a schedule of rating which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4 (1999). Separate diagnostic codes identify the various disabilities. Consideration of the whole recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2 (1999); Peyton v. Derwinski, 1 Vet. App. 282 (1991). While evaluation of a service-connected disability requires review of the appellant's medical history, where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). Therefore, although the Board has reviewed all the evidence of record, it finds that the most probative evidence is that which has been developed immediately prior to and during the pendency of the claim on appeal. When all the evidence is assembled, the determination must then be made as to whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The appellant testified before the RO in December 1998 and before the Board in November 1999. In summary, he testified that his panic attacks had worsened and caused him to lose his job and go on Social Security disability. His symptoms included tightness in his chest, numbness in his left hand with dizziness and headaches. These symptoms had become worse over the previous months and his medication had been changed. He resigned from his full-time job because of his panic disorder in January 1999 and went on major medical leave until May. He was awarded Social Security Administration benefits due to panic disorder. The appellant has been rated under the schedule for rating mental disorders, Diagnostic Code 9410 for unspecified neurosis. See also, Diagnostic Code is 9412 for panic disorder and/or agoraphobia. However the rating criteria under either Diagnostic Code are the same. 38 C.F.R. § 4.130 (1999). With total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name, a 100 percent evaluation is warranted. With 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, a 70 percent evaluation is warranted. With 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 50 percent evaluation is warranted. With 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), a 30 percent evaluation is warranted. With occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication, a 10 percent evaluation is warranted. When a mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication, a noncompensable evaluation is assigned. The appellant was seen for a panic attack in March 1996. A stomach ache had precipitated this feeling. The appellant was seen for an acute anxiety attack in May 1996. He had been stressed at his job, and felt tightness in his chest, headache and tremulousness. He was unsteady on his feet. In a September 1997 letter, a VA treatment provider indicated that the appellant had a panic disorder. His symptoms were worse when he was under stress, and driving seemed to create a very stressful situation for him. He often had to pull over due to hyperventilation. He was keeping regular appointments and taking medication for this disorder. He was admitted to the VA Medical Center in December 1997 for treatment of alcohol dependence. Panic disorder by history was diagnosed and he was advised to consider individual treatment for panic disorder with agoraphobia after completion of treatment for substance abuse. His Global Assessment of Functioning score was 70-80 currently and for the prior year. In January 1998, he reported experiencing panic attacks on a daily basis, and was coping through relaxation and positive thinking. His antianxiety medications were renewed. In April 1998 he reported daily panic attacks that varied in their intensity. He had some degree of anxiety every day. The attacks might not be precipitated by an event or a thought. He reported headache, dizziness, and blurred vision with the panic attacks and he had to sit down or brace himself. The frequency of the attacks had increased, but were less severe with the addition of a new medication. There had been no unusual stressors in recent weeks or months. A new medication was added and later in April he reported positive results with less anxiety and increased rest and sleep. In June 1998 he reported continuous stress on the job, a certain amount of anxiety daily, and severe anxiety attacks 2 to 3 times per week. Interstate driving and staying in constant fear of having an anxiety attack precipitated an anxiety attack. Later in June the attacks continued. He reported a 1-year history of intermittent dizziness and second-long blurred vision that might occur during or after an anxiety attack. In July 1998 the appellant requested a 3 to 4 day work excuse due to anxiety. There had been no increase in the frequency of the attacks but some were worse. He was overcome with fear and anxiety that precipitated shortness of breath. He had an attack just as he was getting ready to go to work on a night shift as a security office. When he attempted to call in sick he was told to take leave without pay. He felt a few days off would help. His work excuse was written by the provider. In July 1998 he reported an improved mood and less anxiety after a few days off work. The transfer of a difficult employee had also helped. He had no recurrence of dizziness, headache or blurred vision. On October 6, 1998, the appellant reported a 3-day recurrence of a panic episode. He had tightness in his chest and noticed red eyes. On October 8th, he had a co-worker drive him to the VA Medical Center after the onset of a severe panic attack at work. His symptoms had begun approximately 2 hours prior to his visit and worsened during his effort to call for an appointment while attending a staff meeting. He became extremely dizzy, overwhelmed