Citation Nr: 1319015 Decision Date: 06/11/13 Archive Date: 06/21/13 DOCKET NO. 05-08 250 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUE Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD D. Schechter, Counsel INTRODUCTION The Veteran served on active military duty from December 1968 to December 1970. The appeal comes before the Board of Veterans' Appeals (Board) from a February 2005 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. Previously before the Board were several claims for increased rating for service-connected disabilities, which increased rating claims were denied by the Board in March 2007. FINDINGS OF FACT 1. For the rating interval prior to March 5, 2013, with consideration of his educational level, work experience, and vocational attainment, but without consideration of his age, the Veteran has not been precluded from securing or following a substantially gainful occupation due to his service-connected disabilities. 2. Beginning March 5, 2013, with consideration of his educational level, work experience, and vocational attainment, but without consideration of his age, the Veteran has been unable to secure or follow a substantially gainful occupation due to his service-connected disabilities. CONCLUSIONS OF LAW 1. Prior to March 5, 2013, the criteria for a total disability rating based on individual unemployability due to service-connected disabilities have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.340, 3.341, 4.16(a) (2012). 2. Beginning March 5, 2013, the criteria for a total disability rating based on individual unemployability have been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.340, 3.341, 4.16(a) (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duty to Notify and Assist VA has a duty to notify and assist claimants in substantiating their claims for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). The Veteran's appeal arises from his submission of a claim for a total disability rating based on individual unemployability (TDIU) on December 8, 2003. Appropriate notice was then afforded the Veteran, by letters issued in December 2003 and January 2005, prior to the RO's adjudication of the TDIU claim in February 2005. A claim for TDIU is a claim for increased rating. Hurd v. West, 13 Vet. App. 449 (2000). In a claim for increased rating, the notice that is required is generic, that is, the type of evidence needed to substantiate the claim, namely, evidence demonstrating a worsening or increase in severity of the disability and the effect that worsening has on employment and earning capacity, as well as general notice regarding how disability ratings and effective dates are assigned. Vazquez-Flores v. Shinseki, 580 F.3d 1270 (Fed. Cir. 2009). The December 2003 and January 2005 notice letters informed the Veteran of the notice and duty-to-assist provisions, and of the information and evidence necessary to substantiate the claim, as well as informing of the respective roles of the Veteran and VA in developing the claim and obtaining evidence, with the ultimate responsibility for ensuring that relevant evidence is obtained assigned to the Veteran. The letters also provided the Veteran with general notice of the evidence required to satisfy the claim, on both schedular and extraschedular bases. By an additional letter issued in March 2006, the Veteran was afforded notice of how disability ratings and effective dates are assigned. Dingess v. Nicholson, 19 Vet. App. 473 (2006). VA's duty to assist the Veteran in the development of the claim includes assisting him in the procurement of service medical records and pertinent treatment records, and providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. These duties were accomplished in this case. The Board finds that the RO appropriately assisted the Veteran in obtaining indicated treatment and evaluation records, including both VA and private records. Service records were also associated with the claims file. The RO also informed the Veteran, including in the appealed rating action, subsequent rating actions, and by a statement of the case and supplemental statements of the case, of records obtained and thus, by implication, of records not obtained, in furtherance of his claim. VA's duty to assist the Veteran by providing examinations when necessary was also adequately fulfilled. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. As discussed infra, the Veteran was afforded multiple disability rating examinations over the course of TDIU claim development, addressing the Veteran's service-connected disabilities both individually and as a whole with respect to their impact on his capacity for substantially gainful employment. These examinations, taken together with past examinations, and records of VA, private, and service treatment, statements by the Veteran, as well as other evidence of record, are adequate for the Board's adjudication herein. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. These examination, taken as a whole, adequately addressed both the medical findings upon current examination and the Veteran's history. The examination reports presented findings and conclusions reasonably consistent with the Veteran's medical history and the balance of contemporaneous medical records over the course of the rating period, and sufficiently addressed the criteria for TDIU to allow the Board to adjudicate the claim based on informed medical findings and medical judgment. Specifically, as addressed herein, the examination reports revealed the Veteran's severity of PTSD and intertwined depressive symptoms, as well as his service-connected physical disabilities, and afforded informed medical opinions fully supported by the clinical record as to the nature and extent of service-connected disabilities addressed at these examinations, and their impact on employability. Ultimately, in the absence of credible evidence that the evidence obtained, including VA examination evidence, is materially incomplete or inadequate for the Board's adjudication of the claim, the burden must shift to the Veteran to produce evidence of greater severity of disability, or of unemployability, which has not been found upon VA examination or otherwise shown by the evidence of record. The claimant bears the burden of presenting and supporting his claim for benefits. 38 U.S.C.A. § 5107(a); see Fagan v. Shinseki, 573 F.3d 1282 (Fed. Cir. 2009). The Board also finds that requirements of the Board's prior remands of the TDIU claim in March 2007, January 2011, and December 2012 have been substantially fulfilled. This included affording the Veteran the opportunity to submit additional evidence or argument and to assist VA in obtaining additional relevant evidence, obtaining indicated treatment records, affording the above-noted VA examinations addressing the impact of service-connected disabilities on employability, and readjudicating the claim by an supplemental statement of the case. Only substantial, and not strict, compliance with the terms of a Board remand is required. Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97 (2008). The Veteran has not indicated the existence of additional pertinent evidence. The case presents no reasonable possibility that additional evidentiary requests would further the appealed claim. 38 U.S.C.A. § 5103A(a)(2); 38 C.F.R. § 3.159. Hence, no further notice or assistance to the appellant is required to fulfill VA's duty to assist the appellant in the development of the claim. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001). In short, in this case, with regard to the TDIU claim herein adjudicated, the Board finds that any error in notice and development assistance cannot "reasonably affect the outcome of the case," and hence will not affect "the essential fairness of the [adjudication]" for the rating assigned for the rating period in question, for the appealed claim. ATD Corp. v. Lydall, Inc ., 159 F.3d 534, 549 (Fed. Cir. 1998); Mayfield v. Nicholson, 19 Vet. App. 103 (2005). The Veteran was duly afforded the opportunity to produce additional evidence to support his claim. Thus, the Board determines that the evidentiary record is adequate, and the only significant medical question remaining pertaining to the Veteran's claim for TDIU - that of evidence of preclusion of substantially gainful employment due to service-connected disabilities - was in this case, based on development already undertaken, the responsibility of the Veteran. See 38 C.F.R. § 4.16. In view of the foregoing, the Board finds that all notification and development actions needed to render a decision on the Veteran's claim on appeal herein adjudicated have been accomplished. II. Claim for TDIU TDIU is, in essence, a claim for an increased rating and vice versa. Norris v. West, 12 Vet. App. 413, 420 (1999). TDIU is an alternate way to obtain a total disability rating without recourse to a 100 percent evaluation under the Rating Schedule. See, e.g., Parker v. Brown, 7 Vet. App. 116, 118 (1994). Any claim for an increased rating is also a claim for a 100 percent evaluation under VA's Schedule for Rating Disabilities (Rating Schedule). 38 C.F.R. Part 4 (2012); see also, e.g., AB v. Brown, 6 Vet. App. 35 (1993). Entitlement to TDIU is an element of all claims for an increased rating. Rice v. Shinseki, 22 Vet. App. 447 (2009). Entitlement to TDIU is raised when a veteran: (1) submits evidence of a medical disability; (2) makes a claim for the highest rating possible; and (3) submits evidence of unemployability. See Roberson v. Principi, 251 F.3d 1378 (Fed. Cir. 2001); Jackson v. Shinseki, 587 F.3d 1106, 1109-10 (2009) (holding that an inferred claim for TDIU is raised as part of an increased rating claim only when the Roberson requirements are met). The Board finds that the claim for TDIU has been properly raised and is properly the subject of the instant appeal. TDIU may be assigned where the schedular rating for the service-connected disabilities is less than 100 percent when it is found that the veteran's service-connected disabilities render him unable to secure or follow a substantially gainful occupation. 