Citation Nr: 18153509 Decision Date: 11/28/18 Archive Date: 11/27/18 DOCKET NO. 15-42 974 DATE: November 28, 2018 ORDER For the period of appeal from February 17, 2004, until March 19, 2008, a rating in excess of 50 percent is denied. For the period beginning March 20, 2008, a 70 percent rating for service-connected post-traumatic stress disorder (PTSD) is granted. For the period beginning March 20, 2008, an evaluation in excess of 70 percent for PTSD is denied. Beginning March 20, 2008, a TDIU is granted. FINDINGS OF FACT 1. The Veteran filed a claim for PTSD on February 17, 2004 and an August 2009 rating decision granted service connection for PTSD and assigned a 30 percent rating effective February 17, 2004. The Veteran did not appeal the effective date of the grant of service connection. 2. Within one year of the August 2009 rating decision, new and material evidence concerning the rating was received and the claim was reconsidered in a January 2010 rating decision which granted a 50 percent evaluation effective February 17, 2004. 3. Within one year of the January 2010 rating decision, new and material evidence concerning the rating was received and the claim was reconsidered in a September 2010 rating decision which continued the 50 percent rating. 4. The Veteran timely appealed the September 2010 rating decision. 5. During the pendency of the appeal, in a February 2014 rating decision, the RO granted the Veteran a 100 percent disability rating for service-connected PTSD, effective May 25, 2010. 6. For the period of appeal prior to March 20, 2008, the Veteran’s symptoms did not more nearly approximate occupational and social impairment resulting in deficiencies in most areas. 7. For the period of appeal beginning March 20, 2008, the Veteran’s symptoms more nearly approximated occupational and social impairment resulting in deficiencies in most areas. 8. Beginning March 20, 2008, the Veteran met the schedular criteria for TDIU. 9. Beginning March 20, 2008, the Veteran’s service connected disabilities rendered him unemployable. CONCLUSIONS OF LAW 1. For the period from February 17, 2004, until March 19, 2008, the criteria for an evaluation in excess of 50 percent for PTSD have not been met. 38 U.S.C. § 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.130, Diagnostic Code 9411 (2017). 2. For the period beginning March 20, 2008, the criteria for an evaluation of 70 percent for PTSD have been met. 38 U.S.C. § 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.130, Diagnostic Code 9411 (2017). 3. For the period beginning March 20, 2008, the criteria for an evaluation in excess of 70 percent for PTSD have not been met. 38 U.S.C. § 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.130, Diagnostic Code 9411 (2017). 4. Resolving reasonable doubt the Veteran’s favor, the criteria for a TDIU have been met beginning March 20, 2008. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.159, 3.340, 3.341, 4.1, 4.3, 4.15, 4.16, 4.18, 4.19 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1967 to July 1969. 1. Entitlement to an increased initial rating in excess of 50 percent for service-connected post-traumatic stress disorder (PTSD) The Board notes that this appeal was initially characterized as one for entitlement to an earlier effective date for the 100 percent evaluation. By way of history, the Veteran’s claim for service connection for PTSD was received at VA February 17, 2004. A July 2004 rating decision denied service connection and the Veteran timely appealed. During the pendency of the appeal, an August 2009 rating decision granted service connection for PTSD and assigned a 30 percent rating effective February 17, 2004. Within one year of that rating decision new evidence, in the form of VA outpatient treatment records, including mental health treatment records were associated with the claims file and accordingly 3.156(b) applies. Significantly, however, there was no indication within one year of the August 2009 rating decision that the Veteran disagreed with the February 17, 2004 effective date for the grant of service connection. Accordingly, to the extent that the grant of service connection is effective February 17, 2004, that decision is final. Due to the newly submitted evidence, the claim concerning the rating of the PTSD was reconsidered and a January 2010 rating decision granted an increased 50 percent rating effective February 17, 2004. Although in March 2010 the Veteran indicated he was “pleased with the 50%,” just a couple months later and still within one year of that rating decision the veteran filed a new claim for an increased rating for PTSD in May 2010. Additional treatment records were associated with the file in May 2010, a VA examination was obtained in June 2010 and a lay statement was received in July 2010. The question is what controls, the “withdrawal” or the provisions of 3.156(b). Significantly, in this case, the withdrawal was a withdrawal of the appeal for hearing loss and tinnitus, claims that had been included with the original appeal of the denial of service connection for PTSD. The Veteran had not filed a notice of disagreement as to the rating of PTSD so that the provisions of 38 C.F.R. § 20.204 could apply. See 38 C.F.R. § 20.204(c)(noting that a withdrawal will be deemed a withdrawal of the Notice of Disagreement and, if filed, the Substantive Appeal, as to all issues to which the withdrawal applies). As no NOD had been filed, there was nothing with regard to the increase of the PTSD for him to withdraw. Furthermore, the provisions for withdrawal specifically indicate it does not preclude filing a new Notice of Disagreement and, after a Statement of the Case is issues, a new Substantive Appeal, as to any issue withdrawn, provided such filings would be timely under these rules if the appeal withdrawn had never been filed. Id. It follows therefore that a withdrawal of a claim would not preclude the application of 38 C.F.R. § 3.156(b). Accordingly, in this case, as there was no NOD as to the rating to withdraw, and new evidence pertinent to the rating was submitted within one year, 38 C.F.R. § 3.156(b) again applies and the January 2010 rating decision did not become final. The claim was reconsidered in September 2010 and the RO continued the 50 percent evaluation. The Veteran timely appealed and perfected his appeal. Before the claim was transferred to the Board, however, a February 2014 rating decision granted a 100% rating for the PTSD effective May 25, 2010 and informed the Veteran that this constituted a full grant of his appeal. The Veteran replied in a March 2014 statement that he wanted an earlier effective date but also specified the statement was “not a NOD.” An October 2014 rating decision denied an earlier effective date and the Veteran timely appealed. In the present case, as outlined above, the RO incorrectly indicated the February 2014 rating decision granting a 100 percent only from May 25, 2010, was a full grant of the appeal. As outlined above, the claim had been continuously ongoing under 38 C.F.R. § 3.156(b) since the RO initially granted service connection in the August 2009 rating decision. Significantly, in this case, the Veteran has not appealed the February 17, 2004 effective date for the grant of service connection. Additionally, after receipt of an August 2011 Statement of the Case, the Veteran timely perfected his appeal of the initial 50 percent rating by submitting a Substantive Appeal in October 2011. Although the February 2014 rating decision mistakenly characterized the grant of 100 percent, effective May 25, 2010 to be a “full grant” of the appeal, the Board notes that the rating did not constitute a full grant of the issue for the period prior to May 25, 2010. Accordingly, the Board has recharacterized the issue to entitlement to an increased initial rating in excess of 50 percent for the period prior to May 25, 2010. Disability evaluations are determined by the application of VA’s Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civil occupations. 38 U.S.C. § 1155 ; 38 C.F.R. §§ 3.321 (a), 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 required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. 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. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Nevertheless, where the evidence contains factual findings that show a change in the severity of symptoms during the course of the rating period on appeal, assignment of staged ratings would be permissible. See Fenderson v. West, 12 Vet. App. 119 (1999). The rating criteria for rating mental disorders reads as follows: a 100 percent rating requires total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions of hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation or own name. 38 C.F.R. § 4.130. A 70 percent rating requires 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. Id. A 50 percent rating requires 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 effective work and social relationships. Id. Evaluation under § 4.130 is symptom-driven, meaning that symptomatology should be the fact-finder’s primary focus when deciding entitlement to a given disability rating under that regulation. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). The Federal Circuit explained that the frequency, severity, and duration of the symptoms also played an important role in determining the rating. Id. at 117. Significantly, however, the symptoms listed under the rating criteria are meant to be examples of symptoms that would warrant the rating, but are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002). If the evidence shows that the Veteran suffers symptoms listed in the rating criteria or symptoms of similar severity, frequency, and duration, that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the criteria for a particular rating, the appropriate equivalent rating will be assigned. Id. at 443; see also Vazquez-Claudio, 713 F.3d at 117. The Veteran’s initial claim reported having stress and being seen in mental health. A May 2003 letter from a P.S., M.D. indicated that the Veteran was seen for epigastic pain, nausea and vomiting that defied extensive workup. The physician concluded he suspected the Veteran had an anxiety disorder, which is currently well-controlled. A January 2004 statement from his spouse described a period during the prior year when he spent months in a dark room, lost weight, was anxious over the thought of leaving the house. She described him having bad dreams and jumping out of bed before he started medication and described a very negative attitude and him not wanting to be around anyone. VA treatment records in 2004 reflect the predominant symptoms were anxiety and anger. A January 2004 record reflects the Veteran was casually dressed. He described stuff setting him off easily, anxiety, and panic episodes several months back. He had poor eye contact. Speech was normal. He had an anxious demeanor and mood. There was no evidence of a thought disorder, and he had normal intellect with okay concentration and memory. No insight. He had infrequent disturbing dreams. Weight gain was noted. There was no suicidal homicidal ideation. He reported intrusive thoughts, isolation, hypervigilance, and weekly memories but no real history of disturbing thoughts or nightmares. In May 2004 he reported his anxiety was very much better but indicated he still had issues with anger. Another February 2005 statement of the Veteran’s spouse described times when the Veteran tried to run over people, started an argument at his son’s graduation, had trouble sleeping and memory loss. She again described the period when he spent 7 months in his room and reported panic attacks and anxiety. An April 2005 Vet Center mental status examination described the Veteran as neat, friendly, and of average intelligence. He had appropriate speech and was oriented in all spheres. He had normal memory, appropriate affect, and relaxed motor activity. There was no evidence of thought disorder such as delusions, disorganized thinking or hallucinations. There was sleep disturbance and low energy. No suicidal or homicidal thoughts were noted. Other symptoms included nightmares, low stress level tolerance and inability to tolerate being around Vietnamese people. Other Vet Center notes reflect trouble sleeping, depression, low energy, fatigue, nightmares. A February 2005 note described a blunted affect and at times difficulty recalling details. A February 2006 note indicated the Veteran was neat and clean and gaining insight. While recall of traumatic events was increasing he was better able to express and manage painful memories. During a January 2008 VA treatment visit the Veteran described intrusive memories. In March 2008 the Veteran reported that talking about his stressors at the VA examination made him worse for 2-3 weeks and medication did not help his dreams or anxiety. He described good and bad days. He was casually dressed and groomed, speech and movements were calm. He was slightly depressed and affect was constricted. No perceptual abnormalities were noted and thinking was linear with no suicidal or homicidal ideation. Orientation and memory were grossly intact. A March 2008 VA examination reflects the Veteran reported being upset upon seeing Vietnamese people. He reported being married 3 times and indicated that he stayed in touch with his second wife’s children. He indicated he had been married to his current wife for 23 years. He reported working on and off over the years and indicated he was most recently laid off as he had gotten into a conflictual relationship with a co-worker. He indicated one supervisor took him off all mill machines and threatened to fire him for harassing other employees. He described playing horseshoes, fishing and hunting. Mental status examination reflects the Veteran was oriented in all spheres, had a dysthymic mood and slightly anxious affect. Content of thoughts was clear; however, he was extremely tangential and vague and was a poor historian. There was no indication of psychotic thought processes to include delusions, hallucinations or any overt signs of generalized paranoia. Hee reported checking the doors and stove when he left his home and described generalized anxiety attacks. A mini-mental status examination was indicative of mild to moderate impairment and some problems with concentration. He described often being depressed and not wanting to go out and indicated sleep was poor. He described often “hearing someone through the wires” at night when he was unable to return to sleep. He indicated he was not currently suicidal but explained prior to medication he often had passive thoughts of suicide. He was often irritable and expressed anger at anti-war protestors and indicated he could be very mean and “snap at people.” A May 2008 assessment from Lone Mountain described depressed mood, anxiety and panic attacks, difficulty with concentration, energy and motivation. He had some difficulty with obsessive thinking and transient suicidal ideation but no plan. He had sleep disturbance, including insomnia, thrashing, and even struck his wife in his sleep. He had nightmares and night sweats and an elevated startle response. He had difficulty with episodes of anger and irritability. He isolated from others and had few friends. He had difficulty coping with coworkers and supervisors and says distress impacted his intimate relationship as well. He described staring off into space and losing track of time and some disorientation. Mental status examination reflected he was casually dressed with appropriate hygiene. Affect was subdued and flat. Speech was clear and coherent and he was oriented in all spheres. Associations were logical and orderly and no evidence of thought disorder or delusions. No hallucinations were noted. Insight and judgment were intact and mood was depressed. There was transient suicidal ideation but no plan. Memory was within normal limits. The physician indicated the distress significantly impacted work, social and intimate relationships. An October 2008 VA treatment record reflects report of nightmares and increasing anxiety; however, he also indicated he recently went fishing. Speech was calm and he was alert and casually dressed. Mood was subdued and affect constricted. No perceptual abnormalities and no suicidal or homicidal thinking were noted. In December 2008 he reported he was fed up and doesn’t want to do anything. He was tired but casually dressed and groomed. He was depressed and a little irritable with constricted affect. No perceptual abnormalities were noted. Thinking was linear and no suicidal or homicidal ideation was noted. Orientation and memory were grossly intact. A March 2009 record reflects he reported mood having ups and downs and that he “doesn’t want to get out of bed a lot of the time.” He also indicated he felt he has “nothing going for him.” He attended the Vet Center and felt it helped him and also reported medications must be helping as when he missed it he got mean. He was casually dressed and groomed and speech and movement were normal. Demeanor was cooperative and engaging. Mood was superficially euthymic, and affect was fairly wide. There was no suicidal or homicidal ideation. There were no psychotic symptoms and cognitive function was grossly intact. Judgment and insight were good. A June 2009 record reflects the Veteran just needed to come in. He was casually dressed and groomed and speech and movement were normal. Demeanor was cooperative and engaging. Mood was superficially euthymic, and affect was fairly wide. There was no suicidal or homicidal ideation. There were no psychotic symptoms and cognitive function was grossly intact. Judgment and insight were good. In November 2009 he reported a lot of problems and indicated he had been depressed and angry during past month. He reported that he chased all his friends off and was angry and argumentative. He also indicated he quit group treatment after a verbal altercation with another member. In January 2010 he described himself as easily upset and irritable. Records in February 2010 described his mood and motivation as still down and some short-term memory impairment was noted. A May 2010 record reflects he reported he was more anxious after reducing the dosage of the Celexa. He was edgy all the time, flies off the handle at anything and was disturbing to his wife. He was night sleeping well and having nightmares. He continued to deny suicidal and homicidal ideation. He was noted to have poor insight and have a little difficulty processing the discussion of medication risks. Significantly a June 2010 VA examination noted his anger had increased in the last few years impacted personal relationships as he no longer has close friendships. He reported if working he would have had a hard time with authority figures based on increased anger and the examiner concluded the increased anger and irritability has resulted in impairment in social functioning which would have been a problem if he were working. The Veteran also sent in several lay statements in July 2010. J.M. described grave concern over his actions especially negative mood swings, over reactions and angry disposition. H.B. described an incident during a fishing trip where the Veteran yelled at him and the others on the trip to the point Mr. B. left the trip early. The Veteran’s spouse described the Veteran going into a rage quite often for no reason and developed problems with his bosses and authority. She described running off their friends with his angry attitude and indicated he was upset if he saw Vietnamese people. For the period from February 17, 2004 until March 19, 2008, an evaluation in excess of 50 percent is not warranted. The Veteran has reported a number of PTSD symptoms, primarily anxiety and anger. However, the Board finds that the nature and severity of those symptoms and their occupational and social effect on the Veteran do not cause his PTSD to more closely meet the criteria for a 70 percent rating. While the records reflect symptoms and treatment, the records also reflect he reported that the condition was improving at times and he was able to effectively use coping strategies. During this period despite his reported PTSD symptoms, the Veteran has regularly been found to have significant functioning. He has always been appropriately groomed at VA examinations and medical appointments, he has been noted to have normal speech, with fair insight and generally organized thought processes, and no gross memory impairment or attentional defects. The Board acknowledges all the symptoms reported by the Veteran. However, the Board finds that the Veteran’s condition overall reflects that the nature and severity of the Veteran’s PTSD symptoms causes at most occupational and social impairment with reduced reliability and productivity. While the Veteran has symptoms that clearly interfere with his social and occupational functioning, he has been able to perform activities of daily living; perform some work, and maintain relationships with some family members. His overall functioning is greater than that contemplated by a 70 percent rating, and the nature and severity of his symptoms are adequately considered by his currently assigned 50 percent rating. Based on the forgoing, the Board finds that a preponderance of the evidence is against a rating in excess of 50 percent for this period. Beginning March 2008, however, the criteria for a 70 percent evaluation has been approximated. Significantly, the March 2008 VA examination noted the presence of tangential, vague thoughts and the Veteran described hearing someone over the wires. He also reported prior passive suicidal ideation. Bankhead v. Shulkin, 29 Vet. App. 10 (2017). The May 2008 private record further elaborates on these symptoms and this report also supports the higher rating by noting transient suicidal ideation and disorientation at times. Treatment records beginning around this time also reflect increased symptoms. These records reflect periods of anger and irritability, feeling nothing is going for him and even reflect he quit group treatment in 2009 after an altercation. Thus, resolving all doubt in the Veteran’s favor an increased 70 percent evaluation for this period is warranted. During this period however, there is no evidence of total social or occupational impairment that more nearly approximates a 100 percent disability rating, including due to symptoms such as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name, based on review of treatment records, VA and private examination reports, or the Veteran’s lay statements. Objective examinations demonstrated he had appropriate dress and grooming. While he had some suicidal ideation and anger, including some physical confrontations, he was never deemed to present a danger to himself or others. Likewise while he heard things through the wires, these hallucinations were not described or assessed as persistent. There is no question the Veteran has severe symptoms; however, these symptoms have never been shown to be so frequent or disabling that the rise to the level of total occupational or social impairment, which is a level of severity so disabling that some of the examples of symptoms include not knowing one’s own name or posing a persistent threat of danger to self or others. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002) (finding that symptoms contained in rating schedule criteria 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.”). The records reflect that the Veteran retained some social functioning as he was still married and was able to engage in some activities with friends such as fishing. Thus, in consideration of the evidence above, the Board finds that, for the entire rating period, the weight of the evidence is against finding that the service-connected PTSD resulted in total occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. Because the preponderance of the evidence is against the appeal for a higher disability rating in excess of 70 percent for PTSD, the benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 4.3, 4.7. TDIU 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) (2014). 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). A TDIU may be assigned when the disabled veteran is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. If there is only one such disability, it must be rated at 60 percent or more; if there are two or more disabilities, at least one disability must be rated at 40 percent or more, with sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16 (a). Even when the percentage requirements are not met, entitlement to a total rating, on an extraschedular basis, may nonetheless be granted, in exceptional cases, when the veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities. 38 C.F.R. §§ 3.321 (b), 4.16(b). Individual unemployability must be determined without regard to any non-service-connected disabilities or a veteran’s advancing age. 38 C.F.R. §§ 3.341 (a), 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). The sole fact that a veteran is unemployed or has difficulty obtaining employment is not enough. A high rating in itself is recognition that the impairment makes it difficult to obtain or keep employment, but the ultimate question is whether a veteran is capable of performing the physical and mental acts required by employment, not whether a veteran can find employment. Id. at 361. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in a veteran’s favor. 38 C.F.R. § 4.3. In Faust v. West, 13 Vet. App. 342 (2000), the Court defined “substantially gainful employment” as an occupation that provides an annual income that exceeds the poverty threshold for one person, irrespective of the number of hours or days that a veteran actually works and without regard to a veteran’s earned annual income. In Hatlestad v. Derwinski, 5 Vet. App. 524, 529 (1993), the Court held that the central inquiry in determining whether a veteran is entitled to TDIU is whether a veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability. The determination as to whether a total disability is appropriate should not be based solely upon demonstrated difficulty in obtaining employment in one particular field, which could also potentially be due to external bases such as economic factors, but rather to all reasonably available sources of employment under the circumstances. See Ferraro v. Derwinski, 1 Vet. App. 326, 331-332 (1991). In evaluating a veteran’s employability, consideration may be given to the level of education, special training, and previous work experience in arriving at a conclusion, but not to age or impairment caused by non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. The Veteran’s sole service-connected disability is PTSD. As discussed above, beginning March 20, 2008, the criteria for a 70 percent disability have been met and the Veteran meets the criteria of 38 C.F.R. § 4.16. Therefore, application of a TDIU is appropriate so long as the severity of the Veteran’s service-connected disabilities warrant such a rating. See 38 C.F.R. §§ 3.340, 3.341, 4.16(a). The evidence reflects the Veteran graduated from high school and worked in various positions in mills and canneries and as a watchman. The record reflects the Veteran last