Citation Nr: 18145292 Decision Date: 10/26/18 Archive Date: 10/26/18 DOCKET NO. 16-16 198 DATE: October 26, 2018 ORDER 1. A 100 percent schedular rating for PTSD with depressive disorder not otherwise specified (NOS) and generalized anxiety disorder (PTSD) is granted from (the earlier effective date of) May 20, 2016, and a 50 percent rating is granted throughout prior to that date (from November 18, 2005), subject to the regulations governing payment of monetary awards. REMANDED 2. Entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU) prior to May 20, 2016 is remanded. FINDINGS OF FACT 1. Throughout prior to May 20, 2016 the Veteran’s PTSD is reasonably shown to have been manifested by symptoms productive of occupational and social impairment with reduced reliability and productivity; symptoms productive of occupational and social impairment with deficiencies in most areas were not shown. 2. From May 20, 2016 the Veteran’s PTSD is reasonably shown to have been manifested by symptoms productive of total occupational and social impairment. CONCLUSION OF LAW A 50 percent rating is warranted for the Veteran’s PTSD throughout prior to May 20, 2016; a 100 percent schedular rating for PTSD is warranted throughout from that date. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.130, Diagnostic Code (Code) 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSION The appellant is a Veteran who served on active duty from May 1970 to January 1972. These matters are before the Board on appeal from a December 2014 rating decision. A 50 percent rating for PTSD is granted throughout prior to May 20, 2016. A June 2018 rating decision assigned a 100 percent rating for the Veteran’s psychiatric disability effective July 13, 2016, the date of a VA examination. Accordingly, the matter of the rating for PTSD from that date is not before the Board. What remains before the Board is whether a rating higher than 30 percent is warranted prior to July 13, 2016 for the Veteran’s psychiatric disability. On December 2005 treatment, the Veteran’s mood was slightly depressed. Although he had thoughts of death, he denied suicidal or homicidal ideation. He reported that his thoughts seemed to race and his emotions fed back quickly into more negative thoughts. He reported flashbacks and fear of falling asleep due to nightmares. The diagnoses were PTSD and depressive disorder NOS. On September 2006 treatment, the Veteran was cooperative and provided relevant detailed information about his traumatic experiences. He identified triggers of trauma memories and reported feeling bothered and frustrated because he did not recall what happened shortly after the traumatic experience. He was able to recognize that he had limited alternatives to participating in the incidents and, if he had done so, it would have been only to defend his life. He accepted that there was no hatred toward anyone. The diagnoses were PTSD and generalized anxiety disorder. On November 2007 treatment, the Veteran appeared anxious after sharing his stressor event story and agreed to participate in a self-hypnosis exercise for stress relaxation, with which he demonstrated proficiency and reported lessening of his anxiety level. He was being followed for medication management and reported no problems with medication compliance or side effects. He denied current homicidal or suicidal ideation, audio or visual hallucinations, or psychosis/mania. He was oriented in all spheres, his mood and affect were congruent with his reported depression and anxiety level, and he was cooperative and alert and maintained good eye contact. His speech was clear and goal-directed. His judgment was good, and there was no evidence of psychosis, hallucinations, or delusions. On December 2007 treatment, the Veteran was noted to have severe chronic PTSD. There was no indication of suicidal or violent ideation, plan, or recent behaviors. On mental status examination, there were no indications of mental content symptoms, perceptual disturbance, or gross cognitive confusion, and his thinking and speech were within normal limits. The diagnosis was PTSD, chronic, severe. On February 2008 treatment, the Veteran reported nightmares and flashbacks about his experiences in service; he reported waking up at night in a sweat, and that he. felt depressed and helpless at times. He had variable sleep and his appetite was fine. He reported guilty feelings about his experiences in service. On mental status examination, he was cooperative with fair eye contact and grooming. There were no tremor, tics, or fidgetiness or any abnormal movements. His mood was “good” and affect was appropriate (with a constricted range and no lability). His speech was spontaneous, articulated, and coherent, and normal in rate, rhythm, and volume. His thought process was goal directed, with no circumstantiality or tangentiality. He reported no suicidal ideation, homicidal ideation, delusions, audiovisual hallucinations, or illusions. His attention and concentration were fair and his recent and remote memory were fair. His judgment and insight were fair to good. The diagnosis was PTSD with comorbid depression. On May 2008 treatment, the Veteran reported continued nightmares 4 to 6 times per month, and his depression was somewhat better with the warmer weather. He continued to dissociate in response to triggers that reminded him of his trauma experience; occasionally, he would become violent when disassociating, although this had not happened for a while. He enjoyed socializing with other members