Citation Nr: 18153825 Decision Date: 11/29/18 Archive Date: 11/28/18 DOCKET NO. 16-42 396 DATE: November 29, 2018 ORDER 1. Entitlement to an effective date earlier than February 10, 2010, for the grant of service connection for posttraumatic stress disorder (PTSD) is denied. 2. Entitlement to an initial disability rating of 70 percent for PTSD, but no higher, prior to June 8, 2015, is granted, subject to laws and regulations. 3. Entitlement to a total disability rating based on individual unemployability (TDIU) prior to June 8, 2015, is granted, subject to laws and regulations. FINDINGS OF FACT 1. The Veteran has not submitted sufficient evidence to rebut the presumption of regularity as to the mailing of the August 2009 Statement of the Case concerning the April 2007 rating decision that denied service connection for PTSD; the Veteran did not appeal that decision and it became final. 2. On February 10, 2010, the Veteran filed a claim to reopen his previously denied claim of entitlement to service connection for PTSD. 3. No communication received prior to February 10, 2010, can be reasonably construed as a claim to reopen the previously denied claim of entitlement to service connection for PTSD. 4. From February 10, 2010, through June 8, 2015, the Veteran’s PTSD manifested in occupational and social impairment with deficiencies in areas such as work, family relations, judgment, thinking and mood due to symptoms such as suicidal ideations, depression, suspiciousness, mistrust of authorities, difficulty in adapting to stressful circumstances and inability to establish and maintain effective relationships. 5. The evidence has shown that prior to June 8, 2015, the Veteran was unable to secure and follow substantially gainful employment due to his service-connected PTSD. CONCLUSIONS OF LAW 1. The criteria for an effective date earlier than February 10, 2010, for the grant of service connection for PTSD have not been met. 38 U.S.C. §§ 5110 (2012); 38 C.F.R. §§ 3.400 (2017). 2. The criteria for entitlement to an initial disability rating of 70 percent for PTSD prior to June 8, 2015, have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.156 (b), 4.3, 4.7, 4.126, 4.129, 4.130, Part 4, Diagnostic Code 9411 (2017). 3. The criteria for entitlement to TDIU prior to June 8, 2015, have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16, 4.18, 4.19, 4.25, 4.26 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from February 1963 until October 1964. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from March 2014 and October 2014 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). In an August 2016 rating decision, the RO assigned a 100 percent disability rating for the Veteran’s service connected PTSD, effective June 8, 2015. As the August 2016 rating decision did not represent a total grant of benefits sought on appeal prior to June 8, 2015, the claim for increase prior to June 8, 2015, remains before the Board. See AB v. Brown, 6 Vet. App. 35 (1993). 1. Entitlement to an effective date earlier than February 10, 2010, for entitlement to service connection for PTSD. The Veteran contends that he is entitled to an earlier effective date for his PTSD. Specifically, the Veteran contends that he did not receive the Statement of the Case (SOC) that was mailed to the Veteran by the RO in August 2009. Generally, except as otherwise provided, the effective date of an award of compensation based on an original claim or a claim reopened after final disallowance, will be the date of receipt of the claim, or the date entitlement arose, whichever is later. 38 U.S.C. § 5110 (2012); 38 C.F.R. § 3.400 (2017). For service connection, the effective date will be the day following separation from active service or date entitlement arose if the claim is received within one year after separation from service. 38 C.F.R. § 3.400 (b)(2). The Board notes that VA has amended the regulations pertaining to filing claims on standard VA forms. However, these amendments do not apply to the Veteran’s case given the timing of the claim. In regards to the claim, the record indicates that the Veteran was denied service connection for PTSD in an April 2007 rating decision; the RO sent a VA letter to the Veteran in June 2007 notifying the Veteran that he had appealed; and in August 2009, the RO mailed a Statement of the Case to the Veteran and the Veteran’s representative. The Veteran did not file an appeal within 60 days from the date of the Statement of the Case. Therefore, the decision became final 60 days after the SOC was mailed to the Veteran. The Veteran, however, claims he never received the SOC because the RO mailed the SOC to an incorrect mailing address, and therefore, could not appeal the decision. The U.S. Supreme Court has held that there is a presumption of regularity under which it is presumed that government officials “have properly discharged their official duties.” See United States v. Chemical Foundation, Inc., 272 U. S. 1, 14-15, 47 S. Ct. 1 (1926). In Ashley v. Derwinski, 2 Vet. App. 307, 309 (1992), the U.S. Court of Appeal for Veterans Claims (CAVC) found that the presumption of regularity applied to VA. The Court found that there is a presumption of regularity under which it is presumed that government officials have properly discharged their official duties. The presumption is not absolute; it may be rebutted by the submission of clear evidence to the contrary. Once clear evidence is submitted, VA is no longer entitled to the benefit of the presumption and the burden shifts to VA to establish that a government official properly discharged his or her official duties. Applying the presumption of regularity to the RO, there is no evidence indicating that the RO mailed the August 2009 SOC to an incorrect mailing address, and there is no evidence in the claims file that the Veteran informed the RO of his new mailing address. Moreover, the Board observes that no VA correspondence was returned as undeliverable during the time of the mailing of the August 2009 SOC. The Board notes that in March 2010, the Veteran submitted a letter from his PTSD clinic coordinator restating the Veteran’s contention that paperwork was mailed to the wrong address and the Board also notes the Veteran’s contention that VA had the alleged correct address as of September 4, 2009. There is no evidence, however, that the August 2009 Statement of the Case or any other VA letters sent to the Veteran around that time was returned as undeliverable or that the Veteran had informed the RO of the correct mailing address. In fact, the evidence clearly shows that in August 2009, the RO mailed the Statement of the Case to the Veteran’s last known address, which was written in the May 2007 Statement in Support of Claim. The record does not reflect evidence of documented contact from the Veteran regarding a change of address prior to the mailing of the August 2009 Statement of the Case. Furthermore, there is no evidence in the record that the Statement of the Case was returned to VA as undeliverable. Moreover, the Statement of the Case was also mailed to the Veteran’s representative at that time. Absent clear evidence that the Veteran notified VA of a change of address and absent clear evidence that any notice sent to the claimant at his last known address has been returned as undeliverable, VA is entitled to rely on that address. See Cross v. Brown, 9 Vet. App. 18, 19 (1996). The law provides that a veteran’s statement of non-receipt, standing alone, is not the type of “clear evidence to the contrary” which is sufficient to rebut the presumption of regularity of the notice. Mindenhall v. Brown, 7 Vet. App. 271, 274 (1994). Based on the foregoing, the Board finds the August 2009 Statement of the Case, which confirmed the April 2007 rating decision denying service connection for PTSD, and the June 2007 notification letter were sent to the last known address on file and that decision is final. 38 U.S.C. § 7105 (c); 38 C.F.R. § 20.1103. Consequently, for these reasons and the reasons earlier stated, February 10, 2010, is the correct and only available effective date for the grant of service connection for PTSD. The Veteran filed a claim to reopen the issue of entitlement to service connection for PTSD on February 10, 2010. The Board finds that no correspondence or communication received prior to February 10, 2010, can be reasonably construed as intent to file a formal or informal claim for diabetes. Therefore, the Board must find that the appropriate date of claim is February 10, 2010. In sum, the presently assigned effective date of February 10, 2010, is appropriate and there is no basis for an award of service connection for PTSD prior to that date as finality has attached to the April 2007 rating decision. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). 2. Entitlement to an initial rating in excess of 50 percent for posttraumatic stress disorder prior to June 8, 2015. I. Increased Rating Principles Disability evaluations are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent, as far as can practicably be determined, the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Pertinent regulations also provide that it is not necessary for all of the individual criteria to be present as set forth in the Rating Schedule, but that findings sufficient to identify the disability and level of impairment be considered. 38 C.F.R. § 4.21. If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. PTSD is evaluated under 38 C.F.R. § 4.130, Diagnostic Code 9411. Under the General Rating Formula For Mental Disorders, to include PTSD, 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. A 70 percent evaluation is warranted where there is 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; intermittently illogical, obscure, or irrelevant speech; 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); and inability to establish and maintain effective relationships. A 100 percent evaluation is assignable where 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); and disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. Consideration is given to the frequency, severity, and duration of psychiatric symptoms, the length of remission, and the Veteran’s capacity for adjustment during periods of remission. An evaluation shall be assigned based on all the evidence of record that bears on occupational and social impairment, rather than solely on the examiner’s assessment of the level of disability at the moment of the examination. See 38 C.F.R. § 4.126. Furthermore, when evaluating the level of disability arising from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation solely on the basis of social impairment. Id. It is necessary to evaluate a disability from the point of view of the Veteran working or seeking work. 38 C.F.R. § 4.2. The symptoms associated with the psychiatric rating criteria are not intended to constitute exhaustive lists, but rather 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, 443 (2002). Thus, the Board will consider whether “the evidence demonstrates that a claimant suffers symptoms or effects that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the diagnostic code,” and, if so, the “equivalent rating will be assigned.” Id. The Federal Circuit held previously that a Veteran may only qualify for a given disability rating “by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration.” Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013) (“Reading [38 C.F.R. §§ 4.126 and 4.130] together, it is evident that the ‘frequency, severity, and duration’ of a Veteran’s symptoms must play an important role in determining his disability level.”). II. Entitlement to an initial rating in excess of 50 percent for PTSD prior to June 8, 2015. The Veteran was initially service connected for PTSD in October 2014, at 50 percent, effective February 10, 2010, the date of his application to reopen the claim. In an August 2016 rating decision, following an admission to the PTSD Residential Program from June 8, 2015 to July 24, 2015, the RO increased the disability rating for his PTSD to 100 percent, effective June 8, 2015. The Veteran contends that he should have a higher rating for his service connected PTSD prior to June 8, 2015. Treatment notes from January 2010 until August 2016 reflect that the Veteran attested to suicidal ideation multiple times but also denied suicidal thoughts at other times. For example, in December 2011, the Veteran admitted himself to the VA hospital because he was having suicidal thoughts and was afraid that he would execute them. In August 2012, he admitted himself to the VA hospital because he had suicidal thoughts and was afraid that he would execute them; he stated that he was depressed and hearing voices. In September 2012, he stated that he was getting along with others and in August 2013 and October 2014, he stated that he had no suicidal thoughts. However, a week later, he stated that he had increased suicidal thoughts. In April 2015, the Veteran stated that he desired to go to a VA PTSD Residential Program. On June 8, 2015, he was admitted to the PTSD Residential Program. During that time, he manifested the following symptoms: anxiety, depression, difficulty concentrating, and fear that something awful may happen. With respect to other symptoms of PTSD, in March 2012, a VA psychologist noted that the Veteran’s symptoms constitute a daily experience of intrusive recollections, hyperarousal and hypervigilance, emotional numbing and social avoidance; that the Veteran experiences severe occupational and social disability as well. In a December 2013 VA examination, the Veteran reported that he has an on and off relationship with his wife of many years, he retired from work in 1993 due to depression and was diagnosed with substance abuse until two years ago. Symptoms included depressed mood, suspiciousness, chronic sleep impairment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships and inability to establish and maintain effective relationships. The VA examiner observed that the Veteran was neatly attired and groomed and that there was no indication of loose association. The examiner opined that the Veteran exhibited occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress. In a June 2014 VA medical treatment record, the psychologist noted that the Veteran’s symptoms were of such frequency and severity that they cause a substantial dysfunction in the areas of concentration, attention, sleep deprivation, social isolation, mistrust of authority figures, mistrust of co-workers and general emotional