worked in January 2008. The March 2008 VA examination described his education and employment history. Significantly it noted that he had experienced several layoffs, the most recent in January 2008. He reported that he felt he was targeted for the layoff because of a conflict with a co-worker and also stated that his supervisor at one point had taken him off all mill machines and threatened to fire him for harassing other employees. He did indicate that he would like to return to his mill job. A May 2008 private assessment indicated the Veteran had previously been employed as a mill worker but had been out of work since January 2008. The private counselor noted the Veteran described difficulty coping with coworkers and supervisors due to his distress. The private counselor concluded that his distress has significantly impacted work, social and intimate relationships. A September 2010 VA examination described the Veteran as having moderate PTSD symptoms. Significantly, the examiner noted the Veteran’s anger due to PTSD has impacted relationships in social and occupational functioning. During this examination he reported he last worked 2 to 5 years ago and was fired due to his foot and wrist problems. The examiner also reported that the Veteran explained his group counselor had once told him that he had problems with employment in November and December because he was having difficulties in those months when he was in Vietnam. The examiner concluded that if the Veteran was working he would have a hard time with authority figures based on his increased anger over the last few years. A May 2013 VA examiner concluded that the Veteran struggled in terms of social and emotional issues and had numerous physical problems which he describes as debilitating which also had a negative impact on his mental health. His report regarding why he lost his job were somewhat vague. The Examiner explained it is possible that his interpersonal problems at the time were due to PTSD including difficulty tolerating individual differences, which led to his being let go. However, he also reports he would not be able to work a similar job at this time largely due to physical limitations including difficulty walking and standing. In sum, the Veteran appears to have long-standing PTSD symptoms for many years. He was able to work despite the PTSD symptoms for many years. Around the time he lost his job, he reported significant deterioration in his health and gives the impression the primary reason he cannot work is due to physical limitations which he believes are due to diabetic neuropathy. The physical limitation are very upsetting and clearly increase the anger and angry reactions to others. This would certainly get in the way of maintaining relationships needed in most jobs. Because of his anger about his physical problems, combined with significant PTSD symptoms he would have great difficultly maintaining appropriate relationships needed in a work setting. Because the veteran is not able to do the physical work he did previously, the PTSD symptoms would prevent him from having any other type of work that would involve social contact and communication. He reports frequent fights, loss of friendship and misperceiving others as personally threatening ot him. He has limited insight into his interpersonal style and limited interest and resources to address it. Thus, it appears the interpersonal difficulties are equally significant as the physical limitation in preventing him from working. Thus the PTSD symptoms do prevent him from securing and maintaining substantially gainful employment. (Continued on the next page)   A January 2013 letter from L.B., LCSW focused on the symptoms exhibited over the past year and noted significant anger management problems and an overall decline in emotional and physical functioning. She indicated the last time he worked was in 2007. She opined that PTSD Symptoms would prevent him from interacting in a positive social manner with coworkers, difficulty concentrating an memory problems would prevent successful completion of certain tasks without mistakes and physiological reactivity would cause significant physical and psychological distress related to sudden environmental changes related to fast paced stressful environments. Overall she opined the PTSD will prevent him from obtaining and maintaining substantially gainful employment. The Board finds that the evidence is at least in relative equipoise on the question of whether the Veteran is unable to work as a result of his PTSD during this period. While the Veteran has other non-service-connected disabilities that clearly impacted the Veteran’s ability to work the evidence also suggests the PTSD also rendered the Veteran unemployable. While he has a high school education and at least some ability to perform sedentary employment, he does not have any work experience in that field and VA examiners further noted he would have difficulty interacting with others and difficulty taking instructions from supervisors. In fact, the record clearly reflects his prior work at the mill was impacted negatively by his symptoms and reflected a long history of trouble interacting with coworkers. In light of the past work experience and education, the Board finds that the Veteran’s PTSD renders him unemployable for the period from March 20, 2008. Beaty v. Brown, 6 Vet. App. 532, 538 (1994). H. SEESEL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Boal, Associate Counsel