Citation Nr: 19136037 Decision Date: 05/09/19 Archive Date: 05/09/19 DOCKET NO. 18-20 002 DATE: May 9, 2019 ORDER Subject to the law and regulations governing the payment of monetary benefits, entitlement to a 70 percent initial evaluation, but no higher, for service-connected posttraumatic stress disorder (PTSD) with Major Depression (hereinafter, acquired psychiatric disability) is granted from March 21, 2007, to February 23, 2016. Entitlement to an initial evaluation in excess of 70 percent for service-connected PTSD with Major Depression from February 24, 2016, is denied. Entitlement to a total evaluation based on individual unemployability due to service-connected disabilities (TDIU) from March 21, 2007, to February 23, 2016, is granted. Entitlement to Dependents' Educational Assistance under 38 U.S.C. Chapter 35 from March 21, 2007, to February 23, 2016, is granted. FINDINGS OF FACT 1. From March 21, 2007, to the present, the most probative evidence reflects that the Veteran's service-connected PTSD and Major Depression are manifested by severe symptomatology, resulting in occupational and social impairment with deficiencies in most areas, such as social relations, work, and mood, without total social impairment. 2. The most probative evidence reflects that the Veteran has been unable to secure or follow a substantially gainful occupation as a result of the symptoms related to his service-connected disabilities since March 21, 2007. 3. From March 21, 2007, to February 23, 2016, the Veteran had a permanent and total disability rating. CONCLUSIONS OF LAW 1. From March 21, 2007, to the present, the criteria for a 70 percent initial evaluation for service-connected PTSD and Major Depression, but not in excess thereof, have been met. 38 U.S.C. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 4.7, 4.130 and Diagnostic Code 9411 (2018). 2. From March 21, 2007, to the present, the criteria for entitlement to TDIU have been met. 38 U.S.C. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.340, 3.341, 4.16(b) (2018). 3. From March 21, 2007, to the present, the criteria for the grant of DEA benefits under Chapter 35 have been met. 38 U.S.C. §§ 3510, 5110, 5113 (West 2002); 38 C.F.R. §§ 3.807, 21.3021 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from May 1960 to April 1962 and from July 1963 to June 1967. He also has more than 14 months of service of an unspecified nature. This matter comes before the Board of Veterans' Appeals (the Board) on appeal from multiple rating decisions and Decision Review Officer (DRO) decisions of the Agency of Original Jurisdiction (AOJ), which is the Department of Veterans Affairs (VA) Veterans Benefits Administration (VBA). Because of the complex procedural history and intertwined nature of the issues on appeal, the Board finds that a brief recitation of pertinent facts would be helpful. In March 2007, the Veteran submitted to VA a statement asserting that he wished to file claims to establish service connection for several disabilities, including “depression.” In developing these claims, the issue of entitlement to service connection for PTSD was noted to be raised by the record, as this disability was diagnosed in the Veteran’s VA treatment records. In a November 2007 rating decision, the AOJ denied separate claims to establish service connection for PTSD and depression, among other disabilities. The Veteran expressed timely disagreement with these determinations and subsequently perfected an appeal to the Board regarding both issues. In October 2011, the Board merged these issues and recharacterized them as entitlement to service connection to an acquired psychiatric disability, to include PTSD and depression, citing to the United States Court of Appeals for Veteran’s Claims’ (the Court’s) holding in Clemons v. Shinseki, 23 Vet. App. 1 (2009). The merged issue, among others, was remanded for further evidentiary and procedural development. In a March 2013 rating decision, the AOJ established service connection for Major Depression; a 30 percent initial evaluation was assigned, effective from March 21, 2007. This narrative section of this rating decision noted that service connection for PTSD could not be established because the Veteran’s reported stressor events could not be corroborated, but the issue was not separately readjudicated. Nonetheless, it was stated that this allowance (for Major Depression) represented a “full grant of the benefits sought, “and the issue was “considered resolved in full.” The Veteran did not express timely disagreement with the assignment of the initial evaluation or effective date of this award or submit pertinent new and material evidence within the appeal period of the March 2013 rating decision, and thus, it became final regarding these downstream elements. 38 U.S.C. § 7105 (c) (West 2002); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (2017); Bond v. Shinseki, 659 F.3d 1362 (Fed. Cir. 2011). While other issues remanded by the Board were readjudicated by the AOJ in a March 2013 Supplemental Statement of the Case (SSOC), entitlement to service connection for PTSD was not among them. In November 2014, the Veteran filed claims seeking an increased evaluation for service-connected Major Depression and TDIU, which were denied by the AOJ in a March 2015 rating decision. Because the Veteran did not express timely disagreement with these determinations or submit pertinent new and material evidence within the appeal period, the March 2015 rating decision became final regarding these claims. 38 U.S.C. § 7105 (c) (West 2002); 38 C.F.R. §§ 3.104, 3.156(b), 20.302, 20.1103 (2017); Bond v. Shinseki, 659 F.3d 1362 (Fed. Cir. 2011). In August 2015, the Board granted service connection for PTSD, noting that the issue, which was remanded in October 2011, had not been readjudicated by the AOJ and remained pending. In implementing this allowance in an October 2015 rating decision, the AOJ recharacterized the Veteran’s service-connected Major Depression to PTSD with depression and assigned a 30 percent evaluation, effective from October 5, 2015 – the date of the rating decision. While not specifically adjudicated or stated, it appears that the effect of this recharacterization was a severance of service connection of Major Depression. In June 2016, the Veteran’s private attorney expressed disagreement with the initial evaluation assigned for this recharacterized service-connected disability (PTSD with depression) and requested that the AOJ consider whether assignment of TDIU was appropriate under the Court’s holding in Rice v. Shinseki, 22 Vet. App. 447, 452 (2009). However, in a September 2016 statement, the Veteran’s private attorney clarified that part and parcel of the appeal for an increased initial evaluation for service-connected PTSD with depression are the matters of (1) whether an earlier effective date for the grant of PTSD is appropriate, and if so, (2) whether separate evaluations for Major Depression and PTSD are warranted. In a March 2018 rating decision, the AOJ partially granted the Veteran’s appeal for an increased initial evaluation for service-connected PTSD with depression, increasing the evaluation from 30 percent to 70 percent, and established TDIU and DEA – all awards effective from February 24, 2016. This represented a partial allowance of all issues and resulted in a "staged" initial evaluation for the Veteran’s service-connected PTSD with depression. Since none of these issues was granted to the fullest extent, they remained in appellate status. See Hart v. Mansfield, 21 Vet. App. 505 (2007); AB v. Brown, 6 Vet. App. 35, 38-39 (1993). Also, in a March 2018 Statement of the Case (SOC), the AOJ readjudicated the issue of entitlement to an initial evaluation in excess of 30 percent for service-connected PTSD with depression at any time from March 21, 2007, (the date of service connection for Major Depression, but not PTSD) to February 24, 2016 (the date that the Veteran’s service-connected PTSD with depression was increased to 70 percent). By considering whether an increased initial evaluation was warranted back to March 2007, the AOJ overcame the finality of the March 2013 and March 2015 rating decisions which adjudicated the same issue, as noted above. In May 2018, the Veteran’s private attorney expressed timely disagreement with the effective date assigned for the grant of service connection for PTSD and establishment of TDIU and DEA. In a statement accompanying this Notice of Disagreement, the Veteran’s private attorney specifically asserted that separate evaluations for depression (or Major Depression) and PTSD were being sought under the United States Court of Appeals for the Federal Circuit’s (Federal Circuit’s) holding in Amberman v. Shinseki, 570 F.3d 1377, 1381 (Fed. Cir. 2009), as part of the Veteran’s appeals for an increased evaluation for service-connected Major Depression (prior to October 5, 2015) and PTSD with depression (after October 5, 2015) and assignment of an earlier effective date for the grant of service connection for PTSD. In July 2018, the AOJ provided the Veteran and his private attorney an SOC that readjudicated the issues of entitlement to effective dates earlier than February 24, 2016, for the awards of TDIU and DEA. The Board notes that the AOJ did not discuss entitlement to an effective date earlier than October 5, 2015, for service connection for PTSD, as was filed by the Veteran’s private attorney. In a separate July 2018 letter, the AOJ stated that there was a separate appeal for an earlier effective date for an increased evaluation for PTSD with depression currently pending; however, the Board notes that no such claim can exist unless service connection for PTSD is established prior to October 5, 2015, and according to the Code Sheet section of the March 2018 rating decision, it is not. Later in July 2018, the AOJ certified the Veteran’s appeal to the Board; however, this VA Form 8 does not list the issues certified to the Board. In August 2018, the Veteran’s private attorney perfected an appeal to the Board for the issues of entitlement to effective dates earlier than February 24, 2016, for the awards of TDIU and DEA. Later in August 2018, the Board remanded the Veteran’s appealed issues of (1) entitlement to an initial evaluation in excess of 30 percent for service-connected Major Depression from March 21, 2007, to October 4, 2015, (2) entitlement to an initial evaluation