Citation Nr: 18159431 Decision Date: 12/20/18 Archive Date: 12/19/18 DOCKET NO. 17-46 081 DATE: December 20, 2018 ORDER Entitlement to a higher initial evaluation for aortic heart valve disease (heart disability), in excess of 60 percent from November 18, 2003, to October 6, 2006, and in excess of 30 percent from October 6, 2006, to September 23, 2013, is denied. A higher initial evaluation of 100 percent for the Veteran’s heart disability, for the period from September 23, 2013, is granted. Entitlement to a higher initial evaluation for hypertension, in excess of 0 percent, from November 18, 2003 to August 29, 2006, in excess of 10 percent, from August 29, 2006, to June 5, 2007, in excess of 0 percent, from June 5, 2007 to November 25, 2014, in excess of 10 percent, from November 25, 2014, to October 20, 2015, in excess of 0 percent, from October 20, 2015 to July 10, 2017, and in excess of 10 percent, from July 10, 2017, is denied. Entitlement to a higher initial evaluation for depressive disorder (psychiatric disability) in excess of 50 percent, from November 18, 2003, to December 19, 2013, in excess of 0 percent, from December 19, 2013 to September 16, 2016, and in excess of 30 percent, from September 16, 2016, is denied. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU), for the period prior to September 23, 2013, is granted. FINDINGS OF FACT 1. For the period from November 18, 2003, to October 6, 2006, the Veteran’s heart disability was not productive of congestive heart failure, a workload of 3 METs or less that results in dyspnea, fatigue, angina, dizziness, or syncope, or left ventricular dysfunction with an ejection fraction of less than 30 percent. 2. For the period from October 6, 2006, to September 23, 2013, the Veteran’s heart disability was not productive of congestive heart failure symptoms or episodes, a workload of 5 METs or less that results in dyspnea, fatigue, angina, dizziness, or syncope, or left ventricular dysfunction with an ejection fraction of less than 50 percent. 3. For the period from September 23, 2013, the Veteran’s heart disability has been productive of chronic congestive heart failure. 4. For the periods from November 18, 2003, to August 29, 2006, from June 5, 2007, to November 25, 2014, and from October 20, 2015, to July 10, 2017, the Veteran’s hypertension was not productive of diastolic pressure predominantly 100 or more, systolic pressure predominantly 160 or more, or a history of diastolic pressure predominantly 100 or more controlled by medication. 5. For the periods from August 29, 2006, to June 5, 2007, from November 25, 2014, to October 20, 2015, and from July 10, 2017, the Veteran’s hypertension has not productive of diastolic pressure predominantly 110 mm or more, or systolic pressure predominantly 200 mm or more. 6. For the period from November 18, 2003, to December 19, 2013, the Veteran’s psychiatric disability was not productive of occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, or mood. 7. For the period from December 19, 2013 to September 16, 2016, the Veteran’s psychiatric disability was not productive of occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication. 8. For the period from September 16, 2016, the service-connected psychiatric disability has not been productive of occupational and social impairment with reduced reliability and productivity. 9. For the period on appeal prior to September 23, 2013, the schedular criteria for a TDIU are met, and the Veteran is unable to secure and follow substantially gainful employment due to the service-connected disabilities. 10. The issue of entitlement to a TDIU for the period from September 23, 2013, is rendered moot by the grant of a 100 percent schedular disability rating for the service-connected heart disability for the same period. CONCLUSIONS OF LAW 1. The criteria for a higher initial evaluation for the Veteran’s heart disability, in excess of 60 percent from November 18, 2003, to October 6, 2006, and in excess of 30 percent from October 6, 2006, to September 23, 2013, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.104, Diagnostic Code 7000 (2018). 2. Resolving reasonable doubt in the Veteran’s favor, the criteria for a 100 percent evaluation for the Veteran’s heart disability, for the period from September 23, 2013, have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.104, Diagnostic Code 7000 (2018). 3. The criteria for a higher initial evaluation for hypertension, in excess of 0 percent, from November 18, 2003 to August 29, 2006, in excess of 10 percent for the period from August 29, 2006, to June 5, 2007, in excess of 0 percent for the period from June 5, 2007 to November 25, 2014, in excess of 10 percent for the period from November 25, 2014, to October 20, 2015, in excess of 0 percent for the period from October 20, 2015 to July 10, 2017, and in excess of 10 percent for the period from July 10, 2017, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.104, Diagnostic Code 7101 (2018). 4. The criteria for a higher initial evaluation for the service-connected psychiatric disability, in excess of 50 percent for the period from November 18, 2003, to December 19, 2013, in excess of 0 percent for the period from December 19, 2013 to September 16, 2016, and in excess of 30 percent for the period from September 16, 2016, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A; 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.130, Diagnostic Code 9435 (2018). 5. Resolving reasonable doubt in the Veteran’s favor, the criteria for entitlement to TDIU have been met for the period on appeal prior to September 23, 2013. 38 U.S.C. § 1155, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1960 to August 1963. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a March 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) located in Atlanta, Georgia. The Detroit, Michigan RO has jurisdiction of the current appeal. Although not developed as a distinct issue, the issue of entitlement to a TDIU is a component of the initial rating claims on appeal in accordance with Rice v. Shinseki, 22 Vet. App. 447 (2009) (where there is evidence of unemployability raised by the record during a rating appeal period, the TDIU is an element of an initial rating or increased rating). In this case, this issue has been raised by the record, as explained below. Increased Rating Disability ratings 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. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran. See 38 C.F.R. § 4.3. Staged ratings are appropriate when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119 (1999). 1. Higher initial evaluation for heart disability The Veteran seeks a higher evaluation for his service-connected heart disability. He is in receipt of a 60 percent rating from November 18, 2003, to October 6, 2006, a 30 percent from October 6, 2006, to September 23, 2013, a 60 percent rating from September 23, 2013, to November 6, 2015, a 30 percent rating from November 6, 2015, to December 22, 2016, and a 60 percent rating from December 22, 2016, under 38 C.F.R. § 4.104, DC 7000. Under DC 7000, a 10 percent evaluation is assigned for a workload greater than 7 METs but not greater than 10 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope, or continuous medication required. A 30 percent evaluation is warranted for a workload of greater than 5 METs but not greater than 7 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope; or evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray. A 60 percent evaluation is warranted for more than one episode of acute congestive heart failure in the past year, or workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent. A 100 percent rating is warranted for chronic congestive heart failure, or when a workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent. 38 C.F.R. § 4.104, DC 7000. One MET is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. When the level of METs at which dyspnea, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, an estimation by a medical examiner of the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in dyspnea, fatigue, angina, dizziness, or syncope may be used. 38 C.F.R. § 4.104, Note 1. The Board finds that the evidence weighs against finding that an initial evaluation in excess of 60 percent is warranted for the Veteran’s heart disability for the period from November 18, 2003, to October 6, 2006. A higher 100 percent rating is available for chronic congestive heart failure, a workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, left ventricular dysfunction with an ejection fraction of less than 30 percent. The evidence weighs against such manifestations. A December 2003 VA echocardiogram (ECG) noted a left ventricular ejection fraction of 30 percent. See also March 2005 VA treatment record (showing an ejection fraction of 30 percent and a workload capacity of more than 4 METs). An April 2005 VA treatment record noted a left ventricular ejection fraction of at least 45 to 50 percent. See also October 2005 VA treatment record. A September 2005 VA treatment record showed that the Veteran did not have dyspnea, or any symptoms of congestive heart failure within the previous 30 days. VA treatment records dated in March 2006 and May 2006 noted an ejection fraction of 55 percent. Based on the foregoing, the Board finds that, for the period from November 18, 2003, to October 6, 2006, the Veteran’s heart disability was not productive of congestive heart failure, a workload of 3 METs or less that results in dyspnea, fatigue, angina, dizziness, or syncope, or left ventricular dysfunction with an ejection fraction of less than 30 percent. For these reasons, the Board finds that an evaluation in excess of 60 percent for the Veteran’s heart disability is not warranted for the period from November 18, 2003, to October 6, 2006. 38 C.F.R. §§ 4.3, 4.7, 4.104, DC 7000. The Board finds that the evidence weighs against finding that an initial evaluation in excess of 30 percent is warranted for the Veteran’s heart disability for the period from October 6, 2006, to September 23, 2013. Higher evaluations are available for congestive heart failure, or when a workload of 5 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or left ventricular dysfunction with an ejection fraction of less than 50 percent. The evidence weighs against such manifestations. An April 2007 VA ECG indicated a left ventricular ejection fraction of 60 percent, with left ventricular hypertrophy. See also December 2007 VA ECG. An August 2010 VA examination report noted that an ECG indicated a left ventricular ejection fraction of 55 percent, with left ventricular hypertrophy. Based on the foregoing, the Board finds that, for the period from October 6, 2006, to September 23, 2013, the Veteran’s heart disability was not productive of congestive heart failure symptoms or episodes, a workload of 5 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or left ventricular dysfunction with an ejection fraction of less than 50 percent. For these reasons, the Board finds that an evaluation in excess of 30 percent for the Veteran’s heart disability is not warranted for the period from October 6, 2006, to September 23, 2013. 38 C.F.R. §§ 4.3, 4.7, 4.104, DC 7000. After a review of all the evidence, the Board finds that the evidence is in relative equipoise that an evaluation of 100 percent is warranted for the Veteran’s heart disability for the period from September 23, 2013. In this regard, the Board finds that the evidence is in relative equipoise that the Veteran’s heart disability has been productive of chronic congestive heart failure since September 23, 2013. VA treatment records show that the Veteran was hospitalized for one week during September 2013 as a result of congestive heart failure. In December 2013, VA received an ischemic heart disease disability benefits questionnaire (DBQ), which was completed by Veteran’s treating VA physician, Dr. R.T., in November 2013. Dr. R.T. noted that the Veteran’s congestive heart failure is chronic, and indicated that the Veteran’s left ventricular ejection fraction is 35 percent to 40 percent. VA treatment records in 2014 and 2015 show continued treatment for congestive heart failure. See, e.g., February 2014, May 2014, August 2014, November 2014, and February 2015 VA treatment records. Based on the foregoing, and resolving all reasonable doubt in the Veteran’s favor, the Board finds that a 100 percent evaluation is warranted for the Veteran’s heart disability for the period from September 23, 2013. 38 C.F.R. §§ 4.3, 4.7, 4.104, DC 7000. This constitutes a full grant of the benefit sought on appeal pertaining to the heart disability for the period from September 23, 2013, because the 100 percent evaluation assigned herein is the maximum evaluation provided under the law for the Veteran’s heart disability. 2. Higher initial evaluation for hypertension The Veteran seeks a higher evaluation for his service-connected hypertension. He is in receipt of a 0 percent evaluation from November 18, 2003 to August 29, 2006, a 10 percent evaluation from August 29, 2006, to June 5, 2007, a 0 percent rating from June 5, 2007 to November 25, 2014, a 10 percent evaluation from November 25, 2014, to October 20, 2015, a 0 percent evaluation from October 20, 2015 to July 10, 2017, and a 10 percent evaluation from July 10, 2017, under 38 C.F.R. § 4.104, DC 7101. Under DC 7101, a 10 percent evaluation is warranted for diastolic pressure predominantly 100 or more, systolic pressure predominantly 160 or more, or for a history of diastolic pressure predominantly 100 or more controlled by medication. A 20 percent evaluation is warranted for diastolic pressure predominantly 110 or more or systolic pressure predominantly 200 or more. A 40 percent evaluation is warranted for diastolic pressure predominantly 120 or more. A maximum 60 percent rating is warranted for diastolic pressure predominantly 130 or more. The Board finds that the evidence weighs against finding that a compensable evaluation is warranted for the Veteran’s hypertension for the periods from November 18, 2003, to August 29, 2006, from June 5, 2007, to November 25, 2014, and from October 20, 2015, to July 10, 2017. Higher ratings are available for hypertension that is productive of diastolic pressure predominantly 100 or more, systolic pressure predominantly 160 or more, or a history of diastolic pressure predominantly 100 or more controlled by medication. The evidence weighs against such manifestations. An August 2010 VA examination report noted blood pressure readings of 128/84 mm, and an August 2014 VA examination report noted blood pressure readings of 140/80 mm. VA treatment records during the above-referenced periods reflect pertinent blood pressure readings as follows: 126/82 mm in February 2004, 148/68 mm in June 2004, 158/88 mm in September 2004, 126/60 mm in January 2005, 170/104 mm in February 2005, 162/89 mm and 140/92 mm in March 2005, 146/94 mm in June 2005, 151/84 mm in October 2005, 138/80 mm in March 2006, and 168/98 mm in May 2006, 143/89 mm in June 2007, 133/85 mm in December 2007, 126/81 mm in August 2008, 135/87 mm in February 2009, 123/87 mm in December 2009, 112/83 mm in July 2010, 135/85 mm in December 2010, 123/78 mm in June 2011, 111/73 mm in March 2012, 138/89 mm in October 2012, 133/79 mm in March 2013, 154/90 mm in June 2013, 145/88 mm in October 2013, 161/96 mm in December 2013, 143/99 mm in February 2014, 134/86 mm in September 2014, 131/81 mm in October 2015, 152/91 mm in December 2015, 139/88 mm in January 2016, 134/91 mm in June 2016, 140/85 mm in September 2016, 145/74 mm in December 2016, and 114/68 mm in March 2017. Based on the foregoing, the evidence does not demonstrate that the Veteran’s hypertension more nearly approximated the criteria for a compensable rating at any point during the periods from November 18, 2003, to August 29, 2006, from June 5, 2007, to November 25, 2014, and from October 20, 2015, to July 10, 2017. Accordingly, a compensable rating for hypertension is not warranted during these periods. 