Citation Nr: 18100683 Decision Date: 04/19/18 Archive Date: 04/19/18 DOCKET NO. 10-12 308 DATE: April 19, 2018 ISSUES DECIDED: 3 ISSUES REMANDED: 0 ORDER Entitlement to an initial increased rating in excess of 30 percent for post-traumatic stress disorder (PTSD) for the period prior March 11, 2015 is denied. Entitlement to an initial increased rating in excess of 50 percent for PTSD for the period from March 11, 2015 and thereafter is denied. A TDIU rating is granted, subject to the regulations governing payment of monetary awards. FINDINGS OF FACT 1. For the period prior to March 11, 2015, the Veteran’s PTSD manifested itself by symptoms no greater than occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks; symptoms productive of occupational and social impairment with reduced reliability and productivity was not shown. 2. For the period from March 11, 2015 and thereafter, the Veteran’s PTSD manifested itself by symptoms no greater than occupational and social impairment with reduced reliability and productivity; symptoms productive of occupational and social impairment with deficiencies in most areas was not shown. 3. The Veteran is currently service-connected for PTSD, rated at 50 percent; urinary incontinence, rated at 40 percent; diabetes mellitus, rated at 20 percent; peripheral neuropathy of the right upper extremity, rated at 10 percent; peripheral neuropathy of the left upper extremity, rated at 10 percent; peripheral neuropathy of the right lower extremity, rated at 10 percent; peripheral neuropathy of the left lower extremity, rated at 10 percent; and onychomycosis and dermatophytosis of the bilateral feet, rated at 10 percent. 4. The competent evidence reasonably establishes the Veteran’s service-connected disabilities are of such nature and severity as to preclude him from securing or maintaining substantially gainful employment. CONCLUSIONS OF LAW 1. For the period prior to March 11, 2015, the criteria for a rating in excess of 30 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107(b), 5110 (2012); 38 C.F.R. §§ 3.102, 4.130, DC 9411 (2017). 2. For the period from March 11, 2015 and thereafter, the criteria for a rating in excess of 50 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107(b), 5110 (2012); 38 C.F.R. §§ 3.102, 4.130, DC 9411 (2017). 3. The schedular requirements for TDIU are met, and a TDIU rating is warranted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.340, 3.341, 4.16 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the United States Army from December 1967 to September 1969. A January 2009 rating decision awarded service connection for PTSD with an evaluation of 30 percent, effective April 25, 2007. The Veteran perfected an appeal for an initial increased rating. A March 2015 rating decision assigned an increased rating of 50 percent, effective March 11, 2015. As this does not constitute a full grant of the benefit sought on appeal, this claim remains in appellate status. AB v. Brown, 6 Vet. App. 35 (1993). Regarding the claim for TDIU, the Veteran filed an informal claim for TDIU in April 2013, which was denied by August 2013 rating decision. In June 2016, the Veteran submitted an Application for Increased Compensation due to Unemployability. The Court has held that a request for TDIU, whether expressly raised by a Veteran or reasonably raised by the record, is not a separate “claim” for benefits, but rather is part of a claim for increased compensation. Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). In this case, the Board finds the issue of entitlement to TDIU is properly before the Board by virtue of his increased initial rating claim for PTSD, pursuant to Rice. The Veteran and his wife appeared for a hearing before the undersigned in May 2017. The transcript has been associated with the claims file. . Increased Rating Disability evaluations are determined by the application of the Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can practicably be determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual disorders in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. The Veteran’s PTSD is assigned a 30 percent rating prior to March 11, 2015, and a 50 percent rating thereafter. The Veteran’s PTSD is evaluated under 38 C.F.R. § 4.130, DC 9411. Under these criteria, a 30 percent rating is warranted where the psychiatric condition produces 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 normal conversation), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events). A 50 percent rating is warranted where the psychiatric condition produces occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is warranted where the psychiatric condition produces 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. A 100 percent rating is warranted where the psychiatric condition results in 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. When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, length of remissions, and the Veteran’s capacity for adjustment during periods of remission. 38 C.F.R. § 4.126(a). Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. In addition, the United States Court of Appeals for Veterans Claims (Court) has determined that staged ratings are appropriate for an increased rating claim 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) (citing Fenderson v. West, 12 Vet. App. 119, 126 (1999)). Evaluation under § 4.130 is symptom-driven, meaning that symptomatology should be the fact-finder’s primary focus when deciding entitlement to a given disability rating under that regulation. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). In Vazquez-Claudio, the United States Court of Appeals for the Federal Circuit explained that the frequency, severity and duration of the symptoms also play an important role in determining the rating. Id. at 117. Significantly, however, 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. 38 C.F.R. § 4.21; Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002). If the evidence shows that the Veteran suffers symptoms listed in the rating criteria or symptoms of similar severity, frequency, and duration, 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. Mauerhan, 16 Vet. App. at 443; see also Vazquez-Claudio, 713 F.3d at 117. 1. Entitlement to an initial increased rating in excess of 30 percent for the period prior March 11, 2015 Prior to March 11, 2015, the Veteran is assigned a 30 percent rating under DC 9411. To warrant the next higher rating of 50 percent, the evidence must demonstrate the Veteran’s PTSD symptoms resulted in occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. The Board finds the evidence during this time period demonstrates the Veteran’s PTSD symptoms most nearly approximate the criteria for a 30 percent rating, reflecting occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. A review of the evidence shows at a March 2007 VA treatment visit, the Veteran reported nightmares. At a May 2007 VA examination, the Veteran reported being married for 15 years, and was previously married for 23 years. He reported working as a truck driver delivering school supplies the last 4 years. The Veteran reported nightmares and avoidance symptoms. He denied any occupational problems, though indicated some anger and irritability towards others. At a June 2007 VA mental health visit, the Veteran reported dreams of war 3 to 4 times a night and only sleeping 2 to 4 hours. He reported being bothered by certain noises and trying to avoid people. He reported he was extremely angry with a quick trigger. He reported the medications help with his anger. At a September 2007 mental health visit, the Veteran reported continued nightmares. He reported he had an incident with a coworker. At a December 2007 mental health visit, the Veteran presented with episodic anxiety, intermittent nightmares, and disturbed sleep. He reported Paxil helped with the frequency and severity of his symptoms. At a July 2008 mental health visit, the Veteran reported he was doing well on his medications. He reported he was still employed full-time. He reported occasional flashbacks, intrusive thoughts, and sleep disturbance about combat. At a February 2009 mental health visit, the Veteran reported nightmares at times. He reported doing well on his medications. At a July 2009 mental health visit, the Veteran reported nightmares at times. He reported his Paxil was working well. At a December 2009 VA examination, the Veteran reported still having anger problems, but not as frequently. He reported his mood was not as erratic. He reported nightmares and hypervigilance. He reported avoiding war movies, crowds, and loud noise. He reported being mistrustful of others and not feeling like people understand him. He reported no close friends. He was still employed as a driver for the school district. He reported few difficulties with his job related to PTSD, noting some difficulty with complex and detailed instructions due to concentration, and difficulty with his temper, although his temper had improved since starting medication 2 years ago. He reported his co-workers sometimes had to tell him to calm down and that he can be “touchy” when he receives criticism from supervisors. He reported having a good relationship with his wife, children, and grandchildren. He reported he enjoys spending time with his grandchildren, attending church, and occasionally going out to dinner. The examiner opined the Veteran’s social impairment was mild to moderate. He opined the effect on thought process and communication was minimal. He opined the effect on occupational functioning was mild to moderate. At a December 2010 VA mental health visit, the Veteran reported nightmares and restlessness. He reported waking up 4-5 times a night, but this could also related to nocturia and using a CPAP machine. He reported he has problems with anger with coworkers, but not at home. He described himself as “easily upset.” At a March 2011 VA mental health visit, the Veteran reported feeling down about his medical issues and stress from work. He reported nightmares twice a week. He reported having a good support system. At an April 2011 VA examination, the Veteran reported intrusive thoughts, nightmares, and constant