Citation Nr: 18120063 Decision Date: 07/23/18 Archive Date: 07/20/18 DOCKET NO. 15-15 840 DATE: July 23, 2018 ORDER Entitlement to service connection for a low back disability is denied. Entitlement to service connection for a cervical spine disability is denied. Entitlement to service connection for hepatitis C is denied. Entitlement to service connection for pseudofolliculitis barbae is denied. Entitlement to a compensable disability rating for service-connected umbilical hernia repair is denied. Entitlement to an initial disability rating in excess of 50 percent prior to February 8, 2017, and in excess of 70 percent thereafter for service-connected PTSD is denied. Entitlement to an effective date prior to May 26, 2011, for the grant of entitlement to service connection for PTSD is denied. Entitlement to a total disability rating based on individual unemployability due to service connected disability (TDIU) prior to February 8, 2017 is denied. FINDINGS OF FACT 1. The probative and competent evidence is against a finding that the Veteran’s low back disability is related to active duty service. 2. The probative and competent evidence is against a finding that the Veteran’s cervical spine disability is related to active duty service. 3. The probative and competent evidence is against a finding that the Veteran’s hepatitis C is related to active duty service. 4. The probative and competent evidence is against a finding that the Veteran has a current disability of pseudofolliculitis barbae. 5. Throughout the period on appeal, the Veteran’s service-connected umbilical hernia repair more nearly approximates the criteria for a noncompensable disability rating as it has not been shown that is not well supported by belt under ordinary conditions, or healed ventral hernia or postoperative wounds with weakening of abdominal wall and indication for a supporting belt. 6. Prior to February 8, 2017, the Veteran’s service-connected PTSD manifested with occupational and social impairment with reduced reliability and productivity. 7. Beginning February 8, 2017, the Veteran’s service-connected PTSD had manifested with occupational and social impairment with deficiencies in most areas. 8. In February 1977, February 2006, March 2009, and March 2010, the Agency of Original Jurisdiction (AOJ) issued rating decisions denying the Veteran’s claims for entitlement to service connection for a mental health disability. The Veteran did not appeal these decisions or submit new and material evidence within the required periods, rendering these decisions final. 9. A claim for entitlement to service connection for PTSD was not received after the last final March 2010 rating decision until May 26, 2011. 10. Prior to February 8, 2017, the Veteran’s service-connected disabilities did not preclude him from obtaining and maintaining substantial gainful employment. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a low back disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309. 2. The criteria for entitlement to service connection for cervical spine disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309. 3. The criteria for entitlement to service connection for hepatitis C have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309. 4. The criteria for entitlement to service connection for pseudofolliculitis barbae have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309. 5. The criteria for a compensable disability rating for umbilical hernia repair have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.114, Diagnostic Code 7339. 6. Prior to February 8, 2017, the criteria for an initial disability rating in excess of 50 percent for service-connected PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.130, Diagnostic Code 9411. 7. Beginning February 8, 2017, the criteria for an initial disability rating in excess of 70 percent for service-connected PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.130, Diagnostic Code 9411. 8. The criteria for entitlement to an effective date prior to May 26, 2011, for the award of entitlement to service connection for PTSD are not met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 9. Prior to February 8, 2017, the criteria for entitlement to a TDIU have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran has active duty service in the United States Navy from January 1974 to September 1974. These matters come before the Board of Veterans’ Appeals (Board) on appeal from rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). In a June 2017 rating decision, the RO granted an increased disability rating of 70 percent for service-connected PTSD effective February 8, 2017. Because the increased disability rating assigned is not the maximum rating available, the claim remains in appellate status, and the Board has re-characterized the issue as shown on the title page. See AB v. Brown, 6 Vet. App. 35 (1993); see also Hart v. Mansfield, 21 Vet. App. 505 (2007). There have been some contentions that the Board has not fulfilled its duty to notify and assist the Veteran with the presentation of his claims. In February 2014, the Veteran’s attorney suggested that the VA mental health opinion was inadequate for rating purposes, although no specific contentions were made. Regardless, a supplemental VA examination was performed later in the appeal period. In April 2017, the Veteran’s representative requested that the Veteran undergo VA examinations in connection with his claims for entitlement to service connection for hepatitis C and for pseudofolliculitis barbae. Nonetheless, the Board finds that the evidence of record is sufficient for determining entitlement to service connection. In this case, there is no evidence or suggestion of evidence that the Veteran had hepatitis C during service; the first record of a hepatitis C diagnosis was in 2000, although there was an allegation of a diagnosis in the 1990s. Nonetheless, both examples suggest a lack of continuity of symptomatology or an in-service