Citation Nr: 18142307 Decision Date: 10/15/18 Archive Date: 10/15/18 DOCKET NO. 16-11 725 DATE: October 15, 2018 ORDER Entitlement to a disability rating in excess of 50 percent for posttraumatic stress disorder (PTSD) with major depressive disorder (MDD) prior to October 15, 2015, and in excess of 70 percent thereafter is denied. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is granted subject to the laws and regulations governing the payment of monetary benefits. FINDINGS OF FACT 1. Prior to October 15, 2015, the Veteran’s service-connected PTSD with MDD has resulted in no more than occupational and social impairment with reduced reliability and productivity, and since October 15, 2015 has resulted in no more than occupational and social impairment with deficiencies in most areas. 2. The Veteran’s service-connected disabilities preclude her from securing or following a substantially gainful occupation. CONCLUSIONS OF LAW 1. Prior to October 15, 2015, the criteria for a disability rating in excess of 50 percent for PTSD with MDD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.125, 4.126, 4.130, Diagnostic Code (DC) 9411. 2. Since October 15, 2015, the criteria for a disability rating in excess of 70 percent for PTSD with MDD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.125, 4.126, 4.130, DC 9411. 3. The criteria for TDIU have all been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.15, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1991 to February 1997. 1. Entitlement to a disability rating in excess of 50 percent for PTSD with MDD prior to October 15, 2015, and in excess of 70 percent thereafter The Veteran contends that her PTSD meets the criteria for a rating higher than currently assigned. The Veteran’s PTSD is currently rated at 50 percent from October 15, 2015, and 70 percent thereafter. Disability ratings are determined by applying the criteria set forth in the VA’s Schedule for Rating Disabilities, which 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. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran’s disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. In deciding this appeal, the Board has considered whether separate ratings for different periods of time are warranted, a practice of assigning ratings referred to as “staging the ratings.” See Fenderson v. West, 12 Vet. App. 119 (1999). The criteria for rating PTSD are found at 38 C.F.R. § 4.130, DC 9411. A 50 percent evaluation is warranted where there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short-and long-term memory; impaired judgment; impaired abstract thinking; disturbance of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent evaluation is warranted where there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); and inability to establish and maintain effective relationships. Id. A 100 percent evaluation requires total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name. Id. Ratings are assigned according to the manifestation of particular symptoms. However, the use of the term “such as” in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). 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. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013). Other language in Vazquez-Claudio indicates that the phrase “others of similar severity, frequency, and duration,” can be thought of as symptoms of like kind to those listed in the regulation for a given disability rating. Id. 116. If the evidence demonstrates that the claimant’s psychiatric disorder produces symptoms and resulting occupational and social impairment equivalent to that set forth in the criteria for a given rating in the General Rating Formula, then the appropriate, equivalent rating will be assigned. Mauerhan, 16 Vet. App. at 443. In this regard, the Board must consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran’s capacity for adjustment during periods of remission. 38 C.F.R. § 4.126. While VA considers the level of social impairment, it shall not assign an evaluation based solely on social impairment. Id. For purposes of considering the evidence in connection with the PTSD issue, the Board notes that the Global Assessment of Functioning (GAF) scale is a scale from 0 to 100, reflecting the “psychological, social, and occupational functioning on a hypothetical continuum of mental health illness.” Diagnostic and Statistical Manual of Mental Disorders 32 (4th ed. 1994) (“DSM-IV”) (100 representing superior functioning in a wide range of activities and no psychiatric symptoms). See 38 C.F.R. §§ 4.125, 4.126, 4.130. In this regard, the Board acknowledges that effective August 4, 2014, VA amended the regulations regarding the evaluation of mental disorders by removing outdated references to “DSM-IV,” American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (1994). The amendments replace those references with references to the recently updated “DSM-5,” and examinations conducted pursuant to the DSM-5 do not include GAF scores. A GAF score of 41-50 denotes serious symptoms or any serious impairment in social, occupational, or school functioning. A GAF of 51-60 denotes moderate symptoms or moderate difficulty in social, occupational, or school functioning. A GAF of 61-70 denotes some mild symptoms or some difficulty in social, occupational, or school functioning, but generally functioning pretty well, has some meaningful interpersonal relationships. While an examiner’s classification of the level of psychiatric impairment as reflected in a GAF score can be probative evidence, such a score is by no means determinative of the rating assigned by VA in evaluating a psychiatric disorder under the rating criteria. See 38 C.F.R. §§ 4.2, 4.126 (2017); VAOPGCPREC 10-95 (March 31, 1995). Rather, VA must take into account all of the Veteran’s symptoms and resulting functional impairment as shown by the evidence of record in assigning the appropriate rating, and will not rely solely on the examiner’s assessment of the level of disability at the time of examination. See 38 C.F.R. § 4.126. The Board notes that in Golden v. Shulkin, No. 16-1208, Slip opinion at 5 (Vet. App. Feb. 23, 2018), the Court held that given that the DSM-5 abandoned the GAF scale and that VA has formally adopted the DSM-5, the Board errs when it uses GAF scores to assign a psychiatric rating in cases where the DSM-5 applies. However, the Court added that it does not hold that the Board commits prejudicial error every time the Board references GAF scores in a decision. Prior to October 15, 2015 The Veteran underwent a VA examination in February 2009. The report indicates that the Veteran had occupational and social impairment with reduced reliability and productivity. It indicates that the Veteran experienced problems with sleep, feeling exhausted, tension headaches, intrusive memories, hyperarousal, re-experiencing of traumatic events, and avoidance behaviors. The report indicates anxiety, a long history of frequent panic attacks, and that the Veteran sometimes avoids outings, particularly parties. The report indicates that the Veteran has felt depressed on and off over the years, particularly during her marriage. She stated that she has been suicidal in the past, but denied any recent thoughts of suicide. The report indicates that the Veteran has never planned, intended, or attempted to hurt herself. She denied auditory or visual hallucinations. The report indicates that the Veteran is able to maintain activities of daily living, including personal hygiene. The report indicates no inappropriate behavior, no significant impairment of thought processes and communication, and social functioning impaired by her high level of avoidance and frequency of panic attacks. The Veteran underwent a VA examination for PTSD in April 2015. The report indicates that the Veteran has occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication. The report indicates no psychiatric hospital admissions or current treatment. The Veteran reported panic attacks while driving in snow and when she sees police officers, but that she enjoys time with her kids and animals, drives, travels, cooks, cleans, shops, does laundry, goes to school events, and enjoys working with horses. She reported a good relationship with her current husband and children, and that she attends school events but otherwise described herself as reclusive. She reported no difficulty getting along with others. The report indicates no psychosis/mania, and that memory, judgment, and insight were intact. The report indicates that the Veteran had one suicide attempt at the end of 2006 or beginning of 2007, stating that she did not try but was thinking and talking about it. She reported no current suicidal or homicidal ideation, intent, or plan. The report indicates that the Veteran exhibited depressed mood, anxiety, panic attacks that occur weekly or less often, chronic sleep impairment, and disturbances of motivation and mood. VA treatment records received in December 2015 include a mental status examination on September 29, 2015, which showed no delusions, preoccupations, obsessions, compulsions, phobias, or suicidal/homicidal ideations. It indicates no overt psychotic symptoms or evidence of thought disorder, and that memory and judgment were intact. The report indicates that she is not suicidal and no psychiatric hospitalization. She continued to struggle with nightmares, flashbacks, emotional withdrawal, isolation, startled easily, hyperarousal, and strong fear response. It indicates that she was impaired in occupation and social domains. The records indicate that the Veteran reported struggling with suicidal thoughts, but denied any attempts. She reported having less suicidal thoughts in the past two years; however, she noted that during stressful times she sometimes thinks “everyone would be better off if [she] were out of the picture” but that she has not made any suicide plans or self-harmed. Based on the foregoing, the Board finds that the evidence is against granting a disability rating higher than 50 percent for the Veteran’s PTSD. The evidence does not show that the Veteran’s symptoms were of the type and degree contemplated by the criteria for a 70 percent disability rating prior to October 15, 2015. The evidence of record does not show that the Veteran has obsessional rituals, illogical speech, impaired impulse control, spatial disorientation, neglect of personal appearance and hygiene, or an inability to establish and maintain effective relationships. The Board acknowledges that the Veteran has reported frequent panic attacks and depression; however, the competent medical evidence of record does not indicate that her panic attacks or depression rise to the level contemplated by the 70 percent criteria and do not affect her ability to function independently, appropriately, and effectively. The Board also acknowledges that the Veteran reported suicidal thoughts and that in the past she had a plan; however, VA treatment records and examinations consistently indicate that the Veteran has not been assessed to be at risk of suicide and has not reported any current suicidal ideation, intent, or plans. Thus, the extent of her impairment has not been shown by the competent medical evidence of record to be that required for a 70 percent or higher rating prior to October 15, 2015. Thus, a rating in excess of 50 percent is not warranted prior to October 15, 2015. A. Since October 15, 2015 VA treatment records received in December 2015 include a mental health conference note on October 15, 2015. It indicates that the Veteran has symptoms, including loss of interest or participation in significant activities, guilt, irritability or anger outburst, problems with sleep, low energy, excessive guilt and worthiness, lack of interest and motivation, persistent sadness or crying, panic attacks, avoidance, anxiety, difficulty concentrating, and marital or family problems. In an October 2015 statement, the Veteran’s treating psychiatrist at the VA stated that she continues to suffer marked nightmares, flashbacks, severe emotional withdrawal, isolation, hypervigilance, hyper-arousal, increased startle reflex, strong fear response with police, and avoidance. In a December 2015 mental health record, a mental status examination revealed no delusions, obsessions, compulsions, phobias, or suicidal/homicidal ideations. It indicates no overt psychotic symptoms or evidence of thought disorder, and memory and judgment were intact. The January 2016 PTSD disability benefits questionnaire (DBQ) indicates that the Veteran has occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal, routine behavior, self-care and conversation. It indicates that she exhibited symptoms of depressed mood, anxiety, suspiciousness, and chronic sleep impairment; she denied any homicidal or current suicidal ideation but endorsed experiencing suicidal ideation without plan or intent a few days prior to the examination. She stated that she typically experiences suicidal ideation without plan or intent once per week. In a March 2016 VA Form 9, the Veteran stated that she has “numerous panic attacks and suicidal thoughts, nightmares, etc.” In a March 2016 statement, the Veteran’s treating psychiatrist stated that the Veteran continues to suffer from nightmares, flashbacks, emotional withdrawal, hyperarousal, hypervigilance, high levels of irritability, and suicidal ideation. In a July 2016 statement, the Veteran’s husband discussed witnessing the Veteran’s fear of law enforcement officers on numerous occasions. He stated that he sees the Veteran’s fear affect her everyday life. In a July 2016 statement, the Veteran’s mother stated that the Veteran’s rape by a military police officer in service had a very “profound effect on her” and that the she now has panic attacks and fears cops or others in authority. VA treatment records received in August 2016 include a record from July 25, 2016, indicating that the Veteran had some suicidal ideation but no plan or intent. In an October 2016 letter, the Veteran’s psychiatrist stated that she continues to suffer from marked nightmares, flashbacks, intrusive thoughts, high level of irritability, hyperarousal, hypervigilance, increased startle reflex, isolation, emotional withdrawal, and anhedonia. He stated that she is impaired in family, work, and interpersonal domains. The April 2017 PTSD DBQ indicates that the Veteran has occupational and social impairment with deficiencies in most areas. The report indicates that the Veteran has difficulty in group situations and often feels overwhelmed and hyper vigilant. She endorsed difficulty with word finding, chronic sleep impairment, nightmares, intrusive thoughts, avoidance, negative alterations in cognitions/moods, and marked alterations in arousal and reactivity. She denied inpatient treatment for PTSD, and exhibited symptoms of depressed mood, anxiety, suspiciousness, panic attacks more than once a week, chronic sleep impairment, mild memory loss, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, including work or a work like setting, suicidal ideation. The examiner noted that the Veteran endorsed vague, intermittent, and fleeting suicidal ideation, without a current plan or intention, but endorsed having a past plan. The report indicates that thought process was linear and goal directed, she denied auditory or visual hallucinations, and did not present with formal thought disorder. The examiner indicated that she believes that the Veteran should be considered an increased but not current imminent risk of harm to herself. Based on the foregoing, the Board finds that the evidence is against granting a rating higher than 70 percent for the Veteran’s PTSD. While she has had symptoms including anxiety, depression, chronic sleep impairment, panic attacks, sleep impairment, mild memory loss, and poor concentration, the evidence does not show that she has had symptoms to the type and degree contemplated by the criteria for a 100 percent rating. The Veteran has not exhibited gross impairment in thought processes or communication, delusions or hallucinations, grossly inappropriate behavior, intermittent inability to perform activities of daily living, or disorientation to time or place. The Veteran has not had memory loss such as contemplated by the 100 percent rating. Thus, the evidence of record does not show total social and occupational impairment. The first evidence from which it is factually ascertainable that the 70 percent criteria have been approximated is the VA treatment record from October 15, 2015. Prior to that date, the record does not show that the Veteran suffered from the symptoms listed in the criteria for a 70 percent rating or symptoms of like kind or that her level of impairment exceeded that contemplated by the 50 percent rating criteria. Therefore, the appeal for a rating higher than 50 percent prior to October 15, 2015, and in excess of 70 percent thereafter must be denied. The Board finds that for the entire appeal period, the evidence does not show that the Veteran’s symptoms have been of the type and degree contemplated by the criteria for a 100 percent disability rating. The evidence does not show that the Veteran has had gross impairment in thought processes or communication, grossly inappropriate behavior, persistent delusions or hallucinations, or memory loss such as contemplated under the 100 percent rating criteria. There have been no symptoms of like kind to those listed for the 100 percent rating. the record does not indicate that the Veteran has ever had total occupational and social impairment. As the preponderance of the evidence is against the claim for a rating in excess of 50 percent prior to October 15, 2015, and in excess of 70 percent thereafter, the benefit-of-the-doubt doctrine is not applicable, and the claim must be denied. 8 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The Board finds that a preponderance of the evidence is against the assignment of a higher disability rating other than that listed herein for the Veteran’s PTSD on a schedular basis for any period on appeal. 38 U.S.C. § 5107(a). For all periods on appeal, the Board has considered whether referral for an extraschedular rating under 38 C.F.R. § 3.321(b)(1) is warranted. he Board finds that the Veteran’s symptoms of PTSD are contemplated by the schedular rating criteria. Neither the facts of the case nor the Veteran’s allegations raise the issue of extraschedular consideration. Thus, no analysis is required. See Yancy v. McDonald, 27 Vet. App. 484, 494 (2017) (holding that an extraschedular analysis is not warranted where it is not “specifically sought by the claimant nor reasonably raised by the facts found by the Board”) (citing Dingess v. Nicholson, 19 Vet. App. 473, 499 (2006), aff’d, 226 Fed. Appx. 1004 (Fed. Cir. 2007); see also Doucette v. Shulkin, 28 Vet. App. 366, 369 (2017) (explaining that the Board had no obligation to analyze whether referral is warranted for extraschedular consideration if an extraschedular rating is not specifically sought by the claimant or reasonably raised by the facts found by the Board). 2. Entitlement to a TDIU The Veteran contends that her service-connected PTSD prevents her from securing or following a substantially gainful occupation. Entitlement to TDIU requires the presence of impairment so severe that it is impossible for the average person to follow a substantially gainful occupation. 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 the Veteran’s age or the impairment caused by any nonservice-connected disabilities. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.19. 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). TDIU may be assigned 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. The service-connected disabilities, employment history, educational and vocational attainment, and all other factors having a bearing on the issue will be addressed in both instances. 38 C.F.R. § 4.16(a),(b). For a schedular TDIU, if there is only one such disability, it must be rated at 60 percent or more; if there are two or more disabilities, at least one disability must be rated at 40 percent or more, with sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). For the above purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable, (2) disabilities resulting from common etiology or a single accident, (3) disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric, (4) multiple injuries incurred in action, or (5) multiple disabilities incurred as a prisoner of war. 38 C.F.R. § 4.16(a). It is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. Therefore, rating boards should submit to the Director, Compensation Service, for extra-schedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities, but who fail to meet the percentage standards set forth in § 4.16. 38 C.F.R. § 4.16(b). The rating board will include a full statement as to the veteran’s service-connected disabilities, employment history, educational and vocational attainment and all other factors having a bearing on the issue. Id. The Veteran is service-connected for PTSD. It is rated at 50 percent from April 28, 2008 and at 70 percent from October 15, 2015. The Veteran meets the schedular percentage requirements as of October 15, 2015. The issue of TDIU was previously determined to have been raised by the record during the Veteran’s increased rating claim. Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). On the April 2016 TDIU application, the Veteran stated that her PTSD prevents her from securing or following any substantially gainful occupation. It indicates that she completed one year of college and that she last worked full-time in 2009. The Veteran stated that she left her job in a Veterinary clinic because she could not handle when it got busy and that she had panic attacks and would try to hide in the back. As noted above, the Veteran underwent a VA examination in February 2009. The report indicates that she denied any problems at her job. She stated that in the past “she was a stay at home mom for some years, then worked at various places for short periods of time.” She reported that she has “had difficulty trying to find jobs where she can make more than minimum wage” and that sometimes she left a job because she was moving but that other times she “left a job secondary to feeling that she needs to be home for her children.” The examiner stated that the Veteran is employable from a psychiatric standpoint, noting that she would do best in settings in which she has limited contact with male public and supervisors. In a June 2010 assessment, the Vocational Rehabilitation Counselor stated that the Veteran’s PTSD does contribute in substantial part to her vocational impairment as indicated by her difficulty performing activities where she is around crowds and policemen. The record indicates that the Veteran has a limited work history because she was a stay at home mother, and her training in the military in Information Systems is considered outdated. The counselor indicates that her competing for jobs in the civilian workforce would be hindered due to a lack of a degree and certificates. It indicates that she has not been employed since 2009, and notes that her previous jobs do not aggravate her PTSD. The counselor noted that full-time employment opportunities in a rural community are difficult to find, and that she has an employment handicap because she is not currently employed and has limitations imposed by her PTSD. However, the counselor noted that the Veteran did not have a serious employment handicap because her issues with her disability had improved and that there is no evidence of significant restrictions on employability. It indicates that the Veteran has a high school diploma and vocational/technical training as equine sports and canine massage therapist but that the certifications have expired. The Veteran underwent a VA examination for PTSD in April 2015. The Veteran reported that she panics if she sees a police office, but that she is otherwise able to be a “stay at home mom.” The report indicates that the Veteran enjoys time with her kids and animals, she drives, travels, cooks, cleans, shops, does laundry, goes to school events, and enjoys working with horses. The report indicates that the Veteran’s work history since leaving service is “mostly stay at home mother,” she held various other short-term positions, was taking some online college courses to be a Veterinary Technician, and volunteered with a clinic for about 5 months. In an October 2015 statement, the Veteran’s treating psychiatrist stated that the Veteran is impaired in occupational, family, interpersonal, and social domains, and that she is totally and permanently disabled due to the chronicity and severity of her PTSD symptoms. VA treatment records received in December 2015 include a mental status examination on September 29, 2015. It indicates that the Veteran reported that she has not worked consistently since 2009 due to her worsening PTSD symptoms. The record notes that she is impaired in occupation and social domains. In the March 2016 and October 2016 statements, the Veteran’s treating psychiatrist indicated that she is impaired in family, interpersonal, and occupational domains. He stated that she is unemployable and has not worked since 2009 due to the chronic and persistent PTSD symptoms. The April 2017 PTSD DBQ indicates that the Veteran has occupational and social impairment with deficiencies in most areas. It indicates that over the past two years, the Veteran has remained a stay-at-home mother and has not endorsed any changes with her occupational history. The Veteran indicated that she is having a difficult time organizing and keeping the house clean. In light of the treatment records, medical opinion from her treating psychiatrist, and limited work experience and education, the Board finds that, considering the record as a whole, and resolving reasonable doubt in favor of the Veteran, the claim for a TDIU should be granted from October 15, 2015. This is the date the Veteran meets the schedular requirements for TDIU. The Board finds that the probative evidence of record reasonably shows that the Veteran’s service-connected PTSD precludes her from securing or maintaining a substantially gainful occupation consistent with her work history and education. The Board resolves reasonable doubt in favor of the Veteran and finds that the evidence shows she is entitled to an award of a TDIU rating based on her service-connected disability PTSD. See Geib v. Shinseki, 733 F.3d 1350 (Fed. Cir. 2013). Thus, the Veteran’s claim for entitlement to a TDIU is granted. (Continued on the next page)   Prior to October 15, 2015, the evidence does not indicate that the Veteran was unable to follow substantially gainful employment. Thus, referral of the TDIU claim to the Director of Compensation Service for the period prior to October 15, 2015 is not warranted because the preponderance of evidence is against a finding that the Veteran’s service connected PTSD renders her unable to secure or follow a substantially gainful occupation during that time period. JAMES G. REINHART Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Labi, Associate Counsel