in his monthly PTSD group. There were no indications of suicidal or violent ideation, plan, or recent behaviors. On mental status examination, he was in some psychological distress. There were no indications of mental content symptoms, perceptual disturbance, or gross cognitive confusion. Thinking and speech were within normal limits. The diagnoses included chronic severe PTSD, dissociative disorder not otherwise specified, and depression not otherwise specified. On July 2009 treatment, the overall picture of the Veteran’s cognitive skills was one of inefficiency/suboptimal functioning, as opposed to grossly impaired functioning. The provider opined that the Veteran’s cognitive problems (poor recent memory functioning and poor attention/concentration) were symptomatic of his PTSD, depression, longstanding tenuous-to-poor psychological adjustment, and apparent over-reliance on somatization and repression as primary psychological defenses and appeared largely secondary to disruptions in attentional functioning. There was no evidence of significant cognitive decline or impairment in daily functioning. The Veteran denied any episodes of socially inappropriate, disinhibited, or uncharacteristic behavior. His grooming and personal hygiene were acceptable and he maintained a socially appropriate interpersonal demeanor. His affective presentation was apprehensive, flat, and moderately restricted in range but was situationally appropriate at all times. His mood was mildly to moderately anxious and depressed. He denied suicidal and homicidal ideations. The diagnostic impressions included cognitive disorder not otherwise specified, chronic PTSD, depressive disorder NOS, dissociative disorder NOS, and somatoform disorder NOS. In a July 2009 statement, the Veteran’s primary care physician opined that the Veteran exhibited serious PTSD and anxiety disorders, panic attacks, depression, and difficulty sleeping. Dr. Baren opined that the Veteran’s mental state had taken a toll on his life and health. On December 2009 treatment, the Veteran reported nightmares and flashbacks about his experiences in service, prompted by the recent Fort Hood shooting. He reported feeling depressed at times. He denied suicidal and homicidal thoughts. He was separated from his wife but working on issues and reported that he may get together and visit with her. He was cooperative with fair grooming and eye contact. There were no tremors, tics, fidgetiness or abnormal movements. His mood was “good” and his affect was appropriate, with constricted range and no lability. His speech was spontaneous, articulated and coherent, with normal rate, rhythm, and volume. His thoughts were goal directed with no circumstantiality or tangentiality. He denied delusions, hallucinations, or illusions. His attention and concentration were fair and his recent and remote memory was fair. His judgment and insight were fair to good. In a March 2010 PTSD treatment summary, it was noted that the Veteran’s treatment included pharmacotherapy, and individual, and group psychotherapy. Symptoms that affected his social and daily functioning included nightmares, flashbacks, anxiety, exaggerated startle response, social withdrawal, tendency to isolate in new situations, depression, insomnia, panic attacks, irritability, poor concentration, and feeling powerless and hopeless with these symptoms. It was noted that these symptoms affected his ability to maintain gainful employment and social relationships. It was noted that further training, education, or vocational rehabilitation may not significantly improve his prospects to return to gainful employment or compete in today’s job market. He denied suicidal and homicidal ideation. The clinical impressions included chronic PTSD, depressive disorder NOS, and general anxiety disorder. On January 2014 VA examination, the Veteran reported that he and his wife had been separated since the 1980s but she was involved in his life, helped take care of him, and drove him places he needed to go, including the examination. His son came to visit for brief periods and his stepdaughters would come check on him occasionally. He reported good relationships with his siblings but did not see them often; he did not have many friends but had one veteran friend from groups he attended. There was no history of psychiatric hospitalizations or suicide attempts. He adhered to his medication, was active in PTSD groups, and saw an individual therapist. He denied any legal or behavioral problems. His reported symptoms included depressed mood, anxiety, suspiciousness, chronic sleep impairment, and mild memory loss (such as forgetting names, directions, or recent events). On mental status examination, the Veteran had adequate grooming and hygiene. He remained relatively still in his chair for most of the exam but became quite animated when discussing the stressor event. His attitude was cooperative and pleasant. He was alert and oriented. His speech was slow but became loud when discussing the stressor. His mood was “just getting by” and his affect was full. He reported taking 2 to 3 hours to initiate sleep at night, which was interrupted by nightmares and he woke easily to extraneous noises. His appetite was fair and his energy was low. He rambled at times. His thought content included suspiciousness and he denied hallucinations. He reported intermittent passive suicidal ideation when stressed, and that he had experienced suicidal ideation as recently as the previous week. He noted that his family was his primary protective factor. He denied homicidal ideation. His judgment was fair and he had limited insight. His attention during the exam was intact and his memory was adequate. He reported depression, nightmares, flashbacks, intrusive thoughts, and excessive worry. The diagnoses were PTSD, unspecified depressive disorder, rule-out personality disorder not otherwise specified cluster B and C traits, and rule-out somatic symptom disorder. The examiner opined that symptoms attributable to PTSD included re-experiencing symptoms, avoidance, negative alterations in cognitions and moods, and hyperarousal; symptoms attributable to depressive disorder included depressed mood, ruminations, suicidal ideation, sadness, hopelessness, and helplessness. Symptoms overlapping PTSD and depressive disorder included sleep disturbance, irritability/anger, detachment/social isolation, decreased attention/concentration, and decreased interest in activities. The examiner opined that the level of occupational and social impairment with regard to all mental diagnoses was 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; this was the examiner’s best estimate of the amount of impairment in functioning related to PTSD alone. Based on this evidence, a December 2014 rating decision granted service connection for PTSD with depressive disorder NOS, rated 30 percent, effective November 18, 2005. In a September 2015 statement, the Veteran stated that his PTSD had progressively worsened through the years, to the point that he could not go out alone, stayed near an exit and stood/sat with his back to the wall, and was constantly on high alert. He reported problems with long-term and short-term memory. He stated that his anger, frustration, and other PTSD symptoms had affected his family relationships because he was intolerably angry or they were unable to cope with seeing him experience his symptoms. In a May 20, 2016 private psychological assessment, Dr. Belle noted (on review of the record) that the Veteran reported a variety of psychiatric symptoms throughout the appeal period. He quoted large sections of previous examinations, medical summaries, and lay statements. On telephone interview, the Veteran reported a mental health history consistent with the records cited. He reported that his PTSD was triggered daily by thoughts of the stressor event. He reported suicidal ideation particularly when triggered; he had prior thoughts of suicide but none currently. He reported that living alone allowed him to control his anger better. He had quit driving due to flashbacks (he felt he was unsafe). Dr. Belle opined that the Veteran’s PTSD is chronic and severe and that he also suffers from major depressive disorder. He opined that the Veteran’s daily triggers and flashbacks regarding his experiences in service contributed significantly to his PTSD, depression and anxiety, and these psychiatric conditions and the resulting social and occupational limitations overlap and cannot be separated. Dr. Belle opined that the Veteran’s behavioral presentation was consistent and significant for social isolation, depression, hopelessness and worthlessness, anxiety, flashbacks, nightmares, poor concentration, memory deficits, apathy, panic attacks, insomnia, irritability, hostility, and suspiciousness/hypervigilance. Dr. Belle opined that the Veteran’s occupational and social functioning was adversely impacted by his psychiatric symptoms, with deficiencies in most areas including work, memory, insight, judgment, and mood from at least 2005. On July 13, 2016 VA examination, the Veteran reported that his wife, from whom he has been separated since 2000, visits him once a week, and his adult son visits him once a month. He felt his family is not there for him as they should be, but he attributed these thoughts to being depressed. He reported having no friends, not leaving the house, and not going to stores except for occasional trips to Walmart. He attended VA appointments and monthly PTSD groups, and otherwise sat and did nothing the whole day. He did not drive because he would forget where he was. He had no motivation, no daily schedule or activity, and was in a constant anxiety state. He slept 2 hours a night and had nightmares 2 to 3 times per week. He reported poor appetite and being hypervigilant at home. He had flashbacks caused by his thoughts or noises and he startled many times per day. He reported dissociative episodes. He denied any homicidal thoughts. His reported symptoms included depressed mood; anxiety; suspiciousness; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; chronic sleep impairment; impairment of short- and long-term memory; circumstantial, circumlocutory or stereotyped speech; impaired judgment; impaired abstract thinking; 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; inability to establish and maintain effective relationships; and suicidal ideation. On mental status examination, the Veteran appeared fidgety and pressured; he talked fast and often dwelled on anxiety loaded themes. He became circumstantial and at times hard to follow. He reported feeling sad and having passive suicidal thoughts, though he denied current suicidal or homicidal ideation. No psychotic thoughts were identified, but his anxiety took paranoid-like nuances at times (exaggerated fear associated with poor insight and poor judgment). Hallucinations were not noted. Attention was poor. The examiner opined that the Veteran should be considered an increased but no current imminent risk. The diagnoses were PTSD and generalized anxiety disorder. The examiner opined that PTSD-specific symptoms included arousal symptoms, re-experiencing, and avoidance that were related (even remotely) to the Veteran’s past traumatic events; anxiety disorder specific symptoms included generalized worries with a lot of psychosomatic components, inability to relax even when “safe”, and permanent ruminating thoughts. The examiner opined there was extensive overlap between the generalized anxiety disorder and PTSD, with anxiety as a common feature as well as fatigue, body tension, irritability, lack of concentration/attention, and poor recall. The examiner opined that the Veteran’s psychiatric diagnoses caused total occupational and social impairment, and that his PTSD is severe and by far the most impairing diagnosis, and that the generalized anxiety disorder is a progression of the PTSD. Additional VA treatment records throughout the appeal period show symptoms similar to those found on the examinations described above. The Veteran has also submitted lay statements describing his difficulties due to his psychiatric disability. Disability ratings are determined by applying the criteria set forth in 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. With the initial rating assigned following a grant of service connection, separate (staged) ratings may be assigned for separate periods of time, based on the facts found. Fenderson v. West, 12 Vet. App. 119, 126 (1999). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Reasonable doubt as to the degree of disability will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. PTSD is rated under the General Rating Formula for Mental Disorders. A 30 percent rating is warranted when there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss (such as forgetting names, directions, recent events. A 50 percent rating is warranted 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; difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is warranted when 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 worklike setting); inability to establish and maintain effective relationships. A 100 percent rating is warranted when there is 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; memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130, Code 9411. The use of the phrase “such symptoms as,” followed by a list of examples, provides guidance as to the severity of symptoms contemplated for each rating, in addition to permitting consideration of other symptoms, particular to each veteran and disorder, and the effect of those symptoms on the claimant’s social and work situation. Mauerhan v. Principi, 16 Vet. App. 436, 443 (2002). Because “[a]ll nonzero disability levels [in § 4.130] are also associated with objectively observable symptomatology,” and the plain language of this regulation makes it clear that “the veteran’s impairment must be ‘due to’ those symptoms,” “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, 116-17 (Fed. Cir. 2013). “[I]n the context of a 70[%] rating, § 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.” Id. at 117. Although a veteran’s symptoms are the “primary consideration” in assigning a rating under § 4.130, the determination as to whether the veteran is entitled to a 70% disability evaluation “also requires an ultimate factual conclusion as to the veteran’s level of impairment in ‘most areas.’” Id. at 118. When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran’s capacity for adjustment during periods of remissions. 38 C.F.R. § 4.126(a). The rating agency shall 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. Id. However, when evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation on the basis of social impairment. 38 C.F.R. § 4.126(b). The Board finds that, throughout (since the award of service connection), the psychiatric symptoms and functional impairment reported by the Veteran and noted by VA and private examiners and treatment providers (such 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; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships) show, or at least approximate a level consistent with occupational and social impairment with reduced reliability and productivity. On January 2014 VA examination, he reported symptoms of a nature and severity similar to those he had reported on treatment throughout since November 2005; progress notes reflect a level of functioning largely consistent throughout. Accordingly, the Board finds that the criteria for a 50 percent rating were met throughout prior to May 20, 2016, and that such rating is warranted throughout prior to that date. The evidence of record does not show that symptoms that met (or approximated) the criteria for a 70 percent (or 100 percent) schedular rating were manifested prior to May 20, 2016. It is not shown that the Veteran had occupational and social impairment, with deficiencies in most areas. While he on occasion self-reported symptoms of greater severity, it is not shown by the record that such symptoms resulted in deficiencies in most areas. Significantly, in the March 2010 VA treatment summary, the Veteran’s symptoms were noted to include nightmares, flashbacks, anxiety, exaggerated startle response, social withdrawal, tendency to isolate in new situations, depression, insomnia, panic attacks, irritability, poor concentration, and feeling powerless and hopeless with these symptoms. He denied suicidal ideation. Notably, on January 2014 VA examination, he reported maintaining relationships with his estranged wife, son and stepdaughters, and siblings (family relations); and that he had one friend from his PTSD group; his affect was full; his judgment was fair; he had intact attention and adequate memory, and his thought content included suspiciousness but no cognitive defects. The January 2014 examiner opined that the Veteran’s PTSD signs and symptoms resulted in occupational and social impairment with [only] 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. The lay statements the Veteran submitted in support of this claim detail the types of problems that result from his PTSD symptoms. The levels of functioning impairment described are encompassed by the criteria for the 50 percent rating assigned, and do not reflect deficiencies in most areas. Deficiencies in most areas simply are not shown, and prior to May 20, 2016 a rating in excess of 50 percent was not warranted. While a 100 percent schedular rating has been assigned from the July 13, 2016 date of a VA examination, the Board finds no reason to dispute the opinions from the Veteran’s evaluating VA and private examiners, as they are laid out with detailed reasoning in support of a finding that the Veteran’s psychiatric disability has caused total occupational impairment from May 20, 2016. The May 2016 evaluating psychologist’s opinions are similar to those offered on July 13, 2016 VA examination (on which the 100 percent schedular rating assigned by the AOJ was based). The Board finds that, from (the earlier effective date of) May 20, 2016, the Veteran has reported and treating/evaluating mental health personnel have found that he has psychiatric symptoms consistent with total occupational and social impairment (due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; persistent danger of hurting self or others; and disorientation to time or place, or other symptoms of similar gravity). Consequently, the Board finds that the criteria for a schedular 100 percent rating are met from (the earlier effective date of) May 20, 2016, but not earlier. REASONS FOR REMAND Entitlement to a TDIU rating prior to May 20, 2016 is remanded. [A June 2018 rating decision assigned a 100 percent rating for the Veteran’s psychiatric disability effective July 13, 2016. As a 100 percent schedular rating for the psychiatric disability is granted from (the earlier effective date of) May 20, 2016, entitlement to a TDIU rating (a total rating under alternate criteria) is rendered moot for the period from May 20 to July 13, 2016.] The Veteran contends that, prior to May 20, 2016, he was unable to maintain substantially gainful employment due to his service-connected psychiatric disability, his sole service connected disability. The 50 percent rating now assigned for his psychiatric disability does not meet the 38 C.F.R. § 4.16(a) schedular rating requirements for TDIU. Accordingly, the analysis turns to whether the PTSD nonetheless rendered him unemployable, requiring referral to the VA Compensation Service Director for consideration of an extraschedular TDIU rating. The Veteran reported that he last worked in 2000 as a self-employed painter. Social Security Administration (SSA) records include an April 2002 decision awarding the Veteran disability benefits due to a primary diagnosis of somatoform disorders and a secondary diagnosis of disorders of the back, with disability onset in October 2000. On July 2016 VA examination, the examiner opined that the Veteran was extremely limited by his symptoms; did not function inside or outside the house, and had not held a job since 2000 (and even then worked by himself). The Board finds that the July 2016 VA examiner’s opinion suggests, but does not clearly or directly indicate, that the Veteran may have been unemployable due to psychiatric disability since 2000. A remand for clarification is necessary. If the examiner confirms that the Veteran is deemed to have been unemployable due to his psychiatric disability since 2000, referral to the VA Compensation Service Director for consideration of an extraschedular TDIU rating would be necessary. The matter is REMANDED for the following: 1. Arrange for the Veteran’s record to be returned to the July 2016 VA examiner [if that provider is unavailable, to another psychiatrist or psychologist] for review and a medical advisory opinion. The consulting provider should opine regarding the impact the Veteran’s service connected psychiatric disability had on occupational functioning prior to May 20, 2016, and from November 2005 (excluding the impact of any co-existing, not service-connected disabilities and the Veteran’s age). The provider should identify all symptoms of the service-connected psychiatric disability that had an adverse effect on occupational functioning, and the types of functions impacted ability to follow instructions, ability to focus on an assigned task, ability to maintain adequate working relations with co-workers and supervisors, etc.) and the degree to which such functions were impaired. The provider should offer some examples of types of employment that would have been precluded by the PTSD and the types of employment, if any, that remained feasible during that time despite the PTSD. The examiner must include rationale with all opinions. 2. If the consulting provider opines that the Veteran’s PTSD rendered him unemployable prior to May 20, 2016, refer the claim for TDIU to VA’s Director of Compensation for consideration of an extraschedular TDIU rating prior to May 20, 2016. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Schechner, Counsel