Citation Nr: 18152158 Decision Date: 11/21/18 Archive Date: 11/21/18 DOCKET NO. 13-34 842 DATE: November 21, 2018 ORDER Entitlement to an effective date earlier than September 13, 2010 for service-connected PTSD is denied. Entitlement to an initial disability rating in excess of 30 percent for posttraumatic stress disorder (PTSD) is granted. Entitlement to a total disability rating for individual unemployability is denied. FINDINGS OF FACT 1. VA received a claim of entitlement to service connection for PTSD on September 13, 2010; a formal or informal claim for this benefit was not received prior to that date. 2. Resolving reasonable doubt in the Veteran’s favor, the Board finds that the Veteran’s PTSD has been manifested by occupational and social impairment with reduced reliability and productivity due to such symptoms as flattened affect, disturbances of motivation and mood, chronic sleep impairment, depression, anxiety, and difficulty in establishing and maintaining effective work and social relationships; however, neither deficiencies in most areas nor total occupational and social impairment have been shown. 3. The preponderance of the evidence shows the Veteran is not unable to secure or follow a substantially gainful occupation due to his service-connected PTSD. CONCLUSIONS OF LAW 1. The criteria for establishing an effective date earlier than September 13, 2010, for the grant of service connection for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.400. 2. The criteria for an initial rating in excess of 50 percent, but no higher, for PTSD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.1, 4.2, 4.7, 4.130, Diagnostic Code (DC) 9411. 3. The criteria for a TDIU have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1951 to January 1953. His awards and decorations include the Combat Infantryman Badge. This matter comes before the Board of Veterans’ Appeals (Board) from an August 2011 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA), which granted an initial disability rating of 10 percent for PTSD, effective September 13, 2010. In a July 2012 rating decision, the RO increased the disability rating for PTSD to 30 percent, effective August 18, 2011. The RO also denied a claim for TDIU. In a December 2013 rating decision, the RO found clear and unmistakable error and granted an earlier effective date of September 13, 2010, for the 30 percent evaluation. These matters were previously before the Board and were remanded in October 2014 and June 2016. In August 2014, the Veteran testified before the undersigned Veterans’ Law Judge at a videoconference hearing. A transcript is of record. Earlier Effective Date for PTSD In a July 2011 rating decision, the RO awarded the Veteran service connection for PTSD, effective September 13, 2010. The Veteran contends that he is entitled to an earlier effective date of January 13, 1983. He asserts that his claim for nonservice-connected pension received on January 13, 1983, included a claim for service connection for PTSD that was never adjudicated and remained pending. The Board has reviewed the record and finds that there is no written communication dated prior to September 13, 2010, that could be construed as a claim of entitlement to service connection for PTSD. Generally, except as otherwise provided, the effective date of an award of compensation based on an original claim will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400. The date of entitlement for an award of service connection will be the day following separation from active service or the date entitlement arose if the claim is received within one year after separation from service. Otherwise, the effective date will be the date of receipt of the claim, or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400 (b)(2)(i). For VA compensation purposes, a “claim” is defined as “a formal or informal communication in writing requesting a determination of entitlement, or evidencing a belief in entitlement, to a benefit.” 38 C.F.R. § 3.1 (p). An informal claim is “[a]ny communication or action indicating an intent to apply for one or more benefits.” It must “identify the benefit sought.” 38 C.F.R. § 3.155 (a). Thus, the essential elements for any claim, whether formal or informal, are “(1) an intent to apply for benefits, (2) an identification of the benefits sought, and (3) a communication in writing.” Brokowski v. Shinseki, 23 Vet. App. 79, 84 (2009). When determining the effective date of an award of compensation benefits, the Board is required to review all communications in the file that could be interpreted as a formal or informal claim for benefits. See Lalonde v. West, 12 Vet. App. 377, 380-81 (1999). Generally, VA must develop all issues raised upon a liberal and sympathetic reading of a claim. See Ingram v. Nicholson, 21 Vet. App. 232, 256 (2007). Moreover, under 38 C.F.R. § 3.151 (a), a claim for compensation may be considered a claim for pension and a claim for pension may be considered a claim for compensation, with the greater benefit awarded unless the claimant specifically elects the lesser benefit. However, VA “is not automatically required to treat every compensation claim as also being a pension claim or vice versa. Stewart v. Brown, 10 Vet. App. 15, 18 (1997); see also Willis v. Brown, 6 Vet. App. 433, 435 (1994) (the operative word in the regulation, “may”, clearly indicates discretion). Determining whether a claim for pension is a simultaneous claim for service connection depends on the contents of the application for benefits and the supporting evidence submitted with the application. Id. On January 13, 1983, VA received a formal claim, Application for Compensation or Pension (VA Form 21-526). On this form, in the section entitled “Nature and History of Disabilities,’ the Veteran listed several disabilities including ‘nervios.’ Here, even on a sympathetic reading, the January 1983 application for benefits, plus supporting documentation, makes clear that it was the Veteran’s intention to apply only for nonservice-connected pension benefits. The Veteran did not indicate on the application, a belief that his nervous disability (or any other disability) manifested during service, was caused by service, or was in any way connected to service. For instance, the Veteran responded to questions 34A-37E, the portion of the claim form regarding “income received and expected from all sources.” Above this section on the form was a note stating- “Items 34A through 37E should be completed only if you are applying for nonservice-connection pension.” The Veteran did not complete Items 27 through 29 on the form, which indicate they need to be completed only if a veteran is claiming compensation for a disability incurred in service. In fact, the Veteran placed slashes through each box in this section. In March 1983, VA sent the Veteran two development letters that referred to his ‘claim for pension,’ but made no mention of a service connection claim. In response to the letters, which requested additional evidence in support of the pension claim, the Veteran submitted information, but nothing that indicated that he was seeking compensation for a service-connected disability instead of or in addition to nonservice-connected pension. In May 1983, VA sent the Veteran a notice letter which stated in pertinent part, “We have determined that you are permanently and totally disabled and entitled to pension benefits.” The Veteran responded to this correspondence later that month (to correct a statement about his Social Security benefits) but did not reference any disagreement with his pension award or express that the RO had failed to adjudicate a claim for service connection related compensation. Review of numerous letters sent from VA between June 1983 and November 2001 shows nearly all of the correspondence was in reference to the Veteran’s continued entitlement to nonservice-connected disability pension benefits and/or amendments made to his pension award and specifically referred to a ‘disability pension award.’ None of the communication received from the Veteran during this time indicated that he wished to seek service connection for a psychiatric disorder to include PTSD, or expressed a belief that VA had not fully developed a claim for service connection disability compensation. Based on this evidence, the Board finds that the Veteran’s January 1983 claim did not put VA on notice that the Veteran was seeking service connection compensation benefits. The Board has also considered the Veteran’s November 2001 Application for Compensation or Pension (VA Form 21-526). However, in response to the first question on the application, “What are you applying for?” the Veteran placed a checkmark in the box for ‘Pension.’ He did not check the preceding box for ‘Compensation,’ nor list any disabilities in Part B - the section of the form for Compensation. Part B requires the applicant to list any disability that he or she believes is related to miliary service. This section was left blank. The Veteran did, however, fully complete Part D: Pension. Thus, the Veteran’s November 2001 claim did not put VA on notice that the Veteran was seeking service connection compensation benefits. Review of letter sent to, and received from the Veteran, between November 2001 and September 2010 shows nearly all of the correspondence was in reference to his continued eligibility to nonservice-connected disability pension benefits and/or amendments made to his pension award. There was no formal or informal communication from the Veteran that indicated an intent to seek entitlement, or evidencing a belief in entitlement, to service connection for a psychiatric disorder, to include PTSD. On September 13, 2010, VA received a formal application for service connection for PTSD. This is the first evidence of a claim, formal or informal, for service connection for PTSD. In this case, service connection was not identified as the benefit sought in the January 1983 or the November 2001 claim. Although the benefit sought need not be specific, it must be identified. See Servello v. Derwinski, 3 Vet. App. 196, 199 (1992); Stewart v. Brown, 10 Vet. App. 15, 18 (1997). Further, although VA must interpret a claimant’s submissions broadly, it is not required to conjure up issues not raised by claimant, nor anticipate any potential claim for a benefit where no intention to raise it was expressed. Brannon v. West, 12 Vet. App. 32, 35 (1998); Talbert v. Brown, 7 Vet. App. 352, 356-57 (1995). There is nothing on the face of the January 1983 or the November 2001 claim that could have put VA on notice that the Veteran was claiming his nerves resulted from an in-service injury or event. As such, the Board finds that neither the January 1983 claim nor the November 2001 claim can reasonably be construed as an informal claim for service connection for PTSD. Even though the Veteran’s symptoms and diagnosis may have predated his claim of entitlement to service connection, the earliest date on which service connection can be granted is either the date the entitlement arose, or the date the claim was received, whichever is later in time. 38 C.F.R. § 3.400 (q)(2), (r). In this case, because the date of the Veteran’s claim for service connection for PTSD is later in time than the date entitlement may have arisen, the date the Veteran’s claim was received is, by law, the proper effective date for service connection. While the Board is sympathetic to the Veteran’s belief that he is entitled to an earlier effective date for the grant of service connection for PTSD, there is no basis for assigning an effective date earlier than September 13, 2010. The Board is without authority to grant a claim on an equitable basis and instead is constrained to follow the specific provisions of law. 38 U.S.C. § 7104; Harvey v. Brown, 6 Vet. App. 416 (1994). Entitlement to an effective date earlier than September 13, 2010, is denied. 38 U.S.C. §§ 5101, 5110; 38 C.F.R. §§ 3.102, 3.400. Higher Initial Rating The Veteran contends entitlement to a higher initial disability rating for his service-connected PTSD. As noted above, his PTSD symptoms are currently rated 30 percent, effective September 13, 2010. 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 of 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. As in this case, when determining the propriety of the initial rating assigned after a grant of service connection, the evidence since the effective date of the grant of service connection must be evaluated and staged ratings must be considered. Staged ratings are appropriate when the evidence establishes that the claimed disability manifested symptoms that would warrant different ratings for distinct time periods during the course of the appeal. Fenderson v. Brown, 12 Vet. App. 119, 126–27 (1999). 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, if 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. PTSD is evaluated under the General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130, DC 9411. Under 38 C.F.R. § 4.130, Diagnostic Code 9411, a 30 percent evaluation is warranted where there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). A 50 percent evaluation is warranted where 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. 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 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, 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 100 percent disability evaluation is warranted when there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time and place; and memory loss for names of close relatives, own occupation, or own name. Id. Ratings are assigned according to the manifestation of symptoms, but the use of the term “such as” in the General Rating Formula demonstrates that the symptoms after the 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 (2002); see also Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013) (explaining that the symptoms that could give rise to a given rating are those in like-kind, i.e., of similar duration, severity, and frequency, to those provided in the non-exhaustive lists). During the appeal period, VA amended the portion of the Rating Schedule dealing with mental disorders and its adjudication regulations that define the term “psychosis” to remove outdated references to the DSM-IV and replace them with references to the updated Fifth Edition (DSM-5), effective August 4, 2014. See 79 Fed. Reg. 149, 45094. The provisions of the interim final rule apply to all applications for benefits that are received by VA or that were pending before the Agency of Original Jurisdiction on or after August 4, 2014. Id. VA adopted as final, without change, the interim final rule and clarified that the provisions of this interim final rule do not apply to claims that have been certified for appeal to the Board or are pending before the Board as of August 4, 2014. See 80 Fed. Reg. 53, 14308 (March 19, 2015). In this case, the RO certified the Veteran’s appeal to the Board before August 4, 2014; therefore, the PTSD claim is governed by DSM-IV and the Global Assessment of Functioning (GAF) scores are relevant for consideration. The GAF score is a scale reflecting the “psychological, social, and occupational functioning in a hypothetical continuum of mental health- illness”. Richard v. Brown, 9 Vet. App. 266, 267 (citing DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, 4th ed. (DSM-IV) at 32. A GAF score of 61 to 70 indicates some mild symptomatology (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 well, with some meaningful interpersonal relationships. Scores ranging from 51 to 60 reflect moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers). Scores ranging from 41 to 50 reflect serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job). Treatment records from 2010 generally describe the Veteran as alert and oriented with good eye contact and grooming. September 2010 treatment records show depressed and anxious mood, appropriate affect, linear thinking, and no delusions or hallucinations. Additionally, a September 2010 treatment record noted a low suicide risk with episodic fatigue, depression, and no current intent to harm self or others. September 2010 treatment records also note symptoms of obtrusive thoughts, lower stress tolerance, poor concentration, and feelings of impending doom. Finally, several September 2010 treatment records note GAF scores of 45, indicative of severe symptoms. October 2010 treatment records note the Veteran experiences flashbacks almost every night when trying to fall asleep, depression, suicidal ideation, and irritability. November 2010 treatment records also show an active prescription for anxiety medication and described the Veteran as alert, cooperative, fully oriented to name, date, and situation; well-groomed; possessing logical and coherent thought processes; and without hallucinations, delusions, suicidal ideation, or homicidal ideation. At a VA examination in October 2010, the Veteran reported symptoms of intrusive thoughts, weekly nightmares, impaired sleep, moodiness, irritability and startle response. He denied any physical confrontations in recent years. He preferred to be alone and avoid crowds. He indicated that he was currently retired but had worked in a jewelry store for a short time and as an engineer for most of his life. He was able to complete activities of daily living without assistance. He denied current suicidal ideation. On mental status examination, he was well-groomed and fully oriented. Mood was anxious and affect was guarded. Thought process was logical and goal-oriented; speech was normal. There was no evidence of psychosis or homicidal ideation. Judgment and insight were intact and impulse control was appropriate. Memory appeared adequate. A GAF of 60 was assigned. Treatment records from 2011 generally note an appropriate affect and depression. Generally, treatment records from 2012 note insomnia, nightmares, obtrusive thoughts, low stress tolerance, poor concentration, and no suicidal ideation. For instance, October 2012 treatment records describe the Veteran as polite and cooperative with sad affect but note clear speech and thought content, continued depression, nightmares, hypervigilant behaviors, difficulty concentrating, and no suicidal ideation. December 2012 treatment records also note symptoms such as episodes of depression with anxiety, hypervigilance, anger, and isolating behaviors. In January 2012, the Veteran underwent a VA examination. The Veteran noted being married for 52 years with a good relationship. The Veteran reported having a great relationship with three of his four children and his seven grandchildren, including talking to them often. The Veteran further reported having a couple of good friends and regularly volunteering at a thrift shop which he enjoyed. Additionally, the Veteran reported struggling with thoughts of service, anxiety, nightmares, concentration, and memory loss. The January 2012 examiner noted only disturbances of motivation and mood as a symptom of the Veteran’s PTSD. The examiner assigned a GAF score of 60 and opined that the Veteran’s level of occupational and social impairment was that his symptoms were not severe enough either to interfere with occupational and social functioning or to require continuous medication. Similarly, treatment records from 2013 note depressed mood, appropriate affect, episodes of anxiety and poor concentration, exaggerated startle reaction, isolating behavior, insomnia, and nightmares. For instance, in a May 2013 treatment record, the Veteran reported avoiding crowded places but denied suicidal ideation. October 2013 treatment records note anhedonia. In November 2013, the Veteran submitted a private psychological assessment report which notes that the Veteran has a couple of good friends, continues to volunteer, and lives a largely sedentary lifestyle. The November 2013 private psychologist opined that the Veteran’s PTSD causes anxiety, suspiciousness, inappropriate affect, impaired impulse control, and intermittent suicidal ideation. The November 2013 private psychologist further opined that the Veteran’s PTSD has caused him problems psychiatrically, socially, occupationally, and legally over the course of his life. Treatment records from 2014 note anxiety and depression, ‘normal’ mood and affect, and isolating behavior. For instance, November 2014 treatment records note that, while the Veteran reports having a couple of friends, he also reports not engaging with them except for ‘simple pleasantries’. November 2014 treatment records also report irritability and avoidance of thinking or talking about his traumatic experiences. In November 2014, the Veteran underwent another VA examination. He was still married and remained close with his wife. He also maintained a close relationship with all of his children, except one with a history of drug problems. He still had a couple of friends but did not engage with them except for pleasantries. He did find the men in his PTSD group supportive and enjoyed participating. He reported having some suicidal thoughts ‘some years ago,’ but denied such thoughts in a few years. On mental status examination, the Veteran was noted to be pleasant and polite, although his affect was somewhat flat, he did not smile, and he appeared somewhat serious. He communicated effectively with clear and logical thinking. No psychosis was evident and he denied suicidal and homicidal ideation. The examiner reported the Veteran’s PTSD symptoms were anxiety, chronic sleep impairment, and disturbances of motivation and mood. The examiner also indicated that his only impairment was isolation from others and reluctance to engage. The examiner opined that the Veteran’s PTSD symptom severity and functioning was similar to when he was last evaluated in January 2012; no significant deteriorations had occurred and his condition appeared stable. Treatment records from 2015 also note a flat affect, depressed mood associated with frequent fleeting suicidal ideation and insomnia, nightmares, fatigue, difficulty concentrating, and decreased appetite. A June 2016 treatment record notes a negative depression screening; however, March 2017 treatment records note fleeting thoughts of suicide and disturbances in mood. Based on review of the evidence, the Board finds that an initial 50 percent rating, but not higher, is warranted since the grant of service connection. The cumulative evidence has shown that the Veteran’s PTSD has manifested with symptoms that more closely approximates occupational and social impairment with reduced reliability and productivity. The Veteran’s PTSD has primarily manifested with symptoms that include, but are not limited to: depression, difficulty concentrating, chronic sleep impairment, some difficulty with social relationships, disturbances of motivation and mood. These types of symptoms are contemplated in the 50 percent disability rating criteria. The evidence does not support a finding of occupational and social impairment with deficiencies in most areas, warranting a 70 percent rating, any time during the appeal. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. Symptoms which could justify a 70 percent rating include neglect of personal appearance and hygiene, near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; suicidal ideation, or inability to establish and maintain effective relationships. The Veteran does not have a history of similar symptoms that manifest with the frequency, duration and/or severity that is contemplated by a 70 percent rating. The evidence of record shows that he has been able to maintain good relationships with his wife, children, grandchildren, and a few friends including some from PTSD therapy. Moreover, the Veteran is generally noted as being appropriately groomed, having logical and goal-directed thought processes, having thought content congruent with reality, oriented to time and space, and displaying socially appropriate behavior and mood. While the Board acknowledges that the Veteran was assessed with GAF scores of 45 throughout September 2010, a GAF score alone is not determinative of a particular rating. The cumulative assessments of the VA examiners’ and other competent medical professionals which discuss the severity of the Veteran’s PTSD do not reflect deficiencies in most areas or total social or occupational impairment due to PTSD. The Board recognizes that Veteran’s November 2013 private psychiatrist did opine that the Veteran’s PTSD causes problems in most areas. Notwithstanding such characterization, the Board finds his symptomatology, as described above, fall within the criteria of a 50 percent rating. The Board acknowledges that the record contains evidence of intermittent suicidal ideation. Also, during the November 2013 private evaluation, the clinician noted impaired impulse control and inappropriate effect. These are the types of symptoms that would fall into the 70 percent disability rating criteria. However, the presence of a single symptom is not dispositive of any disability level. VA must engage in a holistic analysis in which it assesses the severity, frequency, and duration of the signs and symptoms, quantifies the level of occupational and social impairment caused by those symptoms, and assigns an evaluation that more nearly approximates that level of occupational and social impairment. See Bankhead v. Shulkin, 29 Vet. App. 10, 20 (2017). Taking a holistic view of the evidence, the Veteran’s intermittent thoughts of suicide have not been described by either the Veteran or a clinician as causing any significant or severe interference with his ability to function in an occupational or social setting. Significantly, at the November 2014 VA examination, wherein the examiner noted the Veteran’s report of past occasional suicidal ideation, the examiner determined that his overall level of occupational and social functional impairment was mild. The examiner also noted that this same severity level was demonstrated at the January 2012 VA examination and there had not been any significant worsening in his overall functioning since. In the private psychiatric report dated in 2013, Dr. B. noted that the impact from the Veteran’s PTSD over the years is that it has caused him problems psychiatrically, socially, legally and occupationally. He specifically noted that despite reporting past suicidal thoughts, the Veteran appears to be at low acute and chronic risk for suicide due to factors such as a stable relationship with his wife, a supportive family, no previous attempts, and future-oriented thought content towards continuing to participate in treatment. The Board has considered this assessment, and in conjunction with the cumulative evidence, does not find that the frequency, severity, and duration of the Veteran’s suicidal ideation has resulted in a severe impact on his life in terms of occupational and social functioning similar to that which is contemplated by a 70 percent rating. Further, the preponderance of the evidence in the treatment records and VA examination reports does show any significant problems with the Veteran’s impulse control since the grant of service connection such that a 70 percent rating is warranted. Furthermore, total occupational and social impairment, warranting a 100 percent rating, has not been shown at any time during the appeal. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. Symptoms which could justify a 100 percent rating include gross impairment in thought processes or communication; persistent delusions or hallucinations; persistent danger of hurting self or others; intermittent inability to perform activities of daily living; disorientation to time or place; or memory loss of names of close relatives, own occupation, or own name. The Veteran does not have a history of similar symptoms that manifest with the frequency and/or severity that is contemplated by a total rating. In sum, resolving all reasonable doubt in the Veteran’s favor, the Veteran’s PTSD has approximated the criteria for a 50 percent rating, but not higher, since the grant of service connection. TDIU The Veteran also seeks entitlement to TDIU due to his service-connected PTSD. Total disability ratings for compensation may be assigned when a veteran is unable to secure and follow a substantially gainful occupation due to service-connected disabilities. See 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. The regulatory framework includes a rating hurdle. 38 C.F.R. § 4.16 (a). If there is only one service-connected disability, it must be rated at 60 percent or greater to allow for schedular consideration of the claim. Id. It is the policy of VA, however, that all veterans who are unable to secure or follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. Id. § 4.16(b). Therefore, in all cases of veterans who are unemployable by reason of service-connected disability but fail to meet the prescribed rating hurdle, the rating Board should submit to the Director, Compensation Service, the claim for extraschedular consideration. Id. The central inquiry is “whether the Veteran’s service connected disabilities alone are of sufficient severity to produce unemployability”. Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Consideration may be given to the Veteran’s level of education, special training, and previous work experience when arriving at this conclusion; factors such as age or impairment caused by non-service connected disabilities are not to be considered. 38 C.F.R. §§ 3.341, 4.16, 4.19. The Veteran is only service-connected for PTSD, which is rated 50 percent disabling. He does not meet the schedular criteria for a TDIU. Moreover, the Board finds that his service-connected disability does not render him unable to secure or maintain gainful employment such that referral for extraschedular consideration under 38 C.F.R. § 4.13(b) is warranted. The Veteran completed a VA Form 21-8940, Application for Increased Compensation Based on Unemployability in August 2011. The Veteran reported he completed high school. The Veteran also reported that he was unable to work due a period of obscurity in his mind. He reported nightmares that did not let him sleep and that he lived in the streets of New York City and in shelters. The Veteran reported ‘waking up’ from this ‘period of obscurity’ in 1973 and attending a program in high-pressure boilers. He reported he last worked in January 1983 as a maintenance engineer before his first heart attack affected his full-time employment. The Veteran also noted that he was disabled after his second heart attack and was unable to ‘do any kind of work’ following a 1999 diagnosis of diabetes. At his hearing before the undersigned, he testified that the receives Social Security disability benefits only due to his nonservice-connected heart disability. The Board notes that these records were destroyed and thus are unavailable. The Board recognizes the Veteran’s contention that his PTSD prevents him from securing gainful employment; however, the Board notes that the competent evidence of record is against the claim. The January 2012 VA examiner indicated that the Veteran’s PTSD symptoms were not severe enough either to interfere with occupational functioning. The Veteran was volunteering at a thrift shop at this time. Similarly, the November 2014 VA examiner indicated that the Veteran’s PTSD symptoms caused occupational 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. At that time, the Veteran reported that he no longer volunteered thrift because of his physical health condition. The Board recognizes that the Veteran reported outpatient treatment for PTSD in his August 2011 Application for Increased Compensation Due to Individual Unemployability; however, the Board notes that he also reports multiple open-heart surgeries and treatment for his heart conditions and consistently refers to his heart conditions as the disability that prevents him from working. The Board also recognizes that the Veteran’s last employer only noted ‘illness’ as the reason for termination of employment but finds that the preponderance of the evidence is against finding that the Veteran’s PTSD is of sufficient severity to produce unemployability. The Board is limited to analyzing whether service-connected disabilities alone make the Veteran unable to secure and follow a substantially gainful occupation. Given the above, the evidence of record does not show that the Veteran is incapable of securing or following a substantially gainful occupation, consistent with his education and work background due solely to his service-connected PTSD. Although his service-connected disability may have affected his ability to interact with others, the evidence does not show it precludes substantially gainful employment in an unskilled or semi-skilled position consistent with the Veteran’s work history as a maintenance engineer. Given the entirety of the evidence of record, there is no basis for referral to the Director of Compensation for extraschedular consideration of a TDIU under 38 C.F.R. §4.16 (b). As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable. Accordingly, the claim for a TDIU is not warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Aoughsten, Associate Counsel