Citation Nr: 20005488 Decision Date: 01/23/20 Archive Date: 01/22/20 DOCKET NO. 18-31 698 DATE: January 23, 2020 ORDER 1. Entitlement to an initial disability rating in excess of 30 percent for posttraumatic stress disorder (PTSD) prior to April 17, 2017 is denied. 2. Entitlement to an initial disability rating in excess of 50 percent for PTSD since April 17, 2017 is denied. 3. Entitlement to a total disability evaluation for compensation based on individual unemployability (TDIU). FINDINGS OF FACT 1. Prior to April 17, 2017, PTSD symptoms were not manifested by occupational and social impairment with reduced reliability and productivity. 2. Since April 17, 2017, PTSD symptoms have not been manifested by occupational and social impairment with deficiencies in most areas. 3. The preponderance of the credible evidence is against a finding that the Veteran is precluded from securing and maintaining substantially gainful employment due to service-connected PTSD. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial disability rating in excess of 30 percent for PTSD prior to April 17, 2017 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.130, Diagnostic Code (DC) 9411. 2. The criteria for entitlement to an initial disability rating in excess of 50 percent for PTSD since April 17, 2017 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.130, DC 9411. 3. The criteria for entitlement to a TDIU rating have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.3, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served from January 1968 to December 1969. Increased Ratings Disability evaluations are determined by the application of the facts presented to VA’s Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Reasonable doubt as to the degree of the disability will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. The service-connected PTSD is evaluated as 30 percent disabling prior to April 17, 2017 and 50 percent thereafter under DC 9411 of the General Rating Formula for Mental Disorders. Under DC 9411, a 30 percent disability rating is warranted when there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and 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 disability 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 (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is warranted where 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 inability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. A 100 percent rating is warranted where 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 or place; memory loss for names of close relatives, own occupation, or own name. The United States Court of Appeals for the Federal Circuit held that an evaluation under 38 C.F.R. § 4.130 is “symptom-driven,” meaning that “symptomatology should be the fact-finder’s primary focus when deciding entitlement to a given disability rating.” Vasquez-Claudio v. Shinseki, 713 F3d 112, 116–17 (Fed. Cir. 2013). The symptoms listed are not exhaustive, but rather, “serve as examples of the type and degree of symptom, or their effects, that would justify a particular rating.” Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). In the context of determining whether a higher disability evaluation is warranted, the analysis requires considering “not only the presence of certain symptoms[,] but also that those symptoms have caused occupational and social impairment in most of the referenced areas”—i.e., “the regulation... requires an ultimate factual conclusion as to the Veteran’s level of impairment in ‘most areas.’” Vasquez-Claudio, 713 F.3d at 117–18; 38 C.F.R. § 4.130, Diagnostic Code 9411. Further, when evaluating a mental disorder, the Board must consider the “frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran’s capacity for adjustment during periods of remission.” 38 C.F.R. § 4.126(a). The Board must also “assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner’s assessment of the level of disability at the moment of examination.” Id. In deciding claims, it is the Board’s responsibility to evaluate the entire record on appeal. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss each and every piece of evidence submitted by the Veteran or on his behalf. Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. Before the Board addresses whether the Veteran is entitled to higher ratings for PTSD and a TDIU rating, it will address the Veteran’s credibility, as the facts in this case have called into question the truthfulness of the Veteran’s statements. For example, the Veteran underwent an initial VA psychiatric examination in July 2012. The examiner noted that the Veteran had completed the Trauma Symptoms Inventory test as part of the examination, which he wrote is an objective testing measure with well-documented validity scales. The examiner concluded that the Veteran’s test results were invalid as a result of the Veteran over-endorsing symptoms and endorsement of symptoms that are not typical of PTSD. The examiner wrote that the Veteran’s scale score for atypical responses was “significantly clinically elevated rending his response pattern invalid and suggestive of exaggeration or feigning of symptoms.” These findings by the VA examiner have damaged the Veteran’s credibility. The Board is aware that Dr. E. Douglass Brown attempted to explain why the above testing was not necessarily indicative of the Veteran malingering; however, due to the other inconsistent facts provided by the Veteran, which are described below, the Board does not find any reason to question the July 2012 VA psychologist’s