anger. He reported his anger outbursts were of a moderate severity at a frequency of once a week. He reported nightmares were of a moderate to severe severity at a frequency of three times a week. He reported having a good relationship with his family members. He reported having two close friends. The examiner assessed the Veteran to be avoidant and limiting his social interactions. He noted the Veteran experiences intense anger, which negatively impacts his relationships. The examiner opined the severity of the Veteran’s PTSD symptoms produced an occasional decrease in work efficiency or intermittent periods of inability to perform occupational tasks due to PTSD, but generally satisfactory functioning (routine behavior, self-care, and conversation normal). The examiner stated that despite his PTSD symptoms, the Veteran has been gainfully employed for the past 11 years and happily married for 19 years. The examiner considered his overall functioning was adequate. In a May 2011 statement, the Veteran reported his PTSD symptoms included depression, suicidal thoughts, lack of energy, tired all the time, no desire to socialize, keeping to himself, and waking up from nightmares. At an August 2011 VA mental health visit, the Veteran reported running out of his medication. He reported feeling down, with low motivation to go out and socialize. He reported his nightmares were worse, to the extent of waking up his wife. He reported low patience as a truck driver. At an October 2011 VA mental health visit, the Veteran reported doing okay. He reported nightmares that sometimes wake him up hollering. He reported he angers quickly, but has learned to walk away. He reported stable mood, fair appetite, and fair sleep. At a March 2012 VA mental health visit, the Veteran reported doing fairly well. He reported he still has to deal with his moods and worries, but is coping. He reported the medications were working and desired to continue them. He reported having a good holiday with his family and grandchildren. He reported fair appetite and sleep. At a July 2012 VA examination, the Veteran reported a good relationship with wife, children, and grandchildren. He reported he enjoys watching sports and following his grandson’s basketball. He reported still working as a truck driver for the school district. He reported the symptoms of depressed mood, anxiety, chronic sleep problems, mild memory problems, flattened affect, disturbance of motivation and mood, difficulty establishing and maintaining relationships, and difficulty adapting to stressful situations. The examiner observed his thought process and communication skills to be within normal limits. The examiner observed the Veteran’s short and long term memory was without gross deficits, but did note mild difficulty with attention-span and concentration. The Veteran denied delusions, hallucinations, and suicidal or homicidal ideation. The examiner opined the Veteran’s PTSD produced occupational and social impairment with occasional decreased in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. At an August 2012 VA mental health visit, the Veteran reported doing fairly well. He stated life was challenging with growing older and medical issues, but felt he was coping. He reported he stays to himself and with his family. He reported his wife and children are supportive. He reported fair appetite and sleep. At an October 2012 VA mental health visit, the Veteran reported his memory problems are interfering with his work. He reported the school district says he is retiring at the end of the school year, but they are letting him go due to his PTSD. At a November 2012 VA mental health visit, the Veteran reported nightmares and restless nights. At a February 2013 VA mental health visit, the Veteran reported doing well and keeping a positive attitude. He reported some challenges with his medical issues and work. In an April 2013 statement, the Veteran reported his condition caused him to no longer be able to work. He noted frequent bleeding in his urine, numbness in his left leg and feet, back pain, and trouble sleeping. At a May 2013 VA mental health visit, the Veteran reported he was doing well. He reported the reduced stress of retirement has helped with his mood, sleep, and energy. At a September 2013 VA mental health visit, the Veteran reported he still struggles with anger, patience, and nightmares, but is better able to tolerate the symptoms. He reported fair energy, appetite, and sleep. At an August 2014 VA mental health visit, the Veteran reported he was struggling since his brother passed away the week prior. He reported 1 to 3 nightmares a week that wake him up from sleep. He reported increased irritability and that he becomes quickly upset. He reported he avoids watching war movies and gets startled in traffic. He reported his sleep has been poor the past week due to worrying about his brother. He reported increased nightmare frequency with the stress. He reported good energy, concentration, and appetite. The prognosis for his PTSD was good, once his bereavement resolved. The Board gives great probative weight to the December 2009, April 2011, and July 2012 VA examiner opinions that the Veteran’s PTSD produced occupational and social impairment with occasional decreased in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. The examiners’ opinions are credible because they are based on review of the claims file and in-person examination. The Board also gives great probative weight to the Veteran’s statements regarding the frequency and severity of his PTSD symptoms. The Veteran is competent to report symptoms he experienced. The lay statements are credible because they have been consistently reported by the Veteran in his VA mental health treatment notes. The Board finds the December 2009, April 2011, and July 2012 VA examiner opinions consistent with the frequency and severity of symptoms reported by the Veteran. The preponderance of the evidence does not demonstrate the Veteran’s PTSD symptoms resulted in occupational and social impairment with reduced reliability and productivity. During this time period, treatment records reflected the Veteran’s most frequent symptoms to be nightmares and anger, but despite these symptoms the Veteran was able to maintain employment and strong relationships. During this time period, the Veteran maintained good relationships with his wife, children, and grandchildren. While the Veteran reported difficulty getting along with co-workers and receiving criticism from supervisors, he had not been written up or had formal complaints from his job. See December 2009 VA examination. The Veteran was able to maintain employment as a truck driver for the school district for over 10 years. The Veteran was able to attend church and games his son coached. During this time period, mental status examinations consistently observed unremarkable affect with normal speech, thought processes, insight, and judgment. The Board recognizes the list of symptoms under the rating criteria are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. Here, the Board finds the severity, frequency, and duration of the symptoms reported by the Veteran during this time period most closely represent the symptoms listed in the criteria for a 30 percent rating. Accordingly, a rating in excess of 30 percent is denied for the Veteran’s service-connected PTSD for the period prior to March 11, 2015. 2. Entitlement to an initial rating in excess of 50 percent for the period from March 11, 2015 and thereafter For the period from March 11, 2015 and thereafter, the Veteran is assigned a 50 percent rating under DC 9411. To warrant the next higher rating of 70 percent, the evidence must demonstrate the Veteran’s PTSD symptoms resulted in occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. The Board finds the evidence during this time period demonstrates the Veteran’s PTSD symptoms most nearly approximate the criteria for a 50 percent rating, reflecting occupational and social impairment with reduced reliability and productivity. At a March 2015 VA examination, the Veteran reported a good relationship with his wife, children, and grandchildren. He reported he enjoys going to watch one of his sons coach basketball. He reported the symptoms of depression, anxiety, suspiciousness, panic attacks weekly or less, chronic sleep impairment, mild memory problems, flattened affect, disturbed motivation and mood, and difficulty adapting to stressful situations. The examiner noted him to be well-groomed, cooperative, and oriented. The examiner opined his PTSD symptoms produce occupational and social impairment with reduced reliability and productivity. At a June 2015 VA mental health visit, the Veteran reported that while he continues to have anger issues and occasional nightmares, his PTSD symptoms were well controlled on his current regimen. At a March 2016 VA mental health visit, the Veteran reported he was doing well. He reported he had a good holiday. At an August 2016 VA mental health visit, the Veteran reported he was doing well. He reported nightmares here and there, but was doing better. His wife wakes him up when they happen. He said he has a good support from his wife and family. At a September 2016 VA mental health visit, the Veteran reported still having nightmares. At a December 2016 VA mental health visit, the Veteran reported his mood has remained stable despite new physical challenges. He reported improving sleep. He denied suicidal or homicidal ideation, delusions, or hallucinations. Insight and judgment were noted to be intact. At an April 2017 VA mental health visit, the Veteran reported doing well, but still talks in his dreams, wakes up sweating, or his wife waking him up because he is fighting in his dreams. He reported stable mood, improving sleep, and improving energy. In May 2017, the Veteran and his wife appeared for a hearing before the undersigned. He reported he still has nightmares that wake him up. He reported being angry. He reported he doesn’t socialize, mainly spending time with his wife. He reported having poor communication with one of his sons. He reported not having a lot of friends. He reported attending church and occasionally going out with his wife. He reported his PTSD impacted his last job as a driver because he would get stressed and sometimes would have anger when driving. He reported laying things down and not remembering. His wife reported that at night she has to wake him up because he is fighting and screaming. She reported he is depressed. A July 2017 VA mental health visit reported continued nightmares. At an August 2017 VA examination, the Veteran reported living with his wife of 24 years. He reported maintaining a relationship with one of his three sons. He reported his relationship with his first wife ended because of his PTSD. He reported his wife is patient and wakes him up from his nightmares. He reported his sister lives next door and he talks to her occasionally. He reported he attends church occasionally. He reported enjoying watching sports, attending games his son coaches, and going out to eat with wife. He reported he last worked 5 years ago driving a truck. He reported he has a hard time getting along with people, which is why he chose trucking. He reported the symptoms of nightmares, depressed mood, anxiety, suspiciousness, chronic sleep impairment, mild memory impairment, disturbance in motivation and mood, difficulty establishing and maintaining relationships, and difficulty adapting to stressful situations. The examiner opined the Veteran’s PTSD produces occupational and social impairment with reduced reliability and productivity. The Board gives great probative weight to the March 2015 and August 2017 VA examination opinions that the Veteran’s PTSD symptoms produce occupational and social impairment with reduced reliability and productivity. The examiners’ opinions are credible because they are based on review of the medical record and in-person examination. The Board also gives great probative weight to the Veteran’s statements regarding the frequency and severity of his PTSD symptoms. The Veteran is competent to report symptoms he experienced. The lay statements are credible because they have been consistently reported by the Veteran in his VA mental health treatment notes. The Board finds the March 2015 and August 2017 VA examiner opinions consistent with the frequency and severity of symptoms reported by the Veteran. The Board finds the preponderance of the evidence does not demonstrate the Veteran’s PTSD symptoms resulted in occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. While the Veteran was no longer employed during this time period, treatment records reflected the Veteran maintained good relationships with his wife and son. The Veteran attended church, games his son coached, and went out to eat with his wife. During this time period, mental status examinations consistently observed unremarkable affect with normal speech, thought processes, insight, and judgment. When looking to the 70 percent rating criteria, it has not been shown that the Veteran experienced symptoms such 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; spatial disorientation; neglect of personal appearance and hygiene; and inability to establish and maintain effective relationships. The Board recognizes the list of symptoms under the rating criteria are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. Here, the Board finds the severity, frequency, and duration of the symptoms reported by the Veteran during this time period most closely represent the symptoms listed in the criteria for a 50 percent rating. Accordingly, a rating in excess of 50 percent is denied for service-connected PTSD for the period from March 11, 2015 and thereafter. 3. Entitlement to individual employability VA will grant a total rating for compensation purposes based on unemployability when the evidence shows that the veteran is precluded from obtaining or maintaining any gainful employment consistent with his education and occupational experience, by reason of his service-connected disabilities. 38 C.F.R. §§ 3.340, 3.341, 4.16. If there is only one such disability, it must be rated at 60 percent or more, and if there are two or more disabilities, there shall be at least one disability rated at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent. 38 C.F.R. § 4.16(a). “Substantially gainful employment” is that employment “which is ordinarily followed by the non-disabled to earn their livelihood with earnings common to the particular occupation in the community where the veteran resides.” Moore v. Derwinski, 1 Vet. App. 356, 358 (1991). As further provided by 38 C.F.R. § 4.16 (a), “Marginal employment shall not be considered substantially gainful employment.” 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; Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). The Veteran’s service-connected disabilities are PTSD, rated at 50 percent; urinary incontinence, rated at 40 percent; diabetes mellitus, rated at 20 percent; peripheral neuropathy of the right upper extremity, rated at 10 percent; peripheral neuropathy of the left upper extremity, rated at 10 percent; peripheral neuropathy of the right lower extremity, rated at 10 percent; peripheral neuropathy of the left lower extremity, rated at 10 percent; and onychomycosis and dermatophytosis of the bilateral feet, rated at 10 percent. As the Veteran has a service-connected disability rated at 40 percent, and the Veteran has an overall combined disability evaluation of 70 percent or greater, the schedular rating requirements for TDIU, under 38 C.F.R. § 4.16 (a), are satisfied. The Veteran contends his service-connected disabilities render him unemployable. On review of the record, the Board finds that such is reasonably shown. The Veteran last worked in May 10, 2013. See Request for Employment Information form, April 2013 Veteran statement, and May 2013 VA treatment record. In April 2013, the Veteran submitted a statement that his condition has not improved and caused him to no longer be able to work. He stated he had frequent urination with bleeding, numbness is the left leg and feet, back pain, and has to frequently get up at night to urinate. In July 2013, a VA examiner found the Veteran’s service-connected conditions of urinary incontinence, skin condition of the feet, diabetes mellitus, and diabetic peripheral neuropathy had no impact on his ability to work. Further rationale was not provided. In June 2014, the Veteran’s treating physician at VA submitted a statement that the Veteran has urinary incontinence requiring more than 4 pads per day, diabetes mellitus, and neuropathy. He opined the Veteran cannot be gainfully employed due to his service-connected conditions. At a March 2015 VA examination, the Veteran the symptoms of depression, anxiety, suspiciousness, panic attacks weekly or less, chronic sleep impairment, mild memory problems, flattened affect, disturbed motivation and mood, and difficulty adapting to stressful situations. The examiner opined his PTSD symptoms produced occupational and social impairment with reduced reliability and productivity. In June 2016, a VA examiner opined the Veteran’s diabetic peripheral neuropathy impacted his ability to work because the Veteran reports he is unable to walk without a cane or walker and has fallen on several occasions. The examiner opined the Veteran’s urinary incontinence impacted his ability to work because urinary incontinence requires him to be near a restroom at all times due to hygiene requirements involved with incontinence. He noted the Veteran has been debilitated since multiple urological procedures in 2015. The examiner opined the Veteran’s skin condition did not impact his ability to work. The Veteran reported that he was unable to pass his DOT physical due to his diabetes and complications. In June 2016, the Veteran submitted an Application for Increased Compensation due to Unemployability. The Veteran reported his diabetes and neuropathy kept him from passing his DOT physical. At an August 2017 VA examination, the Veteran reported the symptoms of nightmares, depressed mood, anxiety, suspiciousness, chronic sleep impairment, mild memory impairment, disturbance in motivation and mood, difficulty establishing and maintaining relationships, and difficulty adapting to stressful situations. The examiner opined the Veteran’s PTSD produced occupational and social impairment with reduced reliability and productivity. The Board gives great probative weight to the June 2014 treating physician opinion, March 2015 VA examiner opinion, June 2016 VA examiner opinion, and August 2017 VA examiner opinion. The opinions are consistent with the treatment records and lay statements of the Veteran, to which the Board finds competent and credible. The Board gives no probative weight to the July 2013 VA examiner opinion that the Veteran’s service-connected urinary incontinence, diabetes, and neuropathy do not impact the Veteran’s ability to work. The examiner provided no rationale. The opinion is inconsistent with the lay statements of the Veteran and treatment notes of bilateral tingling of the feet, unsteady gait, use of a cane, and urinary incontinence symptoms. While the Board will take into consideration the above medical opinions, the question of unemployability is a legal determination. See Moore v. Shinseki, 555 F.3d 1369, 1373 (Fed. Cir. 2009). The Board finds the combination of the Veteran’s physical and mental limitations as a result of solely his service-connected disabilities are of sufficient severity to produce unemployability. The Veteran’s lay statements regarding the frequency and severity of his PTSD, urinary problems, diabetes, and neuropathy would make the Veteran an unreliable employee. This is consistent with the schedular ratings assigned to the Veteran’s service-connected conditions, the Veteran’s lay statements as to his limitations, and the credible medical opinions of record. Given the foregoing body of evidence, the Board resolves all reasonable doubt in the Veteran’s favor (as required by law) and concludes that the evidence supports a finding that his service-connected disabilities preclude him from securing or following substantially gainful employment. Therefore, the criteria for establishing entitlement to TDIU are met. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD TAW, Associate Counsel