Citation Nr: 18156550 Decision Date: 12/11/18 Archive Date: 12/10/18 DOCKET NO. 10-31 286 DATE: December 11, 2018 ORDER Entitlement to an increased rating greater than 10 percent prior to October 23, 2009, on an extraschedular basis for diabetes mellitus, type II, is denied. Entitlement to an increased rating greater than 20 percent from October 23, 2009, on an extraschedular basis for diabetes mellitus, type II, is denied. Entitlement to an initial rating for posttraumatic stress disorder (PTSD) greater than 30 percent prior to February 1, 2013, is denied. Entitlement to an initial rating for PTSD of 70 percent, but no higher, from February 1, 2013, to November 2, 2015, and from January 1, 2016, is granted. Entitlement to a total disability rating based on individual unemployability (TDIU) prior to February 1, 2013, is denied. FINDINGS OF FACT 1. The record reflects that the Veteran has not required frequent hospitalization for his service-connected diabetes mellitus disability, and that the manifestations of the disability are not in excess of those contemplated by the assigned schedular ratings; further, there is no indication in the record that the average industrial impairment from the diabetes mellitus disability is in excess of that contemplated by the currently assigned ratings. 2. Prior to February 1, 2013, the Veteran’s PTSD was manifested by depression, mood swings, difficulties with anger and violence, irritability, and sleep problems, all resulting in less than occupational and social impairment with reduced reliability and productivity due to associated mental health symptoms. 3. For the period from February 1, 2013, the Veteran’s PTSD is manifested by occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: recurrent memories and dreams, avoidance behavior, diminished interest, feelings of detachment, irritable behavior, hypervigilance, exaggerated startle response, concentration problems, sleep disturbance, depressed mood, anxiety, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, and suicidal and homicidal ideation, all resulting in deficiencies in most areas, but less than total social and occupational impairment. 4. For the period from September 29, 2009, to February 1, 2013, the Veteran did met the schedular criteria for TDIU. 5. The evidence does not support the conclusion that the Veteran was unable to obtain or secure a substantially gainful occupation as a result of service-connected disabilities for the period from September 29, 2009, to February 1, 2013. CONCLUSIONS OF LAW 1. The criteria for entitlement to an increased rating greater than 10 percent on an extraschedular basis for diabetes mellitus, type II have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321(b), 4.119, Diagnostic Code (DC) 7913 (2018). 2. The criteria for entitlement to an increased rating greater than 20 percent from October 23, 2009, on an extraschedular basis for diabetes mellitus, type II have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321(b), 4.119, DC 7913 (2018). 3. The criteria for entitlement to an initial rating greater than 30 percent for PTSD prior to February 1, 2013, have not been met. 38 U.S.C. §§ 1151, 1155, 5107 (2012), 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.3, 4.7, 4.126, 4.130, DC 9411 (2018). 4. The criteria for entitlement to an initial rating of 70 percent for PTSD from February 1, 2013, to November 2, 2015, and from January 1, 2016, have been met. 38 U.S.C. §§ 1151, 1155, 5107 (2012), 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.3, 4.7, 4.126, 4.130, DC 9411 (2018). 5. The criteria for entitlement to TDIU from September 29, 2009, to February 1, 2013, have not been met. 38 U.S.C. § 1155, 5107 (2012); 38 C.F.R. §§ 3.340, 3.341, 4.16 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from August 1969 to March 1971. As to the PTSD claims, the Veteran was awarded a temporary total disability rating for his PTSD between November 2, 2015, and December 31, 2015, due to hospitalization in excess of 21 days. 38 C.F.R. § 4.29 (2018). As the 100 percent rating is the maximum schedular rating available for PTSD, the Board will consider the rating period on appeal to include that portion when PTSD was rated less than 100 percent disabling. As to the Veteran’s diabetes issues, the Board denied entitlement to increased ratings in a December 2016 decision. The Veteran appealed the extraschedular portion of the increased rating denial to the United States Court of Appeals for Veterans Claims (Court) and in a March 2018 Memorandum Decision the Court vacated the Board’s decision with respect to the denial of an increased rating for the diabetes mellitus on an extraschedular basis and remanded the matter to the Board. As to the PTSD claims, the Board denied the issues in an August 2017 decision. The Veteran appealed the determination and in an August 2018 Joint Motion for Partial Remand (Joint Motion) the parties recommended to the Court that the Board’s denial of the PTSD increased rating claims be vacated and remanded to the Board. In a September 2018 Order, the Court ordered that the Joint Motion be granted. As to the TDIU issue, the August 2017 Board determination granted entitlement to TDIU from February 1, 2013, to November 2, 2015. The Veteran appealed the Board’s implicit denial of entitlement to TDIU prior to February 1, 2013, and the August 2018 Joint Motion recommended and the September 2018 Court Order granted the recommendation to remand the issue of entitlement to TDIU on an extraschedular basis for the period prior to February 1, 2013. The Board initially wishes to make it clear that it is aware of the Court’s instructions in Fletcher v. Derwinski, 1 Vet. App. 394, 397 (1991), to the effect that a remand by the Court is not “merely for the purposes of rewriting the opinion so that it will superficially comply with the ‘reasons or bases’ requirement of 38 U.S.C. § 7104(d)(1). A remand is meant to entail a critical examination of the justification for the decision.” The Board’s analysis has been undertaken with Fletcher in mind. Increased Rating 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. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2018). Separate DCs identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to 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 (2018). Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3 (2018). The Veteran’s entire history is reviewed when making a disability determination. See 38 C.F.R. § 4.1 (2018). VA must consider whether the Veteran is entitled to “staged” ratings to compensate when his or her disability may have been more severe than at other times during the course of his or her appeal. The evaluation of the same disability under various diagnoses, known as pyramiding, is generally to be avoided. 38 C.F.R. § 4.14 (2018). The critical element in permitting the assignment of several ratings under various DCs is that none of the symptomatology for any one of the disabilities is duplicative or overlapping with the symptomatology of the other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). 1. Entitlement to an increased rating greater than 10 percent prior to October 23, 2009, on an extraschedular basis for diabetes mellitus, type II 2. Entitlement to an increased rating greater than 20 percent from October 23, 2009, on an extraschedular basis for diabetes mellitus, type II In a decision dated in December 2016, the Board denied entitlement to increased ratings for the Veteran’s service-connected diabetes mellitus, type II, rated as 10 percent prior to October 23, 2009, and as 20 percent from October 23, 2009, on both a schedular and extraschedular basis. The Veteran appealed the denial of the increased ratings on an extraschedular basis (but not the decision regarding the schedular rating) and in a March 2018 Memorandum Decision the Court of Appeals for Veterans Claims (Court) vacated the December 2016 Board decision with respect to the denial of the increased ratings for the diabetes mellitus on an extraschedular basis and remanded the claim to the Board. The Court found that the Board erred in denying the diabetes mellitus claim while at the same time remanding a TDIU claim for additional development because the remand instructions suggested that private medical records containing information about the Veteran’s diabetes mellitus were extant and obtainable. Therefore, the issue of whether the Veteran is entitled to an increased schedular rating for the service connected diabetes mellitus is not currently before the Board. The sole issue now before the Board is whether his disability picture is so unusual as to warrant entitlement to an extraschedular rating. As the development requested in the December 2016 Board remand with respect to the TDIU issue (and by extension the diabetes mellitus claims) has been completed, the Board may proceed with adjudication of the Veteran’s claim without risk of the prejudice to him detailed by the Court in its March 2018 Memorandum Decision. The Court has set forth a three-step analysis that provides guidance in determining whether referral for extraschedular consideration is appropriate. See Thun v. Peake, 22 Vet. App. 111 (2008). According to Thun, the initial step is a comparison between the level of severity and symptomatology of the claimant’s service-connected disability with the established criteria found in the Rating Schedule for that disability. If the criteria reasonably describe the claimant’s disability level and symptomatology, then the claimant’s disability picture is contemplated by the Rating Schedule, the assigned schedular evaluation is adequate and no referral is required. In the second step of the inquiry, if the schedular rating does not contemplate the claimant’s level of disability and symptomatology and is found inadequate, then the RO or Board must determine whether the claimant’s exceptional disability picture exhibits other related factors such as those provided by the regulation as “governing norms.” See 38 C.F.R. 3.321(b)(1) (related factors include “marked interference with employment” and “frequent periods of hospitalization”). When the Rating Schedule is inadequate to evaluate a claimant’s disability picture and that picture has related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of Compensation Service, for completion of the third step, i.e., a determination of whether, to accord justice, the claimant’s disability picture requires the assignment of an extraschedular rating. Id. Disability ratings are determined by the application of a schedule of ratings that is based on the average impairment of earning capacity. See 38 C.F.R. § 3.321(a). The Veteran’s diabetes mellitus is rated under 38 C.F.R. § 4.119. As noted, the Veteran currently is rated at 10 percent prior to October 23, 2009, and at 20 percent from that date. The ratings are assigned pursuant to DC 7913. Diabetes mellitus is evaluated under 38 C.F.R. § 4.119, DC 7913. Under DC 7913, a 10 percent rating is warranted for diabetes mellitus that is manageable by a restricted diet only. A 20 percent rating is warranted where insulin and restricted diet, or; use of oral hypoglycemic agent and restricted diet is required. A 40 percent rating is warranted where insulin, restricted diet, and regulation of activities is required. A 60 percent rating is warranted for diabetes mellitus requiring insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated. A 100 percent rating is warranted for diabetes mellitus requiring more than one daily injection of insulin, restricted diet, and regulations of activities (avoidance of strenuous occupational and recreational activities) with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or complications that would be compensable if separately evaluated. 38 C.F.R. § 4.119. Note (1) to DC 7913 provides that compensable complications of diabetes are to be rated separately unless they are part of the criteria used to support a 100 percent rating (under DC 7913). Non-compensable complications are considered part of the diabetic process under DC 7913. Id. The criteria for rating diabetes mellitus are conjunctive, meaning that each element of the criteria is needed to meet the requirements for the specified evaluation. See Camacho v. Nicholson, 21 Vet. App. 360 (2007); see also Melson v. Derwinski, 1 Vet. App. 334 (1991) (use of the conjunctive “and” in a statutory provision means that all of the conditions listed in the provision must be met). The above notwithstanding, the Board recognizes that the availability of higher schedular ratings plays no role in an extraschedular analysis, including where the schedular rating criteria are successive, such as the criteria for DC 7913. See Petermann v. Wilkie, 30 Vet. App. 150 (2018). In August 2008, the Veteran was noted to be pre-diabetic. As discussed in the prior December 2016 Board decision, during a diabetic optometry consultation in January 2009 the VA clinician diagnosed type II diabetes mellitus without retinopathy. A February 2009 VA treatment record diagnosed the Veteran with glucose intolerance. The VA clinician recommended that the Veteran increase his physical activity and improve his diet. Upon VA examination in September 2009, the VA examiner indicated that the Veteran was being treated for diabetes mellitus through nutritional counseling alone, without the use of insulin or an oral hypoglycemic medication. The VA examiner noted that the Veteran was instructed on maintaining a restrictive diet, but was not restricted in his ability to perform strenuous activities. The Veteran denied episodes of ketoacidosis and symptoms of diabetic neuropathy or retinopathy. The Veteran reported erectile dysfunction, but the VA examiner opined that the most likely etiology was “possibly tobacco/nicotine abuse,” noting that the Veteran has a 20 pack-year smoking history. The VA examiner indicated that there were no diabetic complications; however, the Veteran reported that his diabetes prevented him from participating in long-distance travel. A VA treatment record dated on October 23, 2009, included the Veteran’s reports of concern about his high blood glucose levels, episodes of blurry vision, and numbness in both legs and hands. The VA physician recommended self-monitoring of blood glucose levels with a home glucometer, and prescribed an oral hypoglycemic medication and medication for the complaints of neuropathic pain in all four extremities. In November 2009, the VA clinician diagnosed type II diabetes mellitus without retinopathy. Following VA peripheral nerve examination in February 2010, the VA examiner diagnosed peripheral neuropathy in both lower extremities and bilateral carpal tunnel syndrome with sensory neuropathy. The VA examiner opined that neither the upper extremity nor lower extremity neuropathy was likely due to diabetes mellitus as symptoms in all extremities pre-dated the diagnosis of diabetes mellitus. Upon diabetic optometry consultation in April 2010, the VA clinician diagnosed type II diabetes mellitus without retinopathy. While the VA clinician diagnosed mild retinopathy, this was attributed to interferon therapy for hepatitis C virus, not to his diabetes mellitus. During a VA genitourinary examination in May 2010, the Veteran reported erectile dysfunction as beginning in 1990. Following examination, the VA examiner opined that diabetes mellitus was an unlikely cause as the erectile dysfunction pre-dated the diagnosis of diabetes. In a December 2012 decision, the Board granted entitlement to peripheral neuropathy of the upper and lower extremities as secondary to the Veteran’s diabetes mellitus. In a December 2012 rating decision that effectuated the Board’s grant of service connection, the RO assigned 20 percent disability ratings for each extremity, with an effective date of September 29, 2009. Upon diabetic optometry consultation in January 2013, the VA clinician diagnosed type II diabetes mellitus without retinopathy. In a February 2013 VA examination report the VA examiner noted that the Veteran’s diabetes mellitus required treatment through a restricted diet and an oral hypoglycemic medication. The VA examiner noted there were no hospitalizations for hypoglycemia or ketoacidosis, and indicated that the Veteran’s condition did not require regulation of his activities. The VA examiner further denied any complications as a result of the Veteran’s diabetes, including hypertension, diabetic peripheral neuropathy, diabetic retinopathy, and erectile dysfunction. Following VA eye examination in September 2014, the VA examiner indicated that the Veteran did not have diabetic retinopathy. The VA optometrist noted that the Veteran presented with cataracts, and that some types of cataracts can be more commonly seen in patients with diabetes. However, the type of cataract demonstrated by the Veteran was more likely related to aging. The Veteran was afforded a VA examination in October 2014. In the resulting report, the examiner noted that the Veteran’s diabetes mellitus required treatment through a restricted diet and an oral hypoglycemic medication. The VA examiner specifically denied any hospitalizations for hypoglycemia or ketoacidosis, and indicated that the Veteran’s condition did not require regulation of his activities. The VA examiner noted a diabetic complication of diabetic peripheral neuropathy. The VA examiner specifically opined that hypertension and erectile dysfunction were not complications of the Veteran’s diabetes, as both conditions pre-dated his diabetes diagnosis. Upon diabetic optometry consultation in May 2015, the VA clinician diagnosed type II diabetes mellitus without retinopathy. A June 2015 VA treatment record reflects that the Veteran’s diabetes mellitus was being managed with an oral hypoglycemic medication and restricted diet. The Veteran denied hypoglycemic episodes. A June 2015 VA examination report addendum indicated that the Veteran’s diabetes mellitus and peripheral neuropathy would prevent physical employment, such as those requiring pushing, pulling, lifting, or carrying. The symptoms would not prevent sedentary employment. Upon diabetic optometry consultation in May 2016, the VA clinician diagnosed type II diabetes mellitus without retinopathy. The Veteran was afforded a VA diabetes mellitus examination in January 2017. The Veteran’s diabetes mellitus continued to be managed with a restricted diet and treated with medication, including a prescribed oral hypoglycemic agent. The Veteran did not require regulation of his activities due to the diabetes. He visited his diabetic care provider less than 2 times per month. There had been no hospitalizations for diabetes or associated symptoms in the previous 12 months. There was no unintentional weight loss or strength associated with the diabetes. The Board finds that the preponderance of the evidence is against assigning an extraschedular rating for any period on appeal. The medical evidence shows that the Veteran’s service-connected diabetes mellitus is manifested primarily by elevated blood sugar levels that have been managed by a combination of a restricted diet and medication, depending on the time period. The Veteran is rated under DC 7913 based on his need for a restricted diet and/or medication for his diabetes mellitus. The diagnostic criteria adequately describe the severity and symptomatology of the Veteran’s disability, as the DC specifically addresses the effects of his diabetes mellitus and the nature of treatment required. The Board recognizes that the Veteran has diabetic peripheral neuropathy due to the diabetes; however, he is separately rated for these problems and those ratings fully contemplate his symptoms. The Veteran also has reported blurry vision and erectile dysfunction as being due to his diabetes mellitus. Numerous medical professionals have considered the Veteran’s blurry vision, but have found no evidence of diabetic retinopathy. To the extent that the evidence suggests retinopathy, the associated symptoms have been medically linked to interferon treatment for hepatitis C and not to his diabetes mellitus. Moreover, the Veteran’s cataracts have been definitively linked to the natural aging process and not his diabetes mellitus. The erectile dysfunction has been found by a medical professional to be unrelated to the Veteran’s diabetes mellitus, as the symptoms of erectile dysfunction predated his diabetes mellitus. In any case, the Veteran is service-connected for his erectile dysfunction and any symptoms are contemplated in his separate rating for that disability. Finally, the Veteran indicated during his September 2009 VA examination that long-distance travel was not possible due to his diabetes mellitus. The examiner at that time, however, found that there were no limitations due to the Veteran’s diabetes mellitus and there is no other medical evidence to suggest that the Veteran is limited in his travels due to the diabetes mellitus. The Board finds the medical evidence in this case as to restrictions on travel of significantly greater probative value than the Veteran’s lay representations, based on the education, training, and experience of the medical professionals. Thus, all the issues purported to be related to the Veteran’s diabetes mellitus are fully contemplated in the assigned disability ratings, have been medically determined to be unrelated to the diabetes, or there is insufficient evidence to link the problems to diabetes. The record reflects that the Veteran has not required frequent hospitalization for the service-connected diabetes mellitus and that the manifestations of the disability are not in excess of those contemplated by the assigned ratings. Further, there is no indication in the record that the average industrial impairment from his diabetes mellitus would be in excess of that contemplated by the assigned ratings. As noted, the Veteran has consistently reported symptomatology fully contemplated by the assigned ratings, which is intended to take into account decreased industrial functioning. Moreover, the Veteran’s combined service-connected disabilities have been found to warrant entitlement to TDIU from May 2, 2005, herein. As such, his decreased industrial functioning has been fully compensated for that time period. Because the preponderance of the evidence is against the claim for an extraschedular rating for the diabetes mellitus, the benefit-of-the-doubt doctrine is inapplicable, and the claims on this basis must be denied. See 38 U.S.C. § 5107(b) (2012); see generally Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001). 3. Entitlement to an initial rating for PTSD greater than 30 percent prior to February 1, 2013 The Veteran’s PTSD is rated (in relevant part for this section) as 30 percent disabling prior to February 1, 2013. The Veteran claims the rating does not accurately depict the severity of his condition. The General Rating Formula for Mental Disorders provides, in relevant part: Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events), a 30 percent rating. Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships, a 50 percent rating. 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 worklike setting); inability to establish and maintain effective relationships, a 70 percent rating. 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; memory loss for names of close relatives, own occupation, or name, a 100 percent rating. 38 C.F.R. § 4.130, DC 9411. When determining the appropriate disability evaluation under the general rating formula, the Board’s primary consideration is a veteran’s symptoms, but it must also make findings as to how those symptoms impact the Veteran’s occupational and social impairment. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). Because the use of the term “such as” in the rating criteria demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list. Nevertheless, as all ratings in the general rating formula are also associated with objectively observable symptomatology and the plain language of the regulation makes it clear that the Veteran’s impairment must be “due to” those symptoms, a veteran may only qualify for a given disability rating under the general rating formula by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Id at 117-18. Additionally, a Global Assessment of Functioning (GAF) score is often used by treating examiners to reflect the “psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness.” See Richard v. Brown, 9 Vet. App. 266 (1996). A GAF score is highly probative as it relates directly to the Veteran’s level of impairment of social and industrial adaptability, as contemplated by the rating criteria for mental disorders. See Massey v. Brown, 7 Vet. App. 204, 207 (1994). The Board recognizes that GAF scores are not utilized in the DSM-5. In July 2009, the Veteran stated that overall he was doing well and that coping strategies he had learned had helped. He was accompanied by his significant other, with whom he lived, and said that he enjoyed time with his significant others. The Veteran was working part-time in landscaping 1 to 2 jobs per week, as well as working at Walmart. He had sleep problems, including nightmares, as well as problems with worrying. He had an exaggerated startle response, but was able to recover quickly. He attended church regularly, where he was an usher. He enjoyed watching religious programs on television and denied avoidance behaviors. His appetite and energy were good. Thought processes and content were appropriate, he had good judgment and insight, and denied suicidal or homicidal ideation, intent, or plan. At an October 2009 VA psychiatric examination, the Veteran was described as neatly groomed, and appropriately casually dressed. His attitude was cooperative, friendly, relaxed, and attentive. His speech was unremarkable and spontaneous. His affect was appropriate and full range. Thought processes and content were unremarkable. He was oriented to person, time, and place and had normal recent and remote memory. He had no delusions, panic attacks, suicidal/homicidal thoughts, and good impulse control. The Veteran was described as having a happy mood and his symptoms of depression were noted as under good control with medication. His relationship with his significant other was good and was okay (with a little distance) with respect to the rest of his family. The quality of his relationship with his children had been improving over the past 3 years and currently described his relationship with them as “good.” He had social relationships with others from church, but did not consider them “friends.” He preferred to be alone and did not maintain close relationships with others. The Veteran enjoyed watching television and movies, as well as attending church and family gatherings (as long as the gathering was short). He also liked yard work, listening to music, and reading. There was a history of suicide attempts where on 3 occasions the Veteran stated that he was going to jump off an overpass before changing his mind. The Veteran had a past history of violence, but no violent outbursts since 2006. The same day as the above examination, in a separate October 2009 treatment record the Veteran admitted to suicidal ideation in past years, but no suicidal ideation since 2004. In support of his claim, the Veteran submitted statements from friends and family detailing his symptoms and actions over the years. Problems included sleep issues, mood swings, and difficulties with anger and violence. In October 2010, the Veteran denied suicidality. In January 2011, the Veteran indicated that he and his significant other spent most of their time at home, other than completing errands and going to church. He spent his days reading the bible. He was having frequent nightmares, but denied suicidal or homicidal ideation. In April 2011, the Veteran reported that he was doing fairly well, although at times he would isolate himself. He spent most of his time at home, but he got along well with his partner. He attended a PTSD group once per week. He slept fairly well, with decreased nightmares. He had been doing yardwork with his brother and planned to continue that. At that time, he denied suicidal or homicidal ideation, intent, or plans. He had good judgment and insight, a full affect, and normal thought processes. In a February 2012 VA psychiatric treatment note, the Veteran was described as casually dressed and cooperative. He exhibited coherent, goal-directed thoughts. His speech had a normal, tone, pitch, and rate. He denied hallucinations, paranoid/grandiose ideations, and suicidal/homicidal thoughts, and he was oriented to time, person, place, and circumstance. In September 2011 and June 2012 VA psychiatric treatment notes, the Veteran was charted as being alert and attentive. He was neatly groomed in casual attire. His attitude was calm, cooperative, and pleasant. His speech was spontaneous and fluent with normal rate and tone. His mood was euthymic and his affect was full, mood-congruent, and non-labile. His thoughts were goal-directed, logical, and free of delusions, paranoia, or hallucinations. He had no suicidal/homicidal ideations, intent, or plan. His judgment was good and his cognition was grossly intact. The Veteran continued to be involved in group PTSD therapy in the subsequent months. After a careful review of the record and for the reasons and bases expressed immediately below, the Board finds that the Veteran’s demonstrated PTSD symptomatology does not warrant a rating greater than 30 percent prior to February 1, 2013. The Veteran’s symptoms prior to February 1, 2013, included depression, mood swings, difficulties with anger and violence, irritability, and sleep problems. That said, for the period from February 1, 2013, the Veteran has not manifested unusual speech patterns, panic attacks, difficulty understanding complex commands, memory problems, impaired judgment, or impaired abstract thinking. With respect to the Veteran’s occupational functioning and impairment, the evidence demonstrates that interpersonal difficulties due to his increased irritability affected his occupational functioning. The foregoing certainly would affect the Veteran’s occupational functioning. That said, the Veteran remained capable overall of mentally performing in an occupational environment prior to February 1, 2013. The Board acknowledges that the Veteran has not worked since 1995, but the evidence does not demonstrate that his lack of employment was due to his PTSD symptoms. As noted in numerous medical records, the Veteran’s PTSD symptoms would not preclude employment in circumstances where he had little interpersonal interaction. As such, while the Veteran certainly had some level of occupational impairment due to his PTSD symptoms prior to February 1, 2013, the Board finds that based on the Veteran’s work history he does not have deficiencies in work functioning as contemplated for a 50 percent rating or greater. As to the Veteran’s social functioning and impairment, the Board recognizes that his PTSD problems have resulted in his withdrawing from certain aspects of his social life and that spends less time socializing than he once did. That said, prior to February 1, 2013, the evidence indicates that he had a good relationship with his wife and overall a good relationship with his daughters. In addition, the Veteran attended church regularly, attended short family gatherings, and was able to shop and run other errands with his wife. Thus, the Veteran clearly was able to function effectively in a social setting. The Veteran did have problems with irritability, but he denied any problems with violent outbursts during the appellate time period prior to February 1, 2013, or for multiple years prior to the appellate time period. As such, the Board acknowledges some degree of social impairment. That said, the Veteran maintained a good relationship with his wife and daughters and was able to interact with the public in the normal course of daily life. The Board certainly is sympathetic to the social difficulties experienced by the Veteran and any associated effects felt by his family and others in the community; however, the Veteran retained the ability to function in both the home and his community. As such, while the Veteran may have had some degree of social impairment due to his PTSD symptoms prior to February 1, 2013, the Board finds that based on the lay and medical evidence of record he does not have deficiencies in social functioning as contemplated for a 50 percent rating or greater. In reaching the above opinions, as directed by the August 2018 Joint Motion the Board has considered the Veteran’s reports during his October 2009 VA mental health examination that on 3 occasions he was going to jump off an overpass before changing his mind. Based on the clear evidence of record, the 3 episodes noted above occurred multiple years prior to the appellate time period. In that regard, on the same day as the referenced October 2009 VA examination the Veteran reported to a VA treatment provider that he had suicidal ideation in past years, but no suicidal ideation since 2004. Thus, it is clear that the referenced episodes when the Veteran contemplated suicide were multiple years prior to the appellate time period. As noted above, numerous VA treatment records support the conclusion that the Veteran did not have suicidal ideation during the appellate period prior to February 1, 2013, as they document denials by the Veteran of suicidal ideation, plan, or intent. As such, the Board finds that the Veteran’s reports of 3 episodes of suicidal thoughts multiple years prior to the appellate time period do not warrant a rating greater than the assigned 30 percent rating prior to February 1, 2013. In summary, the Veteran did not have deficiencies in social or occupational functioning as contemplated for a 50 percent rating or greater for the period prior to February 1, 2013. He had deficiencies in those areas, but the greater weight of evidence demonstrates that it was to a degree contemplated by the 30 percent rating currently assigned prior to February 1, 2013. To the extent that the Veteran exhibited any of the criteria for a 50 percent rating or higher, the Board concludes his overall level of disability did not exceed his current 30 percent rating prior to February 1, 2013. In determining that a rating in excess of 30 percent is not warranted prior to February 1, 2013, the Board has considered the Veteran’s complaints regardless of whether they are listed in the rating criteria, but for the reasons discussed above concludes that the Veteran’s level of social and occupational impairment does not warrant a rating in excess of the currently assigned 30 percent rating prior to February 1, 2013. 4. Entitlement to an initial rating for PTSD greater than 50 percent from February 1, 2013, to November 2, 2015, and from January 1, 2016, to the present The Veteran contends that his current 50 percent rating for the period from February 1, 2013, to November 2, 2015, and from January 1, 2016, does not accurately reflect the severity of his condition. The Veteran was afforded a VA psychiatric examination on February 1, 2013, which precipitated an increased rating over the prior 30 percent assessment. The Veteran was recorded as experiencing insomnia, irritability, anger, impaired concentration, hypervigilance, an exaggerated startle response, sleep problems, depressed mood, anxiety, suspiciousness, chronic sleep impairment, difficulty in establishing and maintaining effective work and social relationships, suicidal ideation, and neglect of personal appearance and hygiene. The examiner indicated the Veteran’s symptoms would result in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks commensurate with a 50 percent evaluation under the rating criteria. The Veteran described having a good relationship with his fiancée and daughters. The Veteran’s daily activities involved doing household chores, doing a little yardwork, walking some for exercise, watching television, and attending church every Sunday. The Veteran experienced suicidal thoughts at times, but denied current suicidal ideation. He experienced 5 nightmares per week and struggled with insomnia. The Veteran had occasional auditory hallucinations and sometimes heard people calling to him when no one was there. The Veteran’s speech content and thoughts were appropriate. On testing, there was noted memory problems. Judgment and insight were intact. The Veteran was afforded another VA psychiatric examination in September 2014, where the examiner charted symptoms similar to those identified in the prior examination report, as well as irritable behavior and angry outbursts and reckless or self-destructive behavior. He continued to report past suicidal ideation, without current ideation. The Veteran still had occasional auditory hallucinations. A VA PTSD mental health consult conducted in March 2015 showed the Veteran was alert and oriented to time, place, person, and situation. He was neatly groomed with adequate hygiene. His speech was generally normal with regard to production, volume, content, and clarity. The Veteran described minor instances of hallucinations, which the clinician described as “vague” appearing to be “more of the veteran’s thoughts.” The Veteran had a repaired relationship with his daughters. He was in the church choir. He spent time with his wife, granddaughter, and daughters. The Veteran did not see his sisters in person, but spoke with them on the telephone. He attended some social events that did not have a lot of people and went to the grocery store with his wife. He last used drugs 12 to 17 years previously, which he had used to self-medicate and had contemplated suicide during that period (his faith saved him). His last episode of physical violence had been in 2004 or 2005. The Veteran denied current suicidal ideation, but sometimes felt like after all these years that he was useless. He denied any intent or plan. He had some homicidal ideation especially while driving, but denied any intent or plan. A June 2015 VA examination report addendum included the examiner’s conclusion that there were several issues that would impact the Veteran’s occupational functioning, including difficulty interacting with others and irritability / verbal aggression. The examiner indicated that the Veteran would function best at a low-stress job that allowed him to work alone or nearly alone. At VA PTSD anger management group sessions in April, May, June, and August 2015, the Veteran was described as neat, casually groomed, friendly, and cooperative. His speech was clear, relevant, spontaneous and coherent with normal rate and prosody. Thought processes were linear and goal directed. His mood was euthymic to depressed and his affect was full range. He experienced no perceptual disturbances, delusions or hallucinations, or suicidal/homicidal ideations/intent. In January 2016, the Veteran denied depressed mood, suicidal ideations, perceptual disturbances, or new onset or worsening problems with memory and concentration. The Veteran did report problems with anger, irritability, emotional detachment, hypervigilance, exaggerated startle response, intrusive thoughts and images, nightmares, and avoidance behavior. The symptoms were well controlled on his current medication regimen. In June 2016 and December 2016, the Veteran again denied suicidal ideation. In December 2016, the Veteran stated that all his PTSD symptoms were not controlled with medication, the most significant problem being with irritability. That said, he denied depressed mood, perceptual disturbances, or new onset or worsening problems with memory and concentration. On evaluation, he was fully oriented, with an irritable mood. Speech and thought processes and content were appropriate. The Veteran appeared to have preserved impulse control and had fair attention and concentration. The quality of his decision-making was adequate and he had a good understanding of his current situation. In January 2017, the Veteran was afforded a VA examination. The Veteran was noted to have occupational and social impairment with reduced reliability and productivity. The Veteran’s marriage had been about the same or a little better over the previous few years. His wife tolerated him. The Veteran had some serious issues with attitude toward his wife for a period prior to that that made him feel his marriage had not been too good. The Veteran did not feel very connected to his family anymore. The Veteran communicated with his daughters, but not like they used to in the past. The Veteran felt the communication problems were his fault. That said, he had a granddaughter of whom he was “proud as punch. She makes his day.” The Veteran avoided phone calls and would not always answer the door, depending on whether he wanted to have someone around. He liked to stay home because he felt safe and although he was able to function in crowds it took significant effort to do so. The Veteran enjoyed his spiritual life, but he had not attended his prior church in the past year. He sometimes visited a little church that he enjoyed because it had some Vietnam veterans in the congregation. The Veteran found it difficult to go to the grocery store. He had not worked in several years. The Veteran had a history of a bad temper, but was learning how to calm himself down and manage situations somewhat differently. Symptoms included recurrent memories and dreams, avoidance behavior, diminished interest, feelings of detachment, irritable behavior, hypervigilance, exaggerated startle response, concentration problems, sleep disturbance, depressed mood, anxiety, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, and suicidal ideation. On evaluation, the Veteran was well groomed, calm, and cooperative. There was no unusual behavior noted. Speech and thought processes were appropriate. The Veteran noted intermittent suicidal ideation, without current plan or intent. The Veteran was fully oriented, with fair memory, concentration, insight, and judgment. The Board concludes that the objective medical evidence and the Veteran’s lay statements regarding his symptomatology show disability that more nearly approximates that which warrants the assignment of a 70 percent disability rating for the period from February 1, 2013, to November 2, 2015, and from January 1, 2016. See 38 C.F.R. § 4.7. In reaching that conclusion, the Board notes that the Veteran’s symptoms include recurrent memories and dreams, avoidance behavior, diminished interest, feelings of detachment, irritable behavior, hypervigilance, exaggerated startle response, concentration problems, sleep disturbance, depressed mood, anxiety, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, and suicidal and homicidal ideation. In summary, the Board finds that the above symptoms most closely approximate the higher 70 percent rating. The Board recognizes that all of the above-listed symptoms have not been noted at all times or in all records. Moreover, the Board notes significant inconsistencies as to the existence of ongoing suicidal ideation. That said, multiple VA examination reports over the course of the appellate time period have noted that symptoms included suicidal ideation. As such, the Board will afford the Veteran the benefit of the doubt and presume that such symptoms have existed for the period from February 1, 2013. To the extent that the symptoms have not been consistent throughout the period from February 1, 2013, the severity of the Veteran’s PTSD overall appears to have been essentially consistent for the entire period. For this reason, staged ratings are not applicable for the relevant period from February 1, 2013. Therefore, as explained above, the medical and lay evidence supports the Board’s conclusion that a 70 percent rating is warranted for the entire relevant period from February 1, 2013. The Board acknowledges that the Veteran’s symptoms first reported during his VA examination on February 1, 2013, and that form the basis for the increased rating likely did not begin on the day of examination. That said, there is no clear date when the worsening PTSD symptoms began prior to February 1, 2013. As discussed above, prior to that date the Veteran consistently reported symptomatology that would not warrant a rating greater than 30 percent. In the absence of clear evidence of a date to assign an increased rating of 70 percent, the Board finds that February 1, 2013, is the appropriate date to assign the 70 percent rating. However, a rating greater than 70 percent is not appropriate for the period from February 1, 2013, because the Veteran does not have total social and occupational impairment. Although the Veteran clearly had a serious disability, the evidence does not show that there was total occupational and social impairment. He did not have symptoms such as gross impairment of thought processes or communication; grossly inappropriate behavior; persistent danger of hurting self or others (while he reported suicidal and homicidal thoughts on some occasions he has consistently denied plans or intent); intermittent inability to perform activities of daily living due to mental health problems; disorientation to time or place; or memory loss for names of close relatives, own occupation, or own name. As noted, while the Veteran has expressed suicidal and homicidal thoughts, he has denied any actual intent to harm himself or others. Mental health providers have consistently concluded that he is not a danger to himself or others. As such, his symptoms more closely approximate those for a 70 percent rating, specifically suicidal or homicidal ideation, but without rising to the level required for a 100 percent rating, specifically a persistent danger of hurting self or others. As to the Veteran’s reported concentration and memory problems, there is no indication or suggestion that these problems rise to the level of severity contemplated for a 100 percent rating, namely forgetting one’s own name or those of family or close friends. The Veteran has problems with auditory hallucinations, but these are intermittent in nature and the Board does not find that they are persistent to the point contemplated for a 100 percent disability rating. The Board finds that the foregoing addresses the concerns raised in the August 2018 Joint Motion with respect to this period of the Veteran’s appeal. As to occupational and social functioning, during the appellate period the Veteran has not worked, but multiple examining medical professionals have indicated that the Veteran’s PTSD symptoms would not preclude employment where the Veteran could work in a solitary environment. The Board agrees that the Veteran’s employment difficulties appear to be the result of issues with anger and violence. Although these symptoms have improved over past years they still are present. Such symptoms and potential for occupational relationship difficulties would be mitigated by a work environment where the Veteran could work alone. The Veteran does have some memory and concentration problems, but his abilities in such areas remain in at least the “fair” range and the Board does not see how such abilities would result in total occupational impairment. As to social functioning, the Veteran has been married throughout the period maintains an overall good relationship with his wife. His relationship with his daughters appears to have deteriorated somewhat over the years due to the Veteran’s PTSD symptoms; however, he has a good relationship with his granddaughter. For much of the period, the Veteran has attended church regularly and has been able to shop and be in other social settings, which demonstrates that he does not have total occupational impairment. To the extent that he has ceased going regularly to church in more recent times, he continues to attend another church on a more intermittent basis. Such attendance, again, fails to demonstrate total social impairment, particularly in light of the Veteran’s stated appreciation that the church includes other Vietnam veterans, which suggests that the Veteran interacts with these churchgoers in order to be able to identify them as fellow veterans. Thus, the Veteran does not have total social and occupational impairment sufficient to warrant a total schedular rating. He does have some deficiencies in several areas, but the greater weight of evidence demonstrates that it is to a degree that is contemplated by the 70 percent rating assigned herein. In determining that a rating in excess of 70 percent is not warranted, the Board has considered the Veteran’s complaints regardless of whether they are listed in the rating criteria, but for the reasons discussed above concludes that the Veteran’s level of social and occupational impairment does not warrant a rating in excess of the currently assigned 70 percent rating. In summary, for the reasons and bases set forth above, the Board concludes that an increased rating of 70 percent, but no more, is warranted for the period from February 1, 2013, to November 2, 2015, and from January 1, 2016. 5. Entitlement to TDIU prior to February 1, 2013 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. 38 C.F.R. § 4.16 (2018). 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.” 38 C.F.R. §§ 3.340(a)(1), 4.15 (2018). Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the Veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that if there is only one such disability, such disability shall be ratable as 60 percent or more and if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). To meet the requirement of “one 60 percent disability” or “one 40 percent disability,” the following will be considered as one disability: (1) disability of one or both lower extremities, including the bilateral factor, if applicable; (2) disabilities resulting from one common etiology; (3) disabilities affecting a single body system; (4) multiple injuries incurred in action; and (5) multiple disabilities incurred as a prisoner of war. Id. Substantially gainful employment is defined as work which is more than marginal and which permits the individual to earn a living wage. Moore v. Derwinski, 1 Vet. App. 356 (1991). Where these percentage requirements are not met, entitlement to benefits on an extraschedular basis may be considered when the Veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities, and consideration is given to the Veteran’s background, including his employment and educational history. 38 C.F.R. §4.16(b). The Board does not have the authority to assign an extraschedular total disability rating for compensation purposes based on individual unemployability in the first instance. Bowling v. Principi, 15 Vet. App. 1 (2001). In determining whether unemployability exists, consideration may be given to the Veteran’s level of education, special training, and previous work experience, but it may not be given to his or her age or to any impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19 (2018). In this case, the Board notes that the Veteran is in receipt of TDIU benefits from February 1, 2013, to July 27, 2015, pursuant to an August 2017 Board decision that was effectuated in a September 2017 rating decision. As the above referenced August 2018 Joint Motion failed to address the issue of entitlement to TDIU for the period from July 27, 2015, the Board will consider only the period prior to February 1, 2013.) In a June 2014 determination, the Board found that the issue of entitlement to TDIU was in appellate status pursuant to the Court’s holding in Rice v. Shinseki, 22 Vet. App. 447 (2009), based on the Veteran’s statements that he was unemployable due to his service-connected PTSD with dysthymic disorder that currently was in appellate status with the Board. The PTSD claim initially was received by the Board on September 29, 2009. There was no pending claim for TDIU or compensation benefits for PTSD prior to that time. As such, the Board will limit its consideration to entitlement to TDIU for the period from September 29, 2009, to February 1, 2013. For that time period, the Veteran’s service-connected disabilities included PTSD with dysthymic disorder, rated as 30 percent disabling; peripheral neuropathy of the right and left upper and lower extremities, each rated as 20 percent disabling; and diabetes mellitus, type II, rated as 10 percent disabling prior to October 23, 2009, and as 20 percent disabling from that date. As such, the Veteran’s combined rating was 80 percent for the entire relevant appellate time period. Taking into account the bilateral factor and that the right and left upper and lower extremity peripheral neuropathy disabilities were associated with the diabetes mellitus (i.e. disabilities resulting from one common etiology), the Veteran met the schedular criteria for TDIU for the entire relevant time period. See 38 C.F.R. §§ 4.25, 4.26 (2018). Therefore, the Veteran’s service-connected disabilities met the percentage rating standards for TDIU for the period on appeal. 38 C.F.R. § 4.16(a). Thus, for the period on appeal the Board must now consider whether the evidence reflects that the Veteran’s service-connected disability rendered him unemployable from September 29, 2009, to February 1, 2013. Please see the above sections for relevant lay and medical evidence regarding the Veteran’s diabetes mellitus and PTSD during the relevant time period. In addition, a September 2009 VA diabetes mellitus examination indicated the Veteran had last worked in 1995 in manufacturing work and that the cause of his retirement was that he had issues being around other people. He reported poor social skills and that he left the work force because, “I felt threatened by those people.” An October 2009 VA mental health examination included the Veteran’s reports that his leisure activities included watching movies, attending church / family gatherings (as long as the gatherings were short), yard work, listening to music / radio, and reading. While technically unemployed, he worked as a handy man doing yard work. The reasons for his unemployment were the economy, his educational background, and legal history and the Veteran denied that his unemployment was due to his mental health symptoms. The examiner indicated that the Veteran’s PTSD would result in moderate difficulty in occupational functioning. The Veteran had a difficult time maintaining relationships and employment due to his history of violence and drug use (although there had been no problems in the past 4 years). Since leaving employment, the Veteran had made good progress with individual, group, and psychiatric medication treatment, but his overall prognosis remained guarded. A February 2010 VA peripheral neuropathy examination noted that the Veteran had been working at “odds and ends.” He had never done typing work and had worked all his life as a truck driver. The Veteran’s neuropathy symptoms bothered him only during sleep and with the use of a wrist splint his symptoms had become tolerable. That said, the symptoms in the hands did affect his daily activities when he was able to get work, but he was able to work in jobs involving yard work, clean up, etc. On examination, grip was strong and normal bilaterally. Sensation to light touch was normal in all extremities, but sensation to vibration was diminished in all extremities. Reflexes were normal in all extremities, except in the bilateral ankles where it was absent bilaterally. The Veteran’s gait was normal. The Veteran had moderate to severe peripheral neuropathy to the bilateral feet. The examiner believed that the problems with the hands was due to carpal tunnel syndrome, although such disability had not been diagnosed. During a February 1, 2013, VA diabetes mellitus examination, the Veteran reported that he had experienced trauma to the eye one week previously while doing yard work. At that time, the Veteran was walking with a cane due to right knee pain. The Veteran had normal strength in the extremities, but decreased reflexes and sensation. The Veteran reported that he had last worked in 1994 in an air conditioning plant, but could not work due to PTSD symptoms and an inability to get along with others. The Veteran’s diabetes mellitus did not affect his ability to work. During a February 1, 2013 VA PTSD examination, the Veteran indicated that his daily activities included doing household chores, doing a little yard work when he was able to, walking some for exercise, watching television, and attending church every Sunday. The Veteran had last worked in a plant that manufactured air conditioners. He had worked there for several years. Previously he had worked for 17.5 years for a company making pharmaceutical products as a compounding operator. The Veteran was a high school graduate, where he was a slightly above average student. He also went to trade school for cabinet making, barbering, and cosmetology, but never got certified. The Board acknowledges the Veteran’s reports of an inability to work due to his PTSD and/or diabetes mellitus and associated upper and lower extremity peripheral neuropathy symptoms. The Board notes, however, that the Veteran’s problems with violence were multiple years prior to the appellate time period. As discussed above, during the relevant time period the Veteran was able to attend church and run errands, which indicates that he was able to interact with others on a social level. To the extent that he would have difficulty with extended periods of interactions, there are many types of jobs that would not require extensive and extended interaction with others commensurate with the Veteran’s level of education and training. For example, a manufacturing position on the third shift or at other time periods with fewer employees where the Veteran could work with less personal interaction. During the period prior to February 1, 2013, there is no indication that the Veteran had problems with memory, concentration, or other physical problems such that he would have been unable to mentally perform the duties of manufacturing or other types of employment. As to his diabetes mellitus, the medical evidence does not indicate that the disability would affect the Veteran’s ability to work in a manufacturing or similar environment. Similarly, although the bilateral upper and lower extremity peripheral neuropathy affected sensation and reflexes, the Veteran had normal strength in the extremities and there is no indication that the sensation and reflex problems would make working in a manufacturing or similar environment impossible or so inherently dangerous that he could not have performed such work. Thus, the most probative evidence of record demonstrates that the Veteran’s service-connected disabilities did not preclude him from employment for the appellate period prior to February 1, 2013. J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. J. Houbeck, Counsel