event for service connection purposes. As it pertains to the Veteran’s claim for entitlement to service connection for pseudofolliculitis barbae, the Board notes that the evidence does not show a current disability for service connection purposes. The Veteran has had an ongoing treatment history with VA, but there has been no mention of shaving bumps or other facial skin deficits. Therefore, there is insufficient evidence to justify scheduling a VA examination. In a June 2017 correspondence, the Veteran’s attorney asserted that the Veteran should be entitled to a 70 percent disability rating at an earlier date based on the facts found in the record, rather than based on the date the February 2017 VA examination became available to the VA Secretary. The attorney’s November 2017 correspondence also suggests that a higher disability rating for the Veteran’s service-connected PTSD is warranted. However, as will be discussed in greater detail below, the Board finds that the Veteran’s present disability ratings for his service-connected PTSD are adequate, and that the evidence is insufficient to support a disability rating in excess of 50 percent prior to February 8, 2017. In the same correspondence the Veteran’s attorney asserted that the Veteran’s VA examinations of the low back and cervical spine were inadequate because the rationale was based on a lack of evidence, and that the VA examiner did not consider the Veteran’s lay statements. Again, as will be discussed in greater detail below the Board finds that the VA examination for the low back and cervical spine is adequate for determining entitlement to service connection. In this instance the VA examiner considered the Veteran’s lay statements and provided rationale with references to the claims file in making his determination. Neither the Veteran nor his attorney has raised any other issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Service Connection Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called “nexus” requirement. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). VA has established certain rules and presumptions for chronic diseases, such as arthritis. See 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). With chronic diseases shown as such in service so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless attributable to intercurrent causes. 38 C.F.R. § 3.303(b). If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. § 3.303(b). In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, chronic diseases are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). 1. Low back disability and cervical spine disability In this case, the Veteran has been diagnosed with a low back disability and a cervical spine disability throughout the course of the appeal. He was noted to have back pain during a mental health assessment in 2001, and he underwent a cervical spine diskectomy and fusion in April 2012. He received some spinal treatment from a private treatment provider in 2016. Therefore, the Board finds that there are current disabilities for service connection purposes. As it pertains to an in-service event or injury, the Veteran reported having pain in the back of his neck in January 1974, and he was diagnosed with a back strain in May 1974. Nonetheless, these appear to have been temporary incidents as his separation examination in September 1974 was normal. Despite the Veteran’s assertions that he has had ongoing back and neck pain since active duty service, the first notation of neck and back pain after separation was in the early 2000’s, approximately 25 years later. In February 2017, the Veteran underwent VA examination in connection with his claims. At the time, he reported having back and neck pain that persisted since service, and that he required surgery in 2012. During the physical examination testing, the Veteran had a painful reduced range of motion in the cervical and lumbar spine, although his sensation and strength were normal. After the physical examination, the VA examiner opined that the Veteran’s low back disability was less likely than not incurred in or caused by the low back strain diagnosed in May 1974. In making this determination, the VA examiner reasoned that there was insufficient objective evidence to support a causal relationship between the in-service back strain and his back disability after separation. The VA examiner noted that there was no evidence of spinal MRIs, x-rays, or diagnoses to suggest a chronicity of symptoms and without those measures a causal opinion would be based on speculation. Likewise, the VA examiner opined that the Veteran’s cervical spine disability was less likely than not incurred in or caused by the Veteran’s allegations of neck pain in January 1974. In making this determination, the VA examiner observed that there was insufficient objective evidence of a positive causal relationship between his in-service neck complaints and his present neck disability, and that without objective measurements such as x-rays, MRIs, and diagnoses, there was no evidence of chronicity. The VA examiner concluded that to opine causality without objective measures would be to render an opinion based on speculation. The Board affords these opinions great probative weight as they are based on a physical examination of the Veteran and a review of his lay statements both during the VA examination and in the claims file. Although the Veteran’s attorney has suggested that the examination and opinions are inadequate, the Board notes that despite the Veteran’s long treatment history with VA, he has not sought any ongoing treatment for a back or neck disability even after his initial complaints in the early 2000s. In fact, in April 2014 the Veteran indicated during treatment that he had only had back pain for a few years. Regardless, there is minimal evidence of treatment until the 2000s, which would suggest a lack of continuity of symptomatology. Overall, the Board notes some indication of complaints of neck and back pain during service, but they appear to be fleeting as they were not noted on separation from service or until 25 years later. Given this lack of evidence along with the negative nexus opinions, the Board finds that service connection is not warranted. While the Veteran believes that his current spinal disabilities are related to service, as a lay person, the Veteran has not shown that he has specialized training sufficient to render such an opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, the diagnosis and etiology of his spinal disabilities are matters not capable of lay observation, and require medical expertise to determine. Accordingly, his opinion as to the diagnosis or etiology of his spinal disabilities is not competent medical evidence. Moreover, whether the symptoms the Veteran experienced in service or following service are in any way related to his current disability is also a matter that also requires medical expertise to determine. See Clyburn v. West, 12 Vet. App. 296, 301 (1999) (“Although the veteran is competent to testify to the pain he has experienced since his tour in the Persian Gulf, he is not competent to testify to the fact that what he experienced in service and since service is the same condition he is currently diagnosed with.”). Thus, the Veteran’s own opinion regarding the etiology of his current spinal disabilities are not competent medical evidence. The Board finds the opinion of the VA examiner, medical professional, to be significantly more probative than the Veteran’s lay assertions. In making this determination the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claims, that doctrine is not applicable in this instance. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Hepatitis C The Veteran was diagnosed with hepatitis C as early as 2000, although there was an allegation that he was diagnosed with hepatitis C in the 1990s. He received ongoing treatment for this disability through VA. Therefore, the Board finds that there is a current disability for service connection purposes. As it pertains to an in-service event for hepatitis C, the treatment notes are silent for any treatment for, or evidence of a hepatitis C diagnosis during service. There is no evidence that the Veteran was diagnosed during service or that he had symptoms consistent with hepatitis C which may have led to a hepatitis C diagnosis during service. The Veteran asserted that he developed hepatitis C through inoculations during service, although he did not provide more information to support this contention. Incidentally, the Veteran frequently admitted during his mental health treatment that he was a long-time intravenous drug user, which suggests a possible alternative etiology for his disability. Overall, the Board notes that the objective evidence supports a finding of a diagnosis of hepatitis C at least 15 years after separation from service, and that there is no evidence of this disability during service. Without more information the evidence is insufficient to meet the threshold to warrant a VA examination. Unfortunately, the available evidence is against the finding of a nexus for service connection purposes. Although the Veteran believes that his hepatitis C related to service, as a lay person, the Veteran has not shown that he has specialized training sufficient to render such an opinion. See Jandreau, 492 F.3d at 1376-77. In this regard, the diagnosis and etiology of hepatitis C are matters not capable of lay observation, and require medical expertise to determine. Accordingly, his opinion as to the diagnosis or etiology of his hepatitis C is not competent medical evidence. Moreover, whether the symptoms the Veteran experienced in service or following service are in any way related to his current disability is also a matter that also requires medical expertise to determine. See Clyburn, 12 Vet. App. at 301. Thus, the Veteran’s own opinion regarding the etiology of his hepatitis C is not competent medical evidence. In making this determination the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable and service connection must be denied. 38 U.S.C. § 5107; Gilbert, 1 Vet. App. 49. 3. Pseudofolliculitis barbae Entitlement to service connection requires a current disability. In the absence of competent evidence showing a current disability, service connection cannot be established. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Preliminarily, the Board notes that the Veteran’s treatment records throughout the period on appeal reflect no definitive diagnosis of pseudofolliculitis barbae. The Veteran has had ongoing treatment through VA, but there is no other evidence that has been submitted which documents pseudofolliculitis barbae. When the Veteran underwent VA examinations in connection with his other claims, there was no evidence of a facial skin deformity or other abnormality that would signal a diagnosis of pseudofolliculitis barbae. The Veteran has not pointed to any evidence of pseudofolliculitis barbae. While there is one mention of shaving bumps in January 1974, his separation examination showed that his head, face, neck, and scalp were normal. Simply stated, the best evidence, but by no means all the evidence, indicates that the Veteran does not have pseudofolliculitis barbae. To the extent that the Veteran has contended that he has pseudofolliculitis barbae, he has not shown that he has specialized training sufficient to diagnose this disability or to determine its etiology. See Jandreau, 492 F.3d at 1376-77. In this regard, while the Veteran is competent to report observable symptomatology such as pain or weakness, the diagnosis of pseudofolliculitis barbae requires medical expertise to determine. Accordingly, his opinion as to whether a disability exists and the etiology of such is not competent medical evidence. Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. See 38 U.S.C. § 1110. In the absence of proof of present disability there can be no valid claim. Brammer, 3 Vet. App. at 225; see also Degmetich v. Brown, 104 F.3d 1328 (1997) (38 U.S.C. § 1131 requires existence of present disability for VA compensation purposes); see also Wamhoff v. Brown, 8 Vet. App. 517, 521 (1996). Thus, in the absence of competent evidence showing a current diagnosis of pseudofolliculitis barbae, it is unnecessary to address the remaining elements of the claim for service connection. See Brammer, 3 Vet. App. at 225. Accordingly, the Board finds that the preponderance of the evidence is against the claim, and entitlement to service connection for a pseudofolliculitis barbae. In reaching this conclusion the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable in this case. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 55-57 Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule of Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Other applicable, general policy considerations are: interpreting reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating many accurately reflect the elements of disability, 38 C.F.R. § 4.2; resolving any reasonable doubt regarding the degree of disability in favor of the claimant, 38 C.F.R. § 4.3; where there is a questions as to which of two evaluations apply, assigning a higher of the two where the disability pictures more nearly approximates the criteria for the next higher rating, 38 C.F.R. § 4.7; and, evaluating functional impairment on the basis of lack of usefulness, and the effects of the disability upon the person’s ordinary activity, 38 C.F.R. § 4.10. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). A claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Thus, separate ratings can be assigned for separate periods of time based on the facts found - a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). 4. Umbilical hernia repair The Veteran had hernia surgery while in service, and in a September 2002 rating decision he was assigned a noncompensable disability rating as of the application date. At all times throughout the appeal he has asserted that he is entitled to a higher disability rating. The Veteran’s umbilical hernia repair is rated under 38 C.F.R. § 4.114, Diagnostic Code 7339. Under Diagnostic Code 7339, a non-compensable rating is assigned for a postoperative hernia with healed wounds, without disability, and where a belt is not indicated. A 20 percent rating is assigned for a small hernia, not well supported by belt under ordinary conditions, or healed ventral hernia or postoperative wounds with weakening of abdominal wall and indication for a supporting belt. Id. A 40 percent rating is assigned under Diagnostic Code 7339 for a large ventral hernia, not well supported by belt under ordinary conditions. A 100 percent rating is assigned where the postoperative ventral hernia is massive, persistent, with severe diastasis of recti muscles or extensive diffuse destruction or weakening of muscular and fascial support of abdominal wall so as to be inoperable. 38 C.F.R. § 4.114, Diagnostic Code 7339. In December 2016, the Veteran underwent VA examination in connection with his claim. At the time he reported that he underwent repair of an umbilical hernia during service, but that he had been asymptomatic at the time. The Veteran asserted that he had been taking medicine for his stomach for the 10 years prior, and that he believed his stomach pain and corresponding medication was due to his in-service surgery. The VA examiner observed that the Veteran’s service treatment records documented an umbilical hernia repair in August 1974 with no surgical complications. The VA examiner also noted that the Veteran had a history of gastroesophageal reflux disorder for which he took medication. During the physical examination, it was observed that the Veteran had a scar on the abdomen that was four centimeters long and two tenths of a centimeter wide, and that the scar was neither painful nor unstable. The VA examiner referenced an abdominal CT scan from June 2012 that was negative for an umbilical hernia. In concluding his report, the VA examiner noted that the Veteran had no evidence of recurrent hernia or significant residuals from his previous surgery on examination, and that his gastroesophageal reflux disorder symptoms were unrelated to his umbilical hernia repair in 1974, and were more likely due to his weight and lifestyle. There was minimal other objective evidence of hernia residuals in the record. Based on the foregoing evidence, the Board finds that the Veteran’s umbilical hernia symptoms more nearly approximate the criteria for a noncompensable disability rating. The Veteran’s VA treatment records and VA examination show mild symptoms and no indication of need for a supporting belt, and the Veteran has not reported otherwise. The evidence does not show a hernia that is not well-supported by belt under ordinary conditions or a healed hernia with weakening of abdominal wall and indication for a supporting belt to warrant a 20 percent rating under Diagnostic Code 7339. Also, there is no indication that a separate rating for the scar is warranted. The scar was found not to be painful or unstable, and measured four centimeters long and two tenths of a centimeter wide. See 38 C.F.R. § 4.118, Diagnostic Codes 7801, 7802, 7804. In sum, a compensable disability rating for umbilical hernia repair is not warranted. In making this determination the Board has considered the applicability of the benefit of the doubt doctrine. However as the preponderance of the evidence is against assignment of a higher disability rating, that doctrine is not applicable. 38 U.S.C. § 5107; Gilbert, 1 Vet. App. 49. 5. PTSD Considerations in evaluating a mental disorder include the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran’s capacity for adjustment during the periods of remission. The evaluation must be based on all the evidence that bears on occupational and social impairment rather than solely on an examiner’s assessment of the level of disability at the moment of the examination. 38 C.F.R. § 4.126(a). Although the extent of social impairment is a consideration in determining the level of disability, the rating may not be assigned solely on the basis of social impairment. 38 C.F.R. § 4.126(b). The Veteran contends that his PTSD has caused major impairment in several areas, including sleep loss, nightmares, and social functioning. He has asserted that his treatment notes reflect a condition entitling him to a higher disability rating. By way of history, the Veteran was granted entitlement to service connection for PTSD in an April 2013 rating decision, and was assigned a 50 percent disability rating as of May 26, 2011. He filed a timely notice of disagreement and in June 2017 the RO granted a 70 percent disability rating for his service-connected PTSD as of February 8, 2017. At all times throughout the appeal, he has asserted that he is entitled to a higher disability rating. The facts will be discussed first and an evaluation of each period will follow. The Veteran’s service-connected PTSD has been rated under the provisions of 38 C.F.R. § 4.130, Diagnostic Code 9411, which provides: A 50 percent disability rating is warranted when the Veteran experiences 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 and maintaining effective work and social relationships. Id. A 70 percent disability rating is warranted when the Veteran experiences 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 work-like setting); and inability to establish and maintain effective relationships. Id. A 100 percent disability rating 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 ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of closest relatives, own occupation, or own name. 38 C.F.R. § 4.130. The Veteran’s service-connected PTSD is rated as 50 percent disabling prior to February 8, 2017. Therefore, to warrant a higher disability rating during that period the evidence must show occupational and social impairment with deficiencies in most areas. Beginning February 8, 2017, the Veteran’s service-connected PTSD is rated as 70 percent disabling. Therefore, to warrant a higher disability rating during that period the evidence must show total occupational and social functioning. The Veteran has had a long treatment relationship with VA. He had ongoing mental health treatment in 2010 and 2011, wherein he dealt with substance abuse, situational stressors, and attempted to find work. He admitted around this time that he abused substances due to his military sexual trauma, but his suicide assessment in February 2012 was negative. In August 2012 the Veteran was observed to be well-groomed, alert, and oriented, with no psychomotor agitation or abnormal movements. He had a euthymic mood and full affect, and there was no evidence of suicidal or homicidal intent. His judgment and insight were improving. In October 2012, the Veteran underwent VA examination in connection with his claim. At the time he was diagnosed with PTSD and polysubstance abuse in early full remission. The Veteran claimed that he last worked in a VA vocational program, and that he had worked previously in multiple jobs but that he had lost them due to fighting. He also admitted to a long history of substance abuse. Socially, the Veteran reported that he lived alone but had a fiancée. The VA examiner determined that the Veteran had occupational and social impairment with reduced reliability and productivity. The Veteran continued to seek treatment through VA for mental health and vocational training, and in 2012 he reported that he was having less nightmares and that he was working on empowering himself. He began having some panic attacks in 2013 when he was at public places such as Walmart, and there was one instance of suicidal intent, but he spoke to a friend which helped him. The Veteran reported engaging in self-talk and taking care of his responsibilities, and in July 2013 he applied to work at Goodwill. During a mental health assessment in November 2013 the Veteran reported having a positive support system available to him to include his fiancée and extended family. While the treatment provider observed that the Veteran had poor judgment at times and was guarded occasionally, he was able to engage in rapport building. The Veteran reported that he was able to manage his activities of daily living independently. The treatment provider noted that the Veteran was actively engaged in mental health treatment with the VA Mental Health Gold Team and that he was responding well to treatment; he was noted to be coping well in general and not expressing suicidal or homicidal intent. In 2014, the Veteran experienced some grief due to deaths of family members, but he was thankful for his own mortality and had no complaints during treatment. He applied for a job in housekeeping with VA in April 2014. The Veteran reported having some sleep loss but denied any suicidal or homicidal intent. In November 2014, the VA treatment provider noted that the Veteran had no worsening of his PTSD symptoms and that he was not taking PTSD medications. In April 2016, the Veteran had a mental status examination where he reported that he was doing well and had no other needs outside of his treatment. He denied having any suicidal or homicidal intent, and he appeared relaxed and his speech was normal. The Veteran appeared cooperative and friendly, his affect and thought process was appropriate, and he expressed interest in improving. In February 2017, the Veteran underwent VA examination in connection with his claim, and at the time he was diagnosed with PTSD and heroin and cocaine use in sustained remission. At the time, the Veteran reported that he had some relationship with his children and grandchildren, but that it could be better; he indicated that he texted his friends regularly and that he attended church. As for work, the Veteran asserted that he tried to work for Del Monte in 2016 but had a syncopic episode; his work prior to that was in the VA vocational program. The Veteran indicated that he was having some sleep loss and nightmares. During the mental status examination, the Veteran had normal grooming and hygiene, and his posture and eye contact were normal. The Veteran exhibited moderate psychomotor agitation but his speech was normal and coherent. He became angry when discussing intrusive memories, but denied having any hallucinations or suicidal or homicidal intent. The Veteran had a depressed mood and appeared irritable. The VA examiner determined that the Veteran had occupational and social impairment with deficiencies in most areas. The Veteran continued treatment with VA, and there was some improvement in April 2017 in that he was able to go out to Walmart without added anxiety. There were no other symptom flare-ups after that time. Prior to February 8, 2017 Throughout this period on appeal, the Board finds that the Veteran’s symptoms are consistent with a 50 percent disability rating. The Veteran credibly reported symptoms of sleep impairment, nightmares, irritability, and intrusive thoughts. His irritability and isolationism caused some difficulty establishing and maintaining effective social relationships as evidenced by his somewhat strained relationships with his children and his difficulties maintaining employment. However, the Board finds that the severity, duration, and frequency of the Veteran’s symptoms have not produced functional impairment that has more nearly approximated the criteria for a 70 percent disability rating for any time prior to February 2017. The Veteran reported some increased sleep loss and nightmares, but he was able to maintain his treatment regimen and relate well to the treatment providers. During the mental status examinations, the Veteran was always alert and oriented, and he was able to express himself well within reason. As it pertains to occupational functioning, the Veteran attempted to work several times through the VA vocational program and he applied to jobs at Goodwill and worked at Del Monte, all of which suggest he felt that he was capable of doing some kind of work. As it pertains to social functioning, the Veteran reported that he isolated from others and that he did not tell others about his symptoms, but he reported that he had some familial relationships, and he was engaged to be married. The Veteran also talked with friends regularly and attended church. Despite the Veteran’s allegations of fighting with others, there was no lay or medical evidence of any additional impairment involving speech, thought process, impulse control, orientation, hygiene, communication, or inappropriate behavior. Although the Veteran had one episode of suicidal intent in April 2013, he spoke with a friend and was able to gain his composure, and he denied having any similar symptoms since then. Based on the treatment records, the suicidal intent appeared to be an isolated event as the Veteran continued to deny suicidal thought or intent before and after that time. Considering the evidence holistically, the Board finds that this isolated reference to suicidal intent does not support a finding that the disability is of greater severity than currently warranted; that is, that the disability causes social and occupational impairment more closely approximating the criteria for a 70 percent rating. See Bankhead v. Shulkin, 29 Vet. App. 10, 25 (2017). Additionally, when considering the overall disability picture, the VA examiner indicated in the VA examination report that the Veteran’s symptoms were productive of moderate impairment and, more specifically, opined that the Veteran’s PTSD symptomology was productive of occupational and social impairment with reduced reliability and productivity. While this opinion is not binding on the Board, this opinion clearly holds probative value as it is rendered by an expert in determining social and industrial impairment due to an acquired psychiatric disorder. In the opinion of the Board, the VA examiner’s opinion is entirely consistent with the overall disability level when considering the severity, duration and frequency of the Veteran’s symptoms. As such, the Board finds that the preponderance of the evidence does not suggest that the functional impairment stemming from the Veteran’s PTSD symptoms more nearly approximate the criteria for a 70 percent disability rating. To the contrary, the evidence of record indicates that the Veteran was cooperative and alert. He denied having hallucinations or suicidal and homicidal ideation for a majority of the appeal period. There is nothing to suggest that he was unable to perform his activities of daily living independently; the Veteran was able to live alone and maintain his grooming and meal preparation and was active within the confines of his physical disabilities. There was nothing to suggest that he had deficits in his activities of daily living. The Veteran himself never indicated that he was precluded from performing his activities of daily living due to mental health symptoms. The Board acknowledges the assertions of the Veteran that his PTSD is more severe than currently rated. The Veteran is competent to report matters that he experiences or observes, and the Board has found that his report of symptoms is credible and competent evidence. 38 C.F.R. § 3.159; Layno v. Brown, 6 Vet. App. 465, 469-71 (1994). However, in the absence of evidence of specialized medical training or expertise, which has not been shown, his opinion regarding findings from mental status examinations are greatly outweighed by the VA examiner’s opinion as he has greater expertise and training to evaluate the nature and etiology of an acquired psychiatric disorder. In making this determination the Board has considered the applicability of the benefit of the doubt doctrine. However as the preponderance of the evidence is against the assignment of a higher disability rating during this period, that doctrine is not applicable. 38 U.S.C. § 5107; Gilbert, 1 Vet. App. 49. Beginning February 8, 2017 The Board finds that during this period the Veteran’s PTSD resulted in occupational and social impairment with deficiencies in most areas. As noted, the Veteran reported increased irritability and difficulty interacting with others. The VA examiner noted a clear increase in PTSD severity based on the finding that the Veteran had occupational and social impairment with deficiencies in most areas. As a result, the Board concludes that the evidence as a whole approximates the criteria for a disability rating of 70 percent during this period. 38 C.F.R. § 4.7, 4.130, Diagnostic Code 9411. However, the Board finds that the evidence does not show “total” occupational and social impairment. Despite his symptoms, the Veteran has been able to handle his activities of daily living and self-care. He did not manifest gross impairment in thought process or communication, grossly inappropriate behavior, persistent danger of hurting himself or others, intermittent inability to perform activities of daily living, disorientation to time or place, or memory loss for names of close relatives or himself. His thought process was noted to be normal, and it certainly was not grossly impaired; his judgment and insight were fair to intact and his cognition was consistently normal. The Veteran denied having any hallucinations or suicidal or homicidal intent. Despite his PTSD symptoms, the Veteran was able to communicate with the treatment provider and he asserted that he had relationships with his immediate family; he also showed a slight improvement in that he was able to go to Walmart without experiencing increased anxiety. Based on the evidence, the Board finds that the Veteran’s PTSD did not manifest in total occupational and social impairment. His ability to persist with treatment and maintain his sobriety as well as his social functioning support this finding. The Board has considered the benefit of the doubt doctrine. However, because functional impairment comparable to total occupational and social impairment, the Board finds the preponderance of the evidence is against the assignment of a disability rating in excess of 70 percent during this period. 38 C.F.R. § 5107(b); Gilbert, 1 Vet. App. at 55-57. Other Considerations Neither the Veteran nor his attorney has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Effective Date The Veteran was awarded entitlement to service connection for PTSD in an April 2013 rating decision, and was assigned an effective date of May 26, 2011, which was the date of the receipt of application for the claim on appeal. The Veteran, through counsel, has asserted that he should be assigned an earlier effective date; specifically, that his disability should begin from 2009. Unless specifically provided otherwise, the effective date of an award based on an original claim, a claim reopened after final adjudication, or a claim for increase, of compensation, dependency and indemnity compensation, or pension, shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor. 38 U.S.C. § 5110(a). Generally, the effective date of an evaluation and award of compensation based on an original claim is the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. But unless otherwise provided, the effective date of compensation will not be earlier than the date of receipt of the claimant’s application. 38 U.S.C. § 5110(a). The claim for entitlement to service connection for PTSD has a somewhat lengthy procedural history. The Veteran first filed a claim for entitlement to service connection for a nervous disorder in January 1977, and the AOJ denied the claim in February 1977. The Veteran filed a claim for entitlement to service connection for PTSD in May 2005, which was denied in an August 2005 rating decision. The Veteran requested reconsideration, and the AOJ reopened the claim but denied it on the merits in February 2006. The Veteran did not appeal or submit new evidence within the requisite time period, and therefore the February 2006 rating decision became final. In December 2008, the Veteran filed a claim for entitlement to service connection for chronic depression, which was denied in a May 2009 rating decision. That same month the Veteran made a claim to reopen the issue of entitlement to service connection for PTSD, but the AOJ declined to reopen the claim in a March 2010 rating decision. The Veteran did not appeal or submit new evidence within the requisite time period, and therefore the March 2010 rating decision became final. In May 2011, the Veteran instituted the present claim to reopen the issue of entitlement to service connection for PTSD. The AOJ reopened and granted the claim of entitlement to service connection for PTSD in an April 2013 rating decision, assigning an effective date of May 26, 2011, the application date. This rating decision was based in part on a positive VA nexus opinion from October 2012. No claim for service connection for PTSD, informal or formal, was received by VA between the last final rating decision in March 2010 and May 26, 2011. See 38 C.F.R. §§ 3.1(p), 3.151, 3.155, 3.157. As noted, the AOJ granted entitlement to service connection as of May 26, 2011, the date of application for the present claim. The effective date for service-connection will not be earlier than the date of claim. 38 C.F.R. § 3.400. As the February 1977, February 2006, May 2009, and March 2010 became final and the next claim for entitlement to service connection for PTSD was received by VA on May 26, 2011, this is the earliest possible date the Veteran could receive for the grant of entitlement to service connection for PTSD. Although the Veteran was denied entitlement to service connection for chronic depression in May 2009 and instituted a claim for PTSD in the same month, the Board finds that this does not vitiate the finality of the May 2009 rating decision denying chronic depression, as these were separate claims. The Veteran did not express disagreement with the May 2009 rating decision, but rather instituted a new claim, PTSD, based on a new theory of entitlement (military sexual trauma). Assuming arguendo, the March 2010 rating decision would have finalized the claims for both chronic depression and PTSD if they had not previously been finalized. Overall, given that the prior rating decisions for the mental health claims were finalized prior to the May 2011 application date, the claim for an earlier effective date for the grant of service connection for PTSD must be denied. TDIU Preliminarily, the Board notes that the Veteran is already in receipt of entitlement to a TDIU beginning February 8, 2017. Therefore, that period is no longer on appeal. Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that if there is only one such disability, such disability shall be ratable as 60 percent or more, and if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). For the above purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: disabilities of one or both upper extremities or of one or both lower extremities, including the bilateral factor, if applicable; disabilities resulting from common etiology or a single accident; disabilities affecting a single body system; multiple injuries incurred in action; or multiple disabilities incurred as a prisoner of war. Id. The Veteran is currently service-connected for umbilical hernia repair, rated as noncompensable from March 5, 2002; PTSD, rated as 50 percent disabling from May 26, 2011, and rated as 70 percent disabling from February 8, 2017; and erectile dysfunction, rated as noncompensable from August 24, 2015. His combined disability rating is noncompensable from March 5, 2002, and 50 percent from May 26, 2011 to February 7, 2017. Therefore, he does not meet the schedular requirements for entitlement to a TDIU prior to February 8, 2017. Nonetheless, the inquiry does not end there. The question in a TDIU claim is whether the veteran is capable of performing the physical and mental acts required by employment, not whether the veteran can find employment. A high disability rating in itself is recognition that the impairment makes it difficult to obtain or keep employment. See Van Hoose v. Brown, 4 Vet. App. 361 (1993). There must be a determination that the service-connected disabilities are sufficient to produce unemployability without regard to advancing age or a nonservice-connected disability. 38 C.F.R. §§ 3.340, 3.341, 4.16. In this case, the Veteran asserted in his application that he was unable to work due to his PTSD symptoms. He reported that he last worked in October 2007 in waste management. The Veteran also relayed that he has a high school education with one year of college education. Throughout the period on appeal, especially before February 2017, the Veteran was actively seeking employment, which the Board commends. The Veteran underwent compensated work therapy programs several times throughout the period on appeal. In February 2010, he reported to VA that he had experience as a driver and that he would be willing to work in multiple positions such as the medical field, the mailroom, and warehouse type work. By December 2010, he completed that program and had worked 1,574 hours and earned approximately $12,000. It was the professional and clinical opinion of the staff that the Veteran had the skills necessary to seek, find, and maintain competitive employment. In July 2012 the Veteran applied to rejoin the compensated work therapy program, and the following year he submitted an application at Goodwill and AARP. The Veteran also applied for a job within VA doing housekeeping in April 2014. While continuing mental health treatment with VA, the Veteran’s treatment provider indicated that the Veteran was job-ready and that he was likely to succeed in performing his job. The Veteran continued to use VA as a resource for employment, and in May 2016 he reported that he was interested in attending truck driving school, and he appeared excited to attend. He continued to seek vocational services in July 2016. In addition to the Veteran regularly applying to work prior to February 2017, the Board notes that the VA examiners and treatment providers did not put any special work restrictions on the Veteran. Although the October 2012 VA examiner found that the Veteran had occupational and social impairment with reduced reliability and productivity, he was receiving disability benefits for his PTSD to account for lost work time due to this disability. There is no indication that a VA examiner has found that his service-connected umbilical hernia repair or erectile dysfunction have provided any functional loss at any point in the period on appeal. The Veteran has asserted that he has lost many jobs due to fighting in the workplace, but he has been able to complete the compensated work therapy program without issue. Additionally, he has prior experience as a truck driver, and the Board finds that this work would likely not require significant social interaction. As noted, his VA treatment providers have found that he is work-ready and capable of finding maintaining employment. Moreover, to some extent the Veteran must have felt that he was capable of working prior to February 2017 as he was frequently seeking work during that time. Given the Veteran’s work history and the limitations described by the evidence of record, the Board finds that the Veteran’s service-connected disabilities do not render him unable to secure or follow substantially gainful employment. Thus, entitlement to a TDIU prior to February 8, 2017, is not appropriate in this case. See 38 C.F.R. § 4.16. (Continued on the next page)   In making this determination the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against assignment of a TDIU prior to February 8, 2017, that doctrine is not for application. 38 U.S.C. § 5107; Gilbert, 1 Vet. App. at 53. L. Chu Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. F. Brandau, Associate Counsel