with an anxious feeling and pressure in his chest. He had no headache, shortness of breath, diaphoresis, nausea, vomiting or blurred vision. The symptoms persisted currently. Intramuscular medication was administered and the appellant later reported feeling much better with decreased anxiety and pressure in his chest. On the 9th he reported feeling better. In November 1998 he reported he was doing better on a drug therapy combination. He was working a night shift. His anxiety attacks were less frequent and intense. He felt the episodes were provoked by stress from his supervisory role at work but would not consider stepping down secondary to the loss of money. He was alert and oriented to person, place, time and things. His speech was clear and relevant. His affect and mood were pleasant and appropriate. A VA psychiatric examination was conducted in January 1999. He reported chronic panic attacks. He could not drive on the interstate without pulling over. He got out of a lot of tasks at work due to panic and headaches. He was nervous all of the time but had extreme attacks 7 to 8 times a week. He was employed 40 hours per week as a security guard at a prison. His most recent attack had occurred on the way to the appointment. He was driving alone. On examination he was well developed, well nourished, appropriately dressed and adequately groomed. He had no unusual motor activity. His speech was spontaneous, and fluent without flight of ideas or looseness of association. His mood was euthymic and his affect appropriate. He denied hallucinations and expressed no identifiable delusions. He denied suicidal or homicidal ideation. He was precisely oriented to person, place, situation and time. His remote, recent, and immediate recall were good. His judgment and abstracting ability were adequate and his insight was fair. The claims folder was examined. The examiner opined that the appellant was mildly to moderately impaired in his ability to sustain gainful activity, to concentrate, to relate to co-workers, to receive supervision or to adapt to changes at work. Panic disorder with agoraphobia was diagnosed. His Global Assessment of Functioning score was 70. Lay statements were submitted by a friend and the mother of the appellant. His friend stated that although he did know anything about the appellant's illness, on many occasions while driving with the appellant he would notice trembling and gasping for air. The appellant would have to pull over to let the friend drive. Whatever the illness was it seemed to be a constant problem for the appellant. The appellant's mother stated that the illness made him complain about tightness in his chest and trouble breathing. On several occasions she had to rush him to the emergency room as she feared she was having a heart attack. She had noticed him avoiding certain places and activities in an effort to cope with his problems. The appellant submitted employment records in support of his claim. In May 1998 he received written counseling for failure to report for a mandatory staff meeting scheduled for May 26th. The appellant attached a written statement that indicated he had missed this meeting due to a panic attack. Documentation of 5 days of sick leave requests in June and July 1998 were submitted. A U. S. Department of Labor certificate under the Family and Medical Leave Act was submitted. It was signed in January 1999 by a Family Nurse Practitioner who indicated that the diagnosis was panic/anxiety disorder. The certificate further indicated that hospitalization was not required, that the employee was not unable to perform work of any kind, but that at that time the employee was unable to perform the functions of his position. Paid family medical leave was approved from January to March 1999. The appellant received a citation in February 1999 for careless driving. After review of all of the evidence, the Board is of the opinion that the evidence supports a 30 percent evaluation for panic disorder. Although the appellant has been on medication during the pendency of this appeal, he has been seen on multiple occasions for acute anxiety attacks. Furthermore, the evidence demonstrates that his symptoms have sometimes made him unable to perform at his job. Therefore, the Board concludes that his symptoms are not controlled by continuous medication and amount to more than a decrease in his ability to perform at work, so that an evaluation is excess of 10 percent is warranted. His primary symptoms of panic attacks and anxiety have created intermittent periods of inability to perform occupational tasks. There is evidence that paid family medical leave was granted to the appellant from January to March 1999 due to panic and anxiety that led to an inability to perform his job. He was granted a work excuse in July 1998 due to anxiety. The evidence on examination in January 1999 was that he was otherwise generally functioning satisfactorily with routine behavior, self-care and conversation normal. Therefore, a 30 percent evaluation is warranted. The preponderance of the evidence is against a higher evaluation. Flattened affect, speech disturbances, difficulty in understanding commands, memory impairment, impaired judgment or thinking, mood disturbances or difficulty establishing work or social relationships are not of record. There have been multiple assertions by the appellant that have been documented in the record that he has daily panic attacks or that at least his panic attacks occur more than once a week. The appellant is competent to report the frequency of his symptomatology. However, a bare transcription of a lay history is not transformed into competent medical evidence merely because the transcriber happens to be a medical professional. LeShore v. Brown, 8 Vet. App. 406, 409 (1995). Therefore, there is no competent evidence that what he has reported as a daily panic attack would rise to the level of what a medical professional would consider to be a panic attack. Additionally, even if the Board concludes that panic attacks do occur more than once a week, this evidence alone without competent evidence of any other impairments is insufficient to warrant a higher evaluation. It is not expected that all cases would show all the findings specified, and the Board is not requiring that the evidence demonstrate all of the listed criteria in order to warrant a 50 percent criteria. 