conclusion that the testing was invalid. The examiner evaluated the Veteran in person, and the examiner’s conclusion was made contemporaneously with the testing, which gives his conclusion high probative value. In reviewing the record, the Board saw that the Veteran has provided inconsistent facts regarding past suicide attempts throughout the appeal period. For example, when seen in October 2000 following a positive depression screen, the Veteran specifically denied past suicidal attempts. However, in June 2010, he reported that he made “several suicide attempts in the 70s and 80s.” VA treatment records from July 2012, August 2012, and November 2012 show that when asked if he had any past suicidal attempts, the Veteran replied, “No.” In March 2015, the Veteran denied ever having a suicide attempt. In September 2015, the Veteran reported a past suicidal attempt in the early 1970s. In February 2018 and May 2018, the Veteran denied ever attempting suicide. These inconsistent facts further damage the Veteran’s credibility. The Veteran has also provided inaccurate facts regarding his work history. For example, the evidence shows that for multiple years, the Veteran was working part time boiling crawfish for 20 to 30 hours per week for approximately five to six months out of the year. For example, in an April 2013 VA treatment record, it shows that the Veteran reported to the VA examiner that he was working part time boiling crawfish. In a September 2015 Vet Center record, it was documented that the Veteran had been working at this restaurant for six years, which would mean that this employment began in approximately 2009. In a May 2016 Vet Center record, the Veteran reported he was now working five days per week. In a June 2016 affidavit that the Veteran wrote, he reported he would work in the back of the restaurant boiling crawfish and kept to himself. He said he worked with three or four other people and knew them fairly well. He also reported feeling comfortable to work part time in a “low-stress, behind the scenes environment.” In August 2016, the Veteran reported to a VA examiner that he worked part time in the summer boiling crawfish. At the April 2017 VA examination, the Veteran reported he was working part time boiling crawfish. The above-described evidence shows that the Veteran was working 20 to 30 hours per week for about five to six months out of the year beginning in approximately 2009, which job he was still performing in April 2017—thus, a period of at least seven years. In the VA Form 21-8940, “Veteran’s Application for Increased Compensation Based on Unemployability,” that the Veteran submitted in January 2019, he reported he had become too disabled to work in October 2005. When asked to list all of his employment for the last five years he worked, he did not include the part-time employment he had had for seven years, which seven years of employment he had performed at the time he submitted the VA Form 21-8940, which is a misrepresentation of his employment history, which is a fundamental fact in determining entitlement to a TDIU rating. In other words, the Veteran lied about his employment history. Above the signature on the VA Form 21-8940, a claimant certifies that “the statements in this application are true and complete to the best of my knowledge,” and the form also notes severe penalties may result in the event the statements provided are false or fraudulent. Making false statements while certifying the truth of such statements further damages the Veteran’s overall credibility. The Board is aware that the Veteran has submitted his earnings from the Social Security Administration, which show 0 income from 2007 to 2016. This does not change the finding above that the Veteran was working part time for five to six months during the year for a seven-year period, as such employment is documented contemporaneously with the time period in question. The Board finds no reason to question the accuracy of such facts, as the Veteran reported these facts to VA personnel and Vet Center employees while seeking treatment, which statements tend to be highly reliable. The Veteran also wrote about this employment in his June 2016 affidavit. The Veteran’s statements to VA personnel and Vet Center employees were consistent with each other, which gives such statements additional credibility. They are also statements against interest, as the Veteran has reported he has not worked since 2005 while seeking higher ratings for PTSD and a TDIU rating, but these statements show otherwise, which statements (statements against interest) are highly reliable. These facts show a pattern of the Veteran providing inaccurate and/or inconsistent facts while seeking compensation benefits. This is evidence that the Veteran’s facts lack accuracy. As a result, the Board finds that the Veteran’s statements regarding his symptoms and employment history have significantly lessened probative value, and the Board will apply such finding throughout the appeal period to the claims for increased compensation benefits. 1. Entitlement to an initial disability rating in excess of 30 percent for PTSD prior to April 17, 2017 The Veteran contends that the disability rating for his PTSD should be rated higher than the currently-assigned 30 percent disability rating from June 4, 2007 to April 17, 2017. In the June 2007 Veterans Application for Compensation, the Veteran stated that he drank a lot to keep his nerves down and that he has suicidal thoughts. In a November 2018 affidavit, the Veteran contends that his PTSD has worsened since his diagnosis, and prevented him from maintaining his employment. The Veteran stated that his PTSD has caused him to become “completely housebound, as his depression and paranoia keeps [him] in [his] house nearly all day, every day.” The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against a finding of PTSD symptomatology warranting a rating in excess of 30 percent prior to April 17, 2017. The reasons follow. The evidence of the record during this part of the appeal period reflects that the Veteran’s PTSD was manifested by occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. For example, in a July 2012 VA examination report, the psychologist was asked which of the following best summarized the Veteran’s level of occupational and social impairment, and the psychologist checked, “Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation,” which is the criteria described in the 30 percent rating. While the adjudicator makes the determination of what evaluation is warranted for the service-connected PTSD, the examiner’s conclusion that the Veteran’s psychiatric disorder was summarized best by the criteria described under the 30 percent evaluation is evidence against a finding that the Veteran’s psychiatric disorder caused reduced reliability and productivity to warrant a 50 percent rating. Furthermore, as noted above, the objective testing of the Veteran’s symptoms during the July 2012 VA examination were found to be invalid as a result of the Veteran’s over-endorsing symptoms and endorsement of symptoms that were not typical of PTSD. The July 2012 VA psychologist concluded that the Veteran’s score for Trauma Symptoms Inventory was significantly clinically elevated rendering his response pattern invalid and suggestive of exaggeration or feigning of symptoms. Social Security Records show that a psychologist, Dr. James Hertzog, found that the Veteran retained the mental capacity to understand and carry out instructions for learning to perform work tasks. He added that the Veteran’s mental capacity for maintaining attention and concentration for two-hour periods was sufficient for completing work tasks without excessive interruption from his psychological symptoms. Dr. Hertzog found that the Veteran could interact adequately on a limited basis and could make mental adaptations to function in a work setting. This is evidence in support of a finding that the Veteran’s symptoms entail occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks is consistent with the 30 percent rating. During this part of the appeal period, the Veteran was able to maintain family relationships and expressed that those bonds were a reason for the Veteran to keep living. The Veteran reported that he had some suicidal ideations after receiving a denial letter by the RO in March 2008, again at a VA treatment visit in June 2010, and during his July 2012 VA examination. However, in each instance, the Veteran reported that he would not kill himself because of how it would affect his daughters and grandchildren. In April 2013, he stated he spent “a lot of time” with his two grandchildren, who were 4 and 12 years old. He described his relationship with one of his grandchildren as supportive, and he reported he helped care for her during the week. During this period, the Veteran stated that his eldest daughter lived locally, but he did not have much contact due to him not approving of her life choices. Accordingly, these facts are evidence against difficulty in establishing and maintaining effective relationships to warrant a 50 percent rating. During this period, the Veteran attended both group therapy and individual therapy sessions. The reports from the group therapy sessions show that the Veteran was actively engaged in the sessions and supportive of the other group members. The Veteran reported that he had friends with whom he socialized “every now and again” and later in the appeal period, he reported that he frequently hunted with his friends for several months out of the year. Furthermore, the Veteran reported that he had a part-time job with a crawfish middleman. He reported that he enjoyed working behind the scenes and not with customers, and that he worked with three to four other people at any given time. He stated that he felt comfortable working with them in the low stress environment. This is further evidence against the Veteran having difficulty in establishing and maintaining effective work and social relationships and is evidence against a finding that the Veteran had reduced reliability and productivity at work. Furthermore, the Veteran stated in June 2016 that his symptoms were better controlled “considering that I always make sure to take my medications.” He was also attending weekly PTSD group therapy sessions. He reported he had occasional memory loss and would forget to take his medication. This is evidence against a finding that the Veteran has impairment of short- and long-term memory, as he is able to put himself in a position to retake his medication, and it is not a frequent occurrence. Additionally, the 30 percent rating contemplates mild memory loss. Prior to April 17, 2017, the Veteran was evaluated by VA and private psychologists and consistently was documented as having good hygiene and appearance; normal speech, not having difficulty in understanding complex commands, and not having panic attacks once a week or more. See December 2007 PTSD Nurse Practitioner note; March 2008 PTSD Psychologist note; February 2009 PTSD Nurse Practitioner note; October 2009 PTSD Nurse Practitioner note; June 2010 PTSD Nurse Practitioner note; September 2015 Intake Assessment; and July 2016 Psychological Evaluation Report by E. Douglass Brown, Ph.D. The Board acknowledges that the Veteran indicated that he had suicidal thoughts in June 2007, March 2008, June 2010, and June 2012, which is a symptom contemplated by a 70 percent rating. However, aside from these notations that cover a five-year period, the record shows that he consistently denied suicidal ideation, intent, or plan. Specifically, the Veteran denied a suicidal plan and articulated reasons for living in October 2000, January 2003, December 2007, March 2008, February 2009, June 2010, and March 2015. Additionally, the Veteran reported that he had no past suicide attempts or significant suicidal ideations in October 2000, July 2012, and March 2015. Furthermore, the Veteran consistently noted that he would not kill himself because of how it would affect his daughters and grandchildren. These facts are distinguishable from Bankhead v. Shulkin, 29 Vet. App. 10 (2017), in which the U.S. Court of Appeals for Veterans Claims (Court) held that the presence of suicidal ideation alone may cause occupational and social impairment with deficiencies in most areas (a 70 percent disability rating under 38 C.F.R. § 4.130). Under the unique facts of Bankhead, the claimant was noted to have had recurrent suicidal thoughts and behaviors of varying severity, frequency, and duration throughout the relevant appeal period. The Veteran’s symptoms in this case do not rise to the level of deficiencies in most areas, as the Veteran had positive relationships with family members and his co-workers, he hunted with friends, had positive interactions during group therapy sessions, and he was able to work at least on a part-time basis, which turned into working five days a week in at least May 2016. Here, the Veteran’s instances of suicidal ideation (passive or otherwise) during the appeal and when considered with other symptoms did not cause the level of occupational and social impairment contemplated by the 70 percent disability rating. The Board notes that VA treatment records and VA examination reports overwhelmingly reflect that the Veteran has denied suicidal ideation. Furthermore, the credible evidence in the file does not reflect symptomatology of deficiencies with reduced reliability and productivity such that his symptoms equate to the severity, frequency and duration of weekly panic attacks, impaired judgment, or disturbances motivation or mood. For example, VA treatment records note that the Veteran had appropriate affect, appropriate thought processes, and fair judgment. Furthermore, the Veteran consistently articulated reasons for living, specifically mentioning his relationships with his daughters and grandchildren. Based on the facts of this case, the sporadic instances of reported suicidal ideation do not more nearly approximate occupational and social impairment with deficiencies in most areas, but rather reflect a lesser degree of impairment that is contemplated by the 30 percent rating assigned during this time period. In other words, just because a claimant has an exacerbation of the disability does not mean that the overall disability picture has increased, as the disability ratings contemplate exacerbations of the disability. 38 C.F.R. § 4.1. The Board is aware of the July 2016 VA examination report by Dr. E. Douglass Brown, who checked the Veteran’s level of occupational and social impairment was best described by deficiencies in most areas, which is the criteria that falls under the 70 percent disability rating. The Board has accorded this examination report essentially no probative value, as Dr. Brown wrote that the Veteran had last worked in 2005 and was totally disabled following back surgery in March 2006. As noted above, the evidence shows that the Veteran worked part time boiling crawfish from 2009 to 2017, which occupation was increased to five days a week in at least May 2016. Thus, Dr. Brown’s assessment of the Veteran’s occupational impairment is based on an inaccurate factual premise, as the July 2016 examination report does not document that the Veteran worked after his medical retirement in 2005. The Board also accords more probative value regarding the Veteran’s social impairment to what is documented in the VA treatment records and the Vet Center records, which document that the Veteran was not isolative. The Veteran reported he would go hunting with friends for several months out of the year, he reported looked forward to attending group therapy sessions so that he could see fellow veterans, and he had relationships with his children and grandchildren. The Board finds that the preponderance of the evidences is against a finding that the Veteran PTSD symptoms have been manifested by occupational and social impairment with reduced reliability and productivity during this part of the appeal period. As the Veteran’s PTSD symptoms do not meet the rating criteria for an increased 50 percent disability rating prior to April 17, 2017, it follows that his service-connected PTSD symptoms also do not meet the more severe rating criteria for an increased 70 or 100 percent disability rating for the same period. Significantly, he has not shown the required severity of occupational and social impairment necessary for an increased 50, 70, or 100 percent disability rating during the rating period, and his symptoms, as a whole, are not of similar severity, frequency, and duration as those particular symptoms associated with a 50, 70, or 100 percent disability rating. Accordingly, the preponderance of the evidence is against entitlement to a disability rating in excess of 30 percent prior to April 17, 2017. As the preponderance of the evidence is against the Veteran’s claim, the benefit-of-the-doubt rule does not apply, and the claim must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. 2. Entitlement to an initial disability rating in excess of 50 percent for PTSD since April 17, 2017 The Veteran contends that the disability rating for his service-connected PTSD should be rated higher than the currently-assigned 50 percent disability rating since April 17, 2017. Specifically, in the June 2007 Veteran’s Application for Compensation, the Veteran stated that he drank a lot to keep his nerves down and that he has suicidal thoughts. In a November 2018 affidavit, the Veteran contended that his PTSD had worsened since his diagnosis, and prevented him from maintaining his employment. The Veteran stated that his PTSD had caused him to become “completely housebound, as his depression and paranoia keeps [him] in [his] house nearly all day, every day.” The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against a finding of PTSD symptomatology warranting an initial rating in excess of 50 percent since April 2017 because the frequency, severity, and duration of the Veteran’s symptoms have not resulted in occupational and social impairment with deficiencies in most areas, such as work, relationships, judgment, thinking, and mood, or total occupational and social impairment. The reasons follow. During this part of the appeal period, when VA examiners were asked which of the following best summarized the Veteran’s level of occupational and social impairment, the examiners checked the descriptions that fall under the 30 percent rating (April 2017) and 50 percent rating (March 2019) criteria. While the adjudicator makes the determination of what rating is warranted, the examiners’ conclusions that the Veteran’s psychiatric diagnosis was best summarized by the 30 and 50 percent ratings is evidence against a finding that the Veteran’s psychiatric diagnosis causes occupational and social impairment with deficiencies in most areas. Although the Veteran reported that he has diminished interest or participation in activities, during the entire appeal period, the Veteran was able to establish and maintain social relationships with other veterans he met during group therapy. The Veteran sought regular mental health treatment from VA and also attended group therapy sessions regularly. He reported during his March 2019 VA examination that he liked going to group therapy and felt that it provided “a positive atmosphere with people who understand him.” Additionally, he told the VA examiner that he “can’t wait to get to group to meet with fellow members.” Moreover, examiners who met with the Veteran through VA or through his representative have consistently described the Veteran as “outgoing,” “very nice and cooperative and intelligent…with excellent social skills,” and “pleasant.” See April 2017 Disability Benefits Questionnaire; March 2019 Disability Benefits Questionnaire; and June 2019 TDIU Vocational Assessment Report. This is evidence against a finding that the Veteran is unable to establish and maintain effective social relationships. The Veteran reported during this period of the appeal that he had strained relationships with his daughters. One blamed him for her alcoholism and divorces and the other daughter was not close to him. Regardless, the evidence shows that the Veteran was still escorted to VA by at least one of his daughters. While this is evidence in support of a finding that the Veteran has difficulty establishing and maintaining effective social relationships, which is contemplated by the 50 percent rating, it is not indicative of the Veteran being unable to establish and maintain effective relationships. In April 2017, the Veteran stated that he had panic attacks that occurred weekly or less often. In November 2018, the Veteran reported that he had severe symptoms of paranoia and had panic attacks three to four times a week. However, VA treatment records show that in February 2018, August 2018, and March 2019, the Veteran denied psychiatric symptoms and other medical symptoms while also reporting chronic joint pain in the left shoulder, both knees, and lower back. This means that the Veteran did not summarily deny all medical symptoms, but thought about which symptoms he was currently experiencing and which symptoms he was not currently experiencing, and he specifically denied psychiatric symptoms. The examiners described the Veteran as well appearing and pleasant with appropriate behavior. In March 2018, when asked if he was feeling down, depressed, or hopeless, the Veteran responded, “Not at all.” The examiner found that the Veteran was alert and oriented to person, place, time, and situation and was in no apparent distress. In September 2018, the examiner wrote that the Veteran remained active and enjoyed hunting. At the March 2019 VA examination, the Veteran did not report having panic attacks. These facts establish that the Veteran’s PTSD symptoms are not occurring all the time and are evidence against the Veteran having near-continuous panic or depression affecting the ability to function independently, appropriately and effectively, which is evidence against deficiencies in most areas to warrant an increased rating of 70 percent. The Board acknowledges that the Veteran indicated that he had vague suicidal ideations at the April 2017 VA examination, which is a symptom contemplated by the 70 percent disability rating. However, aside from this notation, the record shows that he has consistently denied suicidal ideation, intent, or plan. For example, the Veteran specifically denied ever attempting suicide or having suicidal thoughts during his VA medical treatments in February 2018 and May 2018. Furthermore, during his March 2019 VA examination, the Veteran denied hallucinations, delusions, and suicidal ideations. The facts of this case are distinguishable from Bankhead, 29 Vet. App. 10, in which the Court held that the presence of suicidal ideation alone may cause occupational and social impairment with deficiencies in most areas (a 70 percent disability rating under 38 C.F.R. § 4.130). Under the unique facts of Bankhead, the claimant was noted to have had recurrent suicidal thoughts and behaviors of varying severity, frequency, and duration throughout the relevant appeal period. Here, the Veteran’s instances of suicidal ideation (passive or otherwise) during this part of the appeal period and when considered with other symptoms, did not cause the level of occupational and social impairment contemplated by the 70 percent disability rating. The Board notes that VA treatment records and VA examination reports overwhelmingly reflect that the Veteran has denied suicidal ideation. Furthermore, the record does not reflect symptomatology of deficiencies in most areas such that the Veteran’s symptoms equate to the severity, frequency and duration of weekly panic attacks, impaired judgment, or disturbances motivation or mood. Based on the facts of this case, the sporadic instances of reported suicidal ideation do not more nearly approximate occupational and social impairment with deficiencies in most areas, but rather reflect a lesser degree of impairment that is contemplated by the 50 percent rating assigned during this time period. In other words, just because a claimant has an exacerbation of the disability does not mean that the overall disability picture has increased, as the disability ratings contemplate exacerbations of the disability. 38 C.F.R. § 4.1. Although the Veteran reported in November 2018 that his paranoia kept him in his house daily, the VA treatment records document that the Veteran does not have persistent delusions or hallucinations. At the March 2019 VA examination report, the Veteran had reported he looked forward to going to group therapy. The April 2017 and March 2019 psychiatric evaluations did not show that the Veteran had gross impairment in processes or communication, grossly inappropriate behavior, or memory loss for names of close relatives or his own occupation or name. He has denied experiencing any physical altercations, which is evidence against a finding that the Veteran has impaired impulse control. Additionally, the Veteran was consistently found to be oriented to time, place, and person, and was found to be in persistent danger of hurting himself or others. The preponderance of the evidence is against a finding that the Veteran has intermittent inability to perform activities of daily living, obsessional rituals which interfere with routine activities, or neglect in his personal appearance and hygiene. The frequency, severity, and duration of the PTSD symptoms have not resulted in deficiencies in most areas, such as work, family relations, judgment, thinking and mood during this part of the appeal. During the August 2019 assessment by Andrea Goldrup, the Veteran reported that he did not regularly bathe or get dressed daily. However, the symptoms the Veteran reported to Ms. Goldrup are inconsistent with what is documented in the VA treatment records. For example, these symptoms are refuted in VA treatment records and VA examination reports. The examiner in the April 2017 VA examination report described the Veteran as “well dressed and groomed with excellent social skills.” In the March 2019 VA examination report, the examiner noted that the Veteran was dressed in jeans and a plaid shirt. When checking what symptoms the Veteran exhibited, neither the April 2017 examiner nor the March 2019 examiner checked neglect of personal appearance and hygiene nor did they check the inability to perform activities of daily living, including minimal personal hygiene. Furthermore, the Veteran was found to be well appearing or not reporting any psychiatric symptoms during multiple visits at his VA medical visits. See January 2018 Dermatology Clinic note; January 2019 Dermatology Clinic note; February 2018 PC Annual Exam; March 2018 History and Physical Endoscopy; May 2018 Preventive Medicine Note. Therefore, the Board finds the preponderance of evidence is against a finding that the Veteran neglects his appearance and hygiene. The Board is aware that the Veteran has alleged worse symptoms than he previously reported; however, as the Board finds that the Veteran’s statements of worsening symptoms lack credibility, it does not accord such allegations any probative value. A VA medical professional evaluated the Veteran in March 2019 and found him pleasant, verbal, outgoing, not neglecting his personal appearance, noted that the Veteran looked forward to his group therapy sessions because it provided a positive atmosphere, and wrote that his thought processes were logical and goal directed. The Veteran’s allegations of severe paranoia, social isolation, aggressive behavior, and being completely housebound are not credible, as the VA examination reports and the VA treatment records do not support this level of severity of symptoms. Therefore, the Board finds that the Veteran’s PTSD symptoms have not manifested with occupational and social impairment with deficiencies in most areas since April 17, 2017. The record of evidence does not reflect that the Veteran has speech intermittently illogical, obscure, or irrelevant; impaired impulse control; obsessional rituals interfering with routine activities; neglect of appearance and hygiene; spatial disorientation; or near-continuous panic or depression affecting independent, appropriate or effective function. For all the reason laid out above, the Board finds that the preponderance of the evidence is against a disability rating in excess of 50 percent for PTSD. As the preponderance of the evidence is against the claim for a higher rating, the benefit of the doubt doctrine is not for application, and the Veteran’s claim for an increased rating is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. TDIU A TDIU rating may be warranted when a veteran demonstrates the inability to secure or follow a substantially gainful occupation due solely to impairment resulting from service-connected disabilities. See 38 C.F.R. § 4.16(a). Minimum disability rating percentages must be shown for the service-connected disabilities, alone or in combination, to qualify for consideration for a TDIU award under § 4.16(a). If there is only one such disability, it must be rated at 60 percent or more; if there are two or more disabilities, at least one disability must be rated at 40 percent or more, with sufficient additional disability rendering a combined rating of 70 percent or more. When a veteran fails to meet the applicable percentage standards enunciated in 38 C.F.R. § 4.16(a), an extraschedular rating may never nevertheless be warranted where the veteran is unemployable due to a service-connected disability. 38 C.F.R. § 4.16(b). Should the Board discern a plausible basis for an extraschedular TDIU, it must refer the matter to the Director of Compensation Service for an initial decision before the Board may decide the issue. The question of unemployability or the veteran’s ability or inability to engage in substantially gainful activity, must be examined in a practical manner. The crux of the matter rests upon whether a particular job is realistically within the capabilities, both physical and mental, of the appellant. The Board shall consider the nature of the employment and the reason for any termination. 38 C.F.R. § 4.16(a). The central inquiry is “whether the veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability.” Neither nonservice-connected disabilities nor advancing age may be considered in the determination. 38 C.F.R. §§ 3.341, 4.19. The record must reflect some factor that takes the case outside the norm with respect to a similar level of disability under the rating schedule. 38 C.F.R. §§ 4.1, 4.15. The fact that a claimant is unemployed or has difficulty obtaining employment is not enough. The question is whether the Veteran can perform the physical and mental acts required by employment, not whether he can find employment. 3. Entitlement to a TDIU rating The Veteran is service connected for PTSD only, for which he has a 30 percent disability rating from June 4, 2007 to April 17, 2017 and then a 50 percent disability rating from April 17, 2017. Thus, the Veteran does not qualify for schedular TDIU. 38 C.F.R. § 4.16(a). Nevertheless, when a veteran fails to meet the applicable percentage standards enunciated in 38 C.F.R. § 4.16(a), an extraschedular rating is for consideration where the veteran is unemployable due to a service-connected disability. 38 C.F.R. § 4.16(b). The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against a finding that the Veteran is unable to secure or follow a substantially gainful occupation due to his service-connected PTSD. Therefore, referral for extraschedular consideration of a TDIU rating is not warranted. The reasons follow. A review of the record reveals that the Veteran filed a VA Form 21-8940 in January 2019. It is noted that the Veteran has a high school diploma, and he reported that he did some college work at a community college. It was also reported that the Veteran completed one year of carpentry school, which is supported by the VA educational records. The Veteran reported that he worked at Winn Dixie for approximately 34 years and that he had had no employment after he stopped working there in 2005. As noted above, such statement is not credible, as the evidence shows he was working at least part time boiling crawfish from approximately 2009 to 2017. In a November 2018 affidavit, the Veteran reported that his PTSD symptoms had become too severe for him to continue working at Winn Dixie, which implies that he stopped working there because of his PTSD symptoms. The Board finds this statement by the Veteran is not credible, as there are multiple records in the file refuting this allegation. For example, records obtained from the Social Security Administration in connection with the Veteran’s application for disability benefits show that the Veteran reported that he became unable to work in October 2005 due to being injured on the job. In the Social Security Administration Disability Report the Veteran indicated that the illnesses and injuries that limited his ability to work were a work injury to his back that affected the neck and legs, knees, PTSD, depression, acid reflux, childhood polio, and weakness in one leg (thus, not just PTSD). At the July 2012 VA psychiatric examination, the Veteran reported that he got injured on the job in 2005 and had to have several surgeries and was not able to return at 100 percent after his last surgