Citation Nr: 1237652 Decision Date: 11/02/12 Archive Date: 11/09/12 DOCKET NO. 94-31 828A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in San Juan, the Commonwealth of Puerto Rico THE ISSUE Entitlement to an effective date earlier than April 8, 2003, for the assignment of a total disability rating for compensation purposes based on individual unemployability. REPRESENTATION Appellant represented by: Public Advocates of Veterans Affairs ATTORNEY FOR THE BOARD David S. Ames, Counsel INTRODUCTION The Veteran served on active duty from February 10, 1955, to March 4, 1955. This matter comes properly before the Board of Veterans' Appeals (Board) on appeal from a rating decision by the Department of Veterans Affairs (VA) Regional Office in San Juan, the Commonwealth of Puerto Rico (RO). In April 2007, the Board denied the Veteran's claim. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims, and pursuant to a Joint Motion for Remand, a January 2009 Order vacated the Board's decision and remanded the matter for compliance with the instructions in the Joint Motion for Remand. This case was remanded by the Board in January 2011 for additional development. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). FINDING OF FACT The preponderance of the evidence of record shows that the Veteran was not prevented him from securing or following a substantially gainful occupation by reason of his schizophrenia and psoriasis prior to April 8, 2003. CONCLUSION OF LAW The criteria for an effective date earlier than April 8, 2003, for the grant of total disability rating for compensation purposes based on individual unemployability (TDIU) have not been met. 38 U.S.C.A. §§ 5103A, 5107, 5110 (West 2002); 38 C.F.R. §§ 3.340, 3.400, 4.16 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION Upon receipt of a substantially complete application, VA must notify the claimant and any representative of any information, medical evidence, or lay evidence not previously provided to VA that is necessary to substantiate the claim. The notice must: (1) inform the claimant about the information and evidence not of record that is necessary to substantiate the claim; (2) inform the claimant about the information and evidence that VA will seek to provide; and (3) inform the claimant about the information and evidence the claimant is expected to provide. 38 U.S.C.A. §§ 5103, 5103A, 5107 (West 2002 & Supp. 2011); 38 C.F.R. § 3.159 (2012); Pelegrini v. Principi, 18 Vet. App. 112 (2004). If VA does not provide adequate notice of any element necessary to substantiate the claim, or there is any deficiency in the timing of the notice, the burden is on the claimant to show that prejudice resulted from a notice error, rather than on VA to rebut presumed prejudice. Shinseki v. Sanders, 129 S. Ct. 1696 (2009). The Board finds that any defect with regard to the timing or content of the notice to the Veteran is harmless because of the thorough and informative notices provided throughout the adjudication and because the Veteran had a meaningful opportunity to participate effectively in the processing of the claim with an adjudication of the claim by the RO subsequent to receipt of the required notice. The record does not show prejudice to the Veteran, and the Board finds that any defect in the timing or content of the notices has not affected the fairness of the adjudication. Mayfield v. Nicholson, 19 Vet. App. 103 (2005); Dingess v. Nicholson, 19 Vet. App. 473 (2006). Specifically, the Veteran was notified in letters dated in March 2001 and May 2004; rating decisions in April 1994, April 1996, June 2004, and January 2011; a statement of the case in August 1994; and supplemental statements of the case in September 2000, July 2001, July 2004. That notice was followed by readjudication of the claim in a June 2012 supplemental statement of the case. The Veteran has neither alleged nor demonstrated any prejudice with regard to the content or timing of the notice provided. Shinseki v. Sanders, 129 S. Ct. 1696 (2009) (burden of showing that an error is harmful or prejudicial falls upon the party attacking the agency determination); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). The Board considers it significant that the subsequent statements made by the Veteran and his representative suggest actual knowledge of the elements necessary to substantiate the claim. Dalton v. Nicholson, 21 Vet. App. 23 (2007) (actual knowledge is established by statements or actions by the claimant or the claimant's representative that demonstrate an awareness of what is necessary to substantiate a claim). Thus, VA has satisfied its duty to notify the Veteran and had satisfied that duty prior to the adjudication in the supplemental statement of the case. Overton v. Nicholson, 20 Vet. App. 427 (2006) (Veteran afforded a meaningful opportunity to participate effectively in adjudication of claim, and therefore notice error was harmless). The Board also finds that the duty to assist requirements have been fulfilled. All relevant, identified, and available evidence has been obtained, and VA has notified the Veteran of any evidence that could not be obtained. The Veteran has not referred to any additional, unobtained, relevant, available evidence. VA has obtained an examination with respect to the claim. Thus, the Board finds that VA has satisfied the duty to assist provisions of law. No further notice or assistance to the Veteran is required to fulfill VA's duty to assist him in development. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Generally, the effective date of a rating and award of compensation for an increased rating is the later of the date of receipt of the claim or the date entitlement arose. 38 U.S.C.A. § 5110(a) (West 2002); 38 C.F.R. § 3.400(o)(1) (2012). A claim is a formal or informal communication in writing requesting a determination of entitlement, or evidencing a belief in entitlement, to a benefit. 38 C.F.R. § 3.1(p) (2012). An informal claim is a communication or action indicating intent to apply for one or more benefits. 38 C.F.R. § 3.155(a) (2012). VA must look to all communications from a claimant that may be interpreted as applications or claims, formal or informal, for benefits and is required to identify and act on informal claims for benefits. Servello v. Derwinski, 3 Vet. App. 196 (1992). In some cases, a report of examination or hospitalization may be accepted as an informal claim for benefits. 38 C.F.R. § 3.157(b) (2012). The date of outpatient or hospital examination or date of admission to a VA hospital will be accepted as the date of receipt of a claim when such reports relate to examination or treatment of a disability for which service-connection has previously been established or when a claim specifying the benefit sought is received within one year from the date of such examination, treatment or hospital admission. 38 C.F.R. § 3.157(b) (2012). An exception to the general rule applies where evidence demonstrates that a factually ascertainable increase in disability occurred within the one-year period preceding the date of receipt of the claim for increased compensation. 38 U.S.C.A. § 5110(b)(2) (West 2002); 38 C.F.R. § 3.400(o)(2) (2012); Harper v. Brown, 10 Vet. App. 125 (1997). The question of when an increase in disability is factually ascertainable is based on the evidence in the Veteran's claims folder. Quarles v. Derwinski, 3 Vet. App. 129 (1992). In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2 (2012). Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of any disability present. 38 C.F.R. §§ 4.2, 4.2 (2012). The Veteran claims entitlement to an effective date earlier than April 8, 2003, for the grant of TDIU. Total disability is considered to exist when there is any impairment which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340(a)(1) (2012). A total disability rating for compensation purposes may be assigned on the basis of individual unemployability when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16(a) (2012). If there is only one service-connected disability, it must be rated at 60 percent or more. If there are two or more service-connected disabilities, at least one disability must be rated at 40 percent or more, and additional disability must bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a) (2012). Individual unemployability must be determined without regard to any nonservice-connected disabilities or the Veteran's advancing age. 38 C.F.R. §§ 3.341(a), 4.19 (2012); Van Hoose v. Brown, 4 Vet. App. 361 (1993). Where the percentage requirements are not met, entitlement to TDIU may be considered when the Veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities, with consideration of the Veteran's background, including his employment and educational history. 38 C.F.R. §4.16(b) (2012). The Board does not have the authority to assign an total disability rating for compensation purposes based on individual unemployability pursuant to 38 C.F.R. § 4.16(b) in the first instance. Bowling v. Principi, 15 Vet. App. 1 (2001). Under the general rule, the effective date is the later of the date of claim or the date entitlement arose. 38 U.S.C.A. § 5110(a) (West 2002); 38 C.F.R. § 3.400(o)(1) (2012). In this case, the evidence of record shows that the Veteran's claim did not originate directly from a specific claim for TDIU. Instead, the claim of TDIU was inferred as part of the Veteran's claim for an increased initial rating for schizophrenia. That claim itself arose from a claim which eventually resulted in the grant of service connection for a psychiatric disability by the Board in March 1994. The RO previously determined that the date of the claim to reopen a previously denied claim of entitlement to service connection for a psychiatric disorder is May 9, 1989. The Board notes that date precedes a July 1989 Board decision which denied service connection for a psychiatric disability. However, the Board shall accept the records received from the Veteran on May 9, 1989, as the origin of his claim for TDIU, as that determination is most favorable to the Veteran. Accordingly, May 9, 1989, is the date of the receipt of the claim. Therefore, the proper effective date for TDIU will be May 9, 1989, or the date entitlement arose, whichever is later. Service connection is currently in effect for (1) schizophrenia, rated 10 percent effective May 9, 1989, 30 percent effective September 7, 2001, 50 percent effective June 3, 2004, and 100 percent effective May 29, 2012; (2) psoriasis associated with schizophrenia, rated 10 percent effective March 23, 1995; (3) psoriatic arthritis of the cervical and lumbar spine, rated 10 percent from April 8, 2003, to May 28, 2012; (4) psoriatic arthritis of the lumbar spine, rated 20 percent effective May 29, 2012; (5) psoriatic arthritis of the cervical spine, rated 10 percent effective May 29, 2012; and (6) six separate 10 percent ratings for psoriatic arthritis of the right wrist, right foot, left hand, left wrist, right hand, and left foot, all effective April 8, 2003. The combined ratings assigned for those disabilities were 10 percent effective May 9, 1989; 20 percent effective March 23, 1995; 40 percent effective September 7, 2001; 70 percent effective April 8, 2003; 90 percent effective June 3, 2004; and 100 percent effective May 29, 2012. Accordingly, the percentage criteria of 38 C.F.R. § 4.16(a) were first met on April 8, 2003. Therefore, under the schedular criteria of 38 C.F.R. § 4.16(a), the effective date for TDIU cannot be earlier than April 8, 2003, as that is the date entitlement arose under the schedular criteria and the provisions of 38 C.F.R. § 4.16(b). That is the currently assigned effective date for TDIU. However, TDIU is warranted under the provisions of 38 C.F.R. § 4.16(b) for veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities and who do not meet the percentage criteria of 38 C.F.R. § 4.16(b). Prior to April 8, 2003, service connection was only in effect for schizophrenia and psoriasis. Accordingly, an effective date prior to April 8, 2003, for TDIU is only warranted if the evidence of record shows that, prior to that date, the Veteran was unable to secure and follow a substantially gainful occupation solely by reason of his service-connected schizophrenia and psoriasis. The Board finds that the preponderance of the evidence of record does not show that the Veteran's service-connected disabilities prevented him from securing or following a substantially gainful occupation prior to April 8, 2003. The evidence of record shows that the Veteran was gainfully employed from approximately 1957 to 1980, but has been unemployed since at least June 15, 1981. The Board notes that a June 1982 Social Security Administration (SSA) decision found that the Veteran became disabled and unable to work due to schizophrenia, effective March 15, 1982. However, that decision is not binding on VA. Holland v. Brown, 6 Vet. App. 443 (1994). While the evidence of record shows that the Veteran has been unemployed since May 9, 1989, the date of his claim, the fact that a veteran is unemployed or has difficulty obtaining employment is not enough to warrant entitlement to TDIU. Van Hoose v. Brown, 4 Vet. App. 361 (1993). The question is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether he can find employment. Prior to the grant of service connection in 1989, several private medical records in 1981 and 1982 related to disability insurance claims indicate that the Veteran was totally disabled. At a VA examination in February 1989, the Veteran complained of anxiety attacks and nightmares that were alleviated with medication. Clinical findings were that the Veteran was alert, oriented times three, and euthymic, although his countenance was serious. His speech was logical, coherent, and relevant. He denied having hallucinations and suicidal or homicidal ideation. The assessment was chronic schizophrenia, undifferentiated type, by history, which was stable. The Veteran was seen for follow-up of medication in April and May 1989. He was euthymic and denied hallucinations and suicidal and homicidal ideations. In May 1989, he was discharged from the VA psychiatric clinic because he was in no acute state and that privileges for long term treatment had expired. He was referred to a state facility. Outpatient progress notes from a state mental health clinic