Citation Nr: 18150572 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 13-34 656 DATE: November 15, 2018 ORDER Entitlement to an initial rating in excess of 30 percent for posttraumatic stress disorder (PTSD) with major depressive disorder, panic disorder, agoraphobia, and alcohol abuse (formerly classified as an anxiety disorder, not otherwise specified (NOS)), prior to November 4, 2014, and to a rating in excess of 70 percent thereafter is denied. Entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU) is denied. FINDINGS OF FACT 1. Prior to November 4, 2014, the Veteran’s PTSD with major depressive disorder, panic disorder, agoraphobia, and alcohol abuse was manifest by 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, mild memory loss (such as forgetting names, directions, recent events). 2. From November 4, 2014, the Veteran’s PTSD with major depressive disorder, panic disorder, agoraphobia, and alcohol abuse was manifest by occupational and social impairment with deficiencies in most area, such as work, school, family relation, 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. 3. The Veteran’s service-connected disability did not prevent him from securing and following a substantially gainful occupation. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 30 percent for PTSD with major depressive disorder, panic disorder, agoraphobia, and alcohol abuse (formerly classified as an anxiety disorder, not otherwise specified (NOS)), prior to November 4, 2014, and to a rating in excess of 70 percent thereafter have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.126, 4.130, Diagnostic Code 9411 (2017). 2. The criteria for TDIU have not been met. 38 U.S.C. § 7105 (d)(5) (2012); 38 C.F.R. § 4.16 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1967 to January 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2012 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania. The Board remanded this matter in July 2015 and January 2018. The Board finds there has been substantial compliance with its January 2018 remand directives. See D’Aries v. Peake, 22 Vet. App. 97, 105 (2008); see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (holding that there was no Stegall (Stegall v. West, 11 Vet. App. 268 (1998)) violation when the examiner made the ultimate determination required by the Board’s remand.) 1. Entitlement to an initial rating in excess of 30 percent for posttraumatic stress disorder (PTSD) with major depressive disorder, panic disorder, agoraphobia, and alcohol abuse (formerly classified as an anxiety disorder, not otherwise specified (NOS)), prior to November 4, 2014, and to a rating in excess of 70 percent thereafter Disability ratings are determined by the application of the VA’s Schedule for Rating Disabilities (Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4 (2017). Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21 (2017); see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). The primary concern in a claim for an increased evaluation for service-connected disability is the present level of disability. Although the overall history of the disability is to be considered, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). VA has a duty to consider the possibility of assigning staged ratings in all claims for increase. See Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran asserts that he is entitled to higher disability ratings for his PTSD with major depressive disorder, panic disorder, agoraphobia, and alcohol abuse. Specifically, the Veteran contends that he should receive a disability rating in excess of 30 percent prior to November 4, 2014, and in excess of 70 percent thereafter. The current regulations establish a general rating formula for mental disorders. 38 C.F.R. § 4.130. Ratings are assigned according to the manifestation of particular symptoms. However, the use of the term “such as” in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. See Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013); see also Sellers v. Principi, 372 F.3d 1318, 1326-27 (Fed.Cir.2004); Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). However, because “[a]ll nonzero disability levels [in § 4.130] are also associated with objectively observable symptomatology,” and the plain language of the 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, 713 F.3d at 116-17. For example, “in 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. Thus, assessing whether an increased evaluation is warranted requires a two-part analysis: “The... regulation contemplates[: (1) ] initial assessment of the symptoms displayed by the veteran, and if they are of the kind enumerated in the regulation[; and (2)] an assessment of whether those symptoms result in occupational and social impairment with deficiencies in most areas.” Id. at 118. Pursuant to Diagnostic Code 9411, PTSD is rated 30 percent disabling 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), and chronic sleep impairment, mild memory loss (such as forgetting names, directions, or recent events). Id. A 50 percent evaluation 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; and difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent evaluation is warranted where there is objective evidence demonstrating occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to 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, or effectively; impaired impulse control, such as unprovoked irritability with periods of violence; spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances, including work or a work-like setting; and the inability to establish and maintain effective relationships. Id. A maximum 100 percent evaluation is for application 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; and memory loss for names of close relatives, own occupation, or own name. Id. In evaluating the evidence, the Board has considered the various Global Assessment of Functioning (GAF) scores that clinicians have assigned. The GAF is a scale reflecting the psychological, social, and occupational functioning on a hypothetical continuum of mental health illness. See Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (DSM-IV); Carpenter v. Brown, 8 Vet. App. 240 (1995). The Board also notes, however, that the GAF scale was removed from the more recent DSM-V for several reasons, including its conceptual lack of clarity, and questionable psychometrics in routine practice. See DSM-V, Introduction, The Multiaxial System (2013). A GAF score of 61-70 reflects some mild symptoms (e.g., depressed mood and mild insomnia) or some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, and has some meaningful interpersonal relationships. A GAF score of 51-60 indicates moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers). A GAF score of 41-50 reflects serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job). A GAF score of 31-40 reveals some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) or major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed man avoids friends, neglects family, and is unable to work; child frequently beats up younger children, is defiant at home, and is failing at school). DSM-IV at 46-47. Prior to November 4, 2014 In an April 2008 VA treatment record, it was noted that the Veteran had minimal prior psychiatric treatment. The Veteran reported occasional nightmares but sleep was generally okay. He had poor frustration tolerance and irritability but denied any violence since he quit drinking more than 20 years earlier. He reported some stress at work aggravating his anxiety. He had diffuse anxiety without panic. He had some dysphoria but no anhedonia. He ate well and denied hallucination or other psychotic symptom. He denied suicidal ideation. He did not endorse flashbacks or intrusive thoughts. It was noted the Veteran had been married for 37 years. Upon examination, the Veteran was alert and oriented, well groomed, spontaneous, relevant, and coherent. His affect and speech were appropriate. Memory was not impaired. Insight and motivation were fair. In a May 2008 VA treatment record, the Veteran reported that he had a history of having difficulty controlling his anger. The Veteran noted almost no friends, but had acquaintances. He said he was always focused on his wife and 2 children, so he never cared to maintain friendships with others. The Veteran was diagnosed with anxiety disorder. In a July 2008 VA treatment record, the Veteran reported feeling well on medication. He denied depression, anxiety, or mood swings. He denied suicidal or homicidal thoughts. He reported sleeping well and his appetite was good. He reported working for United Methodist Home for past 15 years and enjoying his job. He said his wife stated his rages had calmed considerably since starting medication. The Veteran said his best friend was his son. The son also reported improvement in his father’s mood and demeanor since starting medication. The Veteran was alert and oriented. He was cooperative, calm, and pleasant. He was fairly well groomed and appropriately dressed. Mood was described as “mellow,” and affect was consistent. Speech was spontaneous, relevant, and coherent. Thought processes were organized and logical. He denied auditory and visual hallucinations. There were no delusional thoughts. He denied suicidal and homicidal ideation. Memory was intact; insight was fair; judgment was intact. In an August 2008 VA treatment record, the Veteran displayed restricted affect congruent with mood. He seemed alert and aware and did not demonstrate symptoms consistent with current suicidal or homicidal ideation or audio or visual hallucinations. Insight and judgment seemed fair. Speech was logical, coherent, and sequential. In a September 2008 VA examination, the Veteran was noted to be married for the past 37 years with a son, daughter, and 2 grandsons. He reported few friends and liked to keep a distance from these relationships. He enjoyed motorcycles and fishing. Upon examination, the Veteran was clean and speech was unremarkable. He was cooperative, affect was constricted, and mood was anxious and depressed. His attention was intact and the Veteran was oriented. Thought process was unremarkable. Thought content was noted to be homicidal ideation. There were no delusions. Judgment was noted that the Veteran understood