Citation Nr: 18148782 Decision Date: 11/08/18 Archive Date: 11/08/18 DOCKET NO. 06-24 116 DATE: November 8, 2018 ORDER Entitlement to an evaluation of 30 percent for right foot cold weather injury, from September 19, 2011 to July 27, 2015, is granted. Entitlement to an initial evaluation in excess of 50 percent for posttraumatic stress disorder (PTSD) prior to May 15, 2013, and in excess of 70 percent since May 15, 2013, is denied. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is granted. FINDINGS OF FACT 1. For the period from September 19, 2011 to July 27, 2015, the Veteran’s right foot cold weather injury was manifested by cold sensitivity, hyperhidrosis, disturbances in nail grown, and x-ray abnormalities. 2. For the period prior to May 15, 2013, the Veteran’s PTSD was productive of occupational and social impairment with reduced reliability and productivity, but not productive of occupational and social impairment in most areas. 3. Since May 15, 2013, the Veteran’s PTSD has been productive of occupational and social impairment in most areas, but not total occupational and social impairment. 4. The Veteran’s service-connected disabilities have prevented him from obtaining and retaining substantially gainful employment consistent with his educational background and work experience. CONCLUSIONS OF LAW 1. The criteria for entitlement to a 30 percent rating for right foot cold weather injury from September 19, 2011 to July 27, 2015 have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1-4.14, 4.104, Diagnostic Code 7122. 2. The criteria for an evaluation in excess of 50 percent for PTSD prior to May 15, 2013, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1-4.7, 4.10, 4.21, 4.126, 4.130, Diagnostic Code 9411. 3. The criteria for an initial evaluation in excess of 70 percent for PTSD beginning on May 15, 2013, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1-4.7, 4.10, 4.21, 4.126, 4.130, Diagnostic Code 9411. 4. The criteria for an award of a TDIU are met. 38 U.S.C. §§ 1155, 5103, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1994 to March 1995 and from March 2004 to December 2004. He had additional service in the Louisiana Army National Guard. In March 2011, the Veteran and testified at a hearing before a Veterans Law Judge. A transcript of that hearing has been associated with the record. The Veterans Law Judge who conducted that hearing is no longer employed by the Board. The Veteran was offered another Board hearing, but the Veteran’s attorney waived another hearing in an October 2018 letter. The issue of entitlement to an increased rating for PTSD was remanded to the Board of Veterans Appeals (the Board) by the Court of Appeals for Veterans Claims (the Court). In the May 2018 Joint Motion for Partial Remand (the Remand), the Court instructed the Board to consider a June 2016 private medical opinion in determining the severity of the Veteran’s PTSD. The issue of entitlement to an increased rating for residuals of cold weather injury to the right foot prior to July 27, 2015 is on appeal from a February 2016 Rating Decision, which assigned a 30 percent disability evaluation as of July 27, 2015, but no earlier. The Board acknowledges that the Veteran has a pending TDIU claim that is not currently before the Board. However, the Board will adjudicate the TDIU claim as part and parcel of the increased rating claim for PTSD. The claim for TDIU due to PTSD has been expressly raised by the Veteran and reasonably raised by the record. See Rice v. Shinseki, 22 Vet. App. 447 (2009). Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. 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 for that rating. 38 C.F.R. § 4.7. In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). While the regulations require review of the recorded history of a disability by the adjudicator to ensure a more accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, as in this case, where the question for consideration is the propriety of the initial rating assigned, evaluation of the evidence since the effective date of the grant of service connection is required. Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). Where VA’s adjudication of the claim for increase is lengthy and factual findings show distinct time periods where the service-connected disability exhibits symptoms which would warrant different ratings, different or “staged” ratings may be assigned for such different periods of time. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007); Fenderson, 12 Vet. App. at 126-27. In this case, as explained below, uniform evaluations are warranted. Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the weight of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). 