Citation Nr: 18144368 Decision Date: 10/24/18 Archive Date: 10/24/18 DOCKET NO. 14-19 232 DATE: October 24, 2018 ORDER Entitlement to a rating of 50 percent for an acquired psychiatric disorder, diagnosed as posttraumatic stress disorder (PTSD), from December 21, 2005 through May 15, 2006, is granted. Entitlement to a rating higher than 50 percent for an acquired psychiatric disorder, diagnosed as PTSD, is denied. Entitlement to a total disability rating based on individual unemployability is denied. FINDINGS OF FACT 1. Affording the Veteran the benefit of the doubt, the Board finds that from December 21, 2005 through May 15, 2006, the Veteran’s psychiatric disorder has been productive of symptomatology resulting in occupational and social impairment with reduced reliability and productivity, without more severe manifestations that more nearly approximate occupational and social impairment with deficiencies in most areas, or total occupational and social impairment. 2. The most probative evidence indicates that the Veteran’s service-connected disabilities do not preclude him from substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for entitlement to a rating of 50 percent for an acquired psychiatric disorder, diagnosed as PTSD, from December 21, 2005 through May 15, 2006, have been satisfied. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.130, Diagnostic Code 9411. 2. The criteria for an initial rating in excess of 50 percent for an acquired psychiatric disorder, diagnosed as PTSD, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.130, Diagnostic Code 9411. 3. The criteria for a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) have not been satisfied. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1965 to April 1968. He is in receipt of the Combat Infantryman Badge, the Purple Heart Medal, and other various campaign medals. The Veteran testified before the undersigned Veterans Law Judge in July 2014. A transcript of the hearing is of record. In August 2016 the Board remanded the appeal for additional development. Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Other applicable, general policy considerations are: interpreting reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability, 38 C.F.R. § 4.2; resolving any reasonable doubt regarding the degree of disability in favor of the claimant, 38 C.F.R. § 4.3; where there is a question as to which of two evaluations apply, assigning a higher of the two where the disability picture more nearly approximates the criteria for the next higher rating, 38 C.F.R. § 4.7; and, evaluating functional impairment on the basis of lack of usefulness, and the effects of the disabilities upon the person’s ordinary activity, 38 C.F.R. § 4.10. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). A claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Thus, separate ratings can be assigned for separate periods of time based on the facts found – a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. Entitlement to a rating higher than 30 percent for an acquired psychiatric disorder, diagnosed as PTSD, from December 21, 2005 through May 15, 2006, and a rating higher than 50 percent after July 1, 2006 The Veteran contends that he is entitled to a rating higher than 30 percent for his service-connected psychiatric disorder from December 21, 2005 through May 15, 2006, and a rating higher than 50 percent after July 1, 2006. He asserts that the condition is productive of symptomatology that is more severe than currently evaluated and renders him unemployable. The Veteran’s service-connected psychiatric disorder is rated under Diagnostic Codes 9411 which utilizes General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130. Under that Formula, a 30 percent rating is warranted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although found to be generally functioning satisfactorily, with routine behavior, self-care, and normal conversation), due to such symptoms as a depressed mood; anxiety; suspiciousness; panic attacks (weekly or less often); chronic sleep impairment; mild memory loss (such as forgetting names, directions, recent events). 38 C.F.R. § 4.130, General Rating Formula for Mental Disorders, Diagnostic Code 9411. A 50 percent rating is assigned when 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 (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent rating is warranted for 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 the inability to establish and maintain effective relationships. 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 or hallucinations; 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 closest relatives, own occupation, or own name. As the United States Court of Appeals for the Federal Circuit recently explained, evaluation under 38 C.F.R. § 4.130 is “symptom-driven,” meaning that “symptomatology should be the fact-finder’s primary focus when deciding entitlement to a given disability rating” under that regulation. Vazquez–Claudio v. Shinseki, 713 F.3d 112, 116–17 (Fed.Cir.2013). The symptoms listed are not exhaustive, but rather “serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating.” Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). In the context of determining whether a higher disability evaluation is warranted, the analysis requires considering “not only the presence of certain symptoms[,] but also that those symptoms have caused occupational and social impairment in most of the referenced areas” - i.e., “the regulation... requires an ultimate factual conclusion as to the Veteran’s level of impairment in ‘most areas.’” Vazquez-Claudio, 713 F.3d at 117-18; 38 C.F.R. § 4.130, Diagnostic Code 9411. Further, when evaluating a mental disorder, 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,” and must also “assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner’s assessment of the level of disability at the moment of the examination.” 38 C.F.R. § 4.126(a). Global Assessment of Functioning (GAF) scores are a scale reflecting the “psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness.” See Carpenter v. Brown, 8 Vet. App. 240, 242 (1995); see also Richard v. Brown, 9 Vet. App. 266, 267 (1996) [citing the American Psychiatric Association’s DIAGNOSTIC AND STATISTICAL MANUAL FOR MENTAL DISORDERS, Fourth Edition (DSM-IV), p. 32]. GAF scores ranging between 71 and 80 reflect that if symptoms are present they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument; no more than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in schoolwork). GAF scores ranging from 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 is generally able to function “pretty well,” and has some meaningful interpersonal relationships. Scores ranging from 51 to 60 reflect more 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). See 38 C.F.R. § 4.130 [incorporating by reference the VA’s adoption of the DSM-IV, for rating purposes]. VA implemented DSM-5, effective August 4, 2014, and the Secretary, VA, determined that DSM-5 applies to claims certified to the Board after August 4, 2014. See 79 Fed. Reg. 45,093, 45,094 (Aug. 4, 2014). As the Veteran’s increased rating claim was originally certified to the Board after August 4, 2014, the DSM-5 is applicable to this case. Effective August 4, 2014, VA also amended the regulations regarding the evaluation of mental disorders by removing outdated references to DSM-IV. The amendments replace those references with references to the recently updated DSM-5. However, according to DSM-5, clinicians do not typically assess GAF scores. The DSM-5 introduction states that it was recommended that the GAF be dropped from DSM-5 for several reasons, including its conceptual lack of clarity (i.e., including symptoms, the suicide risk, and disabilities in its descriptors) and questionable psychometrics in routine practice. Initially, the Board notes that a temporary total (100 percent) rating is in effect for PTSD (for hospitalization, under 38 C.F.R. § 4.29) for the period from May 15, 2006 to July 1, 2006. As the maximum rating has already been awarded for this period, the matter of an increased rating for this period is moot and will not be addressed herein. VA treatment notes from 2005 to 2007 show that on psychiatric evaluation, the Veteran was described as pleasant and cooperative. His affect was anxious. Speech was intact and his mood was serious. Thought content and process were adequate. Perception was intact. The Veteran was alert and oriented. He denied suicidal ideation or intent. He was assigned a GAF sore of 55. On VA examination in February 2006, the Veteran complained of problems sleeping and difficulty with his concentration. He had been placed on antidepressant medication. There was no history of psychiatric hospitalizations. The Veteran had been married three times. He had a high school degree. After 22 years working for the U.S. Postal Service as a distribution operator, the Veteran retired in 2002. He had worked as a mechanical design and industrial engineer for a six year-period of time prior to his employment with the postal service. The Veteran was described as cooperative and alert. His concentration was fair as he had some difficulty with serial threes. His insight appeared fair. However, his formal operational judgment and problem-solving skills appeared intact. When asked to discuss what a typical day was like for the Veteran, he indicated that he usually woke up at six a.m., engaged in prayer, and would do various chores or errands at his home, such as taking out the garbage or maintaining his automobiles, after breakfast. He and his wife are both responsible for managing finances. His hobbies included bike racing. The Veteran’s motor activity appeared to be grossly within norma1 limits. Speech was slightly verbose but progressed in a normal fashion. His mood was normal, and his affect was appropriate to the content of discussion. Perception appeared normal. He was alert and oriented to time, place and person. Memory appeared largely unimpaired. Insight and judgment were both appear fair. Suicidal risk appeared low at that time. The examiner assigned a GAF of 60. On VA examination in December 2006, the Veteran related being active in church and ministry activities in the community. His only other pastime was reading the Bible and religious literature. He was described as alert and fully oriented. Conversation was spontaneous and speech was fluent and goal directed. Thought processes were logical, judgment was intact, insight was fair and memory was grossly unimpaired. The Veteran was not delusional and he denied auditory or visual hallucinations. His mood was anxious and his affect is broadly reactive and intense. The Veteran denied homicidal ideation but admitted to episodic suicidal ideation. The Veteran endorsed persistent anxiety and irritability. He reported intrusive memories, avoidance of stimuli, numbing of responsiveness and hyperarousal symptoms. The examiner found that the Veteran’s psychiatric symptoms were moderate to serious in severity, and were productive of serious social and occupational impairment. His GAF score was 50. Private treatment records in March 2007 recorded a GAF of 35. The clinician noted post office light duty work due to medical disabilities, including asthma, tinnitus, hyperlipidemia and pain from shrapnel in upper right thigh. The clinician recorded major impairments in functioning such as work, interpersonal, and family relations, and in capacity for regulation of anxiety level and mood. The clinician determined that his prognosis was guarded. In connection with the Veteran’s application for Social Security disability benefits, the Veteran underwent a psychological evaluation in March 2007. The Veteran reported flashbacks, intrusive recollections, a feeling of emotional numbness and estrangement, panic attacks, outbursts of anger, fear of hurting someone, nightmares, and inability to feel grief at his mother’s funeral. He stated that he was twice divorced due to fear he would hurting his former spouses. He had since remarried. Reportedly, the Veteran attempted to take engineering courses, but quit because he couldn’t concentrate. He stated that he retired from the United States Postal Service because of his service-connected shrapnel wound injury. Although initially he was placed on light duty, he was forced into retirement in February 2004. Once he stopped working his financial stressors increased along with his anxiety. The clinician diagnosed severe PTSD and assigned a GAF score of 35. The clinician noted social and occupational impairment with concerns over impulse control. VA treatment records in 2008 described that Veteran’s appearance as adequate. He was pleasant and cooperative. Affect was fair and constricted. Speech was intact and his mood was serious. Thought content and process was adequate. Perception was intact. He was alert and oriented. The Veteran denied the presence of suicidal intent. His GAF was 55. The Veteran underwent a VA examination in July 2010. He complained of problems sleeping, daily intrusive memories, occasional exaggerated startle response, flashbacks, irritability and hypervigilance. He denied suicidal ideation. The Veteran reported he had separated from his third wife. He described having a good relationship with his siblings and children. He stated that he had been forced to retire due to downsizing, but he also reported that he was placed on light duty due to his physical health problems. The Veteran’s immediate, recent and remote memories were satisfactory. He was oriented in all spheres. His speech was normal as to rate and volume. Thought process production was spontaneous and abundant. Continuity of thought contained some rambling and repetition. The Veteran did respond well to being refocused by the examiner and was then goal-directed and relevant. Thought content contained no suicidal or homicidal ideation. There were no delusions, ideas of reference or feelings of unreality. The Veteran’s abstract ability and concentration were satisfactory. His mood was generally euthymic and his range of affect broad. The Veteran was alert, responsive and cooperative. His judgment was adequate and insight was fair. A GAF score of 50 was recorded. The examiner opined that the Veteran’s PTSD would not preclude full participation in routine activities of daily living or employment at his usual occupation. The examiner did find that his symptoms, including sleep disturbance, occasional hypervigilance and occasional exaggerated startle response, would impact the Veteran’s work if he were working, but not to the extent that employment would be prevented or precluded. VA treatment records in 2010, and thereafter, show that the Veteran was oriented to time and place. He was well groomed and his speech was within normal limits. His mood was upbeat and appropriate. He was assigned a GAF score of 50. On VA examination in March 2014 the Veteran was described as nicely dressed. His mood appeared at ease. He was somewhat hyper focused on religious matters, yet he came across as very charismatic, pleasant and cooperative. He denied any current suicidal or homicidal ideation. Insight and judgement appeared fair. He was articulate and able to answer all questions asked of him. Thought production appeared functional and spontaneous. The Veteran who had recently moved to a new state, reported being very involved with the church. He stated that he had recently divorced his third wife and now lived alone. The Veteran reported that he had many friends. He enjoyed spending time with others. The examiner noted that the Veteran was able to get along with others and maintain and have friendships. He often met his friends for outings and enjoyed going to restaurants. He als reported regular exercise at the gym. The Veteran stated that he kept in regular contact with his seven children who resided in a different state. He had nine grandchildren whose company he enjoyed. The Veteran remained unemployed. The examiner, found that the Veteran’s psychiatric symptoms, to include sleep disturbance, hypervigilance and exaggerated startle response, would impact the Veteran’s work, however, opined these would not preclude him from securing and retaining substantially gainful employment. The examiner concluded that the Veteran’s PTSD was productive of occupational and social impairment with reduced reliability and productivity. On VA examination in September 2016, the Veteran complained of sleep problems, exaggerated startle response, nightmares, avoidance of stimuli, problems with concentration, depressed mood, anxiety, suspiciousness, and disturbances of motivation and mood. There was mild memory loss, such as forgetting names, directions or recent events. He also reported difficulty in establishing and maintaining effective work and social relationships. The Veteran denied suicidal or homicidal ideation. There was no evidence of psychosis, or neglect in appearance. At the time of the examination, the Veteran was residing in a home for 2.5 years. He had not been in any romantic relationship, although he frequently went out with women for dinner. He remained involved with his church and attended church service every Saturday. He maintained regular contact with his children and grandchildren. The Veteran reported a tendency to isolate and not interact with people. He spent his day at the jacuzzi to help his leg. He walked the neighborhood and did his errands on his own, taking care of his home independently. The Veteran reported that he stopped working due to his disabilities. He was retired. He has not been seen by any mental health provider since June 2015. The Veteran was described as friendly and engaging, but he tended to isolate and get rattled when around too many people. The examiner determined that the Veteran’s PTSD would not affect productivity at work. He had the ability to adapt to changes in the workplace as PTSD wouldn’t interfere in this capacity. He would be capable of interacting professionally in the workplace. Overall, PTSD would have a mild to moderate impact on employment, and the examiner concluded that the Veteran would be able to be a productive and reliable employee. On review of the evidence of record, the Board finds that from December 21, 2005 through May 15, 2006, the Veteran’s psychiatric disorder most closely approximated the criteria for a 50 percent rating. Although the severity and frequency of symptoms varied throughout the appeal, the evidence shows that the Veteran reported chronic sleep impairment, problems with concentration, irritability, anger outbursts, self-isolation, exaggerated startle response, flashbacks, avoidance of stimuli, hypervigilance, and difficulty in establishing and maintaining effective work and social relationships, which corresponds to a 50 percent rating. Additionally, he has generally denied suicidal ideation, and has consistently been found not to be a danger to self or others. Consistent with these findings, the Veteran’s GAF scores, with the exception of the Veteran’s period of hospitalization and in March 2007, ranged from 50 to 60, indicative of more moderate symptoms to serious symptoms. The Board finds that the evidence of record does not support a disability rating higher than 50 percent at any point during the appeal period. The Veteran has not exhibited other symptoms corresponding to a 70 percent rating during the appeal period, such as: 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; and the inability to establish and maintain effective relationships. Additionally, while the evidence undeniably shows that the Veteran’s psychiatric symptoms are productive of social impairment, overall the Veteran had established good relationships with friends and family members. The Veteran had a history of three marriages ending in divorce. However, the Veteran described close friendships with friends, siblings, children and grandchildren, with whom he often visited and talked on a regular basis. He related regular outings and dining out, as well as being involved in church and community activities. After service the Veteran was employed full time for close to 20 years with the same employer until his retirement. As for the effect of the Veteran’s symptoms on judgment, thinking, or mood, the evidence shows that the Veteran was consistently described as appropriately groomed. His speech was clear, fluent, and goal directed. Language was intact. There was no flight of ideas or loosening of associations. There were no obsessions or compulsions. The Veteran was oriented times three, with generally adequate memory and concentration. Thought processes and association were generally noted as normal and coherent. In sum, the Board finds that the criteria for a 70 percent rating have not been demonstrated. The evidence does not show occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. Nor is there symptomatology of similar severity, frequency and duration consistent with the criteria for a 70 percent rating. Therefore, the Board finds that the evidence does not more nearly approximate the criteria for a rating of 70 percent and a rating greater than 50 percent is denied. Accordingly, the Board resolves reasonable doubt in favor of the Veteran and finds that the criteria for a 50 percent rating, and no higher, for a psychiatric disorder, including PTSD, are met from December 21, 2005 through May 15, 2006. A rating in excess of 50 percent is not warranted at any point during the appeal period. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to a total disability rating based on individual unemployability The Veteran contends that his service-connected disabilities prevent him from obtaining gainful employment. In order to establish entitlement to TDIU due to service-connected disabilities, there must be impairment so severe that it is impossible for the average person to secure or follow a substantially gainful occupation. 38 U.S.C. §1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. In reaching that 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 (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 his age or to the impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). Total disability ratings for compensation may be assigned, where the schedular rating is less than total, 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, provided that, if there is only one such disability, this disability shall be ratable at 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). The Veteran’s anxiety disorder with symptoms of PTSD has been rated as 50 percent disabling throughout the appeal. Prior to July 1, 2006, service connection was also in effect for right thigh shell fragment wound, rated as 30 percent disabling, and conversion disorder, rated as noncompensably disabling. Effective July 1, 2006, the Veteran’s disability rating for conversion disorder was increased to 10 percent disabling. As such, effective July 1, 2006, he meets the schedular criteria for TDIU. 38 C.F.R. § 4.16. In addition, service connection has been established for diabetes mellitus, type II, rated as 20 percent disabling; peripheral neuropathy of the right lower extremity, rated 20 percent disabling; diabetic peripheral neuropathy of the left lower extremity, rated 10 percent disabling; diabetic peripheral neuropathy of the right lower extremity, rated 10 percent disabling; gastroesophageal reflux disease, rated 10 percent disabling; scar right thigh, painful but not unstable linear scar associated with shell fragment wound, right thigh, rated 10 percent disabling; ingrown fourth toe nail, rated as noncompensably disabling; loss of upper teeth (7, 8, 9, 10), rated noncompensably disabling; and bilateral mild cataracts, rated noncompensably disabling. The Veteran’s combined disability evaluation effective July 1, 2006 was 70 percent, 80 percent after December 14, 2012, and 90 percent after April 7, 2007. The question before the Board is whether the Veteran is unemployable by reason of his service-connected disabilities, taking into account his educational and occupational background. The Board finds that the greater weight of the probative evidence is against a finding that the Veteran is unable to secure and follow a substantially gainful occupation by reason of his service-connected disabilities. On his November 2009 application for TDIU he reported having completed at two years of college. He also reports additional training in design engineering and mechanical design engineering. The Veteran worked with the United States Postal Service from 1985 until his retirement in 2003, when reportedly he became too disabled to work. He also had six years of work experience as a mechanical design and industrial engineer prior to his employment with the postal service. It appears that the Veteran may have also done some landscaping work for his church after he retired, although there is no indication that any such work constituted substantially gainful employment. Concerning the Veteran’s psychiatric disability, on VA examination in December 2006, the examiner found that the Veteran’s psychiatric symptoms were moderate to serious in severity, and were productive of serious social and occupational impairment. Private treatment records in March 2007 noted that prior to his retirement, the Veteran had been placed by the post office on light duty work due to medical disabilities, including asthma, tinnitus, hyperlipidemia and pain from shrapnel in upper right thigh. The clinician recorded major impairments in functioning such as work, interpersonal, and family relations, and in capacity for regulation of anxiety level and mood. The clinician determined that his prognosis was guarded. On psychological evaluation in March 2007, the Veteran stated that he retired from the United States Postal Service because of his service-connected shrapnel wound injury. Although initially he was placed on light duty, he was forced into retirement in February 2004. The clinician noted social and occupational impairment with concerns over impulse control. A VA examiner in July 2010 opined that the Veteran’s PTSD would not preclude full participation in routine activities of daily living or employment at his usual occupation. The examiner did find that his symptoms, including sleep disturbance, occasional hypervigilance and occasional exaggerated startle response, would impact the Veteran’s work if he were working, but not to the extent that employment would be prevented or precluded. Similarly, a VA examiner in March 2014 found that the Veteran’s psychiatric symptoms, to include sleep disturbance, hypervigilance and exaggerated startle response, would impact the Veteran’s work, however, these would not preclude him from securing and retaining substantially gainful employment. The examiner concluded that the Veteran’s PTSD was productive of occupational and social impairment with reduced reliability and productivity. Finally, a VA examiner in September 2016, determined that the Veteran’s PTSD would not affect productivity at work. The examiner noted that the Veteran had the ability to adapt to changes in the workplace and PTSD wouldn’t interfere in this capacity. He would be capable of interacting professionally in the workplace. Overall, PTSD would have a mild to moderate impact on employment, and the examiner concluded that the Veteran would be able to be a productive and reliable employee. Concerning his other service-connected disabilities, on VA general examination in August 2010, a VA examiner noted status post shrapnel fragment wound to the right leg, with weakness, numbness and pain, and concluded that the Veteran was capable of sedentary work with his right leg symptoms impairing mobility and ability to do long standing. In June 2012 a VA examiner determined that the Veteran’s diabetes mellitus, type II, did not impact the Veteran’s ability to work. Thereafter, a VA examiner in October 2013 found that the Veteran’s service-connected scar(s) and esophageal conditions did not impact his ability to work. Pertaining to the Veteran’s hip and/or thigh condition, the VA examiner concluded that the condition impaired the Veteran’s ability walk more than a block without pain, which required the Veteran to retire from the postal service. However, there is no indication that the condition precluded substantial gainful employment in a sedentary capacity. Finally, a VA examiner in April 2017 opined that the Veteran’s diabetic peripheral neuropathy and leg/hip muscle injury, did not impact his or her ability to work. There are now numerous examinations in this case that address this key question, all of which provide evidence, in one way or another, against this claim. Overall, there is significant evidence that the provides evidence against this claim that the Board can not simply discount. It is important for the Veteran to understand that there are now repeated examinations which indicate that the service connected problems would not stop the Veteran from working. Although the evidence of record indicates that the Veteran has not worked during the pendency of the appeal, and his service connected disabilities are productive of some occupational limitations, the preponderance of the evidence is against finding that his service-connected disabilities render him unemployable. Moreover, the many VA examination opinion reports, as outlined above, fail to show that the Veteran’s service-connected disabilities either singularly or jointly, preclude the Veteran from gainful employment, and collectively provide evidence against this finding. The Veteran’s VA treatment records do not contradict the VA examination reports described above, only support it. The weight of the evidence of record does not contradict the findings of the Veteran’s VA treating physicians and the VA examiners. In this regard, it is important for the Veteran to understand that there is now a highly significant amount of highly probative medical evidence that provide evidence against this claim that the Board simply cannot ignore. The Board acknowledges that the Social Security Administration (SSA) found the Veteran disabled due, at least in part, to mental health problems. However, while SSA decisions regarding unemployability are relevant and should be weighed, they are not controlling for VA. See Collier v. Derwinski, 1 Vet. App. 413, 417 (1991); Murincsak v. Derwinski, 2 Vet. App. 363, 370 (1992). While the Veteran is competent to report symptoms he experiences, an opinion as to the limitations on gainful employment due to his service-connected disabilities is beyond his medical expertise. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Thus, any such lay statements regarding him being unable to work are not competent or sufficient. Importantly, he has not been found to be unemployable due to any of his service-connected disorders, including his psychiatric disability, by any medical professional. Simply stated, both the best factual evidence, including varying occupational histories reported by the Veteran, and the best medical evidence, in the form of the examinations cited above, provides evidence against this claim. The Veteran’s statements have been carefully considered (in fact, without consideration of the problems the Veteran has cited, there would be little object medical basis for the current 90% finding). The Board observes that the currently assigned disability ratings recognize that the impairment due to his service-connected disabilities makes it difficult to obtain and keep employment (that the Veteran has problems is not in dispute). However, the ultimate question in determining entitlement to a TDIU is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether he can find employment. See Van Hoose, 4 Vet. App. at 363. If the Veteran did not have problems with his service-connected disabilities, including his psychiatric disorder, there would be no basis for the combined disability rating of 90 percent (which, it is important for the Veteran to understand, will cause him many problems). The Veteran’s age can not be used for a basis for granting the TDIU claim. In this case, there is no indication from the record at any time that he is unable to obtain and maintain substantially gainful employment solely as a result of his service-connected disabilities, either singularly or jointly. In fact, the preponderance of the evidence of record tends to show just the opposite, that he is employable, because he engages in work-like activities, and the examiners tend to provide what can only be described as highly negative evidence against this this claim. JOHN J. CROWLEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Azizi-Barcelo, Tatiana