the outcome of his behavior. Insight was normal. The Veteran reported sleep impairment. There were no hallucinations or obsessive/ritualistic behavior. There were no panic attacks. Memory was normal. The Veteran reported sleep impairment, blackouts in which he perceived people to be enemy soldiers, social isolation, loss of interest in recreational activities, stress, combat dreams, and anger control issues. The Veteran was assigned a GAF score of 65 and it was noted that PTSD symptoms did not meet diagnostic threshold. The examiner found deficiencies in judgment shown by substance use/abuse, thinking shown by intrusive cognitions, family relations shown by conflict up until the Veteran stopped drinking and concomitant aggressiveness, and mood shown by labile anxiety and depression. In a December 2008 VA treatment record, the Veteran reported depressed mood most of the days for more than 2 weeks, “out of the blue” anxiety, kicking during sleep, recurrent unpleasant dreams of similar content or emotion, and feelings of guilt or shame. Upon examination, the Veteran was alert and oriented. He was fairly well groomed and appropriately dressed. Mood was described as “good.” Affect was consistent. Speech was spontaneous, relevant, and coherent. Thought processes were organized and logical. There were no auditory or visual hallucinations. There were no delusional thoughts. The Veteran denied suicidal and homicidal ideation. Memory was intact and insight was fair. In an August 2009 private treatment record, the Veteran denied obsessive compulsive behaviors, but reported that everything had to be the right otherwise he got angry. He reported nightmares almost daily and had thrown himself out of the bed during his sleep at times as he was reliving his experiences from service in his dreams. The Veteran’s wife reported that the Veteran had avoided making friends with anyone. He had sleep problems. Loud noises caused him to have a flashback but since taking medication, the duration of the flashbacks had reduced. The Veteran said he got confused with dates and times. The Veteran reported recurring thoughts and efforts to avoid activities and conversations associated with trauma. He further reported intense psychological distress at exposure to external cues and recurrent distressing dreams of the event were ongoing. He had exaggerated startle response and hypervigilance. He had frequent difficulty staying asleep but denied suicidal thoughts. The symptoms were rated as severe. Upon examination, the Veteran’s attitude was cooperative. He displayed a subdued mood and his affect was appropriate. Speech was clear, fluent and spontaneous. In a June 2010 private treatment record, the Veteran reported nightmares and sweats. He had exaggerated startle response, anxiety, disturbances in motivation and memory difficulties. He described difficulties with his son which led to violence and extreme anger. In a September 2011 VA treatment record, the Veteran was voluntarily admitted due to depression with suicidal ideation. He said he could be easily irritable and had poor impulse control. Upon examination, the Veteran was alert and cooperative. His mood was depressed, anxious and angry. Affect was appropriate to content. Speech was normal volume. There were no hallucinations. Thought process was coherent. There were no delusions or obsessions. There was no homicidal or suicidal ideation. Insight and judgment were poor. Memory was intact. The Veteran was assigned a GAF score of 40. In a June 2012 VA examination, the Veteran was diagnosed with a GAF score of 65. The examiner determined that the Veteran had 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 behaviour, self-care and conversation. His symptoms were the following: depressed mood; anxiety; suspiciousness; chronic sleep impairment; flattened affect; and disturbances of motivation and mood. The examiner also noted that he was hypervigilant and always on guard. He also avoided socializing outside of his own family. In a September 2014 VA treatment record, the Veteran was noted to be alert and oriented. His speech was clear and coherent. He was pleasant and polite. The Veteran said his mood was stable and that the medicine was helpful in managing his depression, anxiety and anger. He reported his sleep remained interrupted averaging about 6 hours per night. He had vivid dreams and occasional nightmares. He denied suicidal/homicidal ideation. He did not have any psychotic symptoms. He kept busy doing yard work and household chores. He enjoyed fishing and spending time with his granddaughter. Overall, the evidence of record reflects that prior to November 4, 2014, the Veteran’s PTSD did not warrant a rating in excess of 30 percent. The Veteran’s PTSD was manifested by irritability, suspiciousness, flashbacks, helplessness, depression, anxiety, and sleep impairments. The Board finds that the frequency, severity and duration of these symptoms are consistent with a 30 percent rating, which contemplates occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. In fact, the Veteran enjoyed recreational activities with his family, worked, and enjoyed spending time with his granddaughter. He