Citation Nr: 18145432 Decision Date: 10/29/18 Archive Date: 10/29/18 DOCKET NO. 16-33 106 DATE: October 29, 2018 ORDER Prior to June 14, 2016, an initial disability rating of 70 percent, but no higher, for the service-connected posttraumatic stress disorder (PTSD) is granted. Beginning June 14, 2016, a disability rating higher than 50 percent for the service-connected PTSD is denied. A total disability rating based on individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. Prior to June 14, 2016, the Veteran’s PTSD symptoms resulted in occupational and social impairment with deficiencies in most areas. 2. Beginning June 14, 2016, the Veteran’s PTSD symptoms did not result in occupational and social impairment with deficiencies in most areas. 3. The preponderance of the evidence is against a finding that the Veteran’s service-connected disabilities rendered him unable to secure or follow substantially gainful employment. CONCLUSIONS OF LAW 1. Prior to June 14, 2016, the criteria for a disability rating of 70 percent for PTSD were met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.126, 4.130 (2017). 2. Beginning June 14, 2016, the criteria for a disability rating higher than 50 percent for PTSD were not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.126, 4.130 (2017). 3. The criteria for entitlement to a TDIU are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.340, 3.341, 4.16 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1963 to July 1966. This matter comes on appeal before the Board of Veterans’ Appeals (Board) from a March 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran waived a hearing before the Board in his July 2016 substantive appeal, via a VA Form 9. Preliminary Matter The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). Pertinent Increased Rating Laws and Regulations Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) found in 38 C.F.R. Part 4. 38 U.S.C. § 1155. 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. Where there is a question as to which of two disability ratings shall be applied, the higher rating 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. It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25 (2017). Pyramiding, the rating of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a veteran’s service-connected disabilities. 38 C.F.R. § 4.14 (2017). It is possible for a veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes; however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. Conjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diagnosis, or for those not fully supported by clinical and laboratory findings. Nor will ratings assigned to organic diseases and injuries be assigned by analogy to conditions of functional origin. 38 C.F.R. § 4.20. Where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. See Francisco v. Brown, 7 Vet. App. 55 (1994). Staged ratings are appropriate for any initial rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119, 126 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him or her through their senses. See Layno v. Brown, 6 Vet. App. 465 (1994). Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The criteria for rating psychiatric disabilities other than eating disorders are set forth in a general rating formula found at 38 C.F.R. § 4.130, which includes Diagnostic Code 9411 for PTSD. Under Diagnostic Code 9411, a 50 percent rating is assigned for 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. Id. A 70 percent rating is assigned for occupational and social impairment with deficiencies in most areas, such as work, school, family relationships, judgment, thinking or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. Id. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name. Id. In the process of evaluating a mental disorder, VA is required to consider several pertinent factors, such as the frequency, severity, and duration of a veteran’s psychiatric symptoms. See 38 C.F.R. § 4.126. After consideration of these factors and based on all the evidence of record that bears on occupational and social impairment, VA must assign a disability rating that most closely reflects the level of social and occupational impairment supported by the evidence. 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 solely based on social impairment. 38 C.F.R. § (b). Ratings are assigned according to the manifestation of particular symptoms, but the use of a 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, 442 (2002). However, a Veteran may only qualify for a given disability rating under Section 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration, and that such symptoms have resulted in the type of occupational and social impairment associated with that percentage. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117-118 (Fed. Cir. 2013). In determining the level of impairment under 38 C.F.R. § 4.130, a rating specialist is not restricted to the symptoms provided under the diagnostic code and should consider all symptoms which affect occupational and social impairment, including those identified in the DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (DSM-IV or DSM 5). See Mauerhan v. Principi, 16 Vet. App. 436 (2002). If the evidence demonstrates that a claimant suffers symptoms or effects that cause an occupational or social impairment equivalent to those listed in that diagnostic code, the appropriate, equivalent rating is assigned. See Mauerhan, 16 Vet. App. 436. Within the DSM-IV, Global Assessment Functioning (GAF) scale scores ranging from 1 to 100 reflect “psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness.” Carpenter v. Brown, 8 Vet. App. 240, 242 (1995); see also Richard v. Brown, 9 Vet. App. 266, 267 (1996). Effective August 4, 2014, VA 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.” As the Veteran’s claim was certified to the Board after August 4, 2014, the DSM-5 is applicable to this case. The Court has held that the relevant temporal focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. Prior to June 14, 2016, a 70 percent disability rating for the service-connected PTSD is granted. Turning to the evidence, the Veteran submitted private psychiatric treatment records dated October 2014 from Dr. H.J., a psychiatrist. The Veteran reported that he had been married twice. His current marriage lasted for 31 years and they were still married. The Veteran reported that he had flashbacks, nightmares with night sweats, and he punched and jerked in his sleep. The flashbacks were so real, they made the Veteran anxious. The Veteran felt emotional and depressed. He reported that he had learned to control his angry outbursts and irritability, as this behavior contributed to the end of his first marriage. He did not have many friends, other than his wife and her family, and did not have a relationship with his children. The Veteran reported difficulty with concentration, short-term memory, and disturbing memories. He experienced thoughts and images of his combat service and feeling as if he is reliving the traumatic events. He avoided thoughts or feelings related to his combat service, situations and activities that reminded him of the traumatic events, and he felt distant and cut off from other people. He had diminished interest in activities, felt emotionally numb, and felt that his life would be cut short. He also experienced insomnia, irritability, angry outbursts, hypervigilance, and excessive jumpiness. The Veteran had occasional suicidal ideations without plan or intent. He also was fatigued. A couple of times a week, the Veteran reported experiencing a rush of intense fear, panic, anxiety, and discomfort without apparent reason. During these episodes, his heart pounded and raced, and his body trembled and shook. He began to sweat, had shortness of breath, and felt as if he was choking, nauseated, dizzy, lightheaded, and unsteady. During these episodes, things around him did not feel real. On mental status examination, the Veteran was appropriately dressed and cooperative, but exhibited tension and restlessness. The Veteran had blunted affect with psychomotor retardation. The Veteran reported feeling depressed and anxious with hyperarousal symptoms. The examiner found his affect was congruent to his mood. His tone, volume and speech were normal. No aphasia, dysarthria, flight of ideas, looseness of association, circumstantial thought, preservation, auditory, visual, and tactile hallucinations, current suicidal or homicidal thoughts, paranoia, or delusions were found. The Veteran exhibited word blocking, word searching, and delayed thought. He reported seeing objects move in his peripheral vision. He reported obsessive thoughts about being safe. The examiner diagnosed the Veteran with an Axis I diagnosis of PTSD, major depressive disorder (MDD), moderate to severe, without psychotic features, and panic disorder without agoraphobia. Private psychiatric records dated November 2014 from Dr. H.J. reported seeing the Veteran for a follow up appointment. The Veteran’s anxiety, depressed mood, frequency of panic attacks, flashbacks, nightmares, and hypervigilance was noted to be about the same as previously, but his sleep had improved. He was not socializing. The Veteran denied suicidal and homicidal ideations and auditory and visual hallucinations. On examination, the Veteran was casually dressed, cooperative and generally able to relate to the examiner. He had an increase in tension and restlessness and exhibited blunted affect with psychomotor retardation. The Veteran reported feeling depressed and anxious with hyperarousal symptoms. The examiner found his affect was congruent to his mood. His tone, volume and speech were normal. No aphasia, dysarthria, flight of ideas, looseness of association, circumstantial thought, preservation, auditory, visual, or tactile hallucinations, current suicidal or homicidal thoughts, paranoia, or delusions were found. The Veteran exhibited word blocking, word