Citation Nr: 18128454 Decision Date: 08/23/18 Archive Date: 08/22/18 DOCKET NO. 15-41 390 DATE: August 23, 2018 ORDER Throughout the rating period, a disability rating greater than 60 percent for infectious hepatitis and hepatitis C is denied. For the period from January 24, 2014, to July 5, 2017, a disability rating greater than 10 percent for a depressive disorder is denied. For the period from July 6, 2017, a disability rating greater than 30 percent for a depressive disorder is denied. Prior to July 6, 2017, the claim of entitlement to a total disability rating based on individual unemployability (TDIU) is denied. For the period from July 6, 2017, the claim of entitlement to a TDIU is granted. FINDINGS OF FACT 1. Throughout the rating period, infectious hepatitis and hepatitis C have been manifested by, at most, nausea and right upper quadrant discomfort approximately two-to-three times per week, which last for two-to-three days, and by mild depression; marked liver damage or near-constant debilitating symptoms (such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) are not demonstrated. Neither version of the rating criteria is favorable to the Veteran. 2. Prior to July 6, 2017, the Veteran’s depressive disorder has been manifested by depressed mood and anxiety, which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or with symptoms controlled by continuous medication; occupational and social impairment with an occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks is not shown. 3. For the rating period from July 6, 2017, the Veteran’s depressive disorder has been manifested by depressed mood, anxiety, and chronic sleep impairment; occupational and social impairment with reduced reliability and productivity, occupational and social impairment with deficiencies in most areas, and total occupational and social impairment have not been demonstrated. 4. The Veteran has not worked full-time since 1999; he has a sparse employment history, and has worked as a caregiver for family members; he reportedly has a GED (General Educational Development) certificate, and additional training in nursing. 5. Service connection is in effect for hepatitis C with depression, rated as 60 percent disabling; and for a depressive disorder, rated as 30 percent disabling. The combined disability rating is 60 percent from May 25, 1993, and 70 percent from July 6, 2017. 6. Prior to July 6, 2017, the Veteran’s service-connected disabilities are not shown to be of such a nature or severity to prevent him from obtaining or retaining substantially gainful employment. 7. As of July 6, 2017, the combined effect of the Veteran’s service-connected depressive disorder and physical limitations has resulted in no more than marginal employment and “off and on” again homelessness. CONCLUSIONS OF LAW 1. The criteria for a disability rating greater than 60 percent for infectious hepatitis and hepatitis C are not met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.7, 4.114, Diagnostic Codes 7345 (2001 & 2017), 7354 (2017). 2. For the period prior to July 6, 2017, the criteria for a disability rating greater than 10 percent for the Veteran’s depressive disorder are not met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.7, 4.130, Diagnostic Code 9434 (2017). 3. For the period from July 6, 2017, the criteria for a disability rating greater than 30 percent for the Veteran’s depressive disorder are not met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.7, 4.130, Diagnostic Code 9434 (2017). 4. Prior to July 6, 2017, the criteria for TDIU are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.340, 3.341, 4.15, 4.16(b) (2017). 5. For the period from July 6, 2017, the criteria for TDIU are met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.340, 3.341, 4.15, 4.16(b) (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1972 to February 1975. This appeal was remanded by the Board of Veterans' Appeals (Board) in February 2017 and in August 2017. The RO issued a supplemental statement of the case (SSOC) in March 2018, and a substantive appeal on behalf of the Veteran was filed later that same month. Rating Disability ratings are determined by applying the criteria set forth in the VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity resulting from disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2017). Separate ratings may be assigned for separate periods of time based on the facts found. This practice is known as “staged” ratings.” Fenderson v. West, 12 Vet. App. 119, 126-127 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. Evaluation of Infectious Hepatitis and Hepatitis C, for the Rating Period from May 25, 1993 The Veteran initiated a claim for an increased disability rating in May 1993. The RO has evaluated the Veteran’s disability under former Diagnostic Code 7345 as 60 percent disabling from May 1993, based on findings of moderate liver damage with fatigue and mental depression. Under former Diagnostic Code 7345, a 60 percent evaluation was assigned for moderate liver damage with disabling recurrent episodes of gastrointestinal disturbance, fatigue, and mental depression. A maximum 100 percent evaluation was assigned for marked liver damage manifested by liver function test and marked gastrointestinal symptoms; or with episodes of several weeks duration aggregating three or more a year, and accompanied by disabling symptoms requiring rest therapy. 38 C.F.R. § 4.114, Diagnostic Code 7345 (in effect prior to July 2, 2001). VA revised the criteria for evaluation of liver disabilities, effective on July 2, 2001 (see 66 Fed. Reg. 29486-29489 (May 31, 2001)). VA has a duty to adjudicate the claim under the former criteria during the entire appeal period, and to consider the revised criteria for the period beginning on the effective date of the new provisions. DeSousa v. Gober, 10 Vet. App. 461, 467 (1997); see also VAOPGCPREC 3-2000 (2000) and 7-2003 (2003). Currently, infectious hepatitis and hepatitis C are rated as follows: A 60 percent evaluation requires daily fatigue, malaise, and anorexia, with substantial weight loss (or other indication of malnutrition), and hepatomegaly, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least six weeks during the past 12-month period, but not occurring constantly. A 100 percent evaluation is assigned when there are near-constant debilitating symptoms (such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain). Notes following Diagnostic Code 7354 provide: (1) Evaluate sequelae, such as cirrhosis or malignancy of the liver, under an appropriate diagnostic code, but do not use the same signs and symptoms as the basis for evaluation under Diagnostic Code 7354 and under a diagnostic code for sequelae (see § 4.14); (2) an ‘incapacitating episode’ means a period of acute signs and symptoms severe enough to require bed rest and treatment by a physician. In this case, a July 1993 VA examination report reflects that the Veteran experiences nausea and right upper quadrant discomfort approximately two-to-three times per week, which last for two-to-three days. He vomits approximately two times per month, and the degree of pain is moderate to severe. He has some anorexia, and does develop malaise. The Veteran has lost six pounds in the last four months; he also has generalized weakness. Private records show diagnoses of both hepatitis B and hepatitis C based on liver biopsy in September 1993. The Veteran was started on Interferon in October 1993. His main complaints in November 1993 are feeling fatigued, body aches, and right knee discomfort; he also noticed mild depression. VA records, dated in April 2008 and in November 2010, reflect that the Veteran was diagnosed with hepatitis C in 1993; and, at which time, he was successfully treated with Interferon and has been in remission since then. A June 2014 VA examination report reflects that the last computed tomography scans taken in 2011 revealed no evidence of cirrhosis and no evidence of end-stage liver disease. The Veteran had no current signs or symptoms attributable to chronic or infectious liver diseases. He had no incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) due to liver conditions during the past twelve months. There were no current signs or symptoms attributable to cirrhosis of the liver. No other pertinent physical findings were recorded. VA’s Administrative Review in December 2015 reveals that the Veteran has been receiving medication for hepatitis C for the past six months, and that he experiences mild symptoms of depression. While available evidence supports neither an evaluation for hepatitis C alone in excess of 20 percent nor an evaluation for depression alone in excess of 10 percent, the current protected evaluation of 60 percent for hepatitis C with depression has been in effect for over twenty years and cannot be reduced. In March 2017, a VA physician reviewed the Veteran’s medical records and opined that there is no evidence of liver disease. Here, throughout the rating period, there is no evidence of marked liver damage manifested by liver function test and marked gastrointestinal symptoms; and of disabling symptoms requiring rest therapy for several weeks duration in any year. His symptoms do not meet or approximate the criteria for a disability rating greater than 60 percent for hepatitis with depression at any time under former Diagnostic Code 7345. Moreover, since 2001, none of the evidence suggests near-constant debilitating symptoms (such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain). In this regard, the criteria for a 100 percent rating under current Diagnostic Codes 7345 and 7354 are not met or approximated. The preponderance of the evidence, therefore, is against a disability rating greater than 60 percent under both former Diagnostic Code 7345 and current Diagnostic Codes 7345 and 7354. No other diagnostic codes are applicable. A separate rating is not warranted for eye involvement. Ultimately, the Board places the most probative weight on the results of objective physical examination by medical professionals, which fail to show any evidence of liver disease to warrant an increased rating. 2. Evaluation of Depressive Disorder, for the Rating Period from January 24, 2014, to July 5, 2017 When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran’s capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based upon all the evidence of record that bears on occupational and social impairment, rather than solely upon the examiner’s assessment of the level of disability at a moment of examination. When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation solely based on social impairment. 