Citation Nr: 18159335 Decision Date: 12/18/18 Archive Date: 12/18/18 DOCKET NO. 10-45 047 DATE: December 18, 2018 ORDER Entitlement to a rating in excess of 50 percent disabling for post-traumatic stress disorder (PTSD) prior to November 16, 2011, and in excess of 70 percent thereafter is denied. Entitlement to total disability based on individual unemployability (TDIU) prior to November 16, 2011 is denied. Entitlement to special monthly compensation (SMC) at the housebound rate under 38 U.S.C. §1114(s) from December 6, 2013 is granted. Eligibility for Dependents' Educational Assistance under 38 U.S.C. Chapter 35 prior to November 16, 2011 is denied. FINDINGS OF FACT 1. Prior to November 16, 2011, the Veteran’s PTSD was not productive of occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. 2. Prior to November 16, 2011, the Veteran does not meet the schedular requirements for an award of TDIU. 3. Following November 16, 2011, the Veteran’s PTSD was not productive of total occupational and social impairment. 4. The Veteran was awarded TDIU benefits due to PTSD, effective in November 2011, and as of December 6, 2013, the Veteran’s remaining disability had a 60 percent disabling rating. 5. Basic eligibility for Dependents’ Educational Assistance benefits did not begin prior to November 16, 2011. CONCLUSIONS OF LAW 1. Prior to November 16, 2011, the criteria for a rating in excess of 50 percent for PTSD have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.1-4.14, 4.130, Diagnostic Code (DC) 9411 (2018). 2. Following November 16, 2011, the criteria for a rating in excess of 70 percent for PTSD have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.1-4.14, 4.130, DC 9411 (2018). 3. The criteria for TDIU prior to November 16, 2011 have not been met. 38 U.S.C. §§ 5110 (a), 5107(b) (2012); 38 C.F.R. §§ 3.400, 4.16 (2018). 4. The criteria for special monthly compensation at the housebound rate are met from December 6, 2013. 38 U.S.C. § 1114 (s), 5103, 5103A, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.159, 3.350 (2018). 5. The criteria for an effective date prior to November 16, 2011, for basic eligibility for Chapter 35 Dependents’ Educational Assistance benefits, are not met. 38 U.S.C. § 5110 (West 2012); 38 C.F.R. §§ 3.310, 3.155, 3.400 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS As an initial matter, a January 2018 Court of Appeals for Veteran Claims (“Court”) Decision vacated the August 2016 Board of Veteran Appeals (“Board”) decision to the extent that it denied the Veteran a disability rating in excess of 50 percent for PTSD prior to November 16, 2011, and in excess of 70 percent thereafter, and remanded this matter for readjudication. Increased Rating Disability evaluations are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C.A. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. Where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibits symptoms that would warrant different evaluations during the course of the appeal, the assignment of staged ratings is appropriate. See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). If there is a question as to which of two evaluations should apply, the higher rating is assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. Entitlement to a rating in excess of 50 percent disabling for PTSD prior to November 16, 2011, and in excess of 70 percent disabling thereafter PTSD is evaluated under VA’s General Rating Formula for Mental Disorders. A 50 percent rating is warranted when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty 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 70 percent rating is warranted where there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; 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. A 100 percent rating is warranted when there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene), disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. The symptoms listed in the rating schedule are not intended to constitute an exhaustive list, but rather serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436 (2002). Nevertheless, all ratings in the general rating formula are associated with objectively observable symptomatology, and in Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013), the Federal Circuit stated that “a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration.” The Federal Circuit further noted that “§ 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas.” Id. Thus, “[a]lthough the veteran’s symptomatology is the primary consideration, the regulation also requires an ultimate factual conclusion as to the veteran’s level of impairment in ‘most areas.’” Id. at 118. As such, the Board will consider both the Veteran’s specific symptomatology as well as the occupational and social impairment associated with the rating code to determine whether an increased evaluation is warranted. From early 2008 until early 2009, private medical records show treatment for various physical ailments as well as depression, mood swings, and anxiety, which was noted as stable. In a September 2009 statement, the Veteran’s Vet Center social worker reported that the Veteran presented with sleep difficulties, restlessness, nightmares, fatigue, irritability, anger outbursts, anxiety, tension, suicidal thoughts with no plans, vivid memories of prior unpleasant experiences, avoidance of activities that remind