38 C.F.R. §§ 4.3, 4.7, 4.104, DC 7101. The Board finds that the evidence weighs against finding that an evaluation in excess of 10 is warranted for the Veteran’s hypertension for the periods from August 29, 2006, to June 5, 2007, from November 25, 2014, to October 20, 2015, and from July 10, 2017. Higher ratings are available for hypertension that is productive of diastolic pressure predominantly 110 mm or more, or systolic pressure predominantly 200 mm or more. The evidence weighs against such manifestations. VA treatment records during the above-referenced periods reflect pertinent blood pressure readings as follows: 186/112 mm, 160/98 mm, 196/104 mm, and 200/114 mm in September 2006, as well as 157/109 mm and 147/100 mm in March 2007, 163/93 in November 2014, 183/101 in February 2015, and 177/97 in September 2015. A July 2017 VA examination report noted blood pressure readings of 187/92 mm, 172/87 mm, and 156/82 mm, with an average blood pressure reading of 171/87 mm. Based on the foregoing, the evidence does not demonstrate that the Veteran’s hypertension more nearly approximated the criteria for an evaluation in excess of 10 percent at any point during the periods from August 29, 2006, to June 5, 2007, from November 25, 2014, to October 20, 2015, and from July 10, 2017. Accordingly, an evaluation in excess of 10 percent for hypertension is not warranted during these periods. 38 C.F.R. §§ 4.3, 4.7, 4.104, DC 7101. For these reasons, the Board finds that a higher initial evaluation for the Veteran’s hypertension, in excess of 0 percent, from November 18, 2003 to August 29, 2006, in excess of 10 percent, from August 29, 2006, to June 5, 2007, in excess of 0 percent, from June 5, 2007 to November 25, 2014, in excess of 10 percent, from November 25, 2014, to October 20, 2015, in excess of 0 percent, from October 20, 2015 to July 10, 2017, and in excess of 10 percent, from July 10, 2017, is not warranted, and the appeal is, therefore, denied. 38 C.F.R. §§ 4.3, 4.7, 4.104, DC 7101. 3. Higher initial evaluation for psychiatric disability The Veteran seeks a higher evaluation for his service-connected psychiatric disability. He is in receipt of a 50 percent rating from November 18, 2003, to December 19, 2013, a 0 percent rating from December 19, 2013 to September 16, 2016, and a 30 percent rating from September 16, 2016, under 38 C.F.R. § 4.130, DC 9435. All psychiatric disabilities are evaluated under a general rating formula for mental disorders. Under the general rating formula, a 10 percent rating is warranted for occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication. A 30 percent rating is warranted for 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, or recent events). A 50 percent rating is warranted for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g. retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing effective work and social relationships. A 70 percent rating is warranted for occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, 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 an unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); and inability to establish and maintain effective relationships. A total schedular rating of 100 percent is warranted for 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 mental and personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. The list of symptoms under the rating criteria are meant to be examples of symptoms that would warrant the rating, but are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002). If the evidence shows that the Veteran suffers symptoms or effects that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the criteria for a particular rating, the appropriate equivalent rating will be assigned. Id. at 443. Furthermore, the rating code requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment at a level consistent with the assigned rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). One factor for consideration is the Global Assessment Functioning (GAF) score, which is based on a scale reflecting the “psychological, social, and occupational functioning in a hypothetical continuum of mental health-illness.” See Carpenter v. Brown, 8 Vet. App. 240, 242 (1995); see also Richard v. Brown, 9 Vet. App. 266, 267 (1996) (citing the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (4th ed.), p. 32). Scores ranging from 61-70 indicate some mild symptoms (e.g., depressed mood and mild insomnia) or some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally good functionality with meaningful interpersonal relationships. 