searching, and delayed thought. He reported seeing objects move in his peripheral vision. He had obsessive thoughts about being safe. In a November 2014 statement, the Veteran reported that he currently experienced frequent nightmares of his experiences in Vietnam. The Veteran was afforded a VA PTSD contract examination in February 2015. The Veteran was diagnosed with PTSD, and the examiner, a psychologist, concluded that the Veteran exhibited occupational and social impairment with an 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 Veteran had three children with whom he was not close. The Veteran and his second wife had been married 31 years and were still married. The Veteran took medications to manage his PTSD symptoms. He reported re-experiencing the trauma, avoidance reactions, hyperarousal, high startle reaction, poor sleep patterns, difficulty concentrating, pessimism, feeling that the world was a more dangerous place, loss of interest in activities, and feeling detached from others. The Veteran denied having current suicidal or homicidal ideations. He also denied drug or alcohol use. The Veteran had recurrent intrusive distressing memories and dreams, marked physiological reactions to cues that reminded him of the trauma, avoided distressing memories, thoughts, feelings, and cues about the traumatic events, experienced persistent and exaggerated negative expectations about himself, others, or the world, experienced markedly diminished interest or participation in significant activities, felt detached or estranged, and had persistent inability to experience positive emotions. He exhibited irritable behavior, exaggerated startle response, problems with concentration, depressed mood, anxiety, suspiciousness, chronic sleep impairment, flattened affect, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. The Veteran asserted in an April 2015 correspondence that the records he submitted from his treating psychiatrist should be assigned greater weight than that of the VA contract examiners. He cited the GAF score assigned by the private psychiatrist and contended that his PTSD was severe. VA primary care treatment notes dated October 2015 and April 2016, and reported the Veteran denied being agitated, aggressive, or depressed, and he denied experiencing auditory or visual hallucinations. He was independent in all activities of daily living. It was noted the Veteran’s depression seemed to be stable on prescription medication. Upon review of all evidence of record, both lay and medical, the Board finds that the evidence is at least in equipoise that the Veteran’s symptoms of some suicidal ideations without plan or intent, depressed mood, anxiety, panic attacks three times per week, hypervigilance, chronic sleep impairment, mild memory loss, dissociative reactions, some psychomotor retardation, word blocking, word searching, and delayed thought, seeing objects move in his peripheral vision, obsessive thoughts about being safe, difficulty establishing and maintaining effective work/school and social relationships, and disturbances of motivation and mood warrant a rating of 70 percent. The Veteran has reported that he has a limited social network of his wife and her family. Moreover, his mood has been consistently found to be depressed and anxious with frequent panic attacks. He had decreased concentration, sleep impairment, and mild memory loss. For these reasons, and resolving reasonable doubt in the Veteran’s favor, the Board finds that a 70 percent disability rating for PTSD is warranted for the rating period prior to June 14, 2016. Moreover, the Board finds that the Veteran’s PTSD symptoms do not demonstrate symptoms such 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, or for the veteran’s own occupation or name. See 38 C.F.R. § 4.130. Further, the Veteran remains married and had a relationship with his wife’s family, although limited at times, during this period on appeal. This demonstrates that, although his social interactions are limited, his PTSD disability does not more nearly approximate total social impairment. For these reasons, the Board finds that the evidence of record does not demonstrate total occupational and social impairment. Accordingly, the Board finds that a 100 percent PTSD disability evaluation is not warranted at any time during the rating period on appeal. Finally, the Board notes that the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). 2. Beginning June 14, 2016, a rating higher than 50 percent for the service-connected PTSD is denied. The Veteran was provided another VA psychiatric examination on June 14, 2016. The examiner, a psychologist, examined the Veteran and provided a diagnosis of PTSD. He concluded that the Veteran had occupational and social impairment due to mild or transient symptoms which decreased work efficiency and ability to perform occupational tasks only during periods of significant stress or his symptoms were controlled by medication. The Veteran reported that many changes had occurred. The Veteran reported he felt more emotionally connected to his wife and children and enjoyed travelling with this wife. The examiner noted the Veteran’s PTSD was characterized by persistent re-experiencing of the traumatic events, avoidance behavior, negative alteration in cognition, numbing behavior, and hyperarousal. The Veteran had remained in mental health treatment since a 2012 VA PTSD examination and managed his symptoms with prescription medications. The Veteran denied suicide attempts, psychiatric admissions, or current suicidal and homicidal thoughts. The Veteran admitted to experiencing rare thoughts of suicide but denied intent or planning. The Veteran experienced recurrent distressing dreams, dissociative reactions, and intense or prolonged psychological distress and marked physiological reactions to cues that resembled the trauma. He avoided distressing memories, thoughts or feelings related to the trauma and experienced a persistent negative emotional state. He had markedly diminished interest or participation in significant activities, irritable behavior or angry outbursts, hypervigilance, sleep disturbances, depressed mood, and anxiety. The Veteran was well-groomed, cooperative, and fully oriented. He maintained good eye contact. The Veteran’s mood was euthymic with stable affect. No evidence of significant social discomfort or anxiety was observed. The Veteran’s speech was spontaneous and articulate. No abnormal gait, movements, or mannerisms were noted. No evidence of hallucinations, delusions, or psychoses were seen or endorsed by the Veteran. The Veteran’s attention and concentration were normal and memory recall of service, symptoms, and interview data was easily accessed by the Veteran. The Veteran’s impairments included poor sleep, which caused daytime mental and physical fatigue, and the flash backs exacerbated his daytime anxiety; however, these episodes only occurred approximately three times per month. Thus, the examiner concluded that the Veteran’s occupational impairments were not persistent, and when present, were mild in severity. After a review of the evidence, both lay and medical, the weight of the evidence beginning June 14, 2016 shows that the Veteran reported having only rare suicidal ideations, and denied homicidal ideations, auditory and visual hallucinations, delusions, paranoia, and obsessional rituals and thoughts. Although the Veteran experienced depression and anxiety, there is no evidence that they interfered with his ability to function appropriately or effectively and these symptoms are contemplated by the assigned 50 percent disability rating. Further, the record reflects that the Veteran had only mild depression stabilized with medication, and the record is void of evidence of impaired impulse control, impaired thought processes, impaired communication, inappropriate behavior, or irrelevant, illogical or obscure speech. The Veteran had a good relationship with his wife of many years and his relationship had improved significantly with his children. He reported that he now enjoyed travelling during this period on appeal. Thus, when taking into consideration the medical and the lay evidence of record, his PTSD symptoms more nearly approximated the criteria for the assigned 50 percent rating beginning June 14, 2016. Indeed, his PTSD was shown to result in occupational and social impairment with only reduced reliability and productivity, due to symptoms such as chronic sleep impairment, flash backs that exacerbated his daytime anxiety three times per month, disturbances of motivation and mood (anxiety and depression), and avoidance behavior. Consequently, the Board finds that a disability rating higher than 50 percent under Diagnostic Code 9411 is not warranted beginning June 14, 2016, as the Veteran’s symptoms do not rise to the level of occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. See 38 C.F.R. § 4.130. Notably, because this staged rating does not result in a reduction or discontinuance of compensation payments currently being made, this does not constitute a reduction in compensation, and the process specified in 38 C.F.R. § 3.105(e) was not required. See O’Connell v. Nicolson, 21 Vet. App. 89, 93 (2007); Hamer v. Shinseki, 24 Vet. App. 58, 61-62 (2010). Finally, the Board notes that the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, 28 Vet. App. at 69-70. 3. Entitlement to Total Disability Rating due to Individual Unemployability (TDIU) The Veteran contends that he is unemployable because of the severity of his service-connected disabilities and, therefore, entitled to a TDIU. 