Citation Nr: 18155241 Decision Date: 12/04/18 Archive Date: 12/03/18 DOCKET NO. 13-05 825 DATE: December 4, 2018 ORDER Entitlement to an initial 50 percent disability rating for posttraumatic stress disorder (PTSD) granted. Entitlement to a disability rating in excess of 50 percent for PTSD prior to March 16, 2016 is denied. Entitlement to a disability rating in excess of 70 percent for PTSD, as of March 16, 2016 is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) as due to service-connected disabilities prior to September 26, 2013, and as of October 1, 2016 is denied. FINDINGS OF FACT 1. Prior to March 16, 2016, the Veteran’s PTSD manifested, at worst, in occupational and social impairment with reduced reliability and productivity. 2. As of March 16, 2016, the Veteran’s PTSD manifested, at worst, in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. 3. The probative evidence of record does not establish that the Veteran’s service connected disabilities precluded substantially gainful employment. CONCLUSIONS OF LAW 1. Prior to March 3, 2010, the criteria for an initial 50 percent rating for PTSD were met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.102, 4.1-4.14, 4.130, Diagnostic Code 9411 (2017). 2. Prior to March 16, 2016, the criteria for a rating in excess of 50 percent for PTSD have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.102, 4.1-4.14, 4.130, Diagnostic Code 9411 (2017). 3. As of March 16, 2016, the criteria for a rating in excess of 70 percent for PTSD have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.102, 4.1-4.14, 4.130, Diagnostic Code 9411 (2017). 4. The criteria for a TDIU due to the Veteran’s service-connected disabilities have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1965 to April 1969. This matter was previously before the Board of Veterans’ Appeals (Board) in October 2017. The Board remanded the Veteran’s claim to the agency of original jurisdiction (AOJ) for further development. Specifically, the Board required the AOJ to obtain to attempt to obtain and associate with the record any outstanding records held by the State or local employment offices, and from the Social Security Administration. In April 2018, the RO sent the Veteran a letter asking him to provide information regarding State or local employment agencies and he did not reply. As required by remand directives, the AOJ contacted the Social Security Administration but was informed that no records were available, and the case was returned to the Board. The Veteran was notified of this in September 2018. Accordingly, the Board finds there has been substantial compliance with the remand instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998); see also D’Aries v. Peake, 22 Vet. App. 97, 105 (2008). The Veteran’s appeal includes a claim for a TDIU. From September 26, 2013, to October 1, 2016, the Veteran was assigned a 100 percent disability rating for service-connected throat cancer. The Board notes that in some cases, but not all, the assignment of a total schedular rating renders a TDIU claim moot. See Bradley v. Peake, 22 Vet. App. 280, 294 (2008). The Veteran may receive a total (100 percent) rating based on a combination of his service-connected disabilities, or for a single service-connected disability. Special monthly compensation (SMC) under the provisions of 38 U.S.C. § 1114(s) may be warranted in addition to his regular compensation if the Veteran has a total disability rating for a single disability, and additional service-connected disability or disabilities rated at 60 percent or more. In this case, the assignment of the Veteran’s 100 percent disability rating for throat cancer and the assignment of SMC under the provisions of 38 U.S.C. § 1114(s) during that period renders the TDIU claim moot from September 26, 2013, to October 1, 2016. However, the Veteran’s claim for entitlement to TDIU prior to September 26, 2013, and as of October 1, 2016, remains on appeal. Neither the Veteran nor his attorney have raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Board decisions must be based on the entire record, with consideration of all the evidence. 38 U.S.C. § 7104. The law requires only that the Board address its reasons for rejecting evidence favorable to the veteran. Timberlake v. Gober, 14 Vet. App. 122 (2000). The Board must review the entire record, but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000). The Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a “competent” source. The Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). The third step of this inquiry requires the Board to weigh the probative value of the evidence in light of the entirety of the record. While the Veteran is competent to report (1) symptoms observable to a layperson; (2) a diagnosis that is later confirmed by clinical findings; or (3) a contemporary diagnosis, he is not competent to independently render a medical diagnosis or opine as to the specific etiology of a condition. See Davidson v. Shinseki, 581 F.3d 1313 (2009). Because there is no universal rule as to competence, the Board must determine on a case-by-case basis whether a particular condition is the type of condition that is within the competence of a lay person to provide an opinion as to etiology. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24 Vet. App. 428 (2011). Contemporaneous records can be more probative than history as reported by a veteran. See Curry v. Brown, 7 Vet. App. 59, 68 (1994). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Ratings are assigned based on the average impairment of earning capacity resulting from a service-connected disability. 38 C.F.R. § 4.1. Where two disability ratings are potentially applicable, 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. After careful consideration of the evidence, any reasonable doubt remaining will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. In deciding this appeal, the Board has considered whether separate ratings for different periods of time, based on the facts found, are warranted, a practice of assigning ratings referred to as “staging the ratings.” See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2008). 1. Entitlement to an initial disability rating in excess of 30 percent for PTSD, prior to March 3, 2010. The Veteran claims entitlement to a disability rating in excess of 30 percent for PTSD, prior to March 3, 2010. The Veteran’s PTSD was service-connected and assigned an initial 30 percent disability rating, effective July 11, 2007, in an August 2009 rating decision. Pursuant to Diagnostic Code 9411, a 30 percent rating is warranted when there is occupational and social impairment with occasional decreases 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). 38 C.F.R. § 4.130, Diagnostic Code 9411. 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. 38 C.F.R. § 4.130, Diagnostic Code 9411. A 70 percent evaluation is warranted where there is objective evidence demonstrating occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to suicidal ideation; obsessional rituals which interfere with routine activities, speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, or effectively; impaired impulse control, such as unprovoked irritability with periods of violence; spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances, including work or a work-like setting; and the inability to establish and maintain effective relationships. A maximum 100 percent evaluation is for application when there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name. Id. When rating a mental disorder, VA must consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the claimant’s capacity for adjustment during periods of remission. VA shall assign a rating 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. 38 C.F.R. § 4.126(a). When rating the level of disability from a mental disorder, VA will consider the extent of social impairment, but shall not assign a rating solely on the basis of social impairment. 38 C.F.R. § 4.126(b). Symptoms listed in the General Rating Formula for Mental Disorders 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). A veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013). Additionally, while symptomatology should be the primary focus when deciding entitlement to a given disability rating, § 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused the requisite occupational and social impairment. Id. Effective August 4, 2014, VA amended the portion of its Schedule for Rating Disabilities dealing with mental disorders to remove outdated references to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and replace them with references to the recently updated DSM-5. See 79 Fed. Reg. 149, 45094 (August 4, 2014). This applies to all applications for benefits that are received by VA or that were pending before the AOJ on or after August 4, 2014. 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, even if such claims are subsequently remanded to the AOJ. See 80 Fed. Reg. 53, 14308 (March 19, 2015). In the instant case, the Veteran’s claim was certified to the Board in September 2013 and, as such, the DSM-IV applies to his claim. In this regard, the Board notes that the DSM-5 removed reference to Global Assessment of Functioning (GAF) scores. However, as the DSM-IV governs the Veteran’s claim, such scores are relevant to the evaluation of his PTSD. A GAF score is another component considered to determine the entire disability picture for the Veteran. The GAF scale is a scale reflecting the “psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness” from 0 to 100, with 100 representing superior functioning in a wide range of activities and no psychiatric symptoms. Carpenter v. Brown, 8 Vet. App. 240, 242 (1995). A GAF score of 31 to 40 indicates some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) or major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed man avoids friends, neglects family and is unable to work). A score of 41 to 50 is defined as denoting serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifter) or any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job). Although GAF scores are important in evaluating mental disorders, the Board must consider all the pertinent evidence of record and set forth a decision based on the totality of the evidence in accordance with all applicable legal criteria. Carpenter, 8 Vet. App. 240. An assigned GAF score, like an examiner’s assessment of the severity of a condition, is not dispositive of the percentage rating issue; rather, it must be considered in light of the actual symptoms of a psychiatric disorder (which provide the primary basis for the rating assigned). See 38 C.F.R. § 4.126(a). Accordingly, an examiner’s classification of the level of psychiatric impairment, by word or by a GAF score, is to be considered but is not determinative of the percentage VA disability rating to be assigned; the percentage evaluation is to be based on all the evidence that bears on occupational and social impairment. Id.; see also 38 C.F.R. § 4.126. A March 2009 mental health record described his mood as “low grade” depression. A March 2009 VA PTSD consultation noted the Veteran had a GAF score of 45. The VA physician noted that the Veteran’s PTSD manifested in serious social and moderate occupational impairment. The VA physician also noted the Veteran exhibited excessive levels of emotional detachment, hypervigilance, depression, angry outburst, social isolation, difficulty maintaining effective relationships with family members. Although he had depression sufficient to warrant a diagnosis of depressive disorder, the psychology technician and psychologist stated that they did not meet the criteria for major depression. The Veteran’s PTSD was evaluated in a July 2009 psychiatric examination. At examination, the Veteran reported isolation, difficulty controlling anger, irritability, sleep disturbances, memory impairment, difficulty maintaining occupational and familial relationships. The examiner noted that the Veteran was oriented to person, place, time and purpose. The Veteran’s behavior was appropriate, eye contact was good, affect and mood were depressed. The Veteran communicated well, speech was normal, and concentration was normal. The Veteran did not report panic attacks, suspiciousness, delusions or hallucinations, obsessive rituals, memory loss, suicidal ideation, or homicidal ideation. The Veteran had been married since 1973. He stated that he and his spouse had problems due to his irritability. He had two children from previous marriages and described his relationship not being very good. A GAF score of 45 was assigned. Finally, the examiner stated, “[The Veteran’s] psychiatric symptoms caused occupational and social impairment with reduced reliability and productivity. He is having disturbance in mood and motivation and difficulty establishing and maintaining effective work and social relationship.” A September 2009 mental status examination reports the Veteran is “[A]lert, cooperative, and calm. Eye contact [is] good, speech [is] goal directed. Mood and affect reflect a euthymic mood state. No [suicidal ideation] indicators. Thought organization remains good. He sounds more hopeful overall. Judgment and impulse controls remain intact.” Based on the above-described medical the Board finds that the Veteran’s PTSD is most closely manifests in occupational and social impairment with reduced reliability and productivity, as described by the VA examiner. An initial 50 percent rating is granted. The Veteran’s PTSD is not more accurately described as occupational and social impairment with deficiencies in “most areas.” The record did not show impaired judgment or thinking. Additionally, he was described as having “difficulty” with interpersonal and work relationships, which is more in line with the 50 percent criteria, which specifically contemplates “difficulty,” while the 70 percent criteria contemplates “inability.” Although the 70 percent rating criteria contemplate deficiencies in “most areas,” including work, school, family relations, judgment, thinking, or mood, such deficiencies must be “due to” the symptoms listed for that rating level, “or others or others of similar severity, frequency, and duration.” Vazquez–Claudio, 117 (Fed. Cir. 2013). That is, simply because the Veteran has depressed mood, and because the 70 percent level contemplates a deficiency in “mood” among other areas, does not mean his PTSD rises to the 70 percent level. Indeed, the 30 percent, 50 percent, and 70 percent criteria each contemplate some form of mood impairment. The Board, instead, must look to the frequency, severity, and duration of the impairment. Id. Here, the Veteran’s depressed mood is expressly contemplated by the 50 percent criteria, which contemplates “disturbances” in mood. 38 C.F.R. § 4.130. Notably, the Veteran’s depression was described as “low grade” in March 2009 and was euthymic (normal) in September 2009. The Veteran is adequately compensated for that impairment. 2. Entitlement to a disability rating in excess of 50 percent for PTSD, from March 3, 2010, to March 16, 2016 The Veteran’s PTSD was evaluated in a May 2010 psychiatric examination. At examination, the Veteran reported sleep disturbances, nightmares, intrusive thoughts daily, flashbacks, angry outbursts, and social isolation. The examiner noted that the Veteran exhibited symptoms of detachment, irritability, and anger. He stated that he did not socialize and did not have any close friends. He did not enjoy any of his usual activities. He remained married. He had two adult children from his first marriage. One of them did not speak to him and the other did occasionally. He worked unloading trucks for a restaurant, which he had been doing “all of his life.” The Veteran demonstrated depressed mood and affect, orientation to time and place, and appropriate behavior. The Veteran denied suicidal or homicidal ideation. He did not have memory problems and his judgment was intact. The examiner noted that he was able to perform both simple and complex commands, and that he was not a danger to himself or others. The examiner assigned a GAF score of 35. Finally, the examiner stated that he Veteran’s PTSD resulted in “occupational and social impairment.” The Veteran received VA substance abuse treatment in 2011. VA mental health notes from June 2011 stated: [The Veteran is] alert and oriented to person, place, situation, and time. He presented dressed casually and with normal motor function. He displayed a blunted affect, a pleasant but guarded mood and a cooperative calculating attitude. He appeared to be extremely likeable. He displayed rational thought processes and expressed his thought content in a clear and understandable manner. He denied any [suicidal or homicidal ideation] or hallucinations. Substantially similar notations were made through May 2013. In July 2011, he stated that he was opening an antique store and that it would be a “hangout” for him. He also had “taken …off the street” a drug user and was planning to put her into school. He had known her since the 1970s. Additionally, from May 2011 to May 2013, the Veteran was assigned GAF scores ranging from 45-60, except for in March 2012 when it was 35. The majority of the GAF scores were in the 50s. In March 2012, he was described as having a “brighter mood than recent contacts,” and “not overtly depressed.” In October 2012, he was “struggling” with his mood and felt powerless about the decline of his wife’s health. Because the drug user he was assisting was incarcerated, he was assisting a painter who was an alcoholic by providing him with a place to stay. His depression was described as “low grade.” In November 2012, the Veteran’s mood was dysphoric. His depression was described as “low grade.” In December 2012, he had difficulty with his mood but was “able to deal with these difficulties through acceptance, although he noted that it does not make it easy.” The drug user he was helping had been incarcerated, which provided financial relief to him because he was no longer paying for her expenses. He ended his relationship with her in August 2014 because her drug dealer threatened him. In April and May 2013, his mood was described as “stoic” and his affect was blunted. He was rational, friendly, and his thought content was normal. He denied suicidal or homicidal ideation. VA mental health notes from September 2013 and October 2013 report some suicidal ideation as the Veteran’s physical health worsened, but that ideation resolved without incident. In May 2014, he had increased anxiety. In August 2014, his medications were changed to help him with his hallucinations. In November 2014, he stated that he has not been experiencing hallucinations as often. In September 2015, he reported hallucinations, but they were “under better control” with his medication. In February 2016, he noted that they had worsened. VA treatment notes from September 2013 to March 2016 consistently note symptoms of depressed mood, anxiety blunted affect, sleep disturbance, and feelings of guilt. In August and September 2014, his depression was described as “low grade.” In April 2015 he was described as “minimally depressed with no excess anxiety.” They consistently note normal motor function, orientation to time and space, and logical thought process. In February 2016, he stated that he had been more depressed and increased intrusive thoughts. Based on the above discussed medical evidence, the Board finds that from March 3, 2010, to March 16, 2016, the Veteran’s PTSD is most accurately described by the rating criteria for a 50 percent disability rating. The criteria for a 70 percent disability rating are not met because the medical evidence does not establish occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to suicidal ideation; obsessional rituals which interfere with routine activities, speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, or effectively; impaired impulse control, such as unprovoked irritability with periods of violence; spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances, including work or a work-like setting; and the inability to establish and maintain effective relationships. As described above, the Veteran’s depression was often described as “low grade.” His PTSD symptoms did not cause inability to form relationships. Rather, he assisted a drug user and a painter by providing them with a place to live. He also cared for his wife of many years when her health declined. His mood problems were not of the severity needed to meet the 70 percent criteria. His judgment was not deficient. He reported irritability but did not have outbursts, which indicates that it is less severe than needed to meet the 70 percent criteria. The Veteran reported suicidal ideation. Passive suicidal ideation alone is contemplated by the 70 percent criteria. Intent or plan is not required, because self-harm is contemplated by the 100 percent criteria. Bankhead v. Shulkin, 29 Vet. App. 10 (2017). In this case, the suicidal ideation resolved within two months and did not return after October 2013. It is not of the frequency, severity, or duration needed to result in deficiencies in most areas. The Veteran had a GAF score of 35 at two points during this period, with the remainder of them being between 45 and 60. The GAF scores of 35 are outliers and not as representative of the Veteran’s disability picture as the other GAF scores which were more frequently reported. The DSM-IV notes that a GAF score of 35 indicates some impairment in reality testing or communication. GAF scores of 45-60 contemplate serious symptoms and moderate symptoms. As most of the GAF scores recorded were greater than 50 but less than 60, the preponderance of the evidence reflects that the GAF scores more accurately depict moderate symptoms. The Board acknowledges the Veteran’s statements, and buddy statements submitted by the Veteran, that his PTSD is more severe than evaluated. The Veteran is competent to report his symptoms and has presented credible statements in this regard. Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board finds, however, that neither the Veteran’s statements, submitted buddy statements, nor medical evidence demonstrates that the criteria for a disability evaluation in excess of 50 percent have not been met. The Board also acknowledges that the Veteran’s VA treatment and private medical records note complaints of and treatment for PTSD. These records have been considered in determining the actual degree of disability. To the extent that the Board herein denies a higher rating, the preponderance of the evidence is against such an award. Therefore, the benefit of the doubt doctrine is not applicable in such regard, and higher ratings are not warranted. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 3. Entitlement to a disability rating in excess of 70 percent for PTSD, as of March 16, 2016 In a December 2016 supplemental statement of the case (SSOC), the Veteran’s PTSD disability rating was increased from 50 percent to 70 percent, effective March 16, 2016. The Veteran’s PTSD was evaluated in a March 2016 VA PTSD examination. Upon examination, the Veteran again reported passive suicidal ideation. He stated that he remained married to his wife and that they had no children. He did not speak with his sister. The VA examiner noted symptoms of depression, anxiety, suspiciousness, chronic sleep impairment, disturbances of mood and motivation, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful situations, suicidal ideation, and persistent delusions or hallucinations. At the examination he was appropriately dressed and well groomed. His mood was “somber” and his affect was congruent. He became tearful when discussing his stressors. He stated that he preferred not to socialize because he felt anxious and was uncomfortable around people. He reported seeing “ghosts” and was depressed “all the time.” He denied homicidal ideation. The VA examiner also noted that the Veteran’s PTSD resulted in occupational and social impairment with reduced reliability and productivity, which is contemplated by the 50 percent criteria. VA mental health treatment notes from April 2016 to present report that the Veteran has denied suicidal and homicidal ideation. The VA treatment records further note that the Veteran displayed a blunted affect, a depressed mood, cooperative and friendly attitude, rational thought processes, and expressed his thought content in a clear and understandable manner. Based on the above discussed medical evidence, the Board finds that as of March 16, 2016, the Veteran’s PTSD is most accurately described by the rating criteria for a 70 percent disability rating. The Veteran’s PTSD manifested in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. See 38 C.F.R. § 4.130, Diagnostic Code 9411. A 100 percent disability rating is not warranted because the medical evidence of record does not establish both total occupational and social impairment. Id. “Total” is defined as “whole, not divided; full; complete,” and “utter, absolute.” Black’s Law Dictionary, 1498 (7th ed. 1999). He continued to be his wife’s caregiver, indicating that he was not totally socially impaired. Additionally, In August 2017, he reported that he and his wife had friends that came to visit her when she was sick. He also reported going to the office in March 2017 and September 2018, which supports a finding that he does not have total social impairment. Because total social impairment is not shown, the 100 percent criteria cannot be met. The Board acknowledges the Veteran’s contention that his PTSD is more severe than evaluated. The Veteran is competent to report his symptoms and has presented credible statements in this regard. Layno, 6 Vet. App. at 469. The Board finds, however, that neither the medical evidence demonstrates that the criteria for a disability evaluation in excess of 70 percent have not been met. The Board also acknowledges that the Veteran’s VA treatment and private medical records note complaints of and treatment for PTSD. These records have been considered in determining the actual degree of disability. To the extent that the Board herein denies a higher rating, the preponderance of the evidence is against such an award. Therefore, the benefit of the doubt doctrine is not applicable in such regard, and higher ratings are not warranted. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 4. Entitlement to TDIU The Veteran claim entitlement to TDIU prior to September 26, 2013, and as of October 1, 2016. For the period from September 26, 2013 to October 1, 2016 the Veteran was in receipt of special monthly compensation under the provisions of 38 U.S.C. § 1114(s). 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. 38 C.F.R. § 3.340 (a)(1). A total disability rating for compensation purposes may be assigned on the basis of individual unemployability: that is, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. In such an instance, if there is only one service-connected disability, it must be rated at 60 percent or more; if there are two or more service-connected disabilities, at least one disability must be rated at 40 percent or more, and sufficient additional disability must bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). Individual unemployability must be determined without regard to any nonservice-connected disabilities or the Veteran’s advancing age. 38 C.F.R. §§ 3.341(a), 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). Service connection for PTSD was granted effective July 11, 2007 and the Board has granted an initial 50 percent rating. Until January 26, 2009, PTSD was his only service-connected disability. Therefore, the criteria set forth in 38 C.F.R. § 4.16(a) were not met prior to January 26, 2009. Effective January 26, 2009, service connection for a shell fragment wound (SFW) was granted and assigned an initial 10 percent rating. When determining whether the 38 C.F.R. § 4.16(a) threshold is met, disabilities resulting from common etiology or a single accident may be considered to be a single disability. 38 C.F.R. § 4.16(a). PTSD was granted based upon the Veteran’s SFW. They are of a common etiology and may be considered a single disability. Under the combined rating table, this would result in a 60 percent rating. 38 C.F.R. § 4.25. The criteria for consideration of a schedular TDIU were met effective January 26, 2009. For the period prior to January 26, 2009, when the applicable percentage standards set forth in 38 C.F.R. § 4.16(a) are not met, the issue of entitlement to a TDIU may be submitted to the Director of the Compensation Service for extraschedular consideration where the Veteran is unable to secure or follow a substantially gainful occupation by reason of service-connected disability. 38 C.F.R. § 4.16(b) (2016); Fanning v. Brown, 4 Vet. App. 225 (1993). As discussed below, such evidence is not present. The Veteran’s August 2011 TDIU application notes that his last date of fulltime employment was May 1, 2011. At present, the Veteran’s claim for TDIU prior to September 26, 2013, and as of October 1, 2016 must be denied because the evidence of record does not demonstrate that the Veteran has not been following substantially gainful employment during the appeal period. The Veteran reported working as a small business owner in April 2011. In a December 2016 VA mental health note, the Veteran reported splitting time between his office and his home. More recently, in September 2018 VA treatment records, the Veteran again reported going to his office and staying busy. A letter was sent to the Veteran on September 12, 2016, notifying him to submit income tax records for years associated with the TDIU appeal period so that a determination could be made on his employment status. To date, no response to that request has been received. In the absence of evidence showing establishing unemployment, and based upon VA treatment reports indicating the Veteran was working as a small business owner during the appeal period, the record does not show that the Veteran was not working. Additionally, he did not provide his income information for his work as a small business owner. Marginal employment generally shall be deemed to exist when a Veteran’s earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. Therefore, income information is required to determine whether the Veteran’s employment was marginal. The Board does not have sufficient evidence to determine whether that employment was marginal. While VA has a duty to assist the Veteran in substantiating his claim, that duty is not a one-way street. Wood v. Derwinski, 1 Vet. App. 190 (1991). The Board finds that the probative evidence of record does not support entitlement to TDIU. Entitlement to TDIU prior to September 26, 2013, and as of October 1, 2016 is denied. D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Riordan, Associate Counsel