38 C.F.R. §§ 3.321, 3.340, 3.341, 4.16. The regulatory scheme for TDIU provides both objective and subjective criteria. Hatlestad v. Derwinski, 3 Vet. App. 213, 216 (1992); VAOPGCPREC 75-91, 57 Fed. Reg. 2317 (1992). The objective criteria provide for a total rating when there is a single disability or a combination of disabilities that results in a 100 percent schedular evaluation. 38 C.F.R. § 3.340(a)(2). Subjective criteria provide for a TDIU when, due to service-connected disability, a veteran is unable to secure or follow a substantially gainful occupation, and has a single disability rated 60 percent or more, or at least one disability rated 40 percent or more with additional disability sufficient to bring the combined evaluation to 70 percent. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). In exceptional circumstances, where the veteran does not meet the aforementioned percentage requirements, a total rating may nonetheless be assigned upon a showing that the individual is unable to obtain or retain substantially gainful employment. 38 C.F.R. § 4.16(b). To establish a total disability rating based on individual unemployability on the regular basis, there must be an impairment so severe that it is impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. In reaching such a determination, the central inquiry is whether the Veteran's service-connected disabilities alone are of sufficient severity to produce unemployability. Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). For a veteran to prevail on a claim for a total compensation rating based on individual unemployability, the record must reflect some factor which takes the case outside the norm. The sole fact that a veteran is unemployed or has difficulty obtaining employment is not enough. A high rating in itself is recognition that the impairment makes it difficult to obtain or keep employment, but the ultimate question is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether the Veteran can find employment. Van Hoose v. Brown, 4 Vet. App. 361 (1993). Factors to be considered are the Veteran's education, employment history and vocational attainment, without consideration of his advanced age or of the effects of non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19 (West 2002); see Ferraro v. Derwinski, 1 Vet. App. 326, 332 (1991). In exceptional circumstances, even where the Veteran does not meet the schedular percentage requirements, TDIU may still be assigned on an extraschedular basis, upon a showing that the Veteran is unable to obtain or retain substantially gainful employment due to service- connected disabilities. 38 C.F.R. §§ 3.321(b)(1), 4.16(b). However, where such an exceptional case is indicated, the Board is to refer the case to the Director of the VA Compensation and Pension Service for extraschedular consideration. Id. An extraschedular evaluation may be assigned in exceptional cases where the schedular evaluations are found to be inadequate. Id. The governing norm in such cases, for individual disabilities, is a finding that the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards. Id. The Board is also not precluded from concluding, on its own, that referral for extraschedular consideration is not warranted. See Bagwell v. Brown, 9 Vet. App. 337, 339 (1996) (noting that the Board may affirm an RO conclusion that a claim does not meet the criteria for submission pursuant to 38 C.F.R. § 3.321(b)(1) or reach such a conclusion on its own). The Veteran's service-connected disabilities consist of posttraumatic stress disorder (PTSD), rated 30 percent disabling from June 7, 1984, 50 percent disabling from December 8, 2003, and 70 percent disabling from March 5, 2013; diabetes mellitus, rated 20 percent disabling from May 31, 2003; peripheral neuropathy of the left lower extremity, rated 10 percent disabling from April 25, 2005, and 20 percent disabling from January 17, 2013; peripheral neuropathy of the right lower extremity, rated 10 percent disabling from April 25, 2005, and 20 percent disabling from January 17, 2013; residuals of shrapnel wound at the back of the left thigh with retained foreign body, rated noncompensably disabling from June 7, 1984, and 10 percent disabling from December 8, 2003; right upper extremity peripheral neuropathy, rated 10 percent disabling from January 17, 2013; left upper extremity peripheral neuropathy, rated 10 percent disabling from January 17, 2013; and duodenal ulcer, rated noncompensably disabling from June 7, 1984. With consideration of bilateral factors and application of the combined rating table, this has resulted in a combined disability of 30 percent from June 7, 1984; 40 percent from May 31, 2002; 50 percent from February 5, 2003; 70 percent from December 8, 2003; 80 percent from April 25, 2005; and 90 percent from January 17, 2013. 38 C.F.R. § 4.25 (2012). The Veteran has thus been eligible for consideration of TDIU on a schedular basis since December 8, 2003. 38 C.F.R. § 4.16(a). Upon careful consideration of the evidence presented, the Board has considered the Veteran's TDIU claim on such a schedular basis, and on an extraschedular basis up to a year prior to December 8, 2003, and has found that TDIU was not warranted, by the weight of the evidence, until March 5, 2013. The Global Assessment of Functioning (GAF) Scale is used in assessing a patient's mental health. The GAF score assigned thereon reflects the "psychological, social, and occupational functioning on a hypothetical continuum of mental health - illness." Richard v. Brown, 9 Vet. App. 266, 267, quoting the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (DSM-IV) at 32. GAF scores ranging between 61 to 70 reflect 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, and has some meaningful interpersonal relationships. Scores ranging from 51 to 60 reflect moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers). Scores ranging from 41 to 50 reflect serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting), or any serious impairment in social, occupational or school functioning (e.g., no friends, unable to keep a job). Upon a VA urology examination for compensation purposes in April 2005 for chronic prostatitis and benign prostatic hypertrophy (BPH) symptoms, the Veteran complained of some lethargy and weakness, and reported daytime urinary frequency of five to six times, and nighttime frequency of three times. He reported occasional incontinence, but denied dysuria or hematuria. At a VA psychiatric examination in April 2005, the examiner noted the Veteran's history of difficulty with irritability in factory work and retirement in 1999 after a "29 year" (sic) career. The Veteran reported having had difficulty tolerating supervisors, whom he considered to have been harsh and unfair. The Veteran reported living with his son in a home which the Veteran owned, and having to care for his son, who had developmental problems. The Veteran reported having to take his son to a special school 22 miles away, and being somewhat stressed by this drive. He had two grown daughters who continued to help him with household chores, laundry, cleaning, and bill paying. The Veteran reported doing most of the cooking, though he and his son ate out frequently. The Veteran was previously married twice but currently divorced. The April 2005 psychiatric examiner noted the Veteran's history of a painful and disfiguring severe skin condition, which had improved with treatment in the past year but which the Veteran was still troubled by. He expressed that his skin often felt dry, painful, and too tight. He reported feeling ashamed of his appearance, though this attitude had somewhat improved. At the April 2005 psychiatric examination, the Veteran was sad, and became tearful when speaking of his son, of his health problems, and of his Vietnam experiences. The examiner did not identify psychotic symptoms, and the Veteran denied suicidal ideation. The examiner diagnosed PTSD and major depression, and found a high moderate impairment in social, vocational, and mental functions due to psychiatric difficulties, assigning a GAF score of 51. The examiner attributed the Veteran's PTSD to his Vietnam experiences, and attributed his major depression to a reaction to his skin condition, as well as to family difficulties. The examiner related, however, that it would be speculative to distinguish impairments from the Veteran's PTSD from those of his major depression. The examiner noted that the Veteran's PTSD symptoms would likely result in moderately reduced reliability and productivity, and moderate interference with work effectiveness and effectiveness of interpersonal interactions. The examiner concluded that the Veteran would likely have moderate problems if required to adapt to above-normal stress. The Veteran's complaints of memory and distractibility were assessed by the examiner as likely causing low moderate work difficulties. Upon a VA diabetes examination for compensation purposes in April 2005, the Veteran complained that he at times felt like he was walking on thumbtacks, and that he had numbness or burning or tingling in his feet. He also complained that at times he had tingling in his hands, and his thumb or fingers would lock up. He reported that he retired from his maintenance job after 32 years due to the amount of walking required, adding that he could not exercise and could not walk without pain. Neurological testing in the upper and lower extremities identified no impairment, and strength in the extremities was 5/5, with the exception of the right upper extremity, which was 4/5. The examiner noted that the Veteran was not currently taking medication for his diabetes mellitus. The examiner diagnosed poorly controlled diabetes mellitus, poorly controlled hypertension, peripheral neuropathy, and pityriasis rubra pilaris. The examiner assessed that the Veteran's diabetes mellitus was the likely cause of his peripheral neuropathy. Upon a VA gastrointestinal examination for compensation purposes in April 2005, the Veteran reported difficulties with reflux and feeling tired after meals. Treatment included Prilosec as well as drinking milk or Maalox and lying down. He denied other gastrointestinal symptoms, and the examiner noted that the Veteran had gained weight in the past five years. Physical examination was essentially negative, and the examiner, in pertinent part, diagnosed gastroesophageal reflux disease (GERD). An upper gastrointestinal series which followed the examination revealed a small hiatal hernia without observed evidence of GERD, and no other disability findings. Upon private diabetes treatments dated in 2008, the treating physician noted depression and mood swings. At these treatments, the Veteran's denied numbness or tingling in the extremities, and he reporting walking miles each day or a combination of walking and riding a bike for exercise. The Veteran denied current difficulties with joint pain or stiffness, or muscle weakness. Peripheral neurological examinations were negative. Upon a VA general medical examination for compensation purposes in March 2011, addressing the Veteran's service-connected physical disabilities, the examiner noted that the Veteran took medication for his diabetes mellitus, hypertension, GERD, and PTSD. The Veteran's gait was observed as fairly normal, and he denied vision problems. Though he endorsed hearing problems and ringing in the ears, he was able to hear normal conversation. Joint and spine examinations also identified no significant difficulties. The Veteran's strength in upper and lower extremities was 5/5. Peripheral reflexes were also present. The examiner assessed that the Veteran, with respect to physical disabilities, was not precluded from performing sedentary work or most forms of physical work. A March 2011 VA diabetes examination for compensation purposes noted that the Veteran's diabetes was well-controlled with medication. The examiner concluded that the Veteran's diabetes mellitus did not preclude substantially gainful work. Upon a March 2011 VA peripheral nerves examination for compensation purposes, the examiner noted the Veteran's complaints of numbness and tingling in both feet, and of stiffness and pain at times in the hands. However, the examiner noted that the Veteran's symptoms were fairly constant and without flare-ups. The Veteran reported that movement helped his symptoms. Proprioception was intact in the hands and feet, while monofilament and vibratory sensation was intact in the hands. Monofilament was absent in the toes and forefeet, bilaterally, and vibratory sensation was absent in the great toes. The examiner assessed that foot symptoms interfered with prolonged standing and walking. The Veteran also endorsed that these foot symptoms kept him up at night and interfered with his sleep. The Veteran endorsed that his hand symptoms caused him to drop things more frequently, but he was nonetheless able to accomplish daily activities. The examiner found peripheral neuropathy only in the lower extremities. The examiner concluded that the peripheral neuropathy did not preclude all gainful employment, though it would prevent standing continuously for eight hours per day, rather requiring sitting breaks between intervals of standing. At the examination, the Veteran endorsed that he had ceased working due to inability to get along with others. At a March 2011 VA PTSD examination for compensation purposes, the Veteran expressed remorse about Vietnam, and expressed helplessness, sadness, and worthlessness regarding his current circumstances. He also expressed worry about his skin condition returning. The Veteran reported currently drinking moderately, but also occasionally binge drinking. He reported current activities consisting of watching television. He also reported being visited by his three children and grandchildren, occasionally. The March 2011 PTSD examiner concluded that the Veteran's unstructured days and social isolation contributed to his psychiatric symptoms. The examiner found that the Veteran's depression focused primarily on fear of his skin condition returning. The examiner found the Veteran's PTSD symptoms were moderate in severity. The depression and PTSD symptoms together were assessed as making work around others difficult, with the potential for reactivity and irritability. The examiner concluded that the Veteran's psychiatric difficulties did not preclude janitorial-type work not requiring significant interactions, which was work that which he had previously performed. The examiner also concluded that anxiety and depressive symptoms would impair the Veteran's concentration and ability to remember detailed instructions. The examiner assigned a GAF score of 51. Upon a VA general medical examination for compensation purposes in April 2012, the Veteran reported being divorced and living alone in home, being independent of daily living, and doing yard and house work. He reported current exercise consisting of walking about a mile, two to three times per week. He also reported formerly working on cars as a hobby, but denied any current hobbies. The examiner concluded that with appropriate restrictions, the Veteran's service-connected physical disabilities did not render the Veteran completely unemployable. Upon a VA PTSD examination for compensation purposes in April 2012, by a psychologist, the Veteran was noted to have symptoms of PTSD and depression. The examiner found that the symptoms of each were somewhat differentiable, with symptoms of reexperiencing events, hypervigilance, and exaggerated startle response attributable to his PTSD alone, and symptoms of low mood, worthlessness, weight loss, and low energy attributable to depression alone. The examiner found that symptoms of poor concentration, irritability, amotivation, numbing, and sleep difficulties were attributable to both disorders. That said, the examiner emphasized the "considerable overlap" of symptoms of the two disorders, and noted that the Veteran had interpersonal difficulties attributable to his PTSD. The Veteran was noted to spend the most of his time self-isolating in his home, and that while he would think of things to do around the house to avoid thinking of Vietnam, he would not do the things, with this amotivation attributed by the examiner to the Veteran's depression. At the April 2012 examination the Veteran expressed a belief that he could not physically perform work as a laborer, due to chronic pain and low energy. The Veteran recounted his history of employment with as a laborer for one automotive company performing a variety of tasks including spraying cars, sweeping, cleaning boots, working on railroad tracks, and performing general maintenance until his retirement after 32 years in 1999. However, the Veteran reported that he retired at first due to difficulty with supervisors and getting into arguments and fights. He also reported that toward the end of this career he was always sick, his legs hurt, and he hated his job, not wishing to go in to work anymore. He explained that he had gotten into an argument and was given a choice of retiring or being fired, and so he retired. The Veteran also reported of developing a skin disease toward the end of his career which grew more severe and very painful following his retirement, so that he was bedridden from the disease for a period of four years. The examiner noted that the Veteran also had a fear of recurrence of the skin disease. The examiner noted that the Veteran's current low energy was attributable to the depression, and that his depression was attributable in part to this skin disorder and in part to his erectile dysfunction. The April 2012 VA psychiatric examiner concluded that the Veteran's PTSD likely precluded work requiring interactions with the public, such as answering telephones or telemarketing, and the Veteran's history of poor education and lack of a high school diploma likely precluded other than physical labor jobs. A private psychologist's treatment notes from 2011 and 2012 inform that the fear of recurrence of a skin disorder was factually based. The psychologist checked with the Veteran's treating medical care facility, and was informed that the skin disorder could recur at any time. These psychotherapy records reflect sessions approximately every two to three weeks, and inform of the Veteran's ongoing self-isolation in the home despite regular visits by his grown children. The Veteran also had some ongoing emotionality, guilt, and anger related to his Vietnam war experiences. The Board concludes that weight of the clinical treatment and examination records prior to March 5, 2013, reflected that the Veteran's physical service-connected disabilities had not progressed to the point where they would preclude substantially gainful employment if this did not require continuous standing or walking, with the weight of the evidence against preclusion of slightly less physically demanding physical work. While the Veteran has somewhat inconsistently asserted preclusion of activities related to his peripheral neuropathy of the lower extremities or related to fatigue, the weight of the evidence including the Veteran's own assertions regarding daily activities, are to the effect that moderately physically demanding work was not precluded by physical service-connected disabilities, and has not been over the entire rating period. The Veteran was afforded January 2013 VA examinations addressing his service-connected disabilities, including to address whether these precluded gainful employment. Additionally, on March 5, 2013, a clinical psychologist addressed his PTSD and other psychiatric impairment. In contrast to the April 2012 examiner, the March 2013 clinical psychologist concluded that it would be speculation to differentiate "what portion of each symptom" was attributable to the Veteran's PTSD versus his depression. The March 2013 psychologist reviewed the claims file and the Veteran's history, and noted that he was unable even to help his son in a business cleaning offices due to an inability to handle stress. The examiner concluded as follows: The current severity of the Veteran's mental health symptoms will likely make it very difficult for him to maintain and sustain gainful employment. He would likely struggle greatly to galvanize the energy to maintain consistent attendance and consistently perform job duties. Due to his current interpersonal problems, his ability to work in close contact with others and follow orders from supervisors is severely limited. His level of fatigue, concentration problems, and inner turmoil would likely cause serious work inefficiency and lack of productivity. His ability to adapt to stressful circumstances or changes in his work routine is severely limited. In addition, his employment opportunities are limited by his educational and vocational history. The Veteran's past treatment records are reasonably consistent with these conclusions, as they show persistent and increasing self-isolation, interpersonal difficulties, and difficulty coping with life stressors. They also reflect the Veteran's history of having arrived in the United States as a child, with difficulty learning the language, difficulty in school, and never having completed high school prior to joining the military. The Veteran reportedly never obtained a high school diploma or a GED, and work for an automobile company in various physical maintenance jobs over a 32-year career at that company prior to retirement. While narratives reasons given for this retirement vary, a picture of interpersonal difficulties appears to have played a prominent role. The Board notes that the Veteran's long list of physical ailments including particularly his diabetes mellitus with peripheral neuropathy, renders capacity for ongoing physical work somewhat difficult, but not impossible. The January 2013 examiner concluded that the Veteran would still be capable of performing light physical work, not to include prolong standing due to his peripheral neuropathy of the lower extremities. The Board concludes that clinical treatment and examination records addressing the Veteran's PTSD and depression from 2004 through 2013 reflect a gradual increase in symptoms of self-isolation, difficulties with interactions with others, difficulties handling changing or stressful circumstances, and persistent depressive symptoms. By the time of the March 5, 2013 VA psychiatric examination, but not prior to this time, they appear to reflect a progression to the point that there would be a sufficient impairment in most work and work-like activities including inefficiency, lack of productivity, incapacity to manage stressful circumstances, and difficulties in interactions with others, such that capacity for substantially gainful employment would be unlikely as a result of the service-connected disabilities taken as a whole, particularly in light of the Veteran's limited education and narrow scope of work experience. Prior assessments appear to reflect lesser degrees of interpersonal difficulties or lesser stress-coping difficulties, such that psychiatric impairment prior to March 5, 2013, was not shown to have precluded substantially gainful work, with the weight of the evidence against such preclusion. In making this decision, the varied moderate labor position which the Veteran held for a 32 year career ultimately ended, at least in part, due to conflicts with fellow workers which are attributable to the Veteran's PTSD. Thus, notwithstanding the conclusions of the January 2013 physician's assistant as to the Veteran's capacity for light physical labor, the Board concludes that the preponderance of the evidence favors a finding of unemployability due solely to service-connected disabilities beginning March 5, 2013, and thus favors the TDIU claim from that date. 38 C.F.R. § 4.16. Prior to that date, the weight of the evidence is against the claim, with physical and mental service-connected impairments not having yet reached a combined level of impairment precluding any substantially gainful work. 38 C.F.R. § 4.16. The Board has considered referral for extraschedular consideration, but finds that the weight of the evidence is to the effect that prior to March 5, 2013, and subsequent to his retirement in 1999, the Veteran's unemployment was not wholly attributable service-connected disabilities, and unemployability was not shown. While the Veteran's contends that he was forced into retirement due to work conflicts, other statements by the Veteran reflect retirement due to physical difficulties, or reflect that he retired because he no longer wished to go into work anymore, altogether suggesting a considerably mixed set of circumstances leading to his retirement after 32 years of work for the same company. 38 C.F.R. § 3.321(b). TDIU has not been warranted at any distinct period of time prior to March 5, 2013, with the preponderance of the evidence against preclusion of employment due solely to the Veteran's service-connected disabilities, education level, and age, and thus with the preponderance of the evidence then against the claim. Hart v. Mansfield, 21 Vet. App. 505 (2007). Because the preponderance of the evidence is against the claim prior to January 17, 2013, the benefit of the doubt doctrine does not apply for that interval. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER TDIU is denied prior to March 5, 2013. TDIU is granted effective March 5, 2013, subject to the applicable regulations concerning the payment of monetary benefits.. ____________________________________________ JOY A. MCDONALD Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs