Citation Nr: 18158835 Decision Date: 12/18/18 Archive Date: 12/17/18 DOCKET NO. 17-52 102 DATE: December 18, 2018 ORDER A total disability rating based on individual unemployability due to service-connected disability (TDIU) is granted, subject to the law and regulations governing the award of monetary benefits. FINDING OF FACT The evidence as to whether the Veteran is unable to secure or follow a substantially gainful occupation as a result of her service-connected disabilities is, at least, in equipoise. CONCLUSION OF LAW Resolving reasonable doubt in the Veteran’s favor, the criteria for an award of a TDIU have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.340, 3.341, 4.3, 4.16 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Army from September 2000 to March 2005. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office in Huntington, Virginia. Entitlement to a TDIU The Veteran maintains, in essence, that she is unable to secure or follow a substantially gainful occupation as a result of her service-connected disabilities, to include posttraumatic stress disorder (PTSD) with major depressive disorder (MDD) and asthma. She contends that she was terminated from her job in 2011 due to depression, anxiety, and other symptoms of PTSD. Her representative claims that her psychiatric disorders have manifested in the following manner: difficulty establishing and maintaining effective work and social relationships; disturbances of motivation and mood; flattened affect; impaired abstract thinking; impaired judgment; chronic sleep impairment; depressed mood; and mild memory loss. A TDIU is warranted where the evidence of record shows that a Veteran is unable to secure or follow a substantially gainful occupation, consistent with her education and occupational experience, as a result of service-connected disability, without regard to advancing age. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). If there is only one such disability, it must be rated at 60 percent or more. 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. §§ 3.340, 3.341, 4.16(a). For the purpose of determining one 60-percent disability, or one 40-percent disability in combination, the following will be considered as one disability: (1) disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable; (2) disabilities resulting from common etiology or a single accident; (3) disabilities affecting a single body system (e.g., orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric); (4) multiple injuries incurred in action; or (5) multiple disabilities incurred as a prisoner of war. 38 C.F.R. § 4.16(a). In the present case, the Board finds that the Veteran meets the threshold requirements for a schedular award of a TDIU. She is currently in receipt of the following: a 70-percent disability rating for PTSD; a 30-percent rating for asthma; a 10-percent rating for a right foot injury; a zero-percent (noncompensable) rating for allergies. The Board finds, further, that the evidence supports an award of a TDIU. The evidence reflects that the Veteran has a high school education; that she completed a cosmetology program; that she worked almost exclusively in janitorial services or security guard services; and that she has not had any substantive work experience since approximately 2011. See, e.g., July 2018 Mental Health E&M Note. In October 2015, a VA clinical psychologist conducting an examination for compensation purposes noted that symptomatology associated with the Veteran’s PTSD and MDD included, among other things, the following: flashbacks; avoidance; hyperarousal; sadness; loss of interest in activities; lack of enjoyment in activities; thoughts of death or suicide; chronic sleep impairment; social withdrawal; depressed mood; anxiety; suspiciousness; near-continuous panic or depression affecting the ability to function independently; mild memory loss; disturbances of motivation; difficulty establishing and maintaining effective work and social relationships; and difficulty adapting to stressful circumstances such as work or a work-like setting. The examiner summarized the Veteran as having occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood. In 2016, the Veteran presented to the Health Care for Homeless Veterans (HCHV) program reporting recent homelessness. Supportive Services for Veterans Families (SSVF) assisted the Veteran in finding housing shortly thereafter. In January 2017, the Veteran submitted a private medical opinion from Ms. G.U., a registered nurse practitioner, to support her claim for a TDIU. In the opinion of Ms. G.U., the Veteran’s level of physical, psychological, and cognitive disabilities indicate that she is not capable of performing substantially gainful employment presently (or in the future) in her usual vocation or any full-time work within other vocations. Coming to this conclusion, Ms. G.U. inventoried the Veteran’s PTSD and MDD symptomatology, which includes avoidance, hypervigilance, exaggerated startled response, severe depression, irritability, and daytime fatigue secondary to insomnia and nightmares. Triggers included loud noises, certain smells, sudden movements, crowds, and being in the presence of males. According to the report, the Veteran is unable to interact with others, does not attend social functions, and has difficulty establishing and maintaining effective relationships. The Veteran has difficulty concentrating/focusing and is perpetually restless. She also has a history of suicidal ideations and difficulty functioning in any environment—work or social—apart from her residence. Ms. G.U. opined that the Veteran should be considered permanently and totally disabled. As she writes, “her disabilities render her incapable of substantially gainful employment with self-financial support and vocational opportunities.” The notes from a March 2017 VA mental health consult align with the assessment by Ms. G.U. In her meeting with a VA social worker, the Veteran reported depression, nightmares about military experiences, anxiety, intrusive memories, and flashbacks. She reported extremely strong feelings of anger, fear, and horror, loss of interest in things she used to enjoy, being easily startled, and insomnia. In June 2018, the Veteran received inpatient treatment at a hospital because of depression and suicidal ideation. The final determination with respect to a Veteran’s entitlement to a TDIU is an adjudicatory function. The findings reflected throughout the Veteran’s psychological and social reports are highly probative. Under the circumstances, in light of the totality of the record, and giving due consideration to the Veteran’s description of the functional effects of her service-connected psychiatric impairments, together with service-connected impairments related to asthma, a foot injury, and allergies, as they relate to her level of education and prior occupational experience, the Board is persuaded that the Veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disability. The evidence, at a minimum, gives rise to a reasonable doubt on the matter. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. A TDIU is therefore granted. In arriving at this conclusion, the Board intimates no opinion, either legal or factual, as to the appropriate effective date of the award. That matter will be addressed by the AOJ when the award is effectuated. DAVID A. BRENNINGMEYER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD F. Lanton, Associate Counsel