38 C.F.R. § 4.21 (1999). However, without evidence of other symptomatology as described in the rating criteria that is indicative of further impairment, the preponderance of the evidence is against the higher evaluation. Furthermore, a competent medical examiner in January 1999 described his impairment as mild to moderate. The training and experience of the medical personnel makes their findings more probative as to the extent of the disability when balanced against the assertions of the appellant in this case. The Board has examined the other lay statements and finds that they lack the specificity or evidence of medical expertise that would warrant the assignment of a higher evaluation. The sick slips do not reference panic attacks, and the citation for careless driving gives no indication that this was due to a panic attack. The Board has also considered that in sworn testimony the appellant has asserted that he resigned his job due to his panic disorder and that the Social Security Administration has found him disabled due to the condition. No further evidence in this regard was submitted, and his allegation that he resigned due to panic disorder is not competent evidence that he cannot work due to panic disorder. In other words, there is no evidence from his employer that he was fired or asked to resign due to panic disorder or medical evidence of such a recommendation. There is no confirmation from the Social Security Administration either. The appellant's testimony alone is not competent evidence of total occupational impairment which would warrant a higher evaluation. The fact that the appellant does not work is not competent evidence that he cannot work. The Board's conclusion is further supported by a Global Assessment of Functioning score of 70-80 which was noted at the conclusion of his December 1997 hospitalization and score of 70 which was noted in the January 1999 VA examination. Although the Global Assessment of Functioning score does not fit neatly into the rating criteria, the Global Assessment of Functioning score is also evidence. Carpenter v. Brown, 8 Vet. App. 240 (1995). Global Assessment of Functioning score is a scale reflecting the "psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness." DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS 32 (4th ed. 1994). A Global Assessment of Functioning score of 70 is defined as exhibiting some mild symptoms (e.g., depressed mood and mild insomnia) OR some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships. A score of 80 represents a case where if symptoms are present, they are transient and expectable reactions to psychosocial stressors with no more than slight impairment in social, occupational, or school functioning. Since the higher score was recorded at the conclusion of treatment for the appellant's alcohol addiction and not the panic disorder, the Board finds the score of 70 more probative on the issue of how the appellant functions with regard to his panic disorder. A score of 70 represents occasional occupational impairment and does not support a 50 percent evaluation. Against this background is a checkmark on a preprinted form executed by a nurse practitioner. Although the document is evidence, there is a remarkable absence of findings to support any conclusion reached. The Board concludes that the VA records, covering extensive periods of time and supported by clinical findings, are more probative than an "X" mark on a preprinted form. The preponderance of the evidence is against the higher evaluation and there is no doubt to be resolved. 38 U.S.C.A. § 5107(b), Gilbert v. Derwinski, 1 Vet. App. 49 53 (1990). The appellant has raised the issue of unemployability. The claim for total rating for compensation based on individual unemployability was referred to the RO above. He is currently service connected for a panic disorder, for which a 30 percent evaluation was granted above, and for status post left bunionectomy that is assigned a noncompensable evaluation. Based on his testimony, the Board assumes that his claim is that he believes he is unemployable due to his service connected psychiatric disability alone. The Board notes that the rating criteria for rating mental disorders includes consideration of total occupational impairment which warrants a 100 percent evaluation. Therefore the Board has already considered the issue of the appellant's unemployability when considering the impairment imposed by his panic disorder. As explained previously, the evidence of record does not demonstrate unemployability. ORDER Service connection for hypertension is denied. Service connection for a headache disorder is denied. A 30 percent evaluation for panic disorder is granted, subject to the controlling regulations applicable to the payment of monetary awards. H. N. SCHWARTZ Member, Board of Veterans' Appeals