1. Entitlement to a compensable rating for right foot cold weather injury from September 19, 2011 to July 27, 2015 The Veteran’s residuals of cold weather injury to the right foot were assigned a non-compensable disability evaluation prior to July 27, 2015, and a 30 percent disability evaluation thereafter, pursuant to 38 C.F.R. § 4.130, Diagnostic Code 7122. In February 2017 correspondence, the Veteran’s attorney contends that the Veteran is entitled to a 30 percent disability rating for his service-connected right foot condition from September 19, 2011, the date of a VA examination, to July 27, 2015, the date he was awarded a 30 percent rating, which is the maximum rating available under Diagnostic Code 7122. Under the law extant in 2011, in the context of a claim for increased benefits for a disability for which service connection has already been established, the date of VA outpatient or hospital examination or date of admission to a VA or uniformed services hospital will be accepted as the date of receipt of a claim. See 38 C.F.R. § 3.157 (b)(1) (2011); MacPhee v. Nicholson, 459 F.3d 1323, 1326 (Fed. Cir. 2006). Under 38 C.F.R. § 3.157 (b)(1) (2011), the date of such medical reports will be considered an informal claim when they relate to examination or treatment of a disability for which service connection has already been established or when a claim specifying the benefit sought is received within one year from the date of such examination, treatment, or hospital admission. Therefore, the Board will consider the September 2011 VA examination an informal claim for an increased rating. Under 38 C.F.R. § 4.110, Diagnostic Code 7122, a 10 percent rating is warranted when the record establishes that the cold injury residuals are productive of arthralgia, or other pain, numbness, or cold sensitivity. For a 20 percent rating, the record must establish that the Veteran’s disability is manifested by arthralgia or other pain, numbness, or cold sensitivity plus tissue loss, nail abnormalities, color changes, locally impaired sensation, hyperhidrosis, or X-ray abnormalities (osteoporosis, sub-articular punched out lesions, or osteoarthritis). A maximum 30 percent rating is assigned under Diagnostic Code 7122 for cold injury residuals manifested by arthralgia or other pain, numbness, or cold sensitivity plus 2 or more of the following: tissue loss, nail abnormalities, color changes, locally impaired sensation, hyperhidrosis, or X-ray abnormalities (osteoporosis, subarticular punch out lesions, or osteoarthritis). At the September 2011 VA cold weather injury examination, the Veteran reported cold sensitization, hyperhidrosis, paresthesias, numbness, and tingling. The Veteran also reported disturbances in nail growth. X-rays of the Veteran’s right foot revealed minor arthritis change, which the examiner attributed to the Veteran’s cold weather injury. During a May 2013 VA foot examination, the Veteran reported blue discoloration, that his feet sweat profusely, and that he experiences mild dull pain. A maximum 30 percent rating is warranted for the period from September 19, 2011 to July 27, 2015 because the medical evidence shows that the Veteran’s right foot cold weather injury residuals were manifested by cold sensitivity, nail abnormalities, hyperhidrosis, and x-ray abnormalities. 2. Entitlement to an initial evaluation in excess of 50 percent for posttraumatic stress disorder (PTSD) prior to May 15, 2013, and an evaluation in excess of 70 percent since May 15, 2013 The Veteran’s PTSD was assigned a 50 percent disability evaluation prior to May 15, 2013, and assigned a 70 percent disability evaluation thereafter, pursuant to 38 C.F.R. § 4.130, Diagnostic Code 9411. Under Diagnostic Code 9411, a 50 percent rating is warranted when the psychiatric disorder results in 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 the psychiatric disorder results in 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); inability to establish and maintain effective relationships. A 100 percent rating is warranted when the psychiatric disorder results in 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. The use of the term “such as” in the general rating formula for mental disorders 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 symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). It is not required to find the presence of all, most, or even some, of the enumerated symptoms recited for particular ratings. Id. 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. Id. In Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013), the Federal Circuit stated that “a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration.” It was further noted that “§ 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas.” The Board notes that the regulations were recently revised to incorporate the Fifth Edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-V) rather than the Fourth Edition (DSM-IV). However, these provisions only apply to cases received by or pending before the AOJ on or after August 4, 2014. The change does not apply to cases certified to the Board prior to that date. In this case, the Veteran’s claim was certified to the Board prior to August 4, 2014; therefore, the regulations pertaining to the DSM-IV are for application. Prior to May 15, 2013 As noted above, the Veteran’s PTSD was assigned a 50 percent disability evaluation prior to May 15, 2013. In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran does not meet the criteria for a 70 percent evaluation for his PTSD for the period prior to May 15, 2013. 38 C.F.R. § 4.7. In this case, the record does not demonstrate that the Veteran’s overall disability picture is consistent with a 70 percent rating or higher for the period before May 15, 2013, to include consideration of the Veteran’s lay statements, VA treatment records, and the VA examination reports. As to social impairment, the evidence suggests that he maintained relationships with his family throughout the appeal. Specifically, he stated that he was “very close” with his four children (see February 2006 VA treatment note) and that he has lived with his family at his mother’s house during the appeal (see October 2005 VA treatment). Although he noted that he had problems within his family (see February 2006 VA treatment note), he also stated that he saw his two youngest daughters several times per week, visited with his uncle every week, and continued to talk to his mother, father, younger brother, and two sisters on a weekly to quarterly basis. See April 2009 VA examination report. While the Veteran reported that he did not date (see March 2007 Vet Center intake assessment), the Board notes that the Veteran had numerous relationships since service. During an April 2009 VA examination, the Veteran also indicated that he had married his high school girlfriend after living with her for two years during the appeal period. He separated and divorced from at least one wife during the appeal period (see October 2005 VA psychiatry treatment note). In addition, the Veteran has contended that he had no friends, was defensive with others, and used anger to avoid emotional relationships. See July 2008 Vet Center treatment notes, April 2009 VA examination report. Nevertheless, while he may have had some degree of social impairment, the evidence does show that the Veteran has maintained relationships with multiple family members throughout the appeal prior to May 15, 2013, and had other relationships. Indeed, the April 2009 VA examiner described his marital, family, and social relationships as having only moderate impairment. Concerning occupational impairment, the evidence suggests that the Veteran was employed for a significant portion of this period. In a January 2005 VA general medical examination and in a July 2005 VA treatment note, the Veteran indicated that he completed three years of college education and that he worked as a mortgage financier at a local mortgage company. In a December 2006 Vet Center treatment note, the Veteran indicated that he was employed as a senior operation analyst. In a March 2007 Vet Center intake assessment, the Veteran reported that he worked at Morgan Chase for nine years. During an August 2011 VA rectum and anus examination, the Veteran indicated that he worked as a senior operations supervisor at Morgan Chase from June 1999 until he was laid off in December 2008. However, in an earlier VA mental health note, the Veteran had indicated that his job was at risk due to cut backs and because his department was “top heavy.” Following his employment at Morgan Chase, the Veteran reported that he attended classes at a state university in spring and summer 2010 and that he worked as a substitute teacher in December 2010 for three years. See August 2011 VA examination report, May 2013 VA examination report, and August 2015 VA examination report. More recently, the Veteran worked at a local post office. He stated that he left his full-time substitute teaching position for a better opportunity with the postal service in 2012, but he continued teaching part-time. See August 2015 VA examination report. In January 2013, the Veteran’s supervisor at the main post office branch recommended that the Veteran resign from his job as a clerk. See January 2015 VA treatment note. In a May 2013 VA treatment note, the Veteran related that he was continuing to teach as a substitute teacher, had been interviewing for jobs, and had an interview scheduled for another postal position at the same branch of the post office that he previously worked. The Veteran has indicated that his symptoms impacted his employment during the appeal. For instance, in a January 2006 VA treatment note, he reported that he had provided notice at his sales associate job because he felt like he had to be “constantly on the defensive” and he felt threatened by “aggressive customers.” In addition, in a September 2006 VA treatment note, the Veteran stated that he felt that he was not productive at work and that he was thinking about taking a medical leave of absence from work because he needed a break so he could “rest up to keep fighting some more.” A December 2006 VA treatment note indicated that the Veteran took only one week off from work to rest. Although the Veteran may have had some degree of occupational impairment, the evidence still shows that the Veteran has maintained steady employment throughout much of this period. Thus, prior to May 15, 2013, the Veteran was able to maintain family and social relationships, attend school, and remain employed. In addition, the May 2013 VA examiner opined that the Veteran’s PTSD caused 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. Such an opinion is commensurate with a 30 percent evaluation, whereas the Veteran has already been granted a 50 percent evaluation. Further, the Veteran’s symptomatology has not been similar to that of the 70 percent criteria before May 15, 2013. There is no indication that he had obsessional rituals which interfered with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; spatial disorientation; neglect of personal appearance and hygiene; or inability to establish and maintain effective relationships. Indeed, the April 2009 VA examiner found that the Veteran’s speech was well modulated and non-pressured, he had logical and linear thought, the content of his speech was appropriate, delusions and hallucinations were absent, his personal hygiene was good, and he was well oriented to person, place, time, and purpose. Panic symptoms were also absent. It was noted that some obsessions and compulsions or rituals were present, but the examiner explained that they were only mildly intrusive as he avoids walking on cracks. There was no indication that such actions interfered with the Veteran’s routine activities. The Board also acknowledges that there has been evidence of suicidal thoughts during this appeal period. However, the April 2009 VA examiner indicated that the Veteran had only mild suicidal ideation, and there is no indication that there was any suicidal act. Nevertheless, to the extent that the Veteran has had any suicidal ideation, the Board notes that the symptomatology does not result in the necessary social and occupational impairment to warrant an initial evaluation in excess of 50 percent. Indeed, to the extent any of the symptoms of a 70 percent rating may be shown or argued, the Board again emphasizes that the Veteran’s PTSD has not been shown to be productive of occupational and social impairment in most areas or total occupational and social impairment to warrant a higher rating for the period before May 15, 2013. There is not also indication that he has had any of the other symptoms of the 70 or 100 percent criteria, such as obsessional rituals; illogical, obscure, or irrelevant speech; neglect of his personal appearance and hygiene; or disorientation to time or place. The Board acknowledges that the Veteran has been assigned GAF scores ranging from 53 to 60. A GAF score between 51 and 60 reflects moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning. See 38 C.F.R. §§ 4.125, 4.130, DSM-IV. GAF scores assigned are but one factor for consideration in a rating, but the Board does note that the Veteran’s GAF scores in this case do not suggest that the Veteran’s symptomatology and impairment warrants an evaluation in excess of 50 percent. Nevertheless, while considering the GAF score of record as part of the overall social and occupational functioning picture, the Board finds the narratives contained in the lay statements, treatment records, and examination reports to be the most probative evidence of the Veteran’s psychological symptomatology. After considering the evidence of record, the Board finds that the Veteran’s symptoms more closely approximate the criteria for an initial 50 percent disability rating for the period prior to May 15, 2013. Overall, the Veteran has not demonstrated a level of impairment consistent with the 70 percent criteria, nor have the Veteran’s symptoms caused occupational and social functioning in most of the areas or total occupational and social functioning referenced by the 70 and 100 percent evaluation criteria. Mauerhan, supra, Vazquez-Claudio, supra. The criteria for the next higher rating of 70 percent have not been met or approximated for the period prior to May 15, 2013. See 38 C.F.R. § 4.130, Diagnostic Code 9411. Since May 15, 2013 In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran does not meet the criteria for a 100 percent evaluation for his PTSD for the entire period on appeal. 38 C.F.R. § 4.7. As discussed in the June 2016 Remand, the record contains a medical opinion, dated June 13, 2016, from private physician Dr. M.LC. In this opinion, the examiner opined that Veteran has been unable to function in an occupational environment due to his mental illness marked by unpredictability, volatility, aggressiveness, cognitive disturbance, severely altered interpersonal relationships, and inconsistency of function. As discussed further below, the Board finds this medical opinion supports severe occupational impairment. However, the Board emphasizes that a 100 percent disability evaluation requires both total social and occupational impairment. See Melson v. Derwinski, 1 Vet. App. 334 (1991) (use of the conjunctive “and” in a statutory provision meant that all of the conditions listed in the provision must be met); cf. Johnson v. Brown, 7 Vet. App. 95 (1994) (only one disjunctive “or” requirement must be met in order for an increased rating to be assigned). The Board acknowledges the Veteran’s lay statements regarding the severity of his symptoms. However, throughout the appeal period, the evidence of record does not show that the Veteran has both 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. As to social impairment, the evidence suggests that the Veteran maintained relationships with his family throughout the appeal period. Specifically, he stated that he has lived with his family at his mother’s house during the appeal period. See August 2015 VA examination report. During the August 2015 VA examination, he described a contentious relationship with his mother despite intermittently living with her since 2005. He also indicated that he did not get along with his brothers and nephew. Nevertheless, although he noted that he had problems within his family (see February 2015 VA treatment note), he also stated that he saw his two youngest daughters several times per week, visited with his uncle every week, and continued to talk to his mother, father, younger brother, and two sisters on a weekly to quarterly basis. See May 2013 VA examination report. The Board also notes that the Veteran had a relationship with a girlfriend during the appeal period since May 15, 2013. See November 2014 VA treatment note, August 2015 VA examination report. In addition, during the May 2013 VA examination, the Veteran stated that he saw a few military friends at barbeques and played dominoes with them once per month. In an August 2014 VA treatment note, the Veteran further reported that he had one friend that he could “release and talk to a little bit.” During the August 2015 VA examination, the Veteran also stated that he was a member of the American Legion and that he attended church. Thus, although he has had a degree of social impairment, the evidence shows that the Veteran has maintained relationships with family and friends throughout the appeal period. As such, it cannot be said that the Veteran has had total social impairment. The Veteran’s PTSD symptoms, when taken together, do not more nearly approximate both total social and total occupational impairment as required to warrant a 100 percent rating. Mauerhan, supra, Vazquez-Claudio, supra. The criteria for the next higher rating of 100 percent have not been met or approximated during this period on appeal. See 38 C.F.R. § 4.130, Diagnostic Code 9411. After considering the evidence of record, the Board finds that the Veteran’s PTSD more closely approximates the criteria for the 70 percent disability rating for the period beginning May 15, 2013. Overall, the Veteran has not demonstrated a level of impairment consistent with the criteria for a total evaluation. Mauerhan, supra, Vazquez-Claudio, supra. The criteria for a total evaluation have not been met or approximated at any time during the appeal period. See 38 C.F.R. § 4.130, Diagnostic Code 9411. Thus, the Board concludes that the weight of the evidence is against a rating in excess of 70 percent for PTSD on or after May 15, 2013. As such, the benefit-of-the-doubt rule does not apply. Gilbert, 1 Vet. App. at 53. 3. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU). The Veteran contends that his service-connected PTSDs prevents him from being able to maintain gainful employment. Although the Board has determined that the Veteran’s PTSD does not cause total social impairment as required for a 100 rating under the PTSD criteria, the evidence is at least in equipoise regarding whether the Veteran’s PTSD causes total occupational impairment. Legal Criteria Total disability is considered to exist when there is any impairment which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. Total disability may or may not be permanent. 38 C.F.R. § 3.340(a)(1). Total ratings are authorized for any disability or combination of disabilities for which the Rating Schedule prescribes a 100 percent evaluation. 38 C.F.R. § 3.340(a)(2). TDIU may be assigned where the schedular rating is less than total, when the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability rated at 60 percent or more; or as a result of two or more service connected disabilities, provided at least one disability is rated at 40 percent or more, and there are additional service-connected disabilities to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). As the Veteran has been granted entitlement to a 70 percent rating for PTSD, he meets the criteria to be eligible for a schedular TDIU under 38 C.F.R. § 4.16(a). The Board notes that the Veteran has also been awarded a 30 percent rating for residuals of right foot cold weather injury and a 30 percent rating for residuals of fistulotomy. The Veteran’s combined disability rating is 90 percent, effective July 27, 2015. Analysis Regarding the Veteran’s educational history, the Veteran reported that he had completed his Bachelor’s degree in criminal justice. See August 2015 VA examination report. He graduated from a state university in January 2014, and he planned to pursue a Master’s degree, possibly in criminal justice or public administration. See July 2014 and August 2014 VA treatment notes. Regarding the Veteran’s employment history, the evidence suggests that the Veteran was employed during the appeal period. Historically, following his employment at Morgan Chase, the Veteran reported that he attended classes at a state university in spring and summer 2010 and that he worked as a substitute teacher in December 2010 for three years. See August 2011 VA examination report, May 2013 VA examination report, and August 2015 VA examination report. In a May 2014 VA treatment note, the Veteran later indicated that he was working one day per week for the post office and that there was potential for his hours to increase as other employees retired. He also stated that he resigned from his part-time teaching position because he perceived that he was being used as an “educated security guard.” In a June 2014 VA treatment note, the Veteran explained that he resigned his position as a clerk at the post office in May 2013 and began working as a rural carrier in June 2013. He stated that the role suited him because he liked getting out on the road and enjoyed some of the customer-postman relationships that he developed. He stated that he worked four days that week. In an August 2014 VA treatment note, the Veteran reported that he averaged one day of work per week and regularly drove a postal route on Mondays, but he filled in for other carriers on Saturdays. In a November 2014 VA treatment note, the Veteran related that his work hours had decreased due to decreased requests by full-time postal carriers for him to fill in for them. In a December 2014 VA treatment note, the Veteran indicated that he was planning on filing a grievance with his post office supervisor for creating a hostile work environment. In a March 2015 VA psychiatry note, the Veteran indicated that he was working and increasing his job duties. During the August 2015 VA examination, the Veteran noted that he was fired from his job at the post office because he had a car accident while driving a postal truck on a delivery route, but he had a pending case to get his job back. Although the record contains evidence that the Veteran has worked part-time since August 2015, the record does not show that the Veteran has been able to maintain substantial gainful employment since he was fired from the Postal Service. In June 2016, private physician Dr. M.LC opined that Veteran has been unable to function in an occupational environment due to his mental illness marked by unpredictability, volatility, aggressiveness, cognitive disturbance, severely altered interpersonal relationships, and inconsistency of function. Dr. M.L.C. found that the Veteran was discharged from the United States Postal Service due to his behaviors, actions, and symptoms directly related to his behaviors with other employees, incapacity to focus and concentrate, and loss of executive functioning. Dr. M.LC. provided an updated assessment in June 2018. Dr. M.L.C. reiterated his prior findings, stating that while the Veteran can obtain a job, he cannot maintain a job due the symptoms of his mental illness. The physician noted that the Veteran’s failure at J.P. Morgan Chase was a result of his inability to adapt to civilian lifestyle and engage in the appropriate interpersonal relationships consistent with that job environment. The Board finds this opinion consistent with a finding that the Veteran cannot maintain substantial gainful employment. The Board finds that there is competent and probative evidence which shows that the Veteran’s PTSD causes him to have difficulty maintaining concentration, working with other people, and coping with the mental requirements of a work environment. Furthermore, the Veteran’s residuals of cold weather injury and fistulotomy impact his ability to keep up with the physical demands of a work environment. The Board therefore finds that there is adequate medical evidence indicating that the Veteran’s service-connected disabilities, most significantly his PTSD, prevent him from being able to maintain any gainful employment. The Board acknowledges that the VA examiners came to different medical opinions regarding the Veteran’s occupational limitations. However, the doctrine of reasonable doubt must be resolved in the Veteran’s favor when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, and the Board will resolve this doubt in the Veteran’s favor regarding the question of whether his current service-connected disabilities prevent him from being able to maintain gainful employment. See Wise v. Shinseki, 26 Vet. App. 517, 531 (2014) (“By requiring only an ‘approximate balance of positive and negative evidence’ the Nation, ‘in recognition of our debt to our veterans,’ has ‘taken upon itself the risk of error’ in awarding... benefits.”). Hence, affording the Veteran the benefit of the doubt, entitlement to a TDIU is warranted. 38 U.S.C. § 5107 (b). JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Casey, Associate Counsel