BVA9502184 DOCKET NO. 93-05 046 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Chicago, Illinois THE ISSUES 1. Entitlement to an increased disability rating for anxiety disorder with history of psychophysiological gastrointestinal reaction, currently evaluated 30 percent disabling. 2. Entitlement to an increased disability rating for a duodenal ulcer, currently evaluated 20 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD J. F. Gussio, Associate Counsel INTRODUCTION The veteran had active military service from July 1944 to August 1945. This appeal to the Board of Veterans' Appeals (Board) arises from a December 1990 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Chicago, Illinois. CONTENTION OF APPELLANT ON APPEAL The veteran contends that his service-connected nervous disorder and duodenal ulcer have increased in severity and warrant higher ratings. He claims that he cannot sleep at night and has constant gas and pain. He reports that he takes medication for his ulcer. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against the veteran's claims for increased ratings for his service-connected anxiety disorder and duodenal ulcer. 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 anxiety disorder is principally manifested by some generalized anxiety with somatic complaints. 3. The veteran's anxiety disorder does not cause considerable impairment in his ability to establish or maintain effective and wholesome relationships with people or psychoneurotic symptoms resulting in such reductions in initiative, flexibility, efficiency and reliability levels so as to produce considerable industrial impairment. 4. The veteran's service-connected duodenal ulcer is not manifested by weight loss, or recurrent incapacitating episodes averaging 10 days or more in duration at least four or more times a year. CONCLUSIONS OF LAW 1. The requirements for an increased disability rating for the veteran's service-connected anxiety disorder have not been met. 38 U.S.C.A. §§ 1155, 5107(b) (West 1991); 38 C.F.R. Part 4, Diagnostic Code 9400 (1993). 2. The requirements for an increased disability rating for a duodenal ulcer have not been met. 38 U. S.C.A. §§ 1155, 5107(b) (West 1991); 38 C.F.R. Part 4, Diagnostic Code 7305 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The veteran's claims are well grounded within the meaning of 38 U.S.C.A. § 5107(a) (1991). That is, he has presented claims which are plausible. The Board is satisfied that all relevant facts have been properly developed. No further assistance to the veteran is required in order to comply with the duty to assist him as mandated by 38 U.S.C.A. § 5107(a) (West 1991). Disability evaluations, in general, are intended to compensate for the average impairment of earning capacity resulting from service-connected disability. They are primarily determined by comparing objective clinical findings with the criteria set forth in the rating schedule. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4, (1993). Separate diagnostic codes identify the various disabilities. I. Entitlement to an Increased Disability Rating for Anxiety Disorder. The service medical records reveal that a neurosis was first manifest in service. On the examination in July 1945 prior to separation, gastritic neurosis was noted. On VA examination in June 1946, the diagnosis was psychoneurosis, conversion hysteria. Service connection for psychoneurosis, conversion type was established effective August 1945, and assigned a 10 percent rating at that time. On VA examination in July 1948, the veteran complained of nervousness and tenseness regarding his gastrointestinal systems. The pertinent diagnosis was psychoneurosis, conversion type, hysteria. On special VA neuropsychiatric examination in July 1953, he reported that he had not received psychiatric treatment since the last VA examination. Anxiety reaction was diagnosed. In February 1966, the RO increased the veteran's disability rating for his service-connected nervous disorder to 30 percent. The 30 percent evaluation has been in effect since that time and is protected. 38 U.S.C.A. § 110 (West 1991); 38 C.F.R. § 3.951(b) (1993). On VA examination in March 1970, the veteran reported that he had been married since August 1944 and had 8 children. He reported that he had worked for the VA for over 25 years and had not been evaluated by a psychiatric clinic nor had he been treated at the mental health clinic. He reported that he had many friends, that he attended church regularly, and that he had a good relationship with his wife. He reported that he had been nervous since World War II and could not sleep at night because of his stomach troubles. The diagnosis was hysterical neurosis, conversion type. On VA examination in May 1976, the veteran complained of chronic nervousness with many aches and pains. The pertinent impression was mild anxiety reaction with psycho-physiological features, acute and chronic. When the