Citation Nr: 18141155 Decision Date: 10/09/18 Archive Date: 10/09/18 DOCKET NO. 17-10 554 DATE: October 9, 2018 ORDER Entitlement to a disability rating in excess of 70 percent for posttraumatic stress disorder (PTSD) with alcohol use disorder is denied. Entitlement to a compensable rating for tension-cervicogenic headaches is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) is granted. FINDINGS OF FACT 1. For the period on appeal, the Veteran’s PTSD most closely approximates occupational and social impairment with deficiencies in work, family relationships, thinking and mood; the evidence of record and the Veteran’s symptomatology does not demonstrate total occupational and social impairment. 2. For the period on appeal, the Veteran’s headaches are not manifested by prostrating attacks. 3. Due to his service-connected PTSD, the Veteran is unable to obtain or retain substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 70 percent for PTSD with alcohol use disorder have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 4.1—4.14, 4.130, Diagnostic Code 9411 (2017). 2. The criteria for a compensable rating for tension-cervicogenic headaches have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1-4.14, 4.20, 4.124a, Diagnostic Code 8100 (2017). 3. The criteria for establishing entitlement to TDIU benefits have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had honorable active duty service with the United States Army from February 2005 to October 2012. The Veteran received the Iraq Campaign Medal and the Afghanistan Campaign Medal, among other commendations. The Board of Veterans’ Appeals (Board) acknowledges that additional treatment records of the Department of Veterans Affairs (VA) were associated with the claims file in August 2017 after the issuance of the January 2017 statement of the case (SOC). In addition, the Veteran’s attorney submitted a May 2017 opinion from a licensed professional counselor in May 2017. As these new VA treatment records are duplicative of evidence previously of record insofar as they relate to the increased rating claims for PTSD and headaches, the Board finds a remand for consideration by the Agency of Original Jurisdiction (AOJ) of the newly acquired evidence would serve no useful purpose. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on the VA with no benefit flowing to the veteran are to be avoided); see also 38 C.F.R. § 19.31(b)(1). In addition, as the Veteran’s substantive appeal was received in February 2017 and AOJ consideration of this evidence has not been explicitly requested, a waiver of AOJ consideration is not necessary. See Honoring America’s Veterans and Caring for Camp Lejeune Families Act of 2012, Public Law (PL) 112-154, section 501. Therefore, the Board may properly consider such newly received evidence. 38 C.F.R. § 20.1304 (2017). In July 2018, the Veteran’s attorney submitted additional evidence in support of the instant appeals. This submission was accompanied by a waiver of initial AOJ consideration. Therefore, the Board may properly consider such evidence. Furthermore, the Board notes that in an August 2014 rating decision, the local Regional Office (RO) denied the Veteran’s claim for a TDIU. Although the Veteran did not appeal this decision, his TDIU claim is considered part and parcel of his claims for increased ratings. Rice v. Shinseki, 22 Vet. App. 447 (2009). Increased Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities. The Schedule is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. When two evaluations are potentially applicable, VA will assign the higher evaluation when the disability more nearly approximates the criteria for the higher rating. 38 C.F.R. § 4.7. VA will resolve reasonable doubt as to the degree of disability in favor of the Veteran. 38 C.F.R. § 4.1. If the evidence for and against a claim is in equipoise, the claim will be granted. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). Any reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3. In accordance with 38 C.F.R. §§ 4.1, 4.2 and Schafrath v. Derwinski, 1 Vet. App. 589 (1991), the Board has reviewed all evidence of record pertaining to the history of the service-connected disabilities at issue. The Board has found nothing in the historical record which would lead to the conclusion that the current evidence of record is not adequate for rating purposes. Moreover, the Board is of the opinion that this case presents no evidentiary considerations which would warrant an exposition of remote clinical histories and findings pertaining to the disability. Each disability is viewed in relation to its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). The Board notes that where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. 38 C.F.R. §§ 4.1, 4.2 (2016); see also Francisco v. Brown, 7 Vet. App. 55 (1994). In Hart v. Mansfield, 21 Vet. App. 505 (2007), however, the Court held that “staged ratings” are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. The evaluation of the same disability under various diagnoses is to be avoided. 38 C.F.R. § 4.14. Section 4.14 does not preclude the assignment of separate evaluations for separate and distinct symptomatology where none of the symptomatology justifying an evaluation under one diagnostic code is duplicative of or overlapping with the symptomatology justifying an evaluation under another diagnostic code. Esteban v. Brown, 6 Vet. App. 259, 262 (1994). VA must consider all favorable lay evidence of record. 38 U.S.C. § 5107(b); Caluza v. Brown, 7 Vet. App. 498 (1995). The Veteran is competent to testify in regard to the onset and continuity of symptomatology. Heuer v. Brown, 7 Vet. App. 379, 384 (1995); Falzone v. Brown, 8 Vet. App. 398, 403 (1995); Caldwell v. Derwinski, 1 Vet. App. 466 (1991). The Board has reviewed all the evidence in the record. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that all of the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). In this case, the Veteran seeks entitlement to increased ratings for his service-connected disabilities of PTSD with alcohol use disorder and tension-cervicogenic headaches. Each issue will be discussed in turn. A. PTSD with alcohol use disorder Service connection for PTSD was established by a May 2013 rating decision, at which time a 70 percent rating was assigned, effective as of October 2, 2012. The Veteran did not appeal this decision; rather, in December 2014, the Veteran filed a claim for an increased rating for his service-connected PTSD. Thus, the Veteran contends that he is entitled to an increased rating for his PTSD with alcohol use disorder. The Veteran’s PTSD with alcohol use disorder is rated under 38 C.F.R. § 4.130, Diagnostic Code 9411. This Diagnostic Code provides that PTSD should be rated under the General Rating Formula for evaluating psychiatric disabilities other than eating disorders. See 38 C.F.R. § 4.130, Diagnostic Code 9411. Under the General Rating Formula, a 70 percent rating is assigned for occupational and social impairment with deficiencies in most areas, such as work, school, family relationships, judgment, thinking or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near- continuous panic or depression affecting ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. Id. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name. Id. The symptoms listed in the rating schedule are not intended to constitute an exhaustive list, but rather serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436 (2002). See 38 C.F.R. § 4.130. In Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed.Cir. 2013), the Federal Circuit stated that “a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration.” It was further noted that “§ 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas.” Psychiatric examinations frequently include assignment of a Global Assessment of Functioning (GAF) score. According to the Fourth Edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), GAF is a scale reflecting the “psychological, social, and occupational functioning on a hypothetical continuum of mental health illness.” There is no question that the GAF score and interpretations of the score are important considerations in rating a psychiatric disability. See e.g., Richard v. Brown, 9 Vet. App. 266, 267 (1996); Carpenter v. Brown, 8 Vet. App. 240 (1995). However, the GAF score assigned in a case, like an examiner’s assessment of the severity of a condition, is not dispositive of the evaluation issue; rather, the GAF score must be considered in light of the actual symptoms of the Veteran’s disorder, which provide the primary basis for the rating assigned. See 38 C.F.R. § 4.126(a). VA implemented DSM-5, effective August 4, 2014, and the Secretary, VA, determined that DSM-5 applies to claims certified to the Board on and after August 4, 2014. 79 Fed. Reg. 45,093, 45, (Aug. 4. 2014). The RO certified the Veteran’s appeal to the Board in August 2017; hence; DSM-5 is for application in this claim. Nonetheless, with the adoption of the DSM-5, the general rating criteria remain the same, aside from no longer assigning a GAF score. 38 C.F.R. § 4.126(d). Further, the Board notes the Veteran has been also diagnosed with bipolar disorder by history, but he is not service-connected for this condition. As there is no medical evidence of record distinguishing between the symptoms attributable to the service-connected PTSD and the non-service connected diagnosis, the Board will accord him the benefit of the doubt and consider the totality of his psychiatric symptomatology. See Mittleider v. West, 11 Vet. App. 181, 182 (1998) (holding that when it is not possible to separate the effects of the service-connected condition and a non-service connected condition, reasonable doubt should be resolved in the claimant’s favor). After a thorough review of the record, the Board finds that the evidence during the appeal period is consistent with a 70 percent disability rating for PTSD for occupational and social impairment, with deficiencies in most areas. On VA examination in March 2015, the Veteran reported that he was kicked out of college due to an argument with the dean of the school and blowing up in class. He further reported that he was homeless for a period of time until about three months prior to that time when he moved into his current residence. He indicated that he had verbal conflicts with his family and no longer talked to them. The Veteran reported that he had difficulty falling asleep, some of which he indicated could be due to his sleep apnea. He indicated that he had nightmares or distressing dreams about every other night. He did not report any problems with energy. He described feeling depressed most days and frequently having little interest in anything or any enjoyment. He was chronically irritable and was easily offended by others. He did not trust anyone and did not report that he had any social life or friends at that time. He indicated that he isolated himself and avoided social interactions, partly to avoid any kind of altercations. The Veteran did not report problems with concentration; however, the examiner noted that he did exhibit significant difficulty with concentration during the examination. He clearly denied ever experiencing any suicidal ideation, and he denied that he wanted to kill anyone. As regards to his occupational history, the examiner noted that after being expelled from college, the Veteran worked for a month at a warehouse, but quit abruptly. The examiner further noted that the Veteran was working as a guard for a private security service company. A mental status examination revealed that the Veteran’s speech was clear and his hearing was within normal limits. He was generally cooperative, except towards the end of the examination where he was clearly frustrated or irritated by the examination. His mood was labile, and he would rapidly change from being positive in expression to being irritable, then to appearing being worried. He had problems with concentration and was easily distracted. The Veteran had some difficulty with continuity of thought. Remote and recent memory were grossly intact, but it was evident that he had problems with immediate memory. Based on the findings, the examiner concluded that the Veteran demonstrated PTSD and mental disorder signs and symptoms that resulted in deficiencies in most of the following areas: work, school, family relations, judgment, thinking, and mood. The examiner further noted that the Veteran had chronic difficulty with mild memory loss, chronic sleep impairment, suspiciousness, anxiety, depressed mood, disturbances with motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty with adapting to stressful circumstances, and impaired impulse control with unprovoked irritability. The examiner indicated that the Veteran was able to maintain activities of daily living, including personal hygiene. The examiner noted that the Veteran had not experienced significant trauma since his last examination, which was conducted in June 2014. There had not been remissions during the past year. Symptoms were continuous, and he had problems with alcohol abuse. The examiner also noted that the Veteran showed inappropriate behavior in the form of exaggerated irritable outbursts. Thought processes and communication appeared to be somewhat impaired, and social functioning was impaired. Employment was impacted due to psychological issues. Furthermore, the Veteran’s inability to regulate mood, particularly irritability, led to him being expelled from school, and also caused precipitous or impulsive behavior at work. In an April 2015 VA outpatient treatment record, the examiner noted that the Veteran reported that his symptoms had worsened since 2014, and that moving to a new city may have caused such worsening. He also reported that he felt as though he was not fitting into society after the war. He indicated that he currently worked as a part-time security guard; however, he reported that being around people in the civilian world was hard for him, and that he needed to isolate and avoid people in general. He indicated that he was homeless as a result of scaring a person he was going to live with. The examiner noted that a mental status examination revealed that the Veteran was groomed appropriately, had intense eye contact and intense/bearing expressions, was receptive and responsive, and was patient with ideas. The Veteran’s speech was rapid. He denied auditory verbal hallucinations and delusions. He also denied suicidal and homicidal ideations. The examiner noted that his insight/judgment was intact as observed and probably subject to mood. An August 2015 VA outpatient treatment record shows that the Veteran voluntarily admitted himself to the hospital due to symptoms of anxiety and depression. A mental status examination revealed that the Veteran was having very upsetting flashbacks of his time in Iraq and Afghanistan, as well as other life events. The examiner noted that he was anxious, depressed, not able to obtain sufficient sleep at night, too anxious to eat regularly, had mild paranoia that he was being pre-judged, not compliant with current prescribed medications, afraid to take multiple medications at once, and hyper-aroused. The examiner further noted that the Veteran had never been admitted for psychiatric care and had little to no insight into his mental health condition. The Veteran was initially ambivalent about admitting himself to the hospital, but eventually decided that he would not be able to function at his current status much longer and needed to do it. In making this decision, the Veteran consulted with his father, who was in agreement. The examiner also noted that the Veteran demonstrated pressured speech and fear that he could hurt someone else – not because he intended or desired to do so, but because he was so unstable. The Veteran denied suicidal or homicidal ideations. The examiner noted that the Veteran seemed to be a risk for impulsive behavior. In a September 2016 VA outpatient treatment record, the examiner noted that a mental status examination revealed that the Veteran was dressed casually and weather-appropriate, had a clean appearance, and appeared to have average intelligence. The Veteran was alert and oriented to person, place, time, and situation. He appeared with an anxious/depressed mood and blunted affected. He had good eye contact, was friendly, and was receptive to the meeting. His short-term and long-term memory appeared to be intact. His speech was clear and of a normal rate. His thought process appeared to be coherent, goal-directed, and logical. Further, the content of thought was appropriate for the circumstances. His insight and judgment appeared to be sound. He did not appear to be delusional, and he engaged easily in conversation. A December 2016 VA outpatient treatment record shows that the Veteran contacted the Veterans Crisis Line. The Veteran reported that he drank alcohol so much in order to not think about suicide. He further reported that he needed assistance, as he was unable to maintain a job because he gets angry and cannot be around a lot of people. The Veteran indicated that he was homeless at that time. The examiner noted that the Veteran denied suicidal ideation, plan, or intent at that time. There was no indication of imminent risk of suicide at that time. The Veteran reported that he contacted the Veterans Crisis Line because he was currently living in his car and needed assistance with housing, transportation, and managing his finances. He indicated that he was going to stay with family in Denver; however, it did not work out because he did not get along with his mother’s boyfriend. The Veteran stated that he would like to “get back on my feet.” In an April 2017 VA outpatient treatment record, the examiner noted that a mental status examination revealed that the Veteran was attentive and oriented to person, place, and time. He was polite, open, and cooperative. His grooming and eye contact were good. Speech was at a normal rate and rhythm, and language was intact. Mood was anxious, but the Veteran was calm by the end of the session. His affect was congruent with mood. He did not appear to be having perceptual disturbances. Thought processes were normal and coherent, with no unusual thought content. He demonstrated fair insight and judgment, and his memory was intact. The Veteran presented with an average fund of knowledge. A subsequent April 2017 VA outpatient treatment records shows that the Veteran underwent another mental status examination, which revealed that he was attentive and oriented to person, place, and time. The Veteran did not present to be anxious or irritable and his affect was congruent with mood; however, he appeared to be having some paranoid thinking about his medications and others out to get him. He denied visual and auditory hallucinations. He also denied suicidal ideations and homicidal ideations. A June 2017 VA outpatient treatment record shows that the Veteran contacted the Veterans Crisis Line. The Veteran reported that he was feeling highly overwhelmed with stress. He further reported that he had difficulty trusting others and isolated himself from family and friends. He indicated that he had recently lost his job, which caused concern about his ability to afford his housing. He also indicated that he suffered from anger issues and was easily triggered and irritable with others. He reported that he coped by drinking and smoking marijuana. He felt trapped and hopeless. He denied suicidal ideations. An August 2017 VA outpatient treatment record notes that the Veteran denied suicidal ideations and homicidal ideations. He indicated that he would never hurt himself or someone else. He reported that he had no family support; however, he had a friend in Michigan who tried to help him, but was too far away. Based on the foregoing evidence, at no point during the appeal period is the service-connected psychiatric disorder shown to have met the criteria for the higher rating of 100 percent. As previously noted, a 100 percent rating requires total occupational and social impairment due to symptoms such as gross impairment in thought processes or communication; persistent delusions; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name. See 38 C.F.R. § 4.130, Diagnostic Code 9411. Here, the Veteran has exhibited no such traits, during his examinations or as described by the Veteran’s lay statements. There was no evidence of perceptual disturbances such as hallucinations, mania or psychosis found on mental status examination. The Veteran’s thought processes were found to not be impaired while his thought content was not found to include delusions or hallucinations. His remote and recent memory were consistently found to be intact and he was consistently found to be fully oriented. He consistently reported being able to perform his activities of daily living and was found to be able to perform such activities on objective examination. Moreover, the Veteran has consistently been found to have appropriate hygiene and appearance and he has not alleged being unable to maintain minimal personal hygiene. Additionally, none of the Veteran’s PTSD symptoms are similar in severity, frequency, or duration as found necessary for the assignment of a 100 percent rating. During his examinations and in the clinical records, the Veteran has never shown to be disoriented to where he was or what he was doing. Neither examiner noted any gross impairment to the Veteran’s memory, nor can identify any grossly inappropriate behavior. While the Veteran may have expressed fear of hurting someone during his outbursts, such has yet to happen. Throughout the claims period, there has been no evidence of actual violence against other people, or any evidence of him hurting himself. Finally, the mere fact that the Veteran has repeatedly expressed his desire to stay away from people because of fear of hurting them, demonstrates his judgment and thought process is not grossly impaired. Additionally, the Veteran’s treatment records throughout the appeal period do not show that the frequency and severity of the Veteran’s psychiatric symptoms resulted in total social and occupational impairment. The bulk of the Veteran’s treatment records demonstrate that the Veteran is capable of basic social interaction and occupational functioning and is not completely impaired. The Veteran has reported that he has a relationship, albeit a distant one, with his mother and father. He has also reported a distant relationship with a friend in Michigan. Such evidence shows that the Veteran’s capacity for social relationships is not totally impaired. Thus, the Board finds that such evidence does not show a total social and occupational impairment. For these reasons, the Board finds that an evaluation in excess of 70 percent is not warranted. Therefore, the Board finds that the preponderance of the evidence is against the finding that the Veteran’s condition is productive of total social and occupational impairment, and a rating in excess of 70 percent is not warranted. As such, the doctrine of benefit-of-the-doubt is inapplicable, and the Veteran’s claim for an increased rating must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3; Gilbert, 1 Vet. App. 49, 55-56 (1990). B. Tension-Cervicogenic Headaches The Board will clarify the appeal period being addressed herein for the Veteran’s claim of entitlement to an increased rating for tension-cervicogenic headaches. Service connection was initially granted for tension-cervicogenic headaches in an August 2014 rating decision. The RO assigned a noncompensable rating, effective as of October 2, 2012. The Board notes that in August 2014, via a telephone conversation, the Veteran disagreed with the initially assigned noncompensable rating for headaches in the August 2014 rating decision. See August 2014 Report of General Information. Prior to March 24, 2015, any written communication from a claimant or his or her representative expressing dissatisfaction or disagreement with an adjudicative determination by the AOJ and a desire to contest the result will constitute a notice of disagreement (NOD). 38 C.F.R. § 20.201. Therefore, as the August 2014 statement was not a written communication, the Board does not construe this statement as a NOD. Furthermore, review of the August 2014 statement does not reflect desire for appellate review, but rather a request that the RO reconsider the initially assigned rating. 38 C.F.R. § 20.201. The record reflects that the Veteran did not file a NOD to the August 2014 rating decision, nor did he submit new and material evidence within the appeal period. Bond v. Shinseki, 659 F.3d 1362, 1367 (Fed. Cir. 2011). Thus, the Veteran did not appeal the August 2014 rating decision; rather, in September 2015, he submitted a claim for an increased rating. The Board will not construe the September 2015 claim as a NOD because it does not express dissatisfaction or disagreement with the August 2014 rating decision or a desire to contest the result. 38 C.F.R. § 20.201. Thus, the current appeal originated from the Veteran’s September 2015 claim for an increased rating. Since September 24, 2015, when the Veteran submitted his claim for an increase, he has been in receipt of a noncompensable rating for his tension-cervicogenic headaches. The Board will consider whether an increased rating is warranted from an appeal originating on that date. The Veteran’s tension-cervicogenic headaches are rated under 38 C.F.R. § 4.124a, Diagnostic Code 8100. Because Diagnostic Code 8100 (which pertains to migraines) contemplates the Veteran’s symptoms of headaches and a closely analogous headache diagnosis, the Board finds that the Veteran is properly evaluated under Diagnostic Code 8100. Under Diagnostic Code 8100, a noncompensable rating is warranted for less frequent attacks than as follows. A 10 percent rating is warranted for migraines with characteristic prostrating attacks occurring on an average of once in two months over the last several months. A 30 percent rating is warranted for migraines with characteristic prostrating attacks occurring on an average of once a month over the last several months. A 50 percent rating is warranted for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. Governing case law and regulations have not defined “prostrating.” For reference, the Board notes that “prostration” is defined as “extreme exhaustion or powerlessness.” See DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 1531 (32d. ed. 2012). On VA examination in November 2015, the Veteran reported that he experienced occipital tension, three to four times per week, lasting for an hour. He indicated that he took ibuprofen. The examiner noted that the Veteran experienced headache pain on both sides of the head, lasting for less than one day. The Veteran did not have characteristic prostrating attacks of migraine headache pain. Furthermore, the Veteran did not have prostrating attacks of non-migraine headache pain. The examiner noted that the Veteran’s headaches did not impact his ability to work. On VA examination in September 2016, the Veteran reported that he suffered daily headaches. He further reported that his headaches had progressively worsened and were more frequent over the years. He described the headache as getting worse as the day went on and with increased stress. He reported that he took ibuprofen to alleviate the pain, and also, that he drank beer because it helped. The examiner noted that the Veteran did not have any other associated symptoms, such as nausea, vomiting, photophobia, or phonophobia. The examiner noted that the Veteran’s symptoms consisted of constant head pain, pulsating or throbbing head pain, pain on both sides of the head, and worsening of pain with physical activity. The typical head pain lasted for less than a day. The Veteran did not have characteristic prostrating attacks of migraine headache pain. Furthermore, the Veteran did not have prostrating attacks of non-migraine headache pain. A review of the record shows that the Veteran receives treatment at the VA Medical Center for various disabilities. However, there is no indication from the record that his headache symptoms are manifestly different than those reported at his VA examinations. Based on the foregoing evidence, a compensable rating for the Veteran’s headaches is not warranted. In this regard, there is no evidence of record showing that the Veteran’s headaches were productive of prostrating attacks. To that end, none of the VA examination reports indicate that the Veteran experienced prostrating attacks, and the Veteran’s extensive post-service medical records were silent for such symptoms. Thus, the Board finds that the Veteran’s headaches are productive of less frequent attacks. Therefore, a compensable rating for tension- cervicogenic headaches is not warranted. 38 C.F.R. § 4.124a, Diagnostic Code 8100. Further, the Board has considered the lay evidence offered by the Veteran, in addition to the medical evidence cited above. His factual recitation as to symptomatology associated with the headache condition is accepted as true. However, as a layperson, lacking in medical training and expertise, the Veteran cannot provide a competent opinion on a matter as complex as the present severity of his headache disability, and his assertions are far outweighed by the detailed opinions provided by the medical professionals who examined the Veteran’s headache condition and discussed all relevant details for purposes of rating his disability. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). For these reasons, the Board finds that at no time during the period in question has the disability warranted more than a noncompensable evaluation. See Hart v. Mansfield, 21 Vet. App. 505 (2007). Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt provisions are inapplicable. 38 U.S.C. § 5107; 38 C.F.R. § 4.3. Accordingly, the Veteran’s clai for an increased rating is denied. Entitlement to TDIU The Veteran contends that he is unable to work due to the symptomatology associated with his service-connected disabilities. After a thorough review of the evidence, the Board concludes that the Veteran’s service-connected disabilities prevent him from obtaining and maintaining substantially gainful employment. Entitlement to a TDIU requires the presence of impairment so severe that it is impossible for the average person to follow a substantially gainful occupation. See 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. In reaching such a determination, the central inquiry is “whether the Veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability.” See Hatlestead v. Brown, 5 Vet. App. 524, 529 (1993). Consideration may be given to the Veteran’s level of education, special training and previous work experience in arriving at a conclusion, but not to age or to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. Where the schedular rating is less than total, a total disability rating for compensation purposes may be assigned when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that, if there is only one such disability, this disability shall be ratable at 60 percent or more, or if there are two or more disabilities, there shall be at least one ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). As the Veteran has a rating of 70 percent for PTSD, the Veteran meets the percentage requirement for the schedular criteria for a TDIU. 38 C.F.R. § 4.16(a). His combined rating is currently 90 percent. The Board finds that the evidence of record reveals that the Veteran has been precluded from obtaining and maintaining a substantially gainful occupation consistent with his education and work experience as a result of his service-connected disabilities. The Board notes that the Veteran is currently service connected for several disabilities, to include PTSD, sleep apnea, right wrist strain, a left knee disability, irritable bowel syndrome, lumbar strain with degenerative joint disease, status post right index finger fracture, status post left hand fifth metacarpal fracture with surgery, cervical spine strain, status post-surgery scars of the left hand, traumatic brain injury, tension-cervicogenic headaches, and bilateral lower extremity sciatic radiculopathy. The Veteran asserts that he is unable to work due to his service-connected disabilities, specifically his PTSD. To this end, during the Veteran’s March 2015 VA psychiatric examination, the examiner noted that the Veteran had difficulty in adapting to stressful circumstances, including work or work-like settings, and that he had impaired impulse control with unprovoked irritability. The examiner further noted that the Veteran demonstrated inappropriate behavior in the form of exaggerated irritable outbursts. Additionally, during the Veteran’s May 2016 VA psychiatric examination, the examiner noted that the Veteran was fired from his last job because he had trouble with being on time and getting along with others. The examiner noted that the Veteran’s PTSD and paranoia made it difficult for him to be around people; therefore, it would be hard for him to work with customers, in a team environment, or on a job where he had to collaborate with others. The examiner further noted that the Veteran had trouble with being on time due to his sleep issues. In addition, it was noted that the Veteran’s PTSD symptoms caused clinically significant distress or impairment in social, occupational, or other important areas of functioning. The examiner indicated that the Veteran would do best in a position that was part-time. The examiner noted that the Veteran had just started a part-time position conducting inventory for a store. Recent VA treatment records indicate that the Veteran is now unemployed. The treatment records suggest that he has been unable to hold a job due to his PTSD symptoms. In a December 2017 private vocational assessment, the certified vocational evaluator noted that the Veteran suffered from chronic and severe symptoms of PTSD, including anxiety, hypervigilance, paranoia, depression, irritability with unpredictable explosive behavior, and isolation. The certified vocational evaluator concluded that the Veteran’s symptoms associated with PTSD resulted in the complete inability to perform even sedentary substantial gainful employment. He indicated that the Veteran’s PTSD symptoms caused clinically significant distress or impairment in social, occupational, or other important areas of functioning. The Veteran would experience difficulties with maintaining the required pace and production demands of employment, which include the basic worker traits of showing up on time the days scheduled, staying the scheduled amount of time, and completing required tasks in a timely fashion. Furthermore, he would have difficulty maintaining appropriate relationships with supervisors, coworkers, and the general public, and, if severe enough, can cause the inability to keep a job. In July 2018, the Veteran was awarded Social Security Administration (SSA) benefits due to his bipolar disorder, PTSD and lumbar spine degenerative disc disease. The decision noted that the Veteran had attempted to work part-time in 2016 and that he had no recorded earnings in 2017 and 2018. The Board notes that the Veteran had briefly worked part-time performing inventory in 2016 prior to being terminated. In a May 2016 VA examination report, the Veteran reported that he had worked for two weeks performing inventory for a store. This work is also not sufficient to qualify as substantially gainful employment as the work was part-time and was short-lived. The evidence supports a finding that the Veteran was unable to maintain substantially gainful employment throughout the appeal period. The Veteran’s irritability has been noted throughout the claims period, and has resulted to not only be the cause of problems at his work, but also the source of his severe impairment in social activities. As noted in the March 2015 examination report, the examiner noted that the Veteran demonstrated inappropriate behavior in the form of exaggerated irritable outbursts. While the May 2016 VA examiner noted that the Veteran would be able to work part-time positions, the Board finds that the examiner’s description of significant social and occupational impairment to be sufficient to demonstrate the Veteran’s inability to obtain or retain gainful employment. In fact, as previously stated, the record reflects that the Veteran is currently unemployed. The Board also notes that lay statements made by the Veteran indicate his problems with irritability and anger, to also include his excessive drinking, which the VA examiners have attributed to his PTSD. Therefore, the Board finds that in viewing the totality of the Veteran’s psychiatric disability, to include lay statements made by the Veteran, VA examinations, and the December 2017 private vocational assessment, that the Veteran’s service- (CONTINUED ON NEXT PAGE) connected PTSD prevents him from obtaining and retaining gainful employment. As such, given the evidence above, a TDIU is warranted. Kristy L. Zadora Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Y. MacDonald, Associate Counsel