Citation Nr: 20003041 Decision Date: 01/14/20 Archive Date: 01/14/20 DOCKET NO. 13-02 335 DATE: January 14, 2020 ORDER Entitlement to a disability rating in excess of 70 percent from April 21, 2014 to September 21, 2009 for service-connected posttraumatic stress disorder (PTSD) is denied. Entitlement to a disability rating in excess of 50 percent from September 20, 2009 to December 18, 2008 for service-connected PTSD is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) from April 21, 2014 to December 18, 2008 is granted. FINDINGS OF FACT 1. For the period from April 21, 2014 to September 21, 2009, the severity, frequency, and duration of the Veteran’s symptoms did not more closely approximate total occupational and social impairment. 2. For the period from September 20, 2009 to December 18, 2008, the severity, frequency, and duration of the Veteran’s symptoms did not more closely approximate occupational and social impairment with deficiencies in most areas; total occupational and social impairment is not shown. 3. The probative evidence of record demonstrates that, from April 21, 2014 to December 18, 2008, the Veteran has been unable to secure or follow substantially gainful employment because of his PTSD. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 70 percent from April 21, 2014 to September 21, 2009 for service-connected PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.130, Diagnostic Code 9411. 2. The criteria for a disability rating in excess of 50 percent from September 20, 2009 to December 18, 2008 for service-connected PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.130, Diagnostic Code 9411. 3. The criteria for a TDIU from April 21, 2014 to December 18, 2008 have 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 served on active duty in the United States Army from August 1965 to August 1968, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared at a videoconference hearing before a Veterans Law Judge in April 2014. A transcript of that hearing is of record. The Board remanded the case in April 2015 for additional development. The case has returned to the Board for adjudication. 1. Entitlement to a disability rating for PTSD Disability ratings are determined by applying the criteria set forth in the VA Schedule for 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. The Veteran’s PTSD is evaluated under Diagnostic Code 9411, which assigns ratings based upon the General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130. A 50 percent rating 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 such as, 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 rating 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 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, or effectively; impaired impulse control, such as unprovoked irritability with periods of violence; spatial disorientation, neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances, including work or a work-like setting; and the inability to establish and maintain effective relationships. Id. A maximum 100 percent rating 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 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 symptoms listed in the General Rating Formula for Mental Disorders are not intended to constitute an exhaustive list. Rather, the symptoms serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436 (2002). When there is an approximate balance of positive and negative evidence regarding the degree of disability, the benefit of the doubt shall be given to the veteran. See 38 U.S.C. § 5107; 38 C.F.R. § 4.3. By way of history, the Veteran filed an increased disability rating claim for PTSD in December 18, 2008; a January 2009 rating decision denied the claim. A Notice of Disagreement (NOD) was filed in February 2009, and the RO issued a June 2009 Statement of the Case (SOC) denying the claim. The Veteran had until January 2010 to file an appeal. Instead of filing an appeal, the Veteran filed a new increased disability rating claim for PTSD in September 21, 2009. On December 2009, a VA PTSD examination was conducted. As noted above, the Veteran had until January 2010 to file an appeal, and thus a Supplemental Statement of the Case (SSOC) should have been issued following the VA PTSD examination. See 38 C.F.R. §§ 19.31, 19.37(a), 19.52(b)(2). In light of the record, the Veteran’s instant claim will be reviewed back to the December 2008 claim. A January 2010 rating decision was subsequently issued denying the Veteran’s September 21, 2009 PTSD claim. Veteran filed a NOD in April 2010. In a subsequent rating decision in September 2012, the disability rating for the Veteran’s PTSD increased to 70 percent effective September 21, 2009. In a subsequent August 2015 rating decision, the disability rating for the Veteran’s PTSD was again increased to 100 percent effective April 22, 2014. A 100 percent evaluation is the maximum allowed for PTSD. 38 C.F.R. § 4.130. Because the Veteran was not granted a 100 percent rating for the entirety of the appeal period, that portion of the Veteran’s claim is addressed below. The Veteran contends that his disability rating should be increased because his PTSD has increased in severity and has affected his memory. See April 2014 Hearing Tr. at 7, see also November 2012 Substantive Appeal. In a December 2008 VA medical opinion submitted by the Veteran, the physician noted Veteran’s symptoms to include mood variations, nightmares, and episodes of depersonalization. The physician explained that the symptoms have significantly impaired the Veteran’s ability to interact socially, as well as impairing the Veteran in the workplace. In January 2009, the Veteran presented for a VA examination. The examiner noted that the Veteran’s symptoms are daily and moderate in severity. Veteran reported feeling irritable, and helps his kids work at the farm for about half an hour to two hours before he has to leave the workplace. Veteran had a good relationship with his wife, one of his sons, and his friends. Veteran continues to square dances and occasionally goes hunting. In the mental status examination, the examiner indicated that the Veteran had no impairment of thought process or communication, other than some circumstantiality. There was no evidence of delusions or hallucinations. He had fair eye contact, pleasant, cooperative, and there was no inappropriate behavior. His self-care was fair, he maintained minimal personal hygiene, and he denied suicidal attempts and thoughts. The Veteran was oriented to person, place, and time. Veteran reported short-term memory difficulties, primarily forgetfulness, which causes some mild occupational impairment. There was no evidence of long-term memory difficulties. He did not have long-term memory difficulties, nor obsessive or ritualistic behavior, and his rate and flow of speech was unremarkable. Veteran did not describe panic attacks, complained of low mood, and had brief episodes of dissociation. There was no evidence of impaired impulse control. He had disrupted sleep, irritability, and tiredness. After a review of the record and an interview of the Veteran, the examiner summarized that the Veteran had an occupational and social impairment with reduced reliability and productivity due to PTSD symptomatology. The examiner explained that his PTSD affects his ability to work, leads to difficulties with concentration which impair occupational functioning, and moderate social impairment. In December 2009, the Veteran was presented for a VA examination. The examiner observed the Veteran as reasonably well groomed, calm, and cooperative. He lacked impairment to his thought process or communication and did not suffer any delusions or hallucinations. The Veteran indicated that he had suicidal thoughts that occur monthly for the last several years but had not formed plans or intentions. The Veteran was able to maintain minimal personal hygiene, other basic activities of daily living, and was oriented to person, place, and time. The Veteran reported significant memory impairment. The examiner noted that while the Veteran’s symptoms and signs are chronic, continuous, and fluctuating, and some days, weeks, or months are worse than others, it appears that he has not had any significant deterioration since the time he was last examined. After a review of the record and an interview of the Veteran, the examiner summarized that the Veteran had an occupational and social impairment with reduced reliability and productivity due to PTSD symptomatology and its associated complications and its associated aggravating factors. In March 2011, the Veteran underwent another VA examination. The examiner observed the Veteran’s symptoms to include memory loss, anger, hyperarousal, depression, insomnia, and chronic fatigue. The Veteran was presented as tired, there was no impairment of thought process or communication, and no delusions or hallucinations was detected. The Veteran did not have any suicidal or homicidal ideations and had the ability to maintain minimal personal hygiene and other basic activities of daily living. Further, he was oriented to person, place, and time. The examiner opined that there are clear linkages between PTSD symptomatology and changes and impairment in functional status and quality of life for the Veteran. However, the examiner noted that there are disorders such as memory impairment, chronic fatigue, chronic physical pain, other than PTSD which are independently responsible for impairment in psychosocial adjustment and quality of life for the Veteran. The Veteran was afforded another VA examination in October 2012. Upon interview, the examiner observed the Veteran’s symptoms for PTSD to include depressed mood; anxiety; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; chronic sleep impairment; flattened affect; impaired abstract thinking; disturbances of motivation and mood; difficulty in adapting to stressful circumstances, including work or a worklike setting; suicidal ideation; and neglect of personal appearance and hygiene. After a review of the record and an interview of the Veteran, the examiner summarized that the Veteran had an occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and mood. In June 2015, the Veteran was present for another VA examination. After a review of the record and an interview of the Veteran, the examiner summarized that the Veteran had a total occupational and social impairment. The Board first addresses the rating period from September 20, 2009 to December 18, 2008 where the Veteran’s PTSD disability rating is 50 percent. Based upon the foregoing, the Board finds that the severity of the Veteran’s service-connected PTSD more closely approximated occupational and social impairment with reduced reliability and productivity or a lesser degree of impairment, warranting no more than the currently-assigned 50 percent disability rating under the applicable diagnostic criteria. 38 C.F.R. § 4.130, Diagnostic Code 9411. The evidence of record is absent any indication that the Veteran’s disability from September 20, 2009 to December 18, 2008 has more closely approximated occupational and social impairment with deficiencies in most areas (the criteria for the next higher, 70 percent evaluation), due to symptoms such as: 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; spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances; and an inability to establish and maintain effective relationships. Id. For instance, regarding appearance and hygiene, the Veteran had fair eye contact, pleasant, cooperative, and did not express any inappropriate behavior. See January 2009 VA examination. His self-care was fair, and he maintained minimal personal hygiene. Id. With regards to suicidal ideations, the Veteran denied suicidal attempts or thoughts. Id. When it came to spatial disorientation, he was oriented to person, place, and time, and there was no evidence of delusions or hallucinations. Id. He had no impairment in thought process or communication, other than some circumstantiality. Id. Concerning speech, the Veteran’s rate and flow of speech was unremarkable. Id. Relating to panic attacks, the Veteran did not describe panic attacks, but complained of low mood and brief episodes of dissociation. Id. He felt irritable, had disrupted sleep, and was feeling tired. Id. With regards to adapting to stressful circumstances and relationships, the Veteran had a good relationship with his family and friends and continued to square dance and would occasionally go hunting. Id. At the end of the January 2009 examination, the examiner opined that the level of Veteran’s occupational and social impairment was a reduced reliability and productivity due to PTSD symptomology. In sum, the Board finds that the preponderance of the evidence is against the assignment of a disability rating in excess of 50 percent for the Veteran’s service-connected PTSD from September 20, 2009 to December 18, 2008. Thus, a higher schedular rating is not warranted. A 100 percent disability rating is not warranted prior to April 21, 2014 because total occupational and social impairment is not shown. Although total occupational and social impairment is noted in the June 2015 examination, that evaluation is inapplicable to the period prior to April 22, 2014. 38 C.F.R. § 3.400. Notably, at the October 2012 VA examination, after reviewing the record and interviewing the Veteran, the VA examiner summarized that the Veteran’s symptoms such as depressed mood, anxiety, and neglect of personal appearance reflected an occupational and social impairment in most areas. In the March 2011 VA examination, the Veteran was observed as oriented to time and place and the evidence did not indicate severe memory loss or persistent suicidal or homicidal ideation that would evidence social or occupational impairment that is total. He was not delusional and there was no evidence of psychosis or gross impairment in thought processes or communication. The Veteran also maintained a good relationship with his family. The December 2009 and January 2009 VA examinations, respectively, summarized the Veteran’s symptoms as reflecting occupational and social impairment with reduced reliability and productivity, an assessment less than total. Given the above, the Board finds that the evidence of record reflects occupational and social impairment that is less than total. As such, a higher 100 percent disability rating is not warranted prior to April 22, 2014 for service-connected PTSD. The Board acknowledges the December 2008 VA medical opinion submitted by the Veteran whereby the physician concluded that the Veteran’s disability is total and permanent. Notably, the symptoms listed such as mood variation, nightmares, depersonalization, and difficulty with social and work environments did not reflect a level of occupational and social impairment that is total. In any event, the Board gives more weight to the probative evidence of record such as the January 2009, December 2009, and October 2012 VA examinations, respectively, as they were conducted by VA examiners who reviewed the evidence of record and interviewed the Veteran, finding that his symptoms did not manifest a social and occupational impairment that is total. Thus, the Board find that the evidence is against a disability rating of 100 percent prior to April 22, 2014. The Board is sympathetic to the Veteran’s lay statements that his disability is worse than currently evaluated, and those statements have been considered. The Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. Layno v. Brown, 6 Vet. App. 465 (1994). He is not, however, competent to identify a specific level of disability according to the appropriate diagnostic codes. Such competent evidence concerning the nature and extent of the Veteran’s disability has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings directly address the criteria under which the disabilities are evaluated. The medical and lay evidence of record has been assessed by the Board in determining the overall disability rating. In this case, a disability rating higher than 70 percent for PTSD is not warranted from April 21, 2014 to September 21, 2009. 38 C.F.R. §§ 4.3, 4.7. Additionally, a disability rating for PTSD higher than 50 percent from September 20, 2009 to December 18, 2008 is not warranted. 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 claim, that doctrine is not applicable in this case. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 2. Entitlement to a TDIU The Veteran asserts that he is unable to secure and follow a substantially gainful occupation as a result of his service-connected disabilities. VA will grant a total rating for compensation purposes based on unemployability when the evidence shows a veteran is precluded from obtaining or maintaining any gainful employment consistent with his education and occupational experience, by reason of his service-connected disabilities. 38 C.F.R. §§ 3.340, 3.341, 4.16. In reaching such a determination, the central inquiry is “whether the Veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability.” Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). In arriving at a conclusion, consideration may be given to the veteran’s level of education, special training, and previous work experience, but not to his age or the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. The United States Court of Appeals for Veterans Claims (Court) has held that the term “unable to secure and follow a substantially gainful occupation” in 38 C.F.R. § 4.16 has two components. First, there is an economic component which essentially contemplates an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. Second, there is a non-economic component dealing with the individual veteran’s ability to “follow and secure” employment. For the second component, attention must be given to: (a) the veteran’s history, education, skill and training, (b) the veteran’s physical ability (both exertional and non-exertional) to perform the type of activities (e.g., sedentary, light, medium, heavy or very heavy) required by the occupation at issue, with relevant factors such as lifting, bending, sitting, standing, walking, climbing, grasping, typing, reaching, auditory and visual, and (c) whether the Veteran has the mental ability to perform the type of activities required by the occupation at issue, with relevant factors such as memory, concentration, and ability to adapt to change, handle work place stress, get along with coworkers and demonstrate reliability and productivity. Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). As “sedentary” is defined as “[r]equiring or marked by much sitting ” the Board finds that sedentary employment is a job where the worker primarily sits down. WEBSTER’S II NEW COLLEGE DICTIONARY 999 (1999). If there is only one service-connected disability, it must be rated at least 60 percent disabling to qualify for TDIU benefits; 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). The Veteran is evaluated at 100 percent for his PTSD as of April 22, 2014, which would not permit the Veteran to meet the schedular disability percentage requirement. His only other service-connected disabilities are hearing loss and tinnitus, which have both been rating as 10 percent disabling. As he has not contended that this disabilities render him unemployable, we will review the remaining period on appeal, specifically December 18, 2008 to April 21, 2014, to determine whether Veteran is eligible for a TDIU for that period. For the reasons that follow, a TDIU is warranted. Of note, the Veteran filed an informal claim for TDIU in October 2010, and a formal claim in November 2010. A review of the record shows that when the Veteran submitted his increased disability rating claim for PTSD in December 18, 2008, it was accompanied by a medical opinion by a VA psychiatrist who noted that the Veteran’s PTSD impedes his ability to continue gainful employment. As a claim for a TDIU is part and parcel of an increased rating claim for that disability when raised by the record, the Board finds that entitlement to a TDIU was reasonably raised by the record in December 18, 2008. See Rice v. Shinseki, 22 Vet. App. 447 (2009). In evaluating the individual and combined rating from the time period of December 18, 2008 to April 21, 2014, the Veteran meets the threshold schedular disability percentage requirement for TDIU consideration as a result of his service-connected PTSD, bilateral hearing loss, and tinnitus. 