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 as 60 percent or more, and 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). For purposes of one 60 percent disability or one 40 percent disability in combination, disabilities of common etiology or from single accident or affecting both upper or lower extremities are considered to be one disability. Id. The Veteran has the following service-connected disabilities: PTSD, rated as 70 percent disabling prior to June 14, 2016 and 50 percent thereafter; diabetes mellitus, rated as 20 percent disabling; right lower extremity peripheral neuropathy, rated as 10 percent disabling; and left lower extremity peripheral neuropathy, rated as 10 percent disabling. As of November 8, 2014, the Veteran had a combined rating of 80 percent and beginning June 14, 2016, the Veteran had a combined rating of 70 percent. Thus, the Veteran satisfied the threshold schedular criteria for a TDIU under 38 C.F.R. § 4.16(a) for the entire period on appeal. In determining whether employability exists, consideration may be given to the veteran’s level of education, special training, and previous work experience, but it may not be given to his or her age or to any impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. In a claim for a TDIU, the ultimate question of whether a Veteran is capable of substantially gainful employment is not a medical one; that determination is for the adjudicator. See 38 C.F.R. § 4.16 (a); see also Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013). As to the severity of the Veteran’s PTSD, the evidence of record is set forth above within the context of the increased rating claim for PTSD, and the severity of his symptomatology was considered in this analysis of whether the Veteran was unable to obtain and maintain substantially gainful employment. As discussed above, the Veteran is rated at 70 percent for the service-connected PTSD before June 14, 2016, and 50 percent thereafter. Additional evidence of record includes private treatment records from October 2014, which indicate the Veteran retired from IBM in 1996 as an associate programmer after 30 years. See also February 2015 VA examination. He later worked as an IT consultant for three years. The Veteran reported he was a high school graduate with some college courses and equipment service training at IBM. The Veteran submitted a VA Form 21-8940 dated April 2015, which indicated he worked from 2001 to 2004 as an IT consultant and from 2004 to 2007 at Lowes. He again reported that he graduated high school and completed two years of higher education. The Veteran indicated on the VA Form 21-8940 that he left his last job due to his service-connected disabilities. The Veteran provided an employment verification printout in September 2015 showing he was employed by Lowes until approximately August 2006. The Veteran indicated that he stopped working at Lowes because he was unable to lift heavy objects due ot his service-connected diabetes. The Veteran was treated for a follow-up visit at VA primary care in October 2015. The Veteran reported he was “doing alright” and was “here for his routine follow up visit” without additional complaints. The VA physician noted the Veteran’s blood sugar levels were generally in the low to mid 100s. His mood was stable on his prescription medication. The Veteran denied paralysis, tremors, headaches, dizziness, dysarthria, seizures and insomnia. He endorsed possible memory loss and parasthesia. The Veteran denied being agitated, aggressive, depressed, or having auditory or visual hallucinations. He denied polyuria, polydipsia, heat or cold intolerance, skin or hair changes. He was independent in activities of daily living and instrumental activities of daily living. The Veteran’s neurological examination showed normal muscle tone, strength, and coordination with an unremarkable sensory examination. Deep tendon reflexes were equal and symmetrical, and his gait was steady. His most recent HBA1C was 7.3, which indicated fairly controlled diabetes on oral medications and insulin injections. VA treatment records dated March 2016 indicate that the Veteran reported for an initial diabetic foot evaluation at VA podiatry. He reported occasional numbness and tingling in both feet and fairly controlled diabetes. The assessment was that the Veteran had diabetes and neuropathy, which put him at a level 2 risk for future disabilities with his feet. He was prescribed diabetic shoes with insoles and diabetic socks. The Veteran was treated by his VA primary care physician in April 2016. The Veteran reported that he was being seen for a follow up appointment and denied any current complaints. He reported his blood sugar readings were usually in the 140s, but his blood pressure was always normal. The Veteran denied being agitated, aggressive, depressed, and did not have auditory or visual hallucinations. He denied polyuria, polydipsia, heat or cold intolerance, skin or hair changes. He was independent in activities of daily living and instrumental activities of daily living. The Veteran’s neurological examination showed normal muscle tone, strength, and coordination with an unremarkable sensory examination. Deep tendon reflexes were equal and symmetrical, and his gait was steady. His most recent HBA1C was 7.6 which indicated fair, but worsening, control of the diabetes on oral medications and insulin injections. The Veteran was provided a VA examination in June 2016 to address whether he was unable to obtain and maintain substantially gainful employment due solely to his service-connected PTSD disability. The examiner, a psychologist, concluded that the Veteran had occupational and social psychiatric impairment due to mild or transient symptoms which decreased work efficiency and ability to perform occupational tasks only during periods of significant stress, or his symptoms were controlled by medications. The Veteran reported he felt more emotionally connected to his wife and children than he had before, and he enjoyed travelling with this wife. The examiner noted his PTSD was characterized by persistent re-experiencing of the traumatic events, avoidance behavior, negative alteration in cognition, numbing behavior, and hyperarousal. The Veteran had remained in mental health treatment since a 2012 VA PTSD examination and managed his symptoms with prescription medications. The Veteran denied suicide attempts, psychiatric admissions, and current suicidal and homicidal intent or thoughts. The Veteran admitted to experiencing rare thoughts of suicide but denied intent or planning. The Veteran had recurrent distressing dreams, dissociative reactions and intense or prolonged psychological distress and marked psychological reactions to cues that resembled the trauma. He avoided distressing memories, thoughts or feelings related to the trauma and had a persistent negative emotional state. He exhibited markedly diminished interest or participation in significant activities, irritable behavior or angry outbursts, hypervigilance, sleep disturbances, depressed mood, and anxiety. The Veteran was well-groomed, cooperative, and fully oriented. He maintained good eye contact. The Veteran’s mood was euthymic with stable affect. No evidence of significant social discomfort or anxiety was observed. The Veteran’s speech was spontaneous and articulate. No abnormal gait, movements, or mannerisms were observed. No evidence of hallucinations, delusions, or psychoses were observed or endorsed by the Veteran. The Veteran’s attention and concentration were normal and memory recall of service, symptoms, and interview data were easily accessed by the Veteran. The examiner concluded that it was less likely than not that the Veteran’s PTSD rendered him unable to obtain and/or maintain substantially gainful employment. The Veteran’s impairments included poor sleep, which caused daytime mental and physical fatigue, and the flash backs exacerbated his daytime anxiety; however, the examiner noted these episodes only occurred approximately three times per month. Thus, the examiner concluded that the Veteran’s occupational impairments were not persistent, and when present, were mild in severity. After review of the evidence, both lay and medical, the evidence shows the Veteran retired after 30 years with “IBM” as a programmer and worked as an IT consultant for three years between 2001 and 2004. Subsequently, he worked for Lowes as a plumbing department manager until August 2006. He further reported he had to quit his job at Lowes because he was unable to lift heavy objects due to his service-connected diabetes, and there is no evidence of record that he has been employed since August 2006. The Board recognizes that the Veteran’s service-connected bilateral peripheral neuropathy and fairly controlled diabetes could impact his ability to perform some physical acts, but the evidence does not show that it precludes all physical activities. Moreover, even if the Veteran was precluded from physical employment due to his service-connected bilateral peripheral neuropathy and diabetes, there is no evidence in the record, specifically after considering his education and previous work experience as a computer programmer for 30 years and IT consultant for 3 years, that suggests that his service-connected disabilities would preclude him from obtaining or maintaining substantially gainful sedentary employment. Additionally, the evidence does not suggest that the Veteran’s current physical or psychiatric symptoms substantially affect his reliability, productivity, ability to follow instructions. The evidence does not suggest that he has impairment of long or short-term memory, judgment, or abstract thinking, and he does not exhibit any abnormality of conduct, personal appearance, or self-care. Indeed, to the extent his service-connected disabilities affect the Veteran’s employability, the schedular ratings assigned for his various physical and psychiatric disabilities already compensate him for such impairment. After considering the evidence of record, both lay and medical, the Board finds that the Veteran’s service-connected disabilities do not render him unable to secure or follow substantially gainful employment. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, 28 Vet. App.at 69-70. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Harper, Associate Counsel