veteran was examined by the VA in June 1991, he reported that he was still married and that he had retired from the VA in 1975 after working there since 1946. His complaints were associated with his stomach disorder. The mental status examination was negative. His judgment and memory were normal. The pertinent diagnosis was generalized anxiety reaction, in remission. At the personal hearing before the RO in January 1992, the veteran testified to the effect that his nervous disorder had increased in severity over the years and that he attended group therapy monthly for his nervousness. A 30 percent evaluation is warranted for an anxiety neurosis (generalized anxiety disorder) when there is definite impairment in the ability to establish or maintain effective and wholesome relationships with people and when psychoneurotic symptoms result in such reductions in initiative, flexibility, efficiency and reliability levels as to produce definite industrial impairment. A 50 percent disability evaluation requires that the ability to establish or maintain effective or favorable relationships with people be considerably impaired and that reliability, flexibility, and efficiency levels be so reduced by reason of psychoneurotic symptoms as to result in considerable industrial impairment. A 70 percent disability evaluation requires severe impairment of social and industrial adaptability. 38 C.F.R. § 4.132, Code 9400 (1993). The evidence as outlined above reflects that the veteran has maintained a marriage since August 1944 and has helped raise 8 children. He worked at the VA for over 25 years until his retirement. He has a good relationship with his wife and has many friends. He attends church regularly, but does not attend social functions due to preference. On the most recent VA evaluation in June 1991, his mental evaluation was normal. His memory and judgment were good. The diagnosis was generalized anxiety disorder, in remission. Accordingly, the record does not support a rating in excess of 30 percent for the veteran's service-connected nervous disorder. In reaching this conclusion, we have reviewed the entire clinical history of the veteran's nervous disorder, including the veteran's testimony to the effect that his service-connected nervous disorder has increased in severity over the years. 38 C.F.R. §§ 4.129, 4.130. It is significant that, although the veteran is not now employed, he maintained employment for more than 25 years prior to his retirement. Likewise, he has maintained a marriage since the 1940's. Furthermore, he has not required hospital treatment for psychiatric symptoms since his release from service. He has been treated with group therapy. Additionally, VA examinations have consistently shown that the veteran is alert, well oriented, and more concerned with somatic complaints than with emotional distress. These facts indicate that the psychiatric disability is not productive of such impairment of reliability, flexibility, and efficiency levels as to result in considerable social or industrial impairment. Accordingly, a higher evaluation is not warranted. II. Entitlement to an Increased Disability Rating for Duodenal Ulcer. Service connection for a duodenal ulcer was established effective August 1945. The service medical records reveal that the veteran was treated for complaints of stomach trouble. On the examination in July 1945 prior to discharge, the veteran reported a history of stomach trouble all his life. On VA examination in June 1946, the veteran weighed 168 pounds. A duodenal ulcer was diagnosed. On VA examination in June 1948, X-ray revealed hypersecretory stomach with considerable spasm without evidence of wall lesion. The impression was irritable duodenal bulb, without evidence of an ulcer. On VA examination in July 1953, X-rays revealed residual scarring of duodenal bulb, secondary to an old ulcer. When the veteran was examined by the VA in January 1966, he complained of epigastric discomfort. Clinical evaluation revealed no evidence of a duodenal ulcer. When the veteran was hospitalized in July 1966, it was noted that he was treated for various complaints including chronic duodenal ulcer disease. Clinical evaluation revealed the GI examination was essentially negative, except for considerable deformity of the duodenal bulb without active ulcer. The pertinent diagnosis was chronic duodenal ulcer disease. When the veteran was hospitalized by the VA from September to November 1966 for various complaints including nausea, abdominal pain and vomiting, clinical testing was positive for duodenal ulcer. The veteran was prescribed a diet and given medication. The diagnosis was chronic active duodenal ulcer. VA hospital summary dated in January 1984 revealed that the veteran was hospitalized for various complaints, including abdominal pain. An upper GI endoscopy revealed deformity of the duodenal bulb, but no active ulcer. The diagnosis was abdominal pain secondary to hiatus