show that the Veteran was seen approximately every two to three months from June 1989 to July 1996. He usually went to the appointments alone. When first seen in June 1989, having been referred by VA, he described having visual and auditory hallucinations. He had complaints of sleep disturbance. At the following appointments he stated that he was feeling better and had fewer visual hallucinations. He was alert, coherent, and oriented times three. At an October 1989 hearing before the Board, the Veteran reported that since he separated from service, he felt like he was a different person mentally. He had trouble holding a conversation and felt he couldn't talk to many people. Private treatment records show that in December 1989, the Veteran reported that he had improved with medication. He no longer had hallucinations. Mentally he seemed stable, his memory seemed integrated, and his speech was normal, coherent, and relevant to the theme. During 1990 he denied visual and auditory hallucinations, ideas of reference, and suicidal or homicidal ideas. He was described as relaxed and in contact. On occasion he reported having insomnia and nightmares. At appointments in 1994, he was described as asymptomatic or stable. In May 1995, he was doing well, sleeping regular and eating well. He denied having bad ideas but mentioned sometimes having suicidal ideas. He looked alert, active, conscious, and oriented times three. In August 1995 and April 1996, he was alert and coherent and also felt anxious. Throughout the period he continued on medication. A medical certificate in May 1990 completed by Dr. L.A.T. for a long term disability insurance claim notes that the Veteran had been seen on that date and his subjective symptoms were anxiety, nervousness, irritability, restlessness, ideas of reference, delusions, and hallucinations. Objective findings were tachycardia, shortness of breath, numbness in the upper and lower extremities, dizzy spells, stomach discomfort, high blood pressure, and psoriasis. The diagnosis was schizophrenia, undifferentiated type with anxiety, depression, and conversion symptoms. As to degree of disability Dr. L.A.T. indicated that the Veteran had not been able to do any work and would never be able to work. In May 1994, Dr. L.A.T. wrote that the Veteran had been his patient since March 15, 1982, and was treated with minor and major tranquilizers, hypnotics, and individual psychotherapy. He was very nervous, restless, easily upset, irritable, suspicious, mentally disturbed, and insomniac. He did not relate with people and quite often argued with his wife and sons. Dr. L.A.T. considered the Veteran unable to establish normal interpersonal relationships and to present a definite impairment to establish and maintain effective relationships with people. He was also unable to adapt himself and to get along well in the social and industrial environment consequently presenting a definite and considerate impairment in both areas. The diagnosis was schizophrenic disorder chronic undifferentiated type. The psychiatrist opined that the Veteran was considered to be totally and permanently disabled for gainful employment. At a VA examination in September 1994, the claims folder and hospital records were reviewed by the examiner. The Veteran reported that he was receiving mental health treatment and was taking medication for anxiety and schizophrenia. Mental status examination revealed that he was alert and oriented times three. His mood was depressed and he appeared to be somewhat sleepy. His affect was blunted. He had poor eye contact and his attention was fair. His concentration was fair as was his memory. His speech was clear and coherent. He was not hallucinating. He was not suicidal or homicidal and exhibited good impulse control. The diagnosis was schizophrenia, residual type, and the Global Assessment of Functioning (GAF) score assigned was 75, which contemplates transient and expectable reactions to psychosocial stressors, such as difficulty concentrating after family argument, or no more than slight impairment in social, occupational, or school functioning, such as temporarily falling behind in school work. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, American Psychiatric Association (1994) (DSM-IV). The report of a VA Social and Industrial field survey in September 1994 shows that the Veteran had not been employed since 1981 and was receiving treatment at a state mental health clinic. The information gathered was not consistent as to whether he stayed most of the time at his sister's home or at his own house and whether he drove a car, as he and his sister stated that he primarily stayed with family and did not drive a car, yet three neighbors stated that he lived alone in the country and drove to visit his sister to have lunch and to help out around her home. The sister described the Veteran as ill-humored and he had frequent insomnia but was unable to provide additional information about the Veteran's psychiatric condition or his behavior. A neighbor with whom the Veteran conversed related that the Veteran's conversation was logical and coherent. The Veteran helped his sister with the house and yard chores and fixed things at home. He described the Veteran's behavior as adequate and no abnormal behavior was reported. A January 1995 supplementary claim for disability benefits from an insurance company, completed by his attending physician, noted the Veteran was last seen for schizophrenia, nondifferentiated type, in January 1994 and his visits were every three months. His subjective symptoms were tachycardia, insomnia, gastric sensations, trembling, and incoordination. He had not been confined to a hospital. His condition remained unchanged. He had a psychological limitation. His physical impairment was severe limitations of functional capacity. His mental or nervous impairment was severe. He had significant loss of psychological, physiological, personal, and social adjustment. He was totally disabled from any occupation and would never be able to resume any work. He was not a suitable candidate for further rehabilitation services. VA outpatient treatment records show that in February 1995 the Veteran was referred to a Mental Hygiene Clinic for evaluation of psychosis. He was alert, oriented, coherent, and relevant. He admitted to having occasional hallucinations and auditory and visual experiences. His mood was anxious and he was restless. His memory and intellectual functioning was within normal limits. He had poor insight. The assessment was past history of schizophrenia, chronic undifferentiated type with no psychosis at present; rule out panic attacks without agoraphobia; and rule out somatization disorder. He was admitted to outpatient treatment at a VA mental health clinic and was to return three months later. In June 1995, he was stable and in control. A medical certificate dated in March 1995 from the Mental Health Program of Puerto Rico at a Psychiatric Hospital in Ponce, Puerto Rico, shows that the Veteran began to receive treatment in the Ponce Mental Health Program outpatient clinics in April 1955 and his last visit was in February 1995. He had never been hospitalized at that institution. He continued to receive treatment at the outpatient clinic for chronic schizophrenic reaction of the non-differentiated type. VA outpatient treatments records in March 1997 show that the Veteran complained of poor sleep. He was alert, oriented times three, coherent, and with blunted affect and poor rapport. He was not actively hallucinating and had no suicidal or homicidal ideations. He was to return four months later. At a VA mental disorders examination in June 1998, the Veteran reported that he had not been hospitalized since shortly after service. He reported that he had not worked since 1981. He had been separated from his wife and children since 1986 when they moved to Delaware. He described all sorts of somatic symptoms, and a sensation of confusion and at times fear. Clinical findings were that the Veteran was not actively delusional or hallucinating but there was looseness of associations in his speech and he seemed somewhat depressed. He appeared upset at the course of his appeal with VA and feeling that he was treated unfairly by the Army. He was at times appearing to cry, though there was no evidence of tears. He was not considered actively suicidal or homicidal. His affect was somewhat inappropriate, although he was somewhat histrionic also. His mood was depressed. He was oriented in person, place, and time. Memory was fair and intellectual functioning was average. His judgment was fair and insight was superficial. The diagnosis was schizophrenia, residual type, depressed; and some histrionic personality features. A GAF of 65 was assigned, which contemplates some mild symptoms, such as depressed mood and mild insomnia, or some difficulty in social, occupational, or school functioning, but generally functioning pretty well with some meaningfully interpersonal relationships. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, American Psychiatric Association (1994) (DSM-IV). A certification issued in June 1998 by a psychiatrist at the Outpatient clinic of the Ponce Mental Health Program shows that the Veteran was seen in April 1955 and his last visit was in July 1996. He had not been hospitalized at the Psychiatric Hospital in Ponce, and was not receiving treatment at the outpatient clinic service at that time. His diagnosis was chronic schizophrenic reactions, undifferentiated type. VA outpatient treatment records in March 1999 show that the Veteran was alert, oriented times three, coherent, anxious of mood, concrete, and referential. He had no hallucinations, or suicidal or homicidal ideations. In March 2000, the Veteran received VA vocational counseling and was found eligible and entitled to vocational rehabilitation services. Achievement of a vocational goal was reasonable and feasible. A supervisory session in October 2000 indicated that the Veteran was following the plan and was well motivated toward course activity. For the months from January to April 2001, when a rating was provided for his classes, he received ratings of outstanding or satisfactory, and then for the months of July and August 2001 the ratings were unsatisfactory. However, he successfully completed a 12 month course in electronic mechanics in August 2001. He then participated in a plan to help him obtain and sustain employment. In April 2002, however, he stated that he had been receiving benefits from SSA based on unemployment since 1982 due to his nerves and his case with VA was on appeal. Therefore, for those reasons, he did not desire employment. VA outpatient treatment records show that in September 2000 and January 2001 when the Veteran was seen for medication follow-up purposes, he was cooperative, spontaneous, logical, coherent, and relevant. He was oriented times three. He was not actively suicidal, delusional, homicidal, or hallucinating at that time. In September 2000 he had fair judgment, adequate memory, and superficial insight. In January 2001 he was spontaneous, anxious with congruent affect and his judgment was considered poor with no true insight into his mental condition. The GAF scores were 55 and 50 respectively. The Veteran testified at the RO in February 2001 as to the symptoms and manifestations of his psychosis and the effect on his daily activities. The Veteran stated that he felt that he was increasingly tired, and that sometimes when sitting in his living room, he was overwhelmed with exhaustion and had to get in bed. He stated that after eating, he felt gas pains that he had been told were related to anxiety. When he felt those pains, he would hold his breath. He stated that when he took anxiety medication, he sometimes felt like he was about to fly, and that at times he thought he saw people in the wall that he did not recognize. He sometimes heard voices calling his name and felt like someone was pursuing him. He relayed a history of waking up with panic attacks, but that since he had begun to take anxiety medication, he had noticed a decrease in "blood pressure" and panic. He had thought of suicide in the past, and felt more depressed and suicidal when he was having a flare-up of psoriasis. He stated that he received mental health treatment every three months to manage his medications. His medications had recently been changed to combat his insomnia. He stated that he stopped working in 1981 due to high blood pressure, which was later determined to be related to his nerves. He stated that he did not complete any tasks at home because it was hard for him to focus. At a VA examination in March 2001, the examiner noted that no hospitalizations were shown in the computer file. The Veteran lived with his wife. Clinical findings were that he was clean and adequately dressed and groomed. He was alert and oriented times three. His mood was depressed and his affect was constricted. His attention was good. His concentration and memory were fair. His speech was clear, coherent, and soft. He was not hallucinating. He was not suicidal or homicidal. His insight and judgment were fair. He exhibited good impulse control. The diagnosis was schizophrenia, residual type, with anxiety and depressive features, mild. A GAF score of 80 was assigned, which contemplates transient and expectable reactions to psychosocial stressors, or no more than slight impairment in social, occupational, or school functioning. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, American Psychiatric Association (1994) (DSM-IV). The report of an unannounced Social and Industrial field survey in April 2001 shows that the Veteran was clean and dressed. Although previously the Veteran and his wife were separated, they were once again living together. He reported that he was attending school in the mornings and afterwards he watched television and was idle at home. Sporadically, he conversed with his neighbors and visited his relatives. The Veteran's wife reported that the Veteran seldom was involved in any home tasks. A neighbor who was interviewed reported that the Veteran was a good person with whom he conversed sporadically. He was mostly at home. His behavior at home was described as normal. No abnormal behavior was reported. The Veteran reported that at night, he experienced symptoms of panic