instability. He concluded that the intensity of his PTSD symptoms renders him unable to secure or sustain gainful employment. In an October 2014 VA examination, the Veteran reported that he had one friend and no hobbies and that he had an on and off relationship with his second wife of 14 years. He also reported that he had been attending group therapy every week, takes Prozac for depression and Trazodone for sleep. Symptoms included depressed mood, anxiety and chronic sleep impairment. The examiner opined that the Veteran exhibited occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. He observed that the Veteran had depressed affect, slow responses but no psychotic or paranoid thinking or suicidal or homicidal ideations. He concluded that the Veteran would be able to secure and maintain substantial employment in performing sedentary type of work only. Taking all factors into consideration with application of the approximating principles of 38 C.F.R. § 4.7, and the benefit-of-the-doubt doctrine, the Board finds that for the period prior to June 8, 2015, the Veteran’s PTSD most nearly approximated occupational and social impairment with deficiencies in areas such as work, family relations, judgment, thinking or mood. In other words, in considering the competent and probative evidence of record and the frequency, duration, and severity of the Veteran’s PTSD symptoms, the Board finds that his symptoms more nearly approximate the degree of occupational and social impairment contemplated by a 70 percent schedular rating prior to June 8, 2105. For instance, medical reports reflect that the Veteran harbored suicidal thoughts and ideations on multiple occasions and admitted himself into the hospital on two occasions. VA psychologist also observed that the Veteran exhibited severe occupational and social impairment due to symptoms such as substantial dysfunction in the areas of concentration, attention, sleep deprivation, social isolation, mistrust of authority figures, mistrust of co-workers and general emotional instability and opined that he would be unable to secure or maintain substantial employment. The Veteran reported that he only had one friend and had not been substantially employed since 1993, and he left employment due to depression. In the VA examination reports, the VA examiners noted that the Veteran exhibited symptoms such as depressed mood, chronic sleep impairment, difficulty in establishing and maintaining effective work and social relationships and inability to establish and maintain effective relationships. Collectively, the Board finds that these symptoms are of the type, extent, severity and/or frequency to result in occupational and social impairment with deficiencies in most areas such as work, family relations, judgment, thinking and mood. The Board, however, notes that the Veteran did not exhibit all of the symptoms for a 70 percent rating. For instance, the evidence of record did not demonstrate speech intermittently illogical, obscure or irrelevant, spatial disorientation or neglect of personal appearance and hygiene. However, the record does demonstrate the enumerated 70 percent symptoms such as suicidal ideations; difficulty in adapting to stressful circumstances (including work and worklike setting); and difficulty in establishing and maintaining effective work and social relationships. Therefore, the Board finds that the functional impairment due to the above symptomatology more nearly approximates the criteria for a 70 percent rating prior to June 8, 2015. See Mauerhan v. Principi, 16 Vet. App. 436 (2002) (symptoms recited in the rating schedule for mental disorders are to serve as examples of the type and degree of the symptoms and not an exhaustive list). In this case, the maximum schedular rating of 100 percent is not warranted because evidence did not reflect a total occupational and social impairment due to such symptoms as gross impairment in thought processes or communication; persistent delusions; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent 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. In this regard, there is no documentation of symptoms such as gross impairment in thought processes or communication or persistent delusions or hallucinations; in fact, the Veteran has been consistently able to actively communicate both in individual and group therapy and during VA examinations. His speech was within normal limits during VA examinations, and there is no evidence of thought disorders or impaired thought processes. Similarly, his symptoms have not been manifested by grossly inappropriate behavior or persistent danger of hurting himself or others. For instance, within the appeal period prior to June 8, 2015, the Veteran denied suicidal thoughts on several occasions. Nor does the record show symptoms such as intermittent inability to perform daily living activities (including maintenance of minimal personal hygiene), disorientation to time or place, or memory loss of names of close relatives own occupation, or own name. In this regard, the evidence of record shows that the Veteran was well groomed and did not show any loose associations. Furthermore, the Veteran was able to remember the names of his spouse and child, and was able to report his work history to the VA physicians. Furthermore, as stated by the Veteran, the Veteran maintained social relationships with a friend and his wife. VA treatment records also show improved symptoms prior to June 8, 2015. For example, in 2013, VA examiner noted the Veteran’s PTSD symptoms appeared mild or transient and his PTSD symptoms would decrease work efficiency and ability to perform occupational tasks only during periods of significant stress. In several VA treatment records dated in 2012 and 2014, the Veteran denied suicidal ideations and the VA examiner in 2014 observed that the Veteran exhibited normal routine behavior, self-care and conversation. Also, in January 2015, the Veteran reported he was doing well and that did not have any suicidal thoughts. While some evidence may warrant a lower rating than 70 percent, giving the Veteran the benefit of the doubt based on other reported PSTD symptoms in frequency and severity, the Board finds that a 70 percent rating for PTSD is warranted prior to June 8, 2015. However, based on the foregoing evidence, the Board finds that a 100 percent disability rating of a total occupational and social impairment has not been shown. The Board emphasizes that, in analyzing this claim, the symptoms identified in the Rating Formula have been considered not as an exhaustive list of symptoms, but as examples of the type and degree of the symptoms, or effects, that would justify a particular rating. The Board has not required the presence of a specified quantity of symptoms in the rating schedule to warrant a higher rating. See Mauerhan, supra. The Board has considered a staged rating, but finds that the totality of the evidence shows a rating of 100 percent is not warranted at any point prior to June 8, 2015. In reaching these conclusions, the Board has considered the applicability of the benefit-of-the-doubt doctrine to the extent noted. See 38 U.S.C. § 5107 (b); 38 C.F.R. §3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to TDIU It is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. See 38 C.F.R. § 4.16. A finding of total disability is appropriate “when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation.” See 38 C.F.R. §§ 3.340 (a)(1), 4.15. TDIU may be assigned where the schedular rating is less than total and it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of either (1) a single service-connected disability ratable at 60 percent or more, or (2) two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). If a sufficient rating is present, then it must be at least as likely as not that the Veteran is unable to secure or follow a substantially gainful occupation as a result of that disease. See 38 C.F.R. § 4.16 (a). 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). The issue is not whether the Veteran can find employment generally, but whether the Veteran is capable of performing the physical and mental acts required by employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Consideration may be given to the Veteran’s education, special training, and previous work experience, but not to his age or to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19; see also Van Hoose, 4 Vet. App. at 363. The Veteran filed a formal TDIU claim in June 2014; however, in consideration of Rice v. Shinseki, the Board will consider the issue of entitlement to TDIU with the issue of entitlement to PTSD, which was filed on February 10. 2010. See Rice at 22 Vet. App. 447 (2009) (the Court has held that entitlement to a TDIU is an element of all appeals for a higher rating). The Veteran has been assigned a 70 percent disability rating for his service connected PTSD prior to June 8, 2015. He has no other service connected disabilities. Therefore, the Veteran meets the criteria for a schedular TDIU and the remaining question concerns whether the Veteran was unable to secure or follow a substantially gainful occupation as a result of his service-connected PTSD prior to June 8, 2015. Regarding the Veteran’s employment history, the Veteran obtained a degree in psychology from Chicago State College after attending for seven years. Upon discharge from military service, the Veteran worked in computer related jobs for 15 years, a switchman at Union Pacific for 3 years, at Motorola testing electrical equipment for 5 to 7 years and retired in 1993 due to depression. Thereafter, he attempted to find employment by working as a part-time shuttle driver from November 2013 until February 2014. See December 2013 and October 2014 VA examinations. Records obtained from Social Security Administration, dated in November 1995, show that the Veteran was found to be unemployable. In March 2012, VA psychologist noted that the Veteran’s symptoms included intrusive recollections, hyperarousal and hypervigilance, emotional numbing and social avoidance and observed that the Veteran experiences severe occupational and social disability as well. The psychologist noted that the intensity of the Veteran’s symptoms can become completely overwhelming, and the Veteran has engaged in substance abuse, suicidal behavior and extreme social isolation in order to escape the experience of his symptoms. The psychologist opined that the frequency and intensity of his symptomatic periods are such that he cannot be expected to seek or sustain employment. In a December 2013 VA examination, the VA examiner noted symptoms of depressed mood, suspiciousness, chronic sleep impairment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships and inability to establish and maintain effective relationships. The VA examiner observed that the Veteran exhibited occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks during periods of significant stress. In a June 2014 VA medical treatment record, the psychologist noted that the Veteran’s symptoms were of such frequency and severity that they cause a substantial dysfunction in the areas of concentration, attention, sleep deprivation, social isolation, mistrust of authority figures, mistrust of co-workers and general emotional instability. He concluded that the intensity of his PTSD symptoms renders him unable to secure or sustain gainful employment. The examiner noted that the last time the Veteran tried to be employed, his symptoms caused him to leave the job, and therefore, disability for employment is likely to last indefinitely. In an October 2014 VA examination, the examiner noted symptoms of depressed mood, anxiety and chronic sleep impairment, and opined that the Veteran exhibited occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. He concluded that the Veteran would be able to secure and maintain substantial employment in performing sedentary type of work only. As noted above, the Veteran reported multiple times that he harbored suicidal thoughts and ideations, he was admitted to the hospital on two occasions due to his suicidal thoughts and, in June 2015, the Veteran was admitted to the PTSD Residential Program due to the severity of his symptoms. The Board notes that the question of employability is ultimately one for the fact finder to decide, and not a medical provider. Geib v. Shinseki, 733 F.3d 1350 (Fed. Cir. 2013). In this case, when considering the Veteran’s prior work experience in that he retired in the 1993 due to depression, secured a part-time job for only three months as a driver from 2013-2014; two VA psychologists observed and opined that the Veteran’s PTSD severely limits the Veteran from securing and maintaining substantial employment; the Veteran harbored suicidal tendencies severe enough to be admitted to the hospital on two occasions; manifested symptoms of depression, suspiciousness and was found to be unable to maintain effective relationships; and reported distrust of authorities, mistrust of authority figures, mistrust of co-workers and general emotional instability, the Board finds that the evidence is at least in equipoise as to whether the Veteran’s service-connected PTSD prevents him from performing any type of labor. The Board notes that one VA examiner found the Veteran’s PTSD symptoms to be mild and transient and another VA examiner opined that the Veteran is able to work in sedentary type of employment. However, when all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). After considering the evidence for and against the claim, the Board finds the evidence at least in equipoise as to whether the Veteran’s service-connected PTSD has rendered him unemployable. As such, a reasonable doubt arises as to his employability, which must be resolved in favor of the Veteran. 38 U.S.C. § 5107 ; 38 C.F.R. § 3.102. Therefore, the Board finds that the Veteran has been unable to secure and follow a substantially gainful occupation by reason of his service-connected PTSD prior to June 8, 2015. The claim, therefore, is granted. 38 U.S.C. § 1155 ; 38 C.F.R. §§ 3.340, 3.341, 4.16. Regarding the issue of TDIU effective June 8, 2015, the Board notes that the RO has assigned a 100 percent rating for the Veteran’s PTSD. As the Veteran is service connected for only PTSD and is already at 100 percent effective June 8, 2015, the issue of entitlement to a TDIU is moot and further consideration of a TDIU is not warranted. See Bradley v. Peake, 22 Vet. App. 280 (2008). TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Lee, Associate Counsel