in excess of 30 percent for PTSD with depression from October 5, 2015, to February 23, 2016, (3) entitlement to an initial evaluation in excess of 70 percent for service-connected PTSD with depression after February 24, 2016, to include separate evaluations for PTSD and Major Depression for each stage, (4) entitlement to an effective date earlier than October 5, 2015, for the grant of service connection for PTSD, (5) entitlement to an effective date earlier than February 24, 2016, for the assignment of TDIU, and (6) entitlement to an effective date earlier than February 24, 2016, for the award of DEA. In a February 2019 DRO decision, the AOJ fully granted the Veteran’s appeal seeking an earlier effective date for the grant of service connection for PTSD based on CUE in the October 2015 rating decision; service connection for PTSD was granted from March 21, 2007, and the disability was evaluated with his service-connected Major Depression from that date until the present. This abrogated the Veteran’s appeal of this issue. Grantham v. Brown, 114 F.3d 1156, 1158-59 (Fed. Cir. 1997). Further, in the February 2019 DRO decision and SSOC, the AOJ denied the Veteran’s claims for an increased evaluation for service-connected PTSD and Major Depression, evaluated 30 percent disabling prior to February 24, 2016, and 70 percent thereafter, and for an effective date prior to February 24, 2016, for the awards of TDIU and DEA. These issues have been returned to the Board for further appellate consideration. Increased Evaluations, PTSD, TDIU, and DEA Eligibility Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. See 38 U.S.C. § 1155; 38 C.F.R. Part 4. The percentage ratings in VA's Schedule for Rating Disabilities (Rating Schedule) represent as far as can practicably be determined the average impairment in earning capacity resulting from such disabilities and their residual conditions in civil occupations. See 38 C.F.R. § 4.1. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more closely approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 3.102, 4.3. Where entitlement to compensation has already been established and increase in disability is at issue, the present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55 (1994). However, "staged" ratings are appropriate where the factual findings show distinct time periods when the service-connected disability exhibits symptoms that would warrant different ratings. See Hart, supra. Separate compensable evaluations may be assigned for separate periods of time if such distinct periods are shown by the competent evidence of record during the appeal, a practice known as "staged" ratings. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). Once the evidence has been assembled, it is the Board's responsibility to evaluate the evidence. 38 U.S.C. § 7104 (a) (West 2002). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107 (West 2002); 38 C.F.R. § 3.102 (2017); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Under 38 C.F.R. § 4.130, Diagnostic Code 9411, a 30 percent rating is warranted when there is occupational and social impairment with an occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). A 50 percent evaluation is warranted when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty 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; the Veteran’s difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent disability evaluation is warranted when there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; 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); inability to establish and maintain effective relationships. Id. A 100 percent disability evaluation is warranted when there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability of the Veteran to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time and place; memory loss for names of close relatives, own occupation, or own name. Id. The use of the phrase "such symptoms as," followed by a list of examples, provides guidance as to the severity of symptomatology contemplated for each rating. The use of such terminology permits consideration of items listed and other symptoms and contemplates the effect of those symptoms on the Veteran's social and work situation. See Mauerhan v. Principi, 16 Vet. App. 436 (2002). The Board acknowledges that symptoms recited in the criteria in the rating schedule for evaluating mental disorders are "not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating." Id., at 442. In adjudicating a claim for a higher rating, the adjudicator must consider all symptoms of a claimant's service-connected mental condition that affect the level of occupational or social impairment. Id., at 443. A Global Assessment of Functioning (GAF) scale, with scores ranging between zero and 100 percent, represents the psychological, social, and occupational functioning of an individual on a hypothetical continuum of mental health-illness. GAF scores included in the record are a scale reflecting the psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness. Carpenter v. Brown, 8 Vet. App. 240, 242 (1995). In this regard, the Board acknowledges that effective August 4, 2014, VA amended the regulations regarding the evaluation of mental disorders by removing outdated references to DSM IV, AMERICAN PSYCHIATRIC ASSOCIATION: DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, 4th Edition (1994). The amendments replace those references with references to the recently updated DSM 5, and examinations conducted pursuant to the DSM 5 do not include GAF scores. As the Veteran's appeal for an increased initial evaluation was in the process of adjudication prior to and during the adoption of the DSM 5 and certified to the Board after August 2014, both the DMS IV and DSM 5 criteria will be utilized in the analysis set forth below. Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, 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, this disability shall be ratable at 60 percent or more, and that, if there are two or more such 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) (2018). It is the established policy of the VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. 38 C.F.R. § 4.16(b) (2018). A total disability will be considered to exist when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. A total disability may or may not be permanent. Total ratings will not be assigned, generally, for temporary exacerbations or acute infectious diseases except where specifically prescribed by the schedule. 38 C.F.R. § 3.340(a) (2018). Consideration may be given to the veteran's level of education, special training, and previous work experience in arriving at a conclusion, but not to his or her age or to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19 (2018). Survivors' and Dependents' Educational Assistance, under Chapter 35, Title 38, of the United States Code, is a program of education or special restorative training that may be authorized for an eligible person, such as a surviving spouse, if the applicable criteria are met. See 38 U.S.C. §§ 3500, 3501 (West 2002); 38 C.F.R. §§ 21.3020, 21.3021 (2018). Basic eligibility for certification of DEA exists if the veteran was discharged from service under conditions other than dishonorable, or died in service, and either (1) has a permanent total service-connected disability, or (2) a permanent total service-connected disability was in existence at the date of the veteran's death, or (3) died as a result of a service-connected disability, or, if a service member (4) is on active duty as a member of the Armed Forces and, for a period of more than 90 days, has been listed by VA concerned as missing in action, captured in line of duty by a hostile force, or forcibly detained or interned in the line of duty by a foreign government or power. 38 C.F.R. § 3.807 (2018). 1. Entitlement to an increased initial evaluation for service-connected PTSD with Major Depression (hereinafter, acquired psychiatric disability), evaluated 30 percent disabling prior to February 24, 2016, and 70 percent disabling, thereafter The Veteran and his private attorney assert that his service-connected PTSD with Major Depression is more disabling than the assigned 30 percent evaluation prior to February 24, 2016, and 70 percent, thereafter. For the reasons expressed below, the Board concludes that the Veteran’s service-connected psychiatric symptoms most closely represent the criteria for a 70 percent evaluation throughout the pendency of the appeal. As noted in the Introduction, the Veteran has been diagnosed with PTSD and Major Depression during the pendency of the appeal. Although both disabilities have been service connected by the AOJ, as noted in the Introduction, there has been some confusion concerning the effective dates assigned for these awards and what psychiatric symptoms were considered in the assigned staged evaluations. As noted by a VA clinician in February 2016 and the Veteran’s private attorney in March 2019, separate evaluations for these psychiatric disabilities may be assigned if the evidence shows that it is possible to differentiate between the symptoms and functional impairment attributable for each. Amberman v. Shinseki, 570 F.3d 1377, 1380 (Fed. Cir. 2009). While the Board has considered this, the record reflects that application of Amberman is inappropriate in this case. Specifically, a June 2017 private psychiatric assessment and the October 2018 VA psychiatric examiner specifically stated that the Veteran’s PTSD and Major Depression symptoms are intertwined, and thus, the symptoms and functional impairment associated with each cannot be differentiated. Based on this evidence, in the February 2019 DRO decision, the AOJ establish service connection for PTSD since March 21, 2007, and evaluated both disabilities together throughout the pendency of the appeal. As such, the Board will attribute all of the psychiatric symptoms to his service-connected psychiatric disabilities. Mittleider v. West, 11 Vet. App. 181 (1998). The evidence of record during the appeal period, includes VA treatment records, the reports of November 2011, March 2015, and October 2018 VA examinations, and a June 2017 private psychiatric assessment from Dr. C.D., a private psychologist. Review of this evidence reflects that the Veteran’s PTSD and Major Depression are manifested by intrusive thoughts, flashbacks, irritability, avoidance, emotional numbing, hypervigilance, an exaggerated startle response, detachment and estrangement from friends and family members, disturbances of motivation and mood, short-term memory impairment, nightmares, anxiety and isolation. However, the November 2011 and March 2015 VA examination reports do not consider the totality of the Veteran’s psychiatric symptoms, as there was disagreement concerning what symptoms were attributable to which diagnosed. Further complicating matters, only PTSD was service connected at the time of these examinations, even though this disability was ruled out by the March 2015 VA examiner. With the above in mind, the Board finds that the June 2017 private psychiatric assessment and October 2018 VA examination reports are more complete and reliable sources of information, as these reports consider symptoms and functional impairment attributable to the Veteran’s service-connected PTSD and Major Depression. Critically, the June 2017 private psychologist and October 2018 VA examiner specifically stated that the Veteran’s psychiatric symptoms and resulting functional impairment, attributable to both service-connected psychiatric disabilities, remained static from 2007 to the present – which represents the appeal period under consideration by the Board. The June 2017 private psychiatric assessment and October 2018 VA examination report reflect that the Veteran has experienced recurrent intrusive thoughts, traumatic nightmares, flashbacks, efforts to avoid memories, negative emotional state, feeling alienated from others, constricted affect, irritability, hypervigilance, an exaggerated startle response, problems with concentration, insomnia, depressed mood, sleep disturbance, psychomotor agitation, fatigue, feelings of worthlessness guilt, and recurrent thoughts of death without suicidal ideation. Further, based on the findings of the June 2017 private psychologist and October 2018 VA examiner, the Board concludes that the functional impairment stemming from these psychiatric symptoms most closely reflects occupational and social impairment with deficiencies in most areas, such as social relations, work, and mood, without total social impairment –the criteria for a 70 percent initial evaluation. The Board notes that the Veteran has not endorsed all or nearly all of the symptoms typically associated with a 70 percent evaluation. There was no evidence showing, for example, spatial disorientation or forgetting his own name. Nevertheless, in assigning an evaluation, the Board is not required "to find the presence of all, most, or even some, of the enumerated symptoms." See Mauerhan, supra. On the other hand, the psychiatric symptoms and resulting functional impairment indicated in the VA treatment records and examination reports are indicative of serious symptoms or serious impairment of social or occupational functioning. If the Board finds that the positive and negative evidence relating to a Veteran's claim are in "approximate balance," then the placement of the risk of nonpersuasion on the VA dictates a finding in favor of the claimant. Ortiz v. Principi, 274 F.3d 1361 (2001). See also, Gilbert v. Derwinski, 1 Vet. App. 49, 54-55 (1990). Here there is positive evidence in support of the claim and negative evidence against it. Given this, the Board finds that the evidence is in a state of "equipoise." As such, affording the Veteran the benefit of the doubt, the Board concludes that the most probative evidence concerning the severity and functional impairment resulting from the Veteran’s psychiatric symptoms most nearly approximates the criteria for a 70 evaluation for service-connected PTSD and Major Depression. Accordingly, to this extent, the benefit sought on appeal is granted for the time period prior to February 24, 2016. However, while the Veteran's psychiatric symptoms result in significant disability, the Board finds that the criteria for a 100 percent schedular evaluation are not met at any time during the appeal period. For instance, symptoms typically associated with a 100 percent evaluation for PTSD and Major Depression are not demonstrated. For example, there was no evidence of spatial disorientation, forgetting his own name, or a persistent danger of hurting himself or others. Further, as stated above, the criteria for a 100 percent schedular evaluation are psychiatric symptoms resulting in total occupational and social impairment. As will be discussed below, these symptoms do result in total occupational impairment. However, the record reflects that the Veteran’s psychiatric symptoms do not result in total social impairment at any time during the appeal period. While the evidence clearly reflects that these symptoms cause him to struggle with periods of irritability, agitation, and isolation, there is uncontroverted evidence that the Veteran spends ample time with his wife of more than 50 years. While the Veteran has reported disagreements and disputes with his wife, there is no evidence that he has experienced marital difficulties or that he is wholly unable to engage in familial and/or social relationships with others due to his psychiatric symptoms. To the extent that undertaking social situations and relationships may be difficult due to the Veteran’s psychiatric symptoms, that functional impairment is accounted for in the 70 percent evaluation which the Board has found to be warranted. As specifically stated by the October 2018 VA examiner, while the Veteran’s psychiatric symptoms result in moderate or severe social impairment, there is no evidence of total social impairment. In sum, because the Veteran’s psychiatric symptoms do not result in total social impairment, assignment of a 100 percent initial evaluation is not warranted. Based on the foregoing, and resolving all doubt in the Veteran’s favor, the Board concludes that the Veteran’s psychiatric symptomatology most nearly approximates the criteria for a 70 percent evaluation, but no higher, for the entirety of the appeal period. 38 U.S.C. § 5107 (West 2002). Lastly, the Board finds that the issue of an extraschedular rating has not been raised by the record, and will not consider referral. Doucette v. Shulkin, 28 Vet. App. 366, 371 (2017). 2. Entitlement to TDIU prior to February 24, 2016 As discussed above, the functional impairment stemming from the Veteran's service-connected PTSD and Major Depression has met the criteria for a 70 percent initial evaluation since March 21, 2007. As such, he meets the criteria for consideration of entitlement to TDIU on a schedular basis from March 21, 2007, to February 23, 2016 – which is the appeal period under consideration by the Board. 38 C.F.R. § 4.16 (a). The evidence reflects that the Veteran was last employed in 1991 as an automobile mechanic. This employment ended when he was injured on the job, as shown by records associated with his claims for worker’s compensation benefits and disability benefits from the Social Security Administration (SSA). These records also show that, in addition to his service-connected psychiatric disability, the physical injury that caused his 1991 retirement, residuals of fracture of odontoid process with osteoarthritis, is also service connected and evaluated 20 percent disabling. The file reflects that the Veteran’s occupational history shows that he was an automobile mechanic at several different businesses between his service separation and his ultimate retirement in 1991. Review of the June 2017 private psychiatric assessment and October 2018 VA examination report reflect the clinicians’ opinions that the Veteran’s service-connected psychiatric and physical disabilities severely and negatively impacted his employability since 2007. In particular, both clinicians noted that the Veteran’s agitation isolation, and angry outbursts, greatly impaired his ability to work with others in a close and/or pressured setting. As reported by the Veteran, his employment as an automobile mechanic did not allow for the type of working conditions conducive for management of his psychiatric symptoms. Further, the June 2017 private examiner noted that the available medical evidence showed that the Veteran’s psychiatric symptoms would result in a significant amount of time off assigned tasks and would reduce work productivity. The Veteran's sleep disturbances would cause him to feel fatigued, irritable, and unable to concentrate, and he would need to isolate himself during severe panic attacks. . Furthermore, the Veteran's irritability and desire to isolate would also preclude the Veteran from any substantially gainful employment, as he would be unable to work in a position that required interaction with others. Therefore, based on all of the foregoing, the Board will resolve reasonable doubt in the Veteran's favor and award entitlement to TDIU from March 21, 2007, to February 23, 2016 – which is the entirety of the appeal period under consideration for this issue. The Veteran has submitted credible lay evidence that he is unable to remain employed due to his psychiatric symptoms, including his irritability and desire to isolate himself. The Board also finds the June 2017 vocational rehabilitation study highly probative in evaluating the Veteran's claim. In this regard, the specialist provided a thorough rationale on the Veteran's inability to obtain substantially gainful employment due to his psychiatric symptoms. Accordingly, resolving reasonable doubt in favor of the Veteran, the Board finds that entitlement to a TDIU is warranted, and that it is warranted during the entire time frame on appeal. 38 U.S.C. § 5107 (b). 3. Entitlement to DEA prior to February 24, 2016 The effective date assigned for eligibility for DEA benefits (February 24, 2016) was based on the Veteran’s award of TDIU from that date to the present. As discussed above, the Board has concluded that the criteria for TDIU have been met for the entirety of the appeal period under consideration – which is March 21, 2007, to the present. As such, the criteria for eligibility for DEA benefits have also been met as of March 21, 2007. Nothing in the evidence shows that the Veteran had a permanent and total disability prior to that point. None of the other criteria for DEA under 38 C.F.R. § 3.807, such as death or capture by the enemy, have been met at any time prior to that date. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Scott W. Dale, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.