Citation Nr: 18157712 Decision Date: 12/14/18 Archive Date: 12/13/18 DOCKET NO. 15-14 209 DATE: December 14, 2018 ORDER Entitlement to a 70 percent rating, but no higher, for service-connected posttraumatic stress disorder (PTSD) with alcohol dependence from February 3, 2011 to September 6, 2016 is granted. Entitlement to a total disability rating based upon individual unemployability (TDIU) due to service-connected disabilities prior to March 5, 2016. is denied. FINDINGS OF FACT 1. From the date of the increased rating claim, February 3, 2011, to September 6, 2016, the Veteran’s service-connected PTSD with alcohol dependence has been manifested by occupational and social impairment, with deficiencies in most areas, but has not more nearly approximated total occupational and social impairment. 2. The Veteran’s service-connected disabilities did not preclude substantially gainful employment prior to March 5, 2016. CONCLUSIONS OF LAW 1. With reasonable doubt resolved in favor of the Veteran, the criteria for a disability rating of 70 percent, but no higher, for PTSD with alcohol dependence were met from February 3, 2011 to September 6, 2016. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.3, 4.130, Diagnostic Code 9411 (2017). 2. The criteria for a TDIU were not met prior to March 5, 2016. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 4.16 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1989 to October 1994. Service in Southwest Asia is indicated by the record. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Buffalo, New York, which increased the assigned rating for service-connected PTSD with alcohol abuse to 50 percent from February 3, 2011. The Veteran subsequently submitted evidence and argument in support of an increased rating for PTSD within one year of the April 2011 rating decision. A February 2014 rating decision denied the Veteran’s claim of entitlement to a TDIU. A statement of the case (SOC) as to both claims was issued in March 2015; the Veteran perfected his appeal in April 2015. The Board notes that a July 2012 rating decision increased the assigned rating for service-connected PTSD to 70 percent from December 27, 2011. The Veteran has not expressed satisfaction with the increased disability rating; this matter thus remains in appellate status. See AB v. Brown, 6 Vet. App. 35, 38 (1993) (when a veteran is not granted the maximum benefit allowable under the VA Schedule for Rating Disabilities, the pending appeal as to that issue is not abrogated). Additionally, a September 2016 rating decision increased the assigned rating for PTSD with alcohol dependence to 100 percent from September 6, 2016; entitlement to a TDIU was granted from March 5, 2016 to September 6, 2016. As such, the issues on appeal have been limited to entitlement to an increased rating for PTSD with alcohol dependence prior to September 6, 2016 and entitlement to a TDIU prior to March 5, 2016, as the maximum schedular rating has otherwise been assigned during the period of the claim. See, e.g., the Appellant’s Brief dated November 2018. 1. Entitlement to a higher rating for service-connected PTSD with alcohol dependence prior to September 6, 2016. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities. 38 C.F.R. Part 4. The Board determines the extent to which a veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, and the assigned rating is based, as far as practicable, upon the average impairment of earning capacity in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.10. Where there is a question as to which of two ratings should be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. In general, when an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, staged ratings are also appropriate in any increased rating claim in which distinct time periods with different ratable symptoms can be identified. Hart v. Mansfield, 21 Vet. App. 505 (2007). Here, analysis in this decision has therefore been undertaken with consideration of the possibility that different ratings may be warranted for different time periods as to the pending claim. In all cases, 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, at 308 (observing that once evidence is determined to be competent, the Board must determine whether such evidence is also credible). The third step of this inquiry requires the Board to weigh the probative value of the proffered evidence in light of the entirety of the record. In this function, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498, 511-12 (1995), aff’d, 78 F.3d 604 (Fed. Cir. 1996) (per curiam) (table); see Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (holding that the Board has the “authority to discount the weight and probative value of evidence in light of its inherent characteristics in its relationship to other items of evidence”). The Board has considered all evidence of record as it bears on the issues before it. See 38 U.S.C. § 7104(a) (“Decisions of the Board shall be based on the entire record in the proceeding and upon consideration of all evidence and material of record”); 38 U.S.C. § 5107(b) (“Secretary shall consider all information and lay and medical evidence of record in a case”). Although the Board has an obligation to provide reasons and bases supporting these decisions, there is no need to discuss, in detail, the extensive evidence of record. The Federal Circuit has held that the Board must review the entire record, but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board’s analysis below will focus specifically on what the evidence shows, or fails to show, as to the Veteran’s appeal. The Veteran’s service-connected PTSD with alcohol dependence is evaluated pursuant to Diagnostic Code (DC) 9411. Under this diagnostic code, a 50 percent evaluation is for assignment 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; difficulty establishing effective work and social relationships. Id. A 70 percent evaluation is contemplated for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control, such as unprovoked irritability with periods of violence; spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances, including work or a work-like setting; inability to establish and maintain effective relationships. 38 C.F.R. § 4.130, DC 9411. A 100 percent evaluation is warranted when there is evidence of total occupational and social impairment, due to such symptoms as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene; disorientation to time and place; memory loss for names of close relatives, own occupation or name. Id. The GAF is a scale reflecting psychological, social, and occupational functioning on a hypothetical continuum of mental health illness. See Carpenter v. Brown, 8 Vet. App. 240, 242 (1995); Richard v. Brown, 9 Vet. App. 266, 267 (1996) (citing DSM-IV). As will be discussed below, the Veteran has been assigned GAF scores ranging from 55 to 61 as determined by VA treatment providers, as well as VA and private examiners. These scores are indicative of moderate to severe impairment. Scores ranging from 51 to 60 reflect more moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers). When determining the appropriate disability evaluation to assign, the Board’s primary consideration is a veteran’s symptoms, but it must also make findings as to how those symptoms impact a veteran’s occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013); Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). 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, the Board need not find the presence of all, most, or even some, of the enumerated symptoms to award a specific rating. Mauerhan, 16 Vet. App. at 442; see also Sellers v. Principi, 372 F.3d 1318, 1326-27 (Fed. Cir. 2004). Nevertheless, 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 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio, 713 F.3d at 118. Historically, the Veteran was granted service connection for PTSD with alcohol dependence in a July 2007 rating decision; a 30 percent rating was granted from August 28, 2002. In February 2011, the Veteran asserted a claim of entitlement to an increased rating for service-connected PTSD. As indicated above, an April 2011 rating decision increased the assigned rating to 50 percent, effective February 3, 2011, the date of the increased rating claim. A July 2012 rating decision increased the assigned rating to 70 percent, effective December 27, 2011. As described above, a 100 percent rating for service-connected PTSD with alcohol dependence, effective from September 6, 2016, the date of the most recent VA examination. For the reasons set forth, the Board concludes that a 70 percent evaluation, but no higher, is warranted from February 3, 2011 to September 6, 2016. The Veteran was afforded a VA psychological examination in March 2011, at which time he reported that he had attempted suicide three times. His most recent suicidal ideation was in March 2011. The Veteran reported that he was attempting to return to college, but felt he could not manage his coursework and his continued employment. He stated that he has no social relationships because he isolates himself. The Veteran reported that he does not initiate friendships and knows people only through his spouse. He and his spouse have a good relationship, and have been together since 1997. The examiner noted that the Veteran’s speech was hesitant and slow; his affect was constricted. The Veteran’s mood was anxious. He was well-oriented and his thought content was unremarkable. The examiner indicated that the Veteran exhibited persistent paranoid delusions. However, the examiner also indicated that the Veteran’s judgment and insight were intact. The Veteran experiences nightmares. He reported panic attacks. The Veteran denied homicidal ideation. The examiner stated that the Veteran is able to maintain personal hygiene. The Veteran indicated that he “cannot handle large crowds or being in situations in which he cannot see what is going on.” His memory was normal. The March 2011 VA examiner stated that the Veteran “tends to isolate himself from everyone but his wife and stepchildren. He uses his sick days as a way to cope with work stress.” He is employed full-time. The examiner reported that the Veteran has some difficulty functioning on the job. The Veteran reported that he has lost less than one week of work during the last twelve-month period due to his psychological symptoms. The examiner confirmed continuing diagnoses of PTSD and bipolar disorder. A GAF of 61 was assigned. The examiner stated that the Veteran’s psychological symptoms result in deficiencies in the areas of judgment, thinking, family relations, work, mood or school. The examiner stated that the Veteran “reports that he tends to act impulsively especially during times of heightened anxiety. His impulsive behavior may impact his judgment.” A VA treatment record dated in March 2011 documented continuing diagnoses of PTSD and bipolar I affective disorder. The treatment provider noted the Veteran’s episodes of mania and depression. A GAF of 55 was indicated. VA treatment records dated in August 2011 noted that the Veteran has increasing depression and exhibited a dysphoric mood. The Veteran was afforded a VA psychological examination in February 2012 at which time the examiner confirmed diagnoses of PTSD, bipolar I affective disorder, and alcohol dependence. A GAF of 55 was identified. The examiner reported that the Veteran’s psychological symptomatology results in “[o]ccupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood.” The examiner stated that the routine of the Veteran’s job distracts him from his depression; he struggles mainly with interpersonal and social interactions in the work setting. The examiner stated that, “[s]ocially, [the Veteran’s] anxiety and depression present him with only a few exceptions for forming emotionally close and trusting relationships.” The Veteran is married with two adult step-children. The Veteran’s spouse, brother, and one friend are his support network; he does not make friends easily. The Veteran denied active suicidal ideation. The Veteran reports that his anxiety is triggered by crowds or a disruption in his routine. He described “a need to feel in control so when things are the worse, he might not shave or brush his teeth to gain a sense of control.” The Veteran endorsed recurrent intrusive thoughts, avoidance, markedly diminished interest or participation in significant activities, feelings of detachment or estrangement from others, restricted range of affect, sense of foreshortened future, difficulty falling or staying asleep, irritability or outbursts of anger, and hypervigilance. The Veteran additionally reported sleep impairment, depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, as well as near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively. The examiner indicated that the Veteran exhibits flattened affect, disturbance of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, including work or a work-like setting, neglect of personal appearance and hygiene, and intermittent inability to perform activity of daily living, including maintenance of minimal personal hygiene. The Veteran reported that he does not manage his personal finances because it causes him too much anxiety. VA treatment records dated in September 2013 noted the Veteran’s report of increasing PTSD symptoms. It was noted that the Veteran “is developing more asocial attributes such as distrust and seeing conspiracies in his life.” The Veteran denied current suicidal or homicidal ideation. VA treatment records dated in June 2014, the treatment provider stated that the Veteran “has continued to experience interpersonal issues in his employment.” The Veteran was afforded a VA psychological examination in January 2014 at which time the examiner indicated that the Veteran’s psychological symptoms continue to result in “[o]ccupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood.” The Veteran continues to reside with his wife, who is supportive. The examiner stated that since the prior VA examination in February 2012, the Veteran “has had on-going difficulty in work-related settings. He has described the difficulties inherent in having multiple internal and external customers and much responsibility in the context of limited authority over may employees.” The examiner noted that, in early January 2014, the Veteran’s therapist indicated that the Veteran is working to apply for alternate positions due to the Veteran’s repeated inability to maintain his emotional well-being in various employment settings. The Veteran endorsed recurrent thoughts, avoidance, markedly diminished interest or participation in significant activities, feelings of detachment or estrangement from others, persistent inability to experience positive emotions, irritable behavior and angry outburst, hypervigilance, and sleep disturbance. He additionally described depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, chronic sleep impairment, flattened affect, disturbance of motivation and mood, difficulty establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances including work or a work-like setting, inability to establish and maintain effective relationships, neglect of personal appearance and hygiene, and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. The January 2014 VA examiner additionally noted that the Veteran has had problems with occupational functioning, which has been documented in previous examination reports. The examiner stated that recently, the Veteran has taken leave from work and has required “additional, non-scheduled psychotherapeutic support ‘to process high levels of occupational stress/facilitate early departure” from work to allow him to regroup at home. The examiner opined, that the Veteran’s mental health conditions “result in at least a moderate level of functional impairment such that he would continue to have difficulty with adapting to stressors, getting along with co-workers, establishing relationships with supervisees, etc.” The examiner concluded, “[t]he impact of this is likely to severely reduce or eliminate his ability to obtain and maintain gainful employment, regardless of physical or sedentary nature.” In a September 2014 statement, the Veteran reported that he has been off work for five weeks this past year. He further stated, “[b]ecause of my inability to deal with stressors, I believe this is going to be an on-going issue dealing with the stressors to the point I have to be off work.” In a December 2014 Report of General Information, it was noted that the Veteran “has been having great difficulties at work due to PTSD to include missing multiple days and not being able to work certain jobs that he is required to do, which has caused him great stress.” It was also indicated that the Veteran reported recurrent suicidal ideation. The Veteran was afforded a VA psychological examination in March 2015 at which time the examiner confirmed continuing diagnoses of PTSD, bipolar disorder, and alcohol dependence. The examiner reported that the Veteran’s psychological symptoms manifest in “[o]ccupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood.” The Veteran continues to be married. He indicated that he maintains full-time employment; however, in a different position that he had at the time of the 2014 VA examination. The Veteran reported that he feels “burned-out” by his work. He described avoidance, markedly diminished interest or participation in significant activities, feelings of detachment or estrangement from others, persistent inability to experience positive emotions, irritable behavior and outburst of anger, hypervigilance, and sleep disturbance. He further endorsed depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, chronic sleep impairment, flattened affect, disturbance of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances including work or a work-like setting, and inability to establish and maintain effective relationships. The Veteran also described neglect of personal appearance and hygiene, as well as intermittent inability to perform activities of daily living including maintenance of minimal personal hygiene. The examiner reported, “[i]t does not appear that his PTSD symptoms have increased since the last time of his evaluation in 2014.” VA treatment records dated in August 2015 documented the Veteran’s report of suicidal ideation. A VA Form 21-4192 (Request for Employment Information in Connection with Claim for Disability Benefits) dated in May 2016 submitted by the Veteran’s employer, a VA Medical Center (VAMC), indicated that the Veteran was still working full-time in an administrative/clinical position. It was reported that concessions have been made; specifically, change of position/restricted driving. VA treatment records dated in May 2016 indicated that, “[a]fter years of nonadherence to recommended treatment for substance use condition and PTSD resulted in deterioration of condition such that [the Veteran] was forced to seek medical retirement from his job on March 16, 2016 when he was unable to pass physical allowing him to drive a government vehicle.” VA treatment records dated in August 2016 noted that the Veteran’s treatment provider had completed forms documenting the treatment provider’s observations regarding the Veteran’s “medical inability to perform his current job functions and recommending that he is not currently able to work.” The Veteran was afforded a VA examination dated in September 2016, at which time the examiner indicated that the Veteran’s psychological symptoms now manifest in total occupational and social impairment. Based on the above, the Board finds that the impact of the Veteran’s PTSD symptoms on his social and industrial functioning approximate the degree of impairment contemplated by a 70 percent rating from the date of the increased rating claim, February 3, 2011. As detailed above, the record includes diagnoses of PTSD, bipolar disorder, and alcohol use disorder. Significantly the VA examiners, as well as the Veteran’s regular treatment providers have not differentiated between such symptoms and have, in fact, repeatedly described the overlapping symptoms of his psychiatric diagnoses. As such, the evidence is in equipoise as to whether the Veteran’s psychiatric symptoms are attributable to his service-connected PTSD, or at least not consistently clearly separable from his service-connected disability. Mittleider v. West, 11 Vet. App. 181 (1998). Thus, all psychiatric symptoms are considered part of the service-connected diagnoses. Id. The symptomatology associated with the Veteran’s service-connected PTSD, to include that indicated by the lay statements and treatment records, supports the assignment of a 70 percent rating because this disability has been shown to result in occupational and social impairment, with deficiencies in most areas, such as work, family relations, and mood, due to such symptoms as near-continuous depression; anxiety; impaired impulse control, with periods of unprovoked irritability with outbursts of anger; difficulty in adapting to stressful circumstances, difficulty in establishing and maintaining effective work and social relationships, and difficulty adapting to stressful circumstances, including work or a work-like setting. 38 C.F.R. § 4.130, DC 9411. Specifically, these symptoms have been endorsed by the Veteran, as corroborated by VA examiners and treatment providers. Given the overall severity of the Veteran’s psychological symptoms, the Board finds that the criteria for a 70 percent evaluation are met from the date of the increased rating claim. In addition, as set forth above, suicidal ideation is one of the symptoms associated with a 70 percent disability rating. Suicidal ideation involves a range from a passive wish not to awaken in the morning or a belief that others would be better off if the individual were dead, to transient but recurrent thoughts of committing suicide, to a specific plan. Bankhead v. Shulkin, 29 Vet. App. 10 (2017). The Court has held that the criteria for a 70 percent rating “indicates that the presence of suicidal ideation alone, that is, a veteran’s thoughts of his or her own death or thoughts of engaging in suicide-related behavior, may cause occupational and social impairment with deficiencies in most areas.” Id. Given the evidence that the Veteran has reported a history of suicide attempts prior to the appeal period as well as intermittent active suicidal ideation throughout the appeal period, as well as the overall severity of the Veteran’s psychological symptoms, the Board finds that the criteria for a 70 percent evaluation were met from the date of the increased rating claim. Significantly, the Veteran’s symptoms have not more nearly approximated total occupational and social impairment at any point prior to September 6, 2016. 38 C.F.R. § 4.7 (2017). The evidence does not show total occupational and social impairment due to depressive disorder with PTSD. There is evidence of significant occupational impairment due to his service-connected psychiatric disability. Also, VA treatment records show that the Veteran was unable to work from March 2016 (and has been granted entitlement to a TDIU from that time). However, there is no evidence of total social impairment prior to September 6, 2016. While the Veteran has generally been socially isolated, he maintains contact with his spouse, his adult step-children, his brother, and a friend. Total social impairment has therefore not been shown at any time prior to September 6, 2016. As such, total occupational and social impairment was not demonstrated by the evidence prior to September 6, 2016. Furthermore, the Veteran has experienced intermittent suicidal ideation, irritability with outbursts of anger, and intermittent inability to perform activities of daily living including maintenance of minimal personal hygiene. Nevertheless, he has not exhibited any grossly inappropriate behavior during the claim period, he has not exhibited memory loss for names of close relatives, own occupation, or name, he has remained fully oriented to time and place from the date of service connection, and he has generally been able to perform activities of daily living. Thus, he has not exhibited most of the symptoms listed in the examples for a 100 percent disability rating at any time prior to September 6, 2016 and total social and occupational impairment has not otherwise been demonstrated. In light of the above evidence and resolving all reasonable doubt in the Veteran’s favor, the Board finds that the criteria for a 70 percent, but no higher, rating for the service-connected PTSD have been met under the General Rating Formula from February 3, 2011 to September 6, 2016. While there may have been day-to-day fluctuations in the manifestations of the Veteran’s service-connected PTSD with alcohol dependence, the evidence shows no distinct periods of time prior to September 6, 2016, when the Veteran’s service-connected disability varied to such an extent that a rating greater or less than 70 percent assigned herein would be warranted. Hart, supra. 2. Entitlement to a TDIU prior to March 5, 2016. Total disability will be considered to exist 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. If the total rating is based on a disability or combination of disabilities for which the Rating Schedule provides an evaluation of less than 100 percent, it must be determined that the service-connected disabilities are sufficient to produce unemployability without regard to advancing age. 38 C.F.R. § 3.341(a). If the schedular rating is less than total, a total disability evaluation can be assigned based on individual unemployability if the Veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disability, provided that the Veteran has one service-connected disability rated at 60 percent or higher; or two or more service-connected disabilities, with one disability rated at 40 percent or higher and the combined rating is 70 percent or higher. The existence or degree of nonservice connected disabilities will be disregarded if the above-stated percentage requirements are met and the evaluator determines that the Veteran’s service-connected disabilities render him incapable of substantial gainful employment. 38 C.F.R. § 4.16(a). The central inquiry is “whether the veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability.” Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Neither nonservice-connected disabilities nor advancing age may be considered in the determination. 38 C.F.R. §§ 3.341, 4.19 (2016); Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). As is pertinent to the appeal period, the Veteran is service connected for PTSD, now rated as 70 percent from February 3, 2011 to September 6, 2016; chronic bronchitis and restrictive lung disease/sleep apnea rated as 50 percent from November 28, 2014; seizure disorder rated as 20 percent prior to April 1, 2013, 40 percent from April 1, 2013, and 20 percent from March 1, 2016; and erectile dysfunction rated as zero percent from March 26, 2015. As such, the Veteran meets the schedular criteria for TDIU for the period under consideration herein, February 3, 2011 to March 5, 2016. Therefore, the Board will consider whether the Veteran’s service-connected disabilities precluded gainful employment for which his education and occupational experience would otherwise qualify him. As detailed above, VA examination reports dated in March 2011, February 2012, January 2014, and March 2015 indicate that the Veteran’s psychological symptoms manifest in “[o]ccupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood.” These VA examinations repeatedly documented the Veteran’s difficulty in adapting to stressful circumstances including work or a work-like setting. The January 2014 VA examiner specifically addressed the question of entitlement to TDIU and reported that the Veteran has had problems with occupational functioning, which has been documented in previous examination reports. The examiner stated that recently, the Veteran has taken leave from work and has required “additional, non-scheduled psychotherapeutic support ‘to process high levels of occupational stress/facilitate early departure” from work to allow him to regroup at home. The examiner opined, that the Veteran’s mental health conditions “result in at least a moderate level of functional impairment such that he would continue to have difficulty with adapting to stressors, getting along with co-workers, establishing relationships with supervisees, etc.” The January 2014 examiner concluded, “[t]he impact of this is likely to severely reduce or eliminate his ability to obtain and maintain gainful employment, regardless of physical or sedentary nature.” In a September 2014 statement, the Veteran reported that he has been off work for five weeks this past year. He further stated, “[b]ecause of my inability to deal with stressors, I believe this is going to be an on-going issue dealing with the stressors to the point I have to be off work.” In a December 2014 Report of General Information, it was noted that the Veteran “has been having great difficulties at work due to PTSD to include missing multiple days and not being able to work certain jobs that he is required to do, which has caused him great stress.” Critically, the record demonstrates that the Veteran remained employed on a full-time basis until March 5, 2016. He worked as a discharge planner at the domiciliary at a VAMC, and then became a supervisor for medical primary care. The Veteran then transitioned to working as a peer support specialist in a VAMC homeless program. See, e.g., the VA examination report dated March 2015. The Veteran filed a formal TDIU claim (VA Form 21-8940) in January 2014, at which time he indicated that he became too disabled to work from December 9, 2013. However, he also reported that he was still employed full-time, working 40 hours per week. A VA Form 21-4192 (Request for Employment Information in Connection with Claim for Disability Benefits) submitted by the Veteran’s employer in May 2016, indicated that the Veteran was still working full-time in an administrative/clinical position. It was reported that concessions have been made; specifically, change of position/restricted driving. Significantly, the evidence throughout the appeal period does not indicate that the Veteran was unable to obtain and maintain gainful employment due solely to his service-connected disabilities at any time prior to March 5, 2016. While the Board acknowledges the functional of the impairment resulting from his service-connected PTSD with alcohol dependence, the evidence does not demonstrate that the service-connected disability resulted in the Veteran’s inability to secure and follow gainful employment at any time prior to March 5, 2016. While the evidence reflects that the Veteran’s service-connected PTSD caused significant occupational impairment, the evidence does not show that the Veteran was unemployable. Critically, although it is undisputed that the Veteran’s PTSD with alcohol dependence has resulted in functional impairment necessitating occupational modifications, the record shows that the Veteran has obtained and maintained full-time employment prior to March 5, 2016. The evidence of record does not reflect that the Veteran’s service-connected disabilities manifested symptoms of such severity as to impact his employability beyond what is contemplated by the assigned schedular ratings prior to March 5, 2016. The severity of the Veteran’s service-connected psychological symptomatology was specifically contemplated by assigned 70 percent evaluation. Whether a veteran could perform the physical and mental acts required by employment at a given time is an issue about which a lay person may provide competent evidence. Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013) (“neither the statute nor the relevant regulations require the combined effect [of disabilities] to be assessed by a medical expert”). Critically, for the above reasons, the evidence of record does not support a conclusion that his service-connected disabilities alone made him unemployable; thus, there is no basis to refer the Veteran’s case for consideration of an extraschedular evaluation prior to March 5, 2016. Id. at 1354 (“[A]pplicable regulations place responsibility for the ultimate TDIU determination on the VA, not a medical examiner”). As detailed above, the probative evidence of record, shows that the Veteran’s service-connected disabilities did not prevent him from following substantially gainful employment prior to March 5, 2016. As described above, the evidence clearly indicates that the Veteran maintained full-time employment with certain modifications during that time. Although his service-connected PTSD with alcohol dependence certainly caused interference with his employability, such interference is contemplated in the schedular ratings currently assigned to said disability, and the evidence of record does not demonstrate that his service-connected disabilities alone results in unemployability. While not discounting the significant effect that the service-connected disabilities have on the Veteran’s employability, the Board finds that such are adequately compensated at the currently assigned levels. Moyer v. Derwinski, 2 Vet. App. 289, 293 (1992) & Van Hoose, supra. In short, the evidence of record demonstrates that the Veteran’s service-connected disabilities alone did not prevent him from following substantially gainful employment prior to March 5, 2016. Instead, the objective medical evidence shows that the Veteran retained the capacity to perform employment. Therefore, the Board does not find that the service-connected disabilities alone render the Veteran unable to secure or follow a substantially gainful occupation at any time prior to March 5, 2016. Accordingly, based on this evidentiary posture, the Board finds that the preponderance of the evidence is against the Veteran’s TDIU claim. The benefit-of-the-doubt rule does not apply, and the issue of entitlement to a TDIU is denied prior to March 5, 2016. See 38 U.S.C. § 5107. K. Conner Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. K. Buckley, Counsel