38 C.F.R. § 4.16(a). Military personnel records reflect the Veteran’s military occupation specialty (MOS)/rating was that of artillery surveyor. On his November 2010 application for unemployability he reported that his PTSD prevents him from following a substantially gainful occupation. The Veteran reported completing a high school education, and some semesters of college. He reported last working full-time in 2008 as a dairy farmer. Prior to service, the Veteran was employed for 2 years in state government taking sample for the development of the interstate. After service, his only employment has been working as dairy farmer at his farm for roughly 50 years. In a December 2008 VA medical opinion submitted by the Veteran, the physician explained that the Veteran’s PTSD symptoms have significantly impaired the Veteran’s ability to interact socially, as well as impairing the Veteran in the workplace. In January 2009, the Veteran presented for a VA PTSD examination. The examiner noted that the Veteran’s symptoms are daily and moderate in severity. Veteran reported feeling irritable, and helps his kids work at the farm for about half an hour to two hours before he has to leave the workplace. After a review of the record and an interview of the Veteran, the examiner summarized that the Veteran had an occupational and social impairment with reduced reliability and productivity due to PTSD symptomatology. The examiner explained that his PTSD affects his ability to work, leads to difficulties with concentration which impair occupational functioning, and moderate social impairment. The Veteran presented for a VA PTSD examination in December 2009 to assess the current severity of his service-connected PTSD, at which time he was interviewed by the examiner who also reviewed the pertinent medical history and performed an examination. The examiner reported the Veteran’s PTSD results in reduced reliability and productivity due to PTSD symptomatology and its associated complications and its associated aggravating factors. During clinical interview the Veteran reported that he has continued to experience diminished success with his employment as a farmer in that he had to turn more work over to his sons. He endorsed psychiatric symptoms such as memory loss and suicidal ideations. When asked to describe the functional impact the Veteran’s disability has on his ability to work the examiner reported that there is clear linkage as previously elucidated between PTSD symptomatology and aforementioned changes in impairment in functional status and quality of life. The Veteran reported that the combination of his mental health and physical health problems have interfered with his ability to be the full-time farmer. He acknowledges that the anger and irritability associated with PTSD as well as the hyperarousal and hypervigilance have led to conflict with his sons in this transition. The examiner indicated that the Veteran’s symptoms and signs are chronic, continuous, and fluctuating, and some days, weeks, or months are worse than others, and concluded that the Veteran has experienced a mild deterioration in occupational and social functioning. The Veteran presented for a VA PTSD examination in October 2012 to assess the current severity of his service-connected PTSD, at which time he was interviewed by the examiner who also reviewed the pertinent medical history and performed an examination. The examiner reported the Veteran’s PTSD results in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and mood. During clinical interview the Veteran reported helping his sons for 1 to 2 hours daily getting cattle inside and wiping the cattle for milking. The Veteran noted that he makes mistakes such as bringing the wrong cattle in, as he has reportedly lost the ability to differentiate between cattle, which has frustrated his sons. He endorsed symptoms to include, among other symptoms, difficulty in adapting to stressful circumstances, including work or a worklike setting. The Veteran presented for a VA PTSD examination in June 2015 to assess the current severity of his service-connected PTSD, at which time he was interviewed by the examiner who also reviewed the pertinent medical history and performed an examination. The examiner reported the Veteran’s PTSD results in total occupational and social impairment. During clinical interview the Veteran reported working on the farm approximately 3 hours a day milking but stated that his forgetfulness and confusion impair his ability to accomplish tasks. He endorsed psychiatric symptoms to include difficulty in adapting to stressful circumstances, including work or a worklike setting. When asked to describe the functional impact the Veteran’s disability has on his ability to work the examiner reported that the Veteran’s current PTSD symptoms have not significantly changed since his 2012 VA examination, and that they continue to impair functioning in multiple areas. However, neurological deficits that are unrelated to the Veteran’s psychiatric diagnosis are considered the primary factor rendering him unemployable. The Veteran was also present at a June 2015 VA examination for his bilateral hearing loss and tinnitus disabilities. The examiner noted that the Veteran’s bilateral hearing loss and tinnitus had a functional impact on his ability to work. The Veteran reported that he is unable to hear high pitched sounds and thus cannot run machinery because he is unable to hear if something goes wrong with the motor or attachments. Treatment records are not in significant conflict with findings during VA examination. For example, in a January 2011 treatment, the Veteran indicated that he helps his sons who work on his farm when he can but find himself easily overwhelmed, frustrated, and frequently confused which leads to having frequent temper outburst. In a March 2014 treatment, a VA physician indicated that the Veteran may be unemployable due to the severity of his PTSD symptoms. During a December 2014 treatment, the Veteran discussed his memory problems, and explained that sometimes when he is milking cattle his sons must watch him because the Veteran would forget what he is doing and will let the cattle out too soon. Further, in another December 2014 treatment note, a VA physician noted that due to the Veteran’s memory issues, he is not able to work as much as he is finding that he cannot escape his re-experiencing, avoidance and hyperarousal symptoms. The physician explained that the Veteran appears to be struggling with learning to manage his symptoms of PTSD while experiencing cognitive issues with memory which may hinder his ability to learn or remember previous coping strategies. Taken as a whole, the Veteran’s symptoms do suggest he was unable to obtain and maintain employment from April 21, 2014 to December 18, 2008. Given the Veteran’s education and work history, symptoms reported by the Veteran, and the level of functional impairment as reported by VA examiners and treatment providers the Board does consider this level of impairment as one that would preclude employment. The Board considered the Veteran’s lay statements that his PTSD symptoms including memory loss, forgetfulness, and anger made it difficult to work. The Board acknowledges his mental limitations would make it difficult to work. In short, the Board finds the evidence to be at least in relative equipoise as to the question of the Veteran’s ability to secure and maintain a substantially gainful occupation due to his service-connected disabilities. The Board finds no reason to afford greater probative value to the evidence against the Veteran’s claim than to the evidence in favor of the claim. While there are examinations against the Veteran’s claim, there are also competing medical evidence and compelling facts in favor of the Veteran. After service, the Veteran’s only employment experience for roughly 50 years has been working as a dairy farmer. The evidence points to the increasing severity of the Veteran’s PTSD and its continuing impact on the Veteran’s ability to continue working as a dairy farmer. Although a skilled farmer all his life, his memory, forgetfulness, and hearing has affected the Veteran’s ability to secure and maintain a substantially gainful occupation, as his disabilities has resulted in his sons becoming frustrated at Veteran’s actions such as when he lets the cattle out early or when he forgets the task he is doing. Further, to conclude that the Veteran would be eligible for sedentary employment is difficult based on the Veteran’s primary experience in his life as a dairy farmer, and the symptoms and severity of his service-connected disabilities. The Board notes that the determination of whether a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities is a factual determination rather than a medical question. Thus, the Board is not bound by the medical and non-medical expert opinions of record. Rather the Board makes its decision herein based on the facts of the case, which are summarized above. Therefore, resolving the benefit of the doubt in the Veteran’s favor, the Board finds the evidence is at least in equipoise as to whether his service-connected PTSD, bilateral hearing loss, and tinnitus renders him unable to secure and follow a substantially gainful occupation from April 21, 2014 to December 18, 2008.   Accordingly, entitlement to a TDIU is warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Michael Lane Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Mathew 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.