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). Scores ranging from 41 to 50 reflect serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in social, occupational or school functioning (e.g., no friends, unable to keep a job). A GAF score ranging from 31 to 40 indicates that there is some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) or major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed man avoids friends, neglects family, and is unable to work). A score ranging from 21 to 30 represents a person who demonstrates behavior that is considerably influenced by delusions or hallucinations or has serious impairment in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation), or has the inability to function in most areas (e.g., stays in bed all day; no job, home, or friends). The Board finds that an evaluation in excess of 50 percent is not warranted for the Veteran’s psychiatric disability for the period from November 18, 2003, to December 19, 2013. Higher evaluations are available for occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, or mood, or for total occupational and social impairment. The Board finds that the evidence weighs against manifestations of such severity. VA treatment records during this period show treatment for depression. See, e.g., December 2003, June 2004, April 2005, October 2006, July 2007, September 2008, May 2009, June 2010, September 2011, March 2012, and October 2013 VA treatment records. However, the evidence does not show near continuous panic or depression affecting the ability to function independently, appropriately and effectively. Aside from some depression, the Veteran’s conversation, behavior, and self-care have been routine and normal. A July 2003 VA treatment record shows that the Veteran reported experiencing psychiatric symptoms of low energy/motivation, increased anxiety and worry about his future, crying spells (two in the previous month), and denied suicidal ideation, homicidal ideation, delusions, and hallucinations. The Veteran stated that he had no problem establishing and maintaining relationships, and that he had good relationships with all his family members. Upon examination, the Veteran was noted to be anxious and depressed, was diagnosed with adjustment disorder and depression, and assigned a GAF score of 50. Based on the foregoing, the totality of the evidence, to include the Veteran’s treatment records, show that the frequency and severity of the Veteran’s psychiatric symptoms has not resulted in social and occupational impairment that more nearly approximates the criteria for a 70 percent evaluation for the period from November 18, 2003, to December 19, 2013. 38 C.F.R. §§ 4.3, 4.7, 4.130, DC 9435. The Board next finds that an evaluation in excess of 0 percent is not warranted for the Veteran’s psychiatric disability for the period from December 19, 2013 to September 16, 2016. A 10 percent rating is warranted for occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication. However, the evidence weighs against such manifestations. A December 2013 VA treatment record shows that the Veteran had no obvious or reported obvious difficulty in employment, social, or daily living situations. A February 2014 VA treatment record shows that the Veteran was oriented to all three spheres, with calm and cooperative behavior, normal attention span, and intact judgment. A March 2014 VA treatment record noted that the Veteran appeared to be doing well from a mental status perspective, and that the Veteran stated that he was “feeling good.” An August 2014 VA treatment record noted no obvious symptoms of depression, agitation, or psychosis. A January 2016 VA examination report noted that the Veteran did not have any psychiatric treatment since December 18, 2013, and was not on any psychiatric medication. It was assessed that the Veteran did not have any psychiatric symptoms or diagnosis. The examiner noted that symptoms of the Veteran’s previously-diagnosed psychiatric disability were not severe enough to interfere with occupational and social functioning or require continuous medication. This evidence is consistent with a noncompensable evaluation under the general rating formula for mental disorders. Based on the foregoing, the totality of the evidence, to include the Veteran’s treatment records, demonstrates that the Veteran did not have any psychiatric complaints, symptoms, or diagnosis for the period from December 19, 2013 to September 16, 2016. Accordingly, a compensable evaluation is not warranted for the Veteran’s psychiatric disability for this period. 38 C.F.R. §§ 4.3, 4.7, 4.130, DC 9435. The Board finds that an evaluation in excess of 30 percent is not warranted for the Veteran’s psychiatric disability for the period from September 16, 2016. Higher ratings are available for occupational and social impairment with reduced reliability and productivity; for occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, or mood; or for total occupational and social impairment. The evidence weighs against such manifestations. The Veteran underwent a VA mental health examination in July 2017. He reported that his relationships with his family were great. The examiner assessed occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication. This level of occupational and social impairment is consistent with a 10 percent rating under the general rating formula for mental disorders. It was noted that the Veteran had symptoms of depressed mood, anxiety, and disturbances to motivation and mood. Symptoms of depressed mood and anxiety are listed under the 30 percent rating criteria under the general rating formula for mental disorders. While the symptom of disturbances to motivation and mood is listed under the 50 percent rating criteria, the totality of the evidence demonstrates that the frequency and severity of the Veteran’s psychiatric symptoms do not otherwise rise to the level of social and occupational impairment as required for a 50 percent evaluation under the general rating formula for mental disorders. Based on the foregoing, the totality of the evidence, to include the Veteran’s treatment records, show that the frequency and severity of the Veteran’s psychiatric symptoms has not resulted in social and occupational impairment that more nearly approximates the criteria for a 50 percent evaluation for the period from September 16, 2016. 38 C.F.R. §§ 4.3, 4.7, 4.130, DC 9435 For these reasons, the Board finds that an evaluation in excess of 50 percent, from November 18, 2003, to December 19, 2013, in excess of 0 percent, from December 19, 2013 to September 16, 2016, and in excess of 30 percent, from September 16, 2016, for the service-connected psychiatric disability is not warranted, and the appeal is, therefore, denied. 38 C.F.R. §§ 4.3, 4.7, 4.130, DC 9435. 4. TDIU prior to September 23, 2013 The Veteran contends that he is unemployable due to the service-connected disabilities, and is therefore entitled to TDIU. Total disability ratings for compensation may be assigned where the schedular rating is less than total, and the disabled person is unable to secure or follow a substantially gainful occupation as a result of the service-connected disabilities. Marginal employment is not considered substantially gainful employment. 38 C.F.R. § 4.16(a). Substantially gainful employment means, essentially, that the work provides income above the poverty level established by the United States Department of Commerce, without benefit of protected family employment or a sheltered workshop. 38 C.F.R. § 4.16(a). There is no requirement that employment be in a certain field or provide a certain standard of living or income level beyond the poverty level. Basic eligibility is established where there is one disability rated 60 percent or more, or multiple disabilities rated at least a combined 70 percent, with one disability rated at least 40 percent. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). In this case, the Veteran is service connected for aortic heart valve disease rated as 60 percent disabling from November 18, 2003, to October 6, 2006, and 30 percent disabling from October 6, 2006, to September 23, 2013. Moreover, the Board has granted herein a 100 percent for the heart disability from September 23, 2013. The Veteran is service connected for hypertension rated 0 percent disabling from November 18, 2003 to August 29, 2006, 10 percent disabling from August 29, 2006, to June 5, 2007, 0 percent disabling from June 5, 2007 to November 25, 2014, 10 percent disabling from November 25, 2014, to October 20, 2015, 0 percent disabling from October 20, 2015 to July 10, 2017, and 10 percent disabling from July 10, 2017. The Veteran is also service connected for a depressive disorder rated 50 percent disabling from November 18, 2003, to December 19, 2013, 0 percent disabling from December 19, 2013 to September 16, 2016, and 30 percent disabling from September 16, 2016. As noted above, the Board has granted herein a 100 percent schedular disability rating for the service-connected heart disability from September 23, 2013. Assignment of a total schedular rating does not automatically render a TDIU claim moot. See Bradley v. Peake, 22 Vet. App. 280 (2008) (holding that there could be a situation where a veteran has a schedular total rating for a particular service-connected disability, and could establish a TDIU rating for another service-connected disability in order to qualify for special monthly compensation (SMC) under 38 U.S.C. § 1114 (s) (West 2014) by having an “additional” disability of 60 percent or more (“housebound” rate)). In Bradley, the Court found that a TDIU was warranted in addition to a schedular 100 percent evaluation where the TDIU had been granted for a disability other than the disability for which a 100 percent rating was in effect. Under those circumstances, there was no “duplicate counting of disabilities.” Bradley, 22 Vet. App. at 293. The facts of this case are distinguishable from the facts in Bradley. Notwithstanding the schedular 100 percent rating assigned for the Veteran’s service-connected heart disability, his other service-connected disabilities alone or together do not meet the criteria for the assignment of a TDIU during the period from September 23, 2013, nor have they been shown to render him unable to secure or follow a substantially gainful occupation apart from the heart disability. As explained below, the award of TDIU is based on all of the Veteran’s service-connected disabilities, to include the heart disability. Therefore, to award a separate TDIU rating for the period from September 23, 2013, in addition to the schedular 100 percent rating based on the Veteran’s service-connected heart disability would result in duplicate counting of disabilities. 38 C.F.R. § 4.14 (2018). As such, the issue of entitlement to a TDIU for the period from September 23, 2013, is rendered moot by the grant of a 100 percent schedular disability rating for the service-connected heart disability for the period from September 23, 2013. Sabonis v. Brown, 6 Vet. App. 426 (1994). Accordingly, the Board will now address the issue of entitlement to a TDIU for the period prior to September 23, 2013. With respect to the period prior to September 23, 2013, under the application of 38 C.F.R. § 4.25, the Veteran’s total combined rating is 80 percent from November 18, 2003 to August 30, 2006, 90 percent from August 30, 2006 to October 6, 2006, 80 percent from October 6, 2006, to October 25, 2006, and 70 percent from October 25, 2006, to September 23, 2013. Therefore, the TDIU schedular eligibility requirements under 38 C.F.R. § 4.16(a) are met for the period prior to September 23, 2013, because the Veteran has multiple service-connected disabilities with one disability of at least 40 percent and accompanied with combined rating of at least 70 percent. The question, then, is whether the service-disabilities have rendered the Veteran unable to obtain or retain substantially gainful. Factors to be considered include but are not limited to employment history, educational achievement, and vocational attainment. Age is not a factor to be considered. 38 C.F.R. § 4.16. After reviewing all of the lay and medical evidence, and upon resolution of all reasonable doubt in favor of the Veteran, the Board finds that the evidence is in equipoise and that entitlement to a TDIU is warranted for the period prior to September 23, 2013. The evidence in favor of the claim for a TDIU includes the Veteran’s assertions that he is unemployable due to his service-connected conditions. See, e.g., November 2016 VA Form 21-0958. Moreover, in June 2018, the Veteran’s representative submitted a statement by C.E., a vocational expert, who listed her credentials, and provided a thorough vocational assessment of the Veteran. C.E. opined that the Veteran’s service-connected heart disease, hypertension, and depression have precluded him from securing and following substantially gainful occupation, to include sedentary employment, as far back 2002 when his records indicated that he was no longer able to work. C.E. listed the basic requirements to sustain unskilled, entry-level work, to include at a sedentary level, and explained that the combination of symptoms caused by the Veteran’s service-connected disabilities caused him to be unable to meet most, if not all, of the basic requirements in a competitive job, to include on a sedentary level. Specifically, it was noted that the Veteran’s symptoms cause him to require multiple breaks due to fatigue, have significant periods of time off-task, and be frequently absent as a result of his heart disease and depression. C.E. also noted that the Veteran is unable to meet the demands of any physical labor due to fatigue. Additional evidence weighing in favor of the claim for a TDIU includes the November 2013 DBQ by Dr. R.T., who opined that he Veteran’s congestive heart failure might have an impact on his ability to work. Moreover, as noted above, the July 2017 VA mental health examination report noted that the Veteran’s psychiatric disability is productive of occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks during periods of significant stress. Evidence weighing against the claim for a TDIU includes the August 2014 and July 2017 VA hypertension examination reports, which noted that the Veteran’s hypertension does not impact the Veteran’s ability to work. Based on the foregoing, the Board finds that the Veteran has significant occupational impairment due to his service-connected disabilities. The determination of unemployability is a factual determination to be made by the Board and is not strictly a medical question. The Board finds that the evidence supports that the Veteran would be unable to perform any jobs based on the limitations discussed above as a result of the service-connected disabilities. Therefore, the Board finds that the evidence at least in equipoise as to whether the Veteran is unable to secure gainful employment due to his service-connected disability for the period prior to September 23, 2013. Accordingly, entitlement to TDIU for the period prior to September 23, 2013, is warranted. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Ragheb, Counsel