38 C.F.R. § 4.126. The current 10 percent evaluation contemplates 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 higher evaluation of 30 percent is contemplated for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss (such as forgetting names, directions, recent events). For the rating period from January 24, 2014, to July 5, 2017, VA records reflect that the nature of the Veteran’s symptoms of a depressive disorder are in the mild range of severity; and that his mood symptoms will likely be exacerbated if he relapses with any substances. He completed a residential substance abuse treatment program in 2014, and attended group counseling sessions. A June 2014 VA examiner described the Veteran’s occupational and social impairment as due to mild or transient symptoms, which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress; or as symptoms controlled by medication. Current symptoms included depressed mood. The June 2014 VA examiner noted that the Veteran’s mood was euthymic, and affect was broad and appropriate. There were no overt behavioral manifestations of depression or anxiety. The Veteran was casually and appropriately dressed; his hygiene and grooming were adequate. He was polite and cooperative, and responded to all questions posed by examiner. His memory and concentration appeared to be grossly intact. When queried, the Veteran reported that he still gets depressed and has some anxiety and crying spells; and reported having good days and bad days. He stated that he was depressed primarily because of his health. The Veteran reported no history of suicide attempts and no history os psychiatric hospitalizations. He reported getting between four and eight hours of sleep per night. While the Veteran reported being anxious “all the time,” his scoring on a psychological assessment indicated only mild symptoms of anxiety. He denied symptoms consistent with panic disorder, obsessive-compulsive disorder, mania, or hypomania; and denied any visual or auditory hallucinations. When queried about social relationships, the Veteran reported having a “handful” of friends he sees regularly, and reported sharing household chores with a friend. VA records, dated in June 2015, show that the Veteran’s appearance, ambulation, eye contact, speech, and thought content on mental status evaluation were within normal limits. His mood was euthymic with mood congruent affect. There was no evidence of psychosis. His insight, reason, and judgment appeared to be adequate. The Veteran expressed intense distress at times, although he denied any suicidal ideation, intent, and plans. In March 2017, a VA physician reviewed the Veteran’s medical records and indicated that the Veteran’s mood was stable; medications were continued. In July 2018, the Veteran contended that his homelessness on numerous occasions suggests that his depression is more severe than currently rated. The Board finds that the overall severity, frequency, and duration of the Veteran’s symptoms are not on par with the level of severity contemplated by disability ratings in excess of 10 percent prior to July 6, 2017. Specifically, there is no showing of occasional decrease in work efficiency or intermittent periods of inability to perform occupational tasks due to such symptoms as depressed mood, anxiety, or chronic sleep impairment. While the Veteran reportedly felt anxious, all psychological testing reports revealed only mild symptoms. Nor is there any showing of reduced reliability and productivity due to symptoms such as pressured speech, or disturbances of motivation and mood. Accordingly, the requirements for an increased disability rating for the Veteran’s depressive disorder are not met prior to July 6, 2017. 3. Evaluation of Depressive Disorder, for the Rating Period from July 6, 2017 The current 30 percent evaluation contemplates occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss (such as forgetting names, directions, recent events). A higher evaluation of 50 percent rating is contemplated 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 and maintaining effective work and social relationships. For the rating period from July 6, 2017, VA records reflect ongoing treatment and medication for a chronic depressive disorder. The July 2017 VA examiner described the Veteran’s occupational and social impairment as due to mild or transient symptoms, which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress; or as symptoms controlled by medication. At the time the Veteran described being homeless “off and on,” and that he was currently renting a house. He reported trying to reconnect with his grandchildren, and trying to relax and practice mindfulness. Current symptoms in July 2017 include depressed mood, anxiety, and chronic sleep impairment. The July 2017 VA examination report reveals no evidence of speech impairment, no panic attacks, no disturbances of motivation and mood, and no other indications of psychosis. The July 2017 examiner indicated that the Veteran’s presentation was forthcoming and cooperative, his thought processes were coherent and within normal limits, and his speech was within normal limits. His mood was dysphoric, and his affect was appropriate to mood. He was tearful at times. The Veteran is fully oriented; his attention and concentration are intact, and his memory is intact. His insight and judgment are intact. Again, the Veteran denied suicidal or homicidal ideation, plan, or intent. The July 2017 examiner opined that the Veteran’s symptoms appear to be mild to moderate, and do not appear to have significantly worsened since his last examination. Thus, based on the above record, while his symptoms are chronic, there is no showing of reduced reliability and productivity due to symptoms such as flattened affect, pressured speech, memory impairment, or disturbances of motivation or mood. Nor is there any compelling indication of deficiencies in most areas—such as work, school, family relationships, judgment, thinking or mood—due to symptoms of depressive disorder. None of the Veteran’s actions throughout the appeal suggests such severity of symptoms. In fact, the July 2017 examiner considered the Veteran’s “on and off” again homelessness, and still described the Veteran’s depressive symptoms as mild to moderate. In short, the Board finds that the overall severity, frequency, and duration of the Veteran’s symptoms due to depressive disorder are not on par with the level of severity contemplated by a disability rating greater than 30 percent at any time. Accordingly, the requirements for a disability rating greater than 30 percent for depressive disorder, for the rating period from July 6, 2017, are not met. Hence, staged ratings are warranted. Fenderson v. West, 12 Vet. App. 119, 126 (1999). 4. TDIU Total disability ratings for compensation based upon individual unemployability may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. For the purpose of one 60 percent disability, or one 40 percent disability in combination, disabilities resulting from a common etiology or a single accident will be considered as one disability; and disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable, will be considered as one disability. 38 C.F.R. §§ 3.340, 3.34l, 4.16(a). In determining whether the Veteran is entitled to TDIU, neither his nonservice-connected disabilities nor his age may be considered. Van Hoose v. Brown, 4 Vet. App. 361 (1993); 38 C.F.R. § 3.341(a). In this case, the Veteran has completed three years of high school; he earned a GED certificate in 1978, and has had additional education and training in nursing from 1996 to 1999. He reportedly last worked full-time for a period of six months as a nurse in 1999. He later worked part-time as a clerk in a grocery store from May 2006 to July 2007. Service connection is currently in effect for hepatitis C with depression, rated as 60 percent disabling; and for depressive disorder, rated as 30 percent disabling. The combined disability rating is 60 percent from May 25, 1993, and 70 percent from July 6, 2017. Hence, the Veteran meets the threshold percentage requirements for consideration of a TDIU as of May 25, 1993 (based on one disability). 38 C.F.R. § 4.16(a). The remaining issue, then, is whether the Veteran’s service-connected disabilities render him unable to obtain and retain substantially gainful employment. The sole fact that a Veteran is unemployed or has difficulty obtaining employment is not enough. A high rating in itself is recognition that the impairment makes it difficult to obtain or keep employment. The ultimate question, however, is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether he can find employment. Van Hoose, 4 Vet. App. at 363. VA’s vocational rehabilitation records, dated in June 1989, reveal that the Veteran’s service-connected infectious hepatitis does not materially hinder his ability to obtain or maintain suitable employment. In July 1990, the Veteran responded that he has been turned down for employment because employers felt his disability was severe enough that he would not be able to perform the job, and it would interfere with his work ability. In November 1993, the Veteran reported that a recent liver biopsy revealed that he also has hepatitis C; and that he now gets Interferon injections five times weekly for a minimum of four-to-six months, which is intended to put the progression of the hepatitis C into remission. The Veteran reported that he currently is unemployed due to the severe side effects of the medication. VA regulations provide that a total disability rating may be provided based on history in cases where the disability has undergone some recent improvement. 38 C.F.R. § 3.340(a)(3). In such cases, specifically: (1) the disability must in the past have been of sufficient severity to warrant a total disability rating; (2) the disability must have required extended, continuous, or intermittent hospitalization or have produced total industrial incapacity for at least one year, or be subject to recurring, severe, frequent, or prolonged exacerbations; and (3) that despite recent improvement, the Veteran will be unable to effect an adjustment into a substantially gainful occupation. Id. Here, as shown above, the Veteran’s infectious hepatitis and hepatitis C have not been severe enough at any time to warrant a total disability rating. While the Veteran has been turned down for employment and he no longer could purchase life insurance, such evidence does not reflect incapacity to perform the physical and mental acts required by employment. Moreover, while the Board finds credible the Veteran’s report that his treatment for six months with Interferon injections caused severe side-effects, there is no demonstration of total industrial incapacity for at least one year. In this regard, a total disability rating based on history of the Veteran’s infectious hepatitis and hepatitis C prior to improvement is not warranted. 38 C.F.R. § 3.340(a)(3). VA records first show an assessment of major depression in November 1995. During a psychological assessment in February 2004, the Veteran reported having two lumbar and two cervical spine surgeries; and reported experiencing significant functional impairment as a result of his pain. The Veteran reported that, in addition to being unable to work, his movements are slowed and he is unable to do much lifting; and that he sometimes feels depressed as a result of his limitations. The Veteran reported that he obtained his LPN (Licensed Practical Nurse) in 1999; and that he worked briefly as a nurse afterward, but was unable to do the required lifting. A vocational assessment in September 2005 reveals that the Veteran currently has no nursing license. He is limited in lifting over fifteen pounds because of degenerative bone disease. VA records show that the Veteran was “trying hard” to obtain some type of employment in July 2007. He reportedly was hired at a local nursing home; however, his background check revealed a past history for using substances at work, and the Veteran lost his job. VA records, dated in March 2011, show that the Veteran has a sparse work history. He was trained to be a nurse, but did not formally work; and has been a caretaker for several family members. A vocational assessment in May 2012 reveals that the Veteran last worked in December 2010, and he reported being homeless for three months in 2011. His medical history reveals that degenerative bone disease impacts his ability to work. The assessor noted that the Veteran has back issues, and that he needs a light limited duty employment position. The Veteran again claimed entitlement to a TDIU on January 24, 2014. A June 2014 VA examiner reviewed the Veteran’s medical history, and noted that computed tomography scans in 2011 revealed no evidence of cirrhosis or of end-stage liver disease. The June 2014 examiner also noted the Veteran’s report of previous treatment with Interferon for six months, and opined that the Veteran’s liver condition has not affected his ability to obtain and maintain gainful employment. During a June 2014 VA mental disorders examination, the Veteran reported that he had worked full-time post-service as an orderly at two hospitals from 1975 to 1978. He then worked approximately eight different jobs, with the longest job being of two years’ duration. The Veteran reported being terminated from employments for missing too many days of work. He was last employed in 2009 at a local grocery store; that job ended because of various operations which the Veteran had scheduled. The Veteran also reported taking care of his parents for a few years, and then no one hired him because of age and his having no recent employment. The June 2014 examiner opined that the Veteran’s psychiatric complaints do not impact sedentary or physical employment. In support of the opinion, the June 2014 examiner reasoned that there are no records indicating mental health treatment prior to 1995; and that the Veteran would be expected to continue to tolerate the demands of the workplace including performing tasks assigned, managing the stress load of the workplace, and managing interpersonal relationships in the workplace. VA records, dated in June 2015, reveal that the Veteran was scheduled to start a “new IT job” on the following Monday. In August 2015, the Veteran reported that he had been denied Social Security disability insurance; and reported that his employment at a grocery store from May 2006 until July 2007 was under 20 hours per week and not considered substantially gainful employment. An August 2015 response from the Social Security Administration reveals that those medical records were destroyed. In October 2015, a VA social worker noted that the Veteran was employed part-time completing medical billing/coding, and working remotely. He received a “per diem” rate, based on the work completed; and his income varied. He reported no other income, and denied receipt of food stamp benefits or any other benefits. VA records reflect that the Veteran was again homeless in July 2016. He subsequently received outreach assistance, and rented a home. He got a job in January 2017, and was provided with furniture in February 2017. In March 2017, a VA nurse practitioner reviewed the Veteran’s medical records; and noted the Veteran’s mood as stable, and that medications were continuing. There was no evidence of liver disease. Hence, the nurse practitioner opined that the Veteran’s service-connected hepatitis C does not impact his ability to secure and follow substantially gainful employment. Here, prior to July 6, 2017, neither examiners nor vocational assessors described total occupational impairment due to the Veteran’s service-connected disabilities. That is evidence that must be considered. The overall evidence prior to July 6, 2017, does not reflect that the Veteran is unable to secure and follow any substantially gainful occupation by reason of his service-connected disabilities. A July 6, 2017 VA mental disorders examination reveals that all symptoms are attributable to the Veteran’s depressive disorder. The July 2017 examiner noted that the Veteran has been homeless “off and on,” and that he now was renting a house. The Veteran reported working about five and one-half hours weekly at a deli, and that he has been doing so for about three months. He stated that, physically, he cannot stand for a long time to work longer hours. The July 2017 examiner noted that the Veteran is prescribed medication for his depression, and opined that his symptoms would not preclude his ability to obtain and maintain employment. In support of the opinion, the July 2017 examiner reasoned that the Veteran did not describe a history of mental health problems impairing his ability to work. Rather, problems with his physical body are limiting his working ability. Here, the Veteran has asserted that he is unemployable due to service-connected disabilities. To this extent, his statement is of some probative value. Significantly, the Board finds that the Veteran’s mental health complaints and need for continuous medications for treatment of depressive symptoms have been corroborated by VA examiners. However, the July 2017 VA examiner has not discussed the impact of whether the Veteran’s service-connected depressive disorder combines with his physical limitations to preclude employment. In this case, no more than marginal employment is demonstrated. Ultimately, VA examiners have not considered the Veteran’s work history. Under these circumstances, and resolving doubt in the Veteran’s favor, the Board concludes that the Veteran’s lay assertions of chronic depressive symptoms combined with significant physical limitations, along with evidence of no more than marginal   employment since July 6, 2017, and “off and on” again homelessness, strongly suggests that the Veteran is unable to obtain or maintain gainful employment. Hence, TDIU benefits are awarded. 38 U.S.C. § 5107(b). H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Mary C. Suffoletta