him of them, memory loss, concentration problems, trouble trusting others, loss of interest in usual activities, depression, and emotional numbing. An October 2009 private medical record reflected the Veteran’s treatment for PTSD. The Veteran reported symptoms starting in November 2002, when he and a coworker were almost covered in rock fall. He started having panic attacks but did not realize what was causing them. Over time, he attributed his symptoms to this event. The Veteran also reported nightmares but was unsure what they were about. Since he retired from work, his symptoms have slowly worsened. In a November 2009 statement, the Veteran’s wife characterized the Veteran as a ball of nerves and stress since his return from Vietnam. She also stated that the Veteran has had difficulty filling time after he stopped worked due to a shoulder accident and is anxious and depressed. In November 2009, the Veteran underwent VA psychiatric examination. The Veteran reported that he receives disability benefits from the Social Security Administration (SSA) due to a “bad shoulder.” The Veteran had worked in coal mines for 26 years, showing up regularly and doing his job adequately, but stopped working in 2003 due to shoulder problems. When he worked, he got along with his coworkers but occasionally experienced some conflict with supervisors over safety issues. Nevertheless, despite speaking out about these concerns, he eventually ended up having better relationship with a couple of his bosses afterward. He also reported that he has been married for 40 years and has 3 children and 4 grandchildren. The Veteran gets along with them well but occasionally gets irritable if the grandchildren make a lot of noise, which will cause him to withdraw to get away from the irritating noise and calm down. However, he made clear that he spends a lot of time with the grandchildren. He also gets along well with his mother-in-law who has Alzheimer’s. The Veteran explained that he does not have time for many friends or interactions outside of his family but reported that he keeps busy with many leisure pursuits- such as riding his motorcycle, target shooting, and hunting. Generally, the Veteran admitted that he is on the move a lot and keeps busy running errands and going to stores or restaurants. The Veteran reported (1) frequent mild to severe anxiety when running late and going to new places and when worrying about his wife’s health; (2) depressed mood was reported 60 percent of the time, consisting of feeling sad, low, pessimistic, or negative without much to look forward to; (3) guilt with periodic angry outbursts; (4) mildly impaired impulse control in the form of cursing or loud talking or yelling but no physical violence or destructive tendencies; and (5) some sleep difficulties involving frequent awaking and periodic insomnia (notably, sleep apnea is suspected by the Veteran’s physician) with 6 to 7 hours of sleep nightly on average. Mental status examination revealed euthymic mood with mild anxiety, no impairment of thought processing, communication, delusions or hallucinations, and appropriate eye contact and behavior. Suicidal and homicidal thoughts were denied but the Veteran reported periodic thoughts of aggression toward others but denied any intent to act upon those thoughts. Memory, speech, and conduct were normal, personal hygiene was adequate, and the Veteran reported no issues with basic activities of daily living. The examiner concluded that the Veteran was mildly affected by PTSD symptoms overall, assigning a GAF score of 65. In February 2010, the Veteran underwent private psychiatric evaluation by Dr. N. D. The Veteran reported that he worked for a telephone company for 5 years, after which he worked in coal mines for 26 years until 2003 when he stopped working due to a shoulder injury. Activities of daily living included watching television, helping with household chores, running errands for necessities only, hunting, and motorcycle riding. Further, he noted that he feels hopeless, helpless, worthless, cries, and has had suicidal thoughts but has not made any definite attempts. Mental status examination showed the Veteran to be neatly and casually dressed, distant and tense, with anxious affect and depressed mood. He was oriented to time, place, person; had coherent thoughts; and related to the examiner. Concentration was impaired, speech revealed frustration, and only 3 of 5 past presidents were recalled. Intellect was noted as average, and recent and remote memory were deemed intact as were judgment and abstract reasoning. No auditory or visual hallucinations or any delusional thinking were observed. The private clinician diagnosed the Veteran with PTSD “Profound”, neurotic depression moderately severe, assigning a GAF of 45. Additionally, the clinician further observed that the Veteran experiences emotional difficulties from his service in Vietnam which affect his daily life significantly, that he did not appear to be able to handle much stress or any gainful employment, that he would not make a good candidate for vocational rehabilitation, and that he would not be able to handle any additional funds, if granted, by himself. In May 2010, the Veteran underwent VA tele-psychiatric consult. He reported trouble sleeping, bad dreams, anxiety, and depression. He stated that he gets upset if things do not go smoothly and that his grandchildren make him irritable when they scream and fight. He indicated that these symptoms have worsened since 2003 when he retired. He also stated that his mother-in-law with Alzheimer’s is a continued stressor for him and his wife. Nevertheless, the Veteran insisted that the “enjoy[s] life despite these problems” and described his relationships with his wife, children, and grandchildren as essentially good. He identified his biggest challenges as depression, impatience, and inability to deal with stress, describing his mood as being more on edge than normal. He sleeps 6 hours each night but awakes feeling tired and weak for only about an hour. Personal interests cited include working around the house, playing with a new puppy, and riding his motorcycle, which is when he feels as though all is well. Additionally, the Veteran stated that his energy has decreased the last couple of years, that concentration has been poor since his retirement, but that is appetite is good. He denied suicidal ideation, plan, or intent and denied crying episodes or feelings of worthlessness, but he clarified that he does feel hopeless or helpless about things not getting better. The Veteran stated that he visited with Dr. D for his PTSD to obtain documentation for an increased disability rating, but he did not return for any treatment from this clinician. Mental status examination showed that the Veteran was pleasant and cooperative without any psychomotor agitation or retardation. Mood and affect were mildly dysthymic with mild constriction. Thoughts were linear, logical, and goal oriented, and there was no suicidal or homicidal ideation, plan, or intent and no paranoid delusions or obsessions. Judgement was good, insight fair, memory lapses were denied, and the Veteran was fully oriented as to person, place, situation, and date. The examiner noted problems with irritability, anger, and nightmares, but the Veteran indicated that these were not his top three problems. Some signs of depression were noted but these did not yet meet full clinical criteria. A GAF of 70 was assigned. In an September 2010 statement, the Veteran reported a loss of interest in activities that he previously enjoyed but continued engagement in some of those activities, anxiety, depressed mood, inability to deal with stress, difficulty understanding instructions, little tolerance for his grandchildren, worsened memory, anger issues but no violent conduct, a highly equivocal statement concerning suicidal thoughts, difficulty making decisions, nightmares, only wanting to be friends with a few people he has met, and a dislike of crowds. In August 2010, the Veteran underwent another VA psychiatry consult because he did not feel comfortable with the VA clinician who conducted the May 2010 consult. The Veteran reported sleeping about 7 hours per night with intermittent waking due to nightmares. He stated that he is usually OK in crowds as long as he does not have to sit still. However, he reported increased startle response to loud noises. He also stated that he had been very irritable, often losing his temper with his wife and having difficulty tolerating his grandchildren. Appetite was noted as all right, energy level was low, and concentration was deemed OK. The Veteran indicated that he continued to enjoy target practicing and enjoying riding his motorcycle as well as household errands. Mental status examination revealed that the Veteran was neatly dressed and groomed, pleasant, and cooperative, who presented with no abnormal involuntary movements or psychomotor agitation or retardation. Speech was fluent and non-pressured, but he had a sad affect. Thought process was linear, logical, and goal directed with no evidence of any delusional or paranoid thinking. Suicidal or homicidal thoughts plans or intent were denied as were visual and auditory hallucinations. Judgment was fair, insight was present, and memory and attention were grossly intact. A GAF of 50 was assigned. A September 2010 VA mental health note reflected the Veteran’s reports of anxiety, depression, irritability accompanied by poor sleep, nightmares, flashbacks, and low mood. The Veteran stated that his symptoms had worsened over the last several months and stated has had suicidal thoughts and occasional plans but no intent of carrying out those plans. Mental status examination showed that the Veteran was groomed well with good hygiene, cooperative and engaged, with no psychomotor abnormalities demonstrated. Speech, thought processes, and content were normal. Homicidal ideation, intent, or plans were denied as were auditory or visual hallucinations. Mood was reported by the Veteran as depressed but his affect was deemed generally euthymic with some anxiousness and a brief period of lability when discussing irritability at home. Insight and judgment were fair, memory was grossly intact, and intelligence was average. A GAF score of 47 was assigned. In a September 2010 statement, the Veteran’s Vet Center social worker stated that the Veteran continues to present with chronic and severe PTSD symptoms, exhibiting occupational and social impairment with deficiencies in most areas such as work, family relations, judgment, memory, concentration, and mood, due to such symptoms as anxiety, dissociation, panic attacks, and major depression affecting his ability to function independently, appropriately, and effectively. The social worker further stated that the Veteran continues to have great difficulty adapting to stressful circumstances which results in behaviors of avoidance, isolation, and irritability manifesting as rage directed toward those around him, and that he has been unable to establish and maintain effective relationships, relying heavily on his wife for support. The Veteran admitted that he has had suicidal thoughts and occasionally plans. A GAF score of 45 was assigned, with a notation that minimal improvement would be expected due to the severity of the Veteran’s symptoms. A March 2011 letter from Dr. G shows that the Veteran reported depression, guilt, worthlessness, intense irritability, nightmares, flashbacks, crowd avoidance, panic-like symptoms, and poor sleep. Additionally, the Veteran stated that his mood, irritability, and avoidance of situations and encounters has had a significant impact on his life and that he is often angry with his wife and grandchildren and also avoids social situations. In June 2011, the Veteran underwent VA psychiatric examination. The Veteran reported ongoing receipt of SSA disability benefits for his shoulder injury, stating that he has not been employed since the stopped working as a coal miner. He stated that his marriage of 42 years was good overall but that there was significant stress in the family from his mother-in-law, who has Alzheimer’s and lives with the family. He acknowledged good relationships with all family members, including his 3 adult children and 4 grandchildren, whom he babysits occasionally and which he enjoys even though he gets very anxious and withdraws when they scream and fight. The Veteran stated that he has very few friends and socializes only with his family. Since the last examination, he expressed an increased loss of interest in hunting or shooting but continued enjoyment in working on and riding motorcycles. Mental status examination showed the Veteran to be neatly dressed and groomed and cooperative and appropriate during the exam. The Veteran reported an increased need for structure as when traveling someplace new and needing to know information concerning the destination and travel time. He also stated that anxiety is more problematic and that he feels tense, on edge, irritable, and jittery. Depression also was noted as problematic but less so than anxiety. The Veteran stated that his impulse is impaired, noting that his anger outbursts have become more frequent but that this is mostly situational and denied any physical aggressiveness. Sleep was disclosed as fragmented with an average of 4 to 5 hours nightly, with 1 to 2 trauma-related nightmares weekly. Affect was restricted and mood was mildly depressed. There were no impairments in thought processes or communication, long-term memory was grossly intact but some increased problems with short-term memory were reported such as forgetting to lock doors or feed the animals. Rate and flow of speech were normal, and there was no evidence of panic attacks. Suicidal and homicidal ideation was denied. The examiner characterized the Veteran’s PTSD symptoms as moderate. A GAF score of 55 was assigned. In November 2011, the Veteran and his wife testified before the undersigned during a videoconference hearing. The Veteran stated that he experiences stress, anxiety, depression, and panic attacks, which have gotten worse and worse over time. He also reported that he gets stressed out at just about anything, that something will turn up and then his grandchildren will come in and frustrate him. From June 2012 to April 2014, the Veteran participated in at least monthly group PTSD meetings at the Princeton, West Virginia Vet Center, which were conducted by a Social Worker. A treatment summary sheet shows that the Veteran received individual or group treatment beginning in 2009, but individual treatment records dating prior to June 2012 were not included. Regardless, the records provided show only general references to topics discussed during group therapy which contain no information specific to the Veteran’s PTSD symptoms. With respect to individual therapy received during this period, the records reflect treatment received in March 2013, December 2013, and March 2014. In March 2013, the Veteran reported difficulty awaking during the night after 3 to 5 hours of sleep as well as restlessness, nightmares, and irritability at least twice a week. He also stated he has difficulty expressing feelings, has vivid memories of prior unpleasant experiences, is depressed especially during the winter months, and experiences panic attack and excessive jumpiness as well as anxiety, loss of interest, and trouble trusting others. In December 2013, the Veteran stated that he underwent cardiac surgery and requested assistance in applying for service connection for ischemic heart disease, noting that he was stated he is stressed out and depressed on a daily basis as a result. In March 2014, the Veteran requested a clinical summary of his PTSD in support of his increased rating claim, and it was noted that the Veteran presented with insomnia, nightmares, irritability, anxiety, depression, panic attacks, trouble trusting others, excessive jumpiness, avoidance, and isolation. Later that same month, the Veteran was noted as continuing to present with deficiencies in memory concentration, occupational and social impairment, panic attacks, major depression, and trouble trusting others. In a March 2014 written statement, the Veteran’s Vet Center social worker stated that the Veteran exhibited occupational and social impairment with deficiencies in areas such as work, family relations judgment, memory, concentration and mood due to such symptoms as anxiety, weekly panic attacks, and major depression affecting his ability to function independently appropriately and effectively. He noted that the Veteran reported difficulties in adapting to stressful circumstances, resulting in behaviors of avoidance and isolation, and that he has been unable to establish and maintain effective relationships, has few friends, and relies heavily on his wife for support. A GAF score of 48 was assigned. In March 2014, the Veteran submitted a statement indicating that he worked the night shift to avoid the regular world and that his bosses knew that if they let him be that he would do his job well and be OK. He also stated that he could not deal with it all now. He reported being more depressed and stressed since December 2012. In March 2014, the Veteran’s daughter submitted a statement. She stated that her father, the Veteran, worked often at nights. She later came to believe that he worked night rather than day shifts due to his irritability and temperamental nature. She also reported that the Veteran did not attend school activities of his children because he did not like crowds or noise. She also stated that the Veteran is more irritable at night, is withdrawn, and struggles with anxiety and depression. In a May 2014, the Veteran again underwent private psychiatric evaluation by Dr. D., who noted that the Veteran continues to have war-related flashbacks and does not sleep well due to restlessness and war-related nightmares, resulting in feeling tired and unrested most of the time. The Veteran also reported feeling irritable, easy to anger, difficulty with crowds and loud noises, preferring to be alone. He also stated that he feels hopeless, helpless, and depressed but denied any suicidal thoughts. Difficulty concentrating and remembering were also disclosed by the Veteran. The Veteran stated that he likes to do things like cutting the grass, talking walks, watching television, and helping with household chores. Although he used to enjoy hunting, he continued to enjoy motorcycle riding. As before, Dr. D. indicated that the Veteran stopped working in coal mines in 2003 due to a shoulder injury which left him disabled. Mental status examination showed the Veteran to be neatly and casually dressed with flat affect and depressed mood, but he was oriented to place, person, time, and situation. He presented with a poverty of thoughts, had difficulty relating with the examiner, and his speech revealed frustration. Concentration was impaired, and he could only recall 3 of the last 5 presidents. Impersonal judgment was intact, abstract reasoning was appropriate, and knowledge was adequate as was insight. No auditory or visual hallucinations or any delusional thinking were observed. The private clinician diagnosed the Veteran with PTSD severe, assigning a GAF of 40. Additionally, the clinician further observed that he does not appear to be able to handle much stress and is unable to handle any gainful employment. In September 2014, the Veteran again underwent VA examination, wherein the examiner diagnosed the Veteran with PTSD and major depressive disorder, finding that the symptoms for each psychiatric condition could be differentiated. The Veteran reported that his marriage to his wife of 45 years is “pretty good,” excepting certain financial and health issues, and that they occasionally go out. His three adult children live fairly close and he babysits all four of his grandchildren daily, which is stressful for him. A typical day of activities consists of feeding his donkey and fish. He stopped shooting and hunting due to lost interest in those activities, but still rides his motorcycles weekly with his neighbor. Otherwise, the Veteran does not like to be around people much. He previously worked as a coal miner until he injured his shoulder and receives SSA disability benefits as a result. The examiner identified the following active symptoms of the Veteran’s psychiatric condition: depressed mood, anxiety, chronic sleep impairment, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. Mental status examination showed the Veteran to be cooperative and well-groomed with good hygiene. Mood was dysphoric, affect depressed, but psychomotor, speech, and thought processes and content appeared normal and appropriate. Immediate and remote memory was intact. The Veteran denied any hallucinations, delusions, and any suicidal or homicidal ideation. The examiner found that the Veteran’s psychiatric conditions both, indistinguishably, resulted in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. Nevertheless, the examiner also concluded that the Veteran’s PTSD primarily impairs his family and social relationships, leading to low mood, but does not preclude his ability to obtain, or maintain, substantially gainful employment as evidenced by his ability to maintain a job for over 20 years until he was injured. In June 2015, Dr. D. opined that the Veteran is unable to handle any gainful employment due to his inability to tolerate even minimal stress, noting the Veteran’s difficulty with concentrating and remembering. Following a review of the record, the Board finds an increased rating for PTSD is not warranted. The Veteran’s symptomatology does not demonstrate occupational and social impairment, with deficiencies in most areas, due to symptoms commensurate with those set out in the rating schedule for a 70 percent evaluation, for the period prior to November 16, 2011. See 38 C.F.R. § 4.130, DC 9411. Medical evidence prior to this date indicates that the symptoms described by the Veteran are best contemplated in the 50 percent rating, predominantly manifested by anxiety, depression, sleep difficulties, nightmares, irritability, mild impulse control, and anger. For this period, none of the lay or medical evidence in the record suggests that the Veteran’s symptoms or their effects included 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; or spatial disorientation; neglect of personal appearance and hygiene. The Board notes that, for this time period, it places greater probative value on the findings of the June 2011 VA examination report, versus other evidence/medical opinions received during the relevant time period. Less weight is accorded to the February 2010 opinion of Dr. D., as the PTSD symptoms noted in his report do not support his finding that the Veteran suffers from profound PTSD. Indeed, the Veteran appeared to be functioning well in the context of his busy family. The September 2009 and September 2010 opinions from the Veteran’s Vet Center social worker have a similar deficiency, and the Veteran’s symptoms of anxiety, dissociation, panic attacks, and major depression are those contemplated in his current disability rating for the period. With regard to the Veteran’s GAF scores, which during this period ranged from the mid 40’s to 79, the Board does not consider these to be significative unto themselves, except when considered in light of the actual symptoms described that form the basis for these scores. As noted above, the the June 2011 VA examination report in which the examiner assigned a GAF score of 55 corresponds to the Appellant’s moderate symptoms described therein. Dr. D.’s February 2010 opinion that contained a GAF score of 45 and other low numbers are incongruent with most of the symptoms accompanying the GAF score. With respect to several instances in the record where the Veteran indicated suicidal ideation and the appellant representative argues that this warrants a higher rating, the Board finds that while there are occasions when providers noted suicidal ideation, these do not control the outcome as the September 2009 reference did not provide any explanation or detail, the February 2010 notation described no effects of such thoughts, and the September 2010 suicidal ideation statements made by the Veteran are contradicted by statements made by the Veteran in the same month in a VA treatment note initiating mental treatment. The Veteran otherwise consistently denied suicidal ideation in VA treatment notes, denied suicidal ideation on his November 2009 initial PTSD examination, the June 2011 review examination for PTSD, and his November 2011 Board hearing. In addition, the Board finds that following November 16, 2011, the evidence of record is devoid of any indication of 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 own name; or any other symptoms that would be indicative of a maximum 100 percent rating. Indeed, the symptoms the Veteran’s experienced during this period, namely insomnia, nightmares, irritability, anxiety, depression, panic attacks, trouble trusting others, excessive jumpiness, avoidance, and isolation, are contemplated in his current 70 percent rating. The Board realizes that the symptoms noted in the rating criteria are not intended to be an exhaustive list, but are examples of the types and severity of symptoms that indicate a certain level of disability. Thus, based on the overall record, including the Veteran lay statements and several private psych evaluations, the effects of the Veteran’s PTSD symptoms were described to be of a type, frequency, and severity that are in accord with the level of impairment contemplated by the criteria for a 50 percent rating prior to November 16, 2011, and 70 percent thereafter. In other words, the most probative evidence of record shows that the Veteran’s symptoms were of the similar type, frequency, and severity as those associated with a 50 percent rating prior to November 16, 2011, and 70 percent thereafter. With regards to the effective date of November 16, 2011, the Board notes that the AOJ established this date as the effective date and the Board would not entertain assigning a lower rating than what the AOJ has assigned. Therefore, the Board approaches the appeal as the RO presents it. Based on a review of all the evidence, it is not shown the criteria for higher ratings at any time during the appeal period beyond what the AOJ had determined were met. Entitlement to TDIU prior to November 16, 2011. The Veteran’s representative contends that the Veteran is entitled to TDIU from September 17, 2009, to November 16, 2011. As an initial matter, the Board notes that the Veteran is currently in receipt of TDIU from November 16, 2011. Total disability ratings for compensation based upon individual unemployability may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more disabilities, provided that at least one disability is ratable at 40 percent or more and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. See 38 C.F.R. §§ 3.340, 3.341, 4.16(a). However, the Veteran does not meet the minimum percentage requirements, set forth in 38 C.F.R. § 4.16(a), for award of a TDIU prior to November 16, 2011. Prior to this date the Veteran was only service-connected for PTSD at 50 percent. As such, he does not meet the schedular requirements for the assignment of a TDIU during the period in question. Further, the Board also brings attention to the Veteran’s own contention that his non service-connected shoulder injury caused him to stop working as a coal miner. Accordingly, TDIU is not granted prior November 16, 2011. Entitlement to SMC SMC “statutory” housebound, pursuant to 38 U.S.C. § 1114 (s), is granted, as applicable, when a veteran has a single disability rated as total and additional service-connected disability or disabilities independently ratable at 60 percent or more. The Court has held that although a TDIU rating may satisfy the “rated as total” element of section 1114(s), a TDIU based on multiple underlying disabilities cannot satisfy the section 1114(s) requirement of “a service-connected disability” because that requirement must be met by a single disability. However, the Court’s decision in Bradley also recognized that if the evidence supported a TDIU rating based solely upon a single service-connected disability (rated less than 100 percent under the rating schedule), then such a finding of TDIU may serve as the factual predicate for an award of SMC pursuant to section 1114(s). See Bradley v. Peake, 22 Vet. App. 280, 293 (2008); see also Buie v. Shinseki, 24 Vet. App. 242, 247-251 (2011). In this case, the Board awarded TDIU based on impairment arising from both service-connected PTSD and CAD. However, the RO made TDIU effective from November 2011, well before service connection for CAD in December 2013. Based on the foregoing, the Board finds that PTSD alone served as a basis for the grant of TDIU benefits, thus, resolving any doubt in the Veteran’s favor, the Board finds that although his PTSD is not at 100 percent under the rating schedule, for SMC purposes this disability satisfies the requirement of a “service-connected disability rated as total.” See Buie v. Shinseki, 24 Vet. App. at 251; see also Bradley v. Peake, 22 Vet. App. at 293. Because the Veteran has a single service-connected disability rated as total (i.e., his service-connected PTSD which alone rendered him unemployable), and has an additional service-connected disability that is independently rated at least 60 percent (i.e. coronary artery disease), the criteria for SMC at the housebound rate were met as of December 6, 2013, the date the Veteran was service-connected at 60 percent disabling for coronary artery disease. Eligibility for Dependents' Educational Assistance under 38 U.S.C. Chapter 35 prior to November 16, 2011. Survivors’ and Dependents’ Educational Assistance is a program of education or special restorative training that may be authorized for an eligible person, such as a surviving spouse, if the applicable criteria are met. 38 U.S.C. §§ 3500, 3501 (West 2012); 38 C.F.R. §§ 21.3020, 21.3021 (2018). Basic eligibility for certification of Dependents’ Educational Assistance exists if the veteran was discharged from service under conditions other than dishonorable, or died in service, and either (1) has a permanent total service-connected disability, or (2) a permanent total service-connected disability was in existence at the date of the veteran’s death, or (3) died as a result of a service-connected disability, or, if a service member (4) is on active duty as a member of the Armed Forces and, for a period of more than 90 days, has been listed by VA concerned as missing in action, captured in line of duty by a hostile force, or forcibly detained or interned in the line of duty by a foreign government or power. 38 C.F.R. § 3.807 (2018). Regarding the claim of entitlement to an earlier effective date for Dependents’ Educational Assistance benefits pursuant to 38 U.S.C., Chapter 35, the Board finds that an effective date prior to November 16, 2011 for basic eligibility for Chapter 35 Dependents’ Educational Assistance benefits, is not warranted. The only method of eligibility for Chapter 35 benefits which is relevant to the Veteran is through having service-connected disability which has been rated 100 percent or to have been granted TDIU. The Veteran was initially awarded eligibility to Dependents’ Educational Assistance effective November 16, 2011, based upon the finding that as of that date, he was permanently unable to secure or follow a substantially gainful occupation, and was thus entitled to a total disability evaluation based on individual employability due to his service connected PTSD. The effective date for Dependents’ Educational Assistance benefits was directly predicated on finding that the Veteran had a permanent and total disability due to service connected disabilities, and because of the Board’s current finding that the Veteran is not entitled to TDIU prior to November 16, 2011, the Board finds that November 16, 2011 is the earliest date on which the Veteran could establish eligibility for Chapter 35 benefits. Accordingly, entitlement to an earlier effective date for Dependents’ Educational Assistance benefits is denied. M. E. KILCOYNE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R.A. Elliott II, Associate Counsel