was also married for over 30 years and continues to be married. The Board notes that the evidence has varied regarding the Veteran’s ability to function in social and occupational settings and his GAF scores varied between 40 and 65, representative of mild to moderate symptoms. However, the Board does not only consider GAF scores when determining the severity of a mental health disability. Looking at all of the symptoms, the Board finds that a 30 percent rating is warranted and no higher. At no point prior to November 4, 2014, has the Veteran’s service-connected PTSD been shown to have met the criteria for the higher rating of 50 percent. The evidence does not show that the Veteran has had 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. As stated above, the evidence shows that the Veteran was married over 30 years with a good relationship with his wife and children and that he had hobbies. At the VA examinations, the Veteran was found to be neat and well groomed and his attention, memory and judgment appeared to be within normal limits. Taken together with the other evidence noted above indicating at most moderate PTSD, with few, if any, of the symptoms described under the 50 percent rating, the Board finds that a higher rating is not warranted. Accordingly, the Board finds that a 30 percent disability rating, but no higher, prior to November 4, 2014, is warranted. From November 4, 2014 In a November 2014 VA examination, the examiner noted that the Veteran experienced fear, terror and helplessness. He had anxiety, avoidance, hypervigilance, exaggerated startle response, flashbacks, and nightmares of service-related trauma. He experienced sadness, lethargy, anhedonia, avolition, feelings of discouragement, helplessness, hopelessness, inadequacy and worthlessness, low self-esteem, poor self-efficacy, sleep disturbances, social isolation, and suicidal ideation. He also had panic attacks. It was stated (by checking a box) that the Veteran had total occupational and social impairment. Symptoms were the following: depressed mood; anxiety; suspiciousness; panic attacks more than once a week; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; chronic sleep impairment; flattened affect; impaired judgment; 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; suicidal ideation; impaired impulse control, such as unprovoked irritability with periods of violence; and persistent danger of hurting self or others. The examiner reported that the Veteran also reported experiencing frustration and anger which resulted in “fits.” These “fits” were described as episodes in which he could become verbally aggressive toward others. The Veteran stated he only slept 2 hours at a time and that he experienced nightmares of various conflicts. He said he was unable to function within close or cramped areas and that he was unable to interact with others on a social basis. In a July 2015 VA treatment record, the Veteran reported decreased irritability since beginning his medication. He reported continued inability to sleep, hyperarousal, and hypervigilance which had worsened in anticipation of the July 4 holiday. There were no reports of depression/homicidality/suicidality or plans. He remained active in daily life and had recently gone on a camping trip with his family. Upon examination, the Veteran was alert and oriented. He was attentive and adequately groomed. He was cooperative. Speech was normal, mood was “okay,” and affect was appropriate. There were no suicidal ideations/homicidal ideations or plans. Thoughts were coherent and logical. Concentration and memory were grossly intact. There were no delusions, hallucinations, obsessions, compulsions, or tics. Insight and judgment were good. In a November 2015 VA examination, the examiner determined that the Veteran had occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. It was noted that the Veteran lived with his wife of 44 years. The Veteran said in the past the marriage was volatile but had been getting better over the years. He said his only source of recreation was getting the mail and playing cards with his wife. It was noted the Veteran was retired. Symptoms were noted as the following: depressed mood; anxiety; suspiciousness; panic attacks that occurred weekly or less often; flattened affect; impaired judgment; 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; and suicidal ideation. The Veteran was accompanied by his wife and was noted to be casually dressed with his grooming and hygiene adequate. He was cooperative and respectful, but appeared guarded, irritable and suspicious. His mood was anxious. Speech was normal. The Veteran sustained attention and impaired, recent and remote memory impaired, test and social judgment were concrete. He adamantly denied any active suicidal ideations or intentions and denied homicidal ideations. There was no evidence of delusions or hallucinations. In a November 2016 VA treatment record, the Veteran was alert and oriented, and attentive. He was adequately groomed, appropriately dressed, and maintained good eye contact. He was cooperative. Speech was normal, and mood was “okay.” Affect was appropriate. There were no suicidal ideations/homicidal ideations or plans. Thoughts were coherent and logical. Concentration and memory were grossly intact. There were no delusions, hallucinations, obsessions, convulsions, or tics. Insight and judgment were good. In a July 2017 VA treatment record, the Veteran reported ongoing nightmares and sleep disturbances. Thought it was noted that the Veteran had sleep apnea and did not keep the mask on all night. His anxiety was chronic with nervousness and worry. He denied psychotic or manic symptoms, suicidal ideation, and homicidal ideation. He also denied impulsivity of risk taking activities. In a March 2018 VA treatment record, the Veteran reported chronic anxiety but that he was stable. He also said his depression was chronic but stable. He said his sleep had improved. He endorsed flashbacks during the knee replacement process but since the pain had lessened his trauma related symptoms had calmed. The Veteran said that his hopelessness had improved and he was enjoying things more; specifically, he planned to resume fishing. He denied psychotic or manic symptoms, suicidal and homicidal ideation, and impulsivity of risk taking activities. Upon examination, the Veteran was alert and oriented, and adequately groomed. He was cooperative. Speech was normal and mood was described as “pretty good.” Affect was congruent with mood. Thought process was linear. Thought content was appropriate. Suicidal and homicidal ideation were denied. There were no delusions, hallucinations, obsessions, or compulsions. Judgment and insight were intact. Overall, the evidence of record reflects that from November 4, 2014, the Veteran’s PTSD does not warrant a rating higher than 70 percent. Despite the November 2014 VA examiner finding that the Veteran had total occupational and social impairment, the overall evidence does not show this. The consistent evidence shows that the Veteran was well groomed, speech was normal, there were no hallucinations or delusions, and there was no isolation. In fact, the Veteran’s VA treatment records seem to show improvement where the Veteran was planning on resuming recreational activities. He was married for over 40 years and said his relationship with his wife had improved. The Board finds that the frequency, severity and duration of these symptoms are consistent with a 70 percent rating, which contemplates occupational and social impairment with deficiencies in most areas, from November 4, 2014. At no point from November 4, 2014, has the Veteran’s service-connected PTSD been shown to have met the criteria for the higher rating of 100 percent. The evidence does not show that the Veteran has had total occupational and social impairment. As stated above, the evidence shows improvement in his symptoms and that the Veteran was married over 40 years with a good relationship with his wife and children and that he was looking forward to resuming more activities he enjoyed before. Again as stated above, at the VA examinations, the Veteran was found to be neat and well groomed and his attention, memory and judgment appeared to be within normal limits. Taken together with the other evidence noted above indicating at most moderate PTSD, with few, if any, of the symptoms described under the 100 percent rating, the Board finds that a higher rating is not warranted. Accordingly, the Board finds that no higher than a 70 percent disability rating from November 4, 2014, is warranted. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (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. Entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU) The Veteran contends that he is unemployable as a result of his service-connected PTSD. The Board notes that the Veteran did not submit a VA Form 21-8940. The Board may assign a TDIU in the first instance provided that certain schedular disability ratings requirements, such as a combined disability rating of 70 percent with at least one disability rating as 40 percent rating, are met. See 38 C.F.R. § 4.16 (a); see also Bowling v. Principi, 15 Vet. App. 1, 10 (2001) (holding that the Board may not assign a TDIU in the first instance when the schedular requirements of 38 C.F.R. § 4.16 (a) are not met). The Veteran is in receipt of service connection for PTSD rated as 70 percent disabling. The Veteran’s combined disability rating is 70 percent. Thus, the preliminary schedular rating requirements for a TDIU are met. 38 C.F.R. § 4.16(a). Although the Veteran meets the percentage requirements set forth in section 4.16(a) for consideration of TDIU, the Board finds that the evidence establishes that his service-connected PTSD has not rendered him unable to secure or follow a substantially gainful occupation during the pendency of the claim. 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. 38 C.F.R. § 4.16 (a). Factors to be considered are a Veteran’s education, employment history, and vocational attainment. Ferraro v. Derwinski, 1 Vet. App. 326, 332 (1991). For a veteran to prevail on a claim based on unemployability, it is necessary that the record reflect some factor which places the claimant in a different position than other Veterans with the same disability rating. The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. A high rating in itself is a recognition that the impairment makes it difficult to obtain and keep employment. The question is whether the particular veteran is capable of performing the physical and mental acts required by employment, not whether that Veteran can find employment. See Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). The Veteran is retired. Social Security records indicate that the Veteran has a high school education. He was last employed as a plant operation manager in May 2011. In a May 2008 VA treatment record, the Veteran reported that he was employed as a maintenance supervisor, but had a difficult time leaving work at work, and found himself constantly thinking about things he needed to get accomplished. In a September 2008 VA examination, it was noted that the Veteran was employed as a maintenance worker and had been for the past 10 to 20 years. Problems related to his occupational functioning difficulty following instructions, poor social interaction; the Veteran noted he had been reprimanded for anger control issues. The examiner did not find any deficiencies in work. In a June 2012 VA examination, the examiner determined that the Veteran had 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 behaviour, self-care and conversation. In a November 2014 VA examination, the examiner noted that the Veteran had total occupational and social impairment. He had difficulty in establishing and maintaining effective work and social relationships. An August 20, 2015 Social Security Administration disability record determined the Veteran to be disabled. It was noted that the Veteran had memory limitations but that this was moderately limited to no limitations at all. Regarding concentration, the Veteran was found to have no limitations to marked limitations. The ability to work with others was moderately limited but the ability to complete a workday was markedly limited. In a November 2015 VA examination, the examiner determined that the Veteran had occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. In a June 2017 independent vocational opinion, it was reported that the Veteran had symptoms that totally disabled him. The PTSD that he experienced reportedly caused symptoms such as rage and lack of patience as well as poor impulse control and judgment that rendered him unemployable. It was further stated that there was no employer that could hire him with the risk that he would injure or disturb other employees, supervisors or the public. It was noted that the Veteran was only left on his job so long because he was a long term employee who was familiar with the work routine. His lack of ability to function independently, lack of ability to concentrate only served to add to his inability to function in any employment situation. Therefore, it was concluded that it was as likely as not that there was no work that the Veteran could secure or follow because of his service-related disability. He had been in this condition since he stopped work in 2011. The Board finds that the evidence as a whole, does not show that the Veteran is unemployable. The Veteran retired in 2011 as a plant manager. In addition, despite the November 2014 VA examiner finding that the Veteran had total occupational and social impairment, and the June 2017 independent vocational opinion finding that the Veteran’s PTSD made him unemployable, the rest of the evidence did find that the Veteran was unable to work. The VA examiners did not find that the Veteran was limited in any form of employment. In fact, the Veteran himself, though retired, continued to enjoy activities with his family and his symptoms improved over time. The Board has carefully considered the Veteran’s statements regarding the effects of his PTSD; on his employability. Although he experiences difficulty dealing with other people, repeated VA examinations do not show that the Veteran was unable to work. The Board has assigned these examination reports great probative value as they were based on an examination of the Veteran and a review of the pertinent evidence of record. In addition, though the Social Security Administration found the Veteran to be disabled, this was based on a number of different disabilities not service-connected, including the Veteran’s PTSD, and the Board notes that the procedure that the Social Security Administration uses for finding a Veteran disabled is different from the procedure that the Board follows; therefore, the Social Security Administration finding is afforded less probative value. In this regard, while it is apparent that the Veteran is impaired and has some difficulty based on his 70 percent combined rating, the critical question is whether the Veteran’s PTSD would cause him to be unable to work, notwithstanding his age or other nonservice-connected problems. For the reasons discussed above, the preponderance of the evidence is against the claim of entitlement to TDIU. The benefit-of-the-doubt doctrine is therefore not for application, and the appeal is denied. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Saudiee Brown, Associate Counsel