hernia, gastritis. VA outpatient and hospital treatment records in June 1991 reveal that he was seen for various complaints, including epigastric pain. He was taking Tagamet and Maalox for stomach complaints. Colonoscopy and endoscopy revealed gastritis in the abdomen and a possible ulcer at the duodenal bulb. In the VA hospital discharge summary, it was noted that no ulcers were seen and gastritis was noted. On the VA examination in June 1991, the physician noted that the veteran had been recently discharged from the hospital with documented peptic ulcer disease and gastrointestinal bleeding resulting in anemia. Clinical evaluation revealed that the veteran weighed 240 pounds. The veteran denied nausea and vomiting. The abdomen was soft, globular, nontender. There were no palpable masses, scars, bruits, or organomegaly with normal peristalsis. The diagnosis was chronic peptic ulcer disease. The prognosis was fair with continuing treatment. In September 1991, the RO informed the examining VA physician by memorandum that VA examination report and hospitalization records of June 1991 presented a contradictory picture as to whether the veteran actually had an active duodenal ulcer. In reply, it was noted that, although an ulcer was not actually seen, but was suspected because of edema and stricture of the pylorus. In October 1991, the RO increased the disability rating for the veteran's service-connected duodenal ulcer to 20 percent. At the personal hearing in January 1992, the veteran testified that his ulcer condition had progressively worsened over the years; that he had abdominal pain for which he took Maalox; that he experienced nausea four times a week and vomited once in a while; and that he had alternating periods of diarrhea and constipation weekly. A 20 percent evaluation requires a moderate duodenal ulcer with recurring episodes of severe symptoms two or three times a year averaging 10 days in duration or with continuous moderate manifestations. A 40 percent disability evaluation is warranted for a duodenal ulcer which is less than severe but with impairment of health manifested by anemia and weight loss; or recurrent incapacitating episodes averaging 10 days or more in duration at least four or more times a year. 38 C.F.R. Part 4, Diagnostic Code 7305. To obtain the higher (40 percent) disability evaluation for his service-connected duodenal ulcer, the medical evidence would have to show an active duodenal ulcer, less than severe, with impairment of health manifested by anemia and weight loss, or recurrent incapacitating episodes averaging 10 days or more in duration at least four or more times a year. The veteran's medical history revealed that he has been treated with medication since separation for service for epigastric pains. Multiple VA examinations and hospital treatment records revealed no active duodenal ulcer. Most recently, in June 1991, he was hospitalized for complaints of epigastric pain. Although an active duodenal ulcer was not seen on examination, a duodenal ulcer was assumed to be present because of edema and pyloric stricture. While the veteran's complaints of epigastric pain and anemia were noted on the most recent VA examination in June 1991, his disability picture did not include evidence of weight loss. If fact, the veteran has gained weight on a steady basis since his discharge from service. It is also recognized that the veteran has been hospitalized on occasion in the past for various complaints, including epigastric pain. The record, however, does not contain evidence of recurrent incapacitating episodes averaging 10 days or more in duration at least four or more times a year for his service- connected duodenal ulcer. Accordingly, the evidence does not support the higher 40 percent disability evaluation for the veteran's service-connected duodenal ulcer. Pertaining to both disabilities on appeal, consideration has also been given to the potential application of the various provisions of 38 C.F.R. Parts 3 and 4, whether or not they were raised by the veteran, as required by Schafrath v. Derwinski, 1 Vet.App. 589 (1991). In particular, we find that the evidence discussed above does not suggest that the veteran's service-connected nervous disorder and duodenal ulcer present such an exceptional or unusual disability picture as to render impractical the application of the regular scheduler standards so as to warrant an assignment of an extraschedular evaluation under 38 C.F.R. § 3.321(b)(1). For example, the disabilities did not recently require frequent periods of hospitalization, nor does it present marked interference with employment that has not already been contemplated by the current evaluation. ORDER An increased disability rating for the veteran's service- connected anxiety disorder is denied. An increased disability rating for the veteran's service- connected duodenal ulcer is denied. V. L. JORDAN Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.