attacks, including shortness of breath, heart palpitations, and needle-like sensations in his extremities. He at times heard voices calling his name. A Certificate of Graduation issued in September 2001 by the Registrar of the Institute of Bank and Commerce certifies that the Veteran completed all of the requirements for graduation in the course of Electronic Technology in August 2001. VA outpatient treatment records for the period from April 2001 to May 2003 show that the Veteran was cooperative, logical, coherent, and relevant. There was no evidence of active suicidal or homicidal ideation, delusions, or hallucinations. His cognitive functions were preserved. At the majority of visits he was oriented in all three spheres but on several occasions he was not oriented to time. He was anxious, with depressed affect or inadequate affect. He was sleepy during one interview. He had impaired judgment and no insight. His memory was also found intact, and that he had adequate judgment and superficial insight. He was adequately dressed and kept. At times he complained of forgetfulness or memory loss, and reported occasionally hearing his name called or having a sensation of somebody walking by his side. A GAF score of 50 was assigned in April 2001, which contemplates serious symptoms, such as suicidal ideation, severe obsessional rituals, or frequent shoplifting, or serious impairment in social, occupational, or school functioning, such as no friends or an inability to keep a job. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, American Psychiatric Association (1994) (DSM-IV). However, at the other visits a GAF score of 55 was assigned, which contemplates moderate symptoms, such as flat affect, circumstantial speech, or occasional panic attacks, or moderate difficulty in social, occupational, or school functioning, such as few friends and conflicts with peers or co-workers. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, American Psychiatric Association (1994) (DSM-IV). A February 2003 handwritten statement from a Professor indicates that the Veteran made a supreme effort in his electronic course to concentrate and to do the jobs that were assigned. Because he had to take several prescribed medications his work and tests were deficient, even when he was granted special accommodations due to his condition. His medications made him sleepy and he had headaches and dizziness. A May 2012 VA mental disorders examination report stated that the Veteran's claims folder and medical records had been reviewed. The report noted that the Veteran had been granted VA vocational rehabilitation services in August 2000, and completed a 12 month training program as an electronic technician in September 2001. The examiner opined that, if the Veteran was able to successfully complete a one-year training program from August 2000 to September 2011, then he was certainly not unemployable during that year. The examiner further opined that, prior to 2001, the Veteran was not unemployable, but had mild to moderate symptoms of his mental disorder, without psychiatric hospitalizations. During the years 2001 and 2002, the Veteran was not eligible for unemployability as he received VA occupational rehabilitation benefits and was able to complete a 12 month training program. The examiner stated that in 2003, the Veteran's psychotic symptoms increased and he had a psychotic episode during which time he was unemployable. The Board finds that the preponderance of the evidence of record shows that the Veteran was not prevented him from securing or following a substantially gainful occupation by reason of his schizophrenia and psoriasis prior to April 8, 2003. The medical evidence of record clearly demonstrates that the Veteran's disabilities resulted in significant occupational impairment prior to that date. However, the Veteran's occupational impairment was already being compensated for by the ratings assigned for his schizophrenia and psoriasis prior to April 8, 2003. 38 C.F.R. §§4.1, 4.130, Diagnostic Code 9204 (2012). In addition, the preponderance of the evidence of record shows that, prior to April 8, 2003, the Veteran remained capable of performing the physical and mental acts required by employment in some fields. The Board places great probative weight on the fact that the Veteran successfully completed a VA vocational rehabilitation course in electronics between August 2000 and September 2001. While there have been numerous medical records dated from 1981 to the present that have commented on the Veteran's employability, none of the reports have evaluated the Veteran's vocational abilities with the thoroughness of the VA vocational rehabilitation program. The Veteran's VA vocational rehabilitation file includes extensive reviews of the Veteran's educational, occupational, social, and medical history. On the basis of that information, and a detailed analysis of the limitations imposed by his disabilities, the VA vocational rehabilitation program reached a consensus that, despite the Veteran's serious employment handicap, it was reasonably feasible that the Veteran could achieve his vocational goal of becoming an electronics technician. While the evidence of record shows that the Veteran did not obtain employment following this course, it also shows that he voluntarily declined employment assistance because he was receiving SSA benefits and hoped to receive VA benefits. The Board also places great probative weight on the opinion provided in the May 2012 VA mental disorders examination report. That report included a complete and thorough review of the Veteran's claims file, and provided a detailed discussion of the Veteran's level of employability at all periods relevant to the claim on appeal. That report stated that the Veteran did not become unemployable until he had a psychotic episode in 2003. The evidence of record shows that this psychotic episode occurred in August 2003. Accordingly, the May 2012 VA mental disorders examination report provides strong evidence that the Veteran was not prevented from securing or following a substantially gainful occupation by reason of his schizophrenia and psoriasis prior to April 8, 2003. Although a private medical doctor, Dr. L.A.T., indicated in May 1990 and January 1995 that the Veteran was unable to work, those statements were provided for a long term disability insurance claim and included symptoms of non-service connected disabilities. In May 1994, Dr. L.A.T. opined that the Veteran was considered to be totally and permanently disabled for gainful employment. However, at a VA examination approximately four months later in September 1994, a GAF score of 75 was assigned, which demonstrates transient symptoms which are expectable reactions to psychosocial stressors. The Board finds that September 1994 VA examination opinion of greater probative value as the VA examiner reviewed the entire claims folder, to include service medical records and private and VA outpatient treatment records, conducted a thorough examination of the Veteran, and had the report of a Social and Industrial survey to verify the Veteran's behavior in the community. The report also suggests that the Veteran's psychiatric illness was not as disabling as his private physician suggested, and that even if there was a great degree of impairment at times, at least in September 1994, the impairment was no more than mild. Throughout the period from 1989 to 2001, the Veteran's schizophrenia was treated with medication and he received follow-up outpatient treatment at a VA medical center and also at a state mental health facility. The majority of the records show that overall the Veteran was stable, alert, oriented, coherent, and relevant and denied visual and auditory hallucinations. Although on one occasion he related sometimes having suicidal ideas, he never indicated that he had a plan and at other visits, suicidal or homicidal ideations were not reported or found. At a VA examination in June 1998 a GAF of 65 was assigned which demonstrates some mild symptoms. At outpatient visits, in September 2000 a GAF score of 55 was assigned which demonstrates moderate symptoms and in January 2001, a GAF score of 50 was assigned which demonstrates the high end of the range of serious symptoms. However, at a VA examination in March 2001, a GAF score of 80 was assigned which shows transient symptoms. In summary, while it is clear that the Veteran's service-connected disabilities made it difficult for him to secure and follow a substantially gainful occupation prior to April 8, 2003, the preponderance of the evidence of record does not show that his service-connected disabilities made him completely unable to do so. Accordingly, it is not factually ascertainable that the Veteran's service-connected disabilities rendered him unable to secure or follow a substantially gainful occupation prior to April 8, 2003. Therefore, the Board finds that referral to the Director of VA's Compensation and Pension Service for consideration of assignment of TDIU prior to April 8, 2003, is not warranted. 38 C.F.R. § 4.16(b). Accordingly, an effective date prior to April 8, 2003for the assignment of TDIU is not warranted. In reaching this decision, the Board finds that the preponderance of the evidence is against the Veteran's claim. Therefore, the claim is denied. 38 U.S.C.A. § 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER An effective date prior to April 8, 2003 for the assignment of TDIU is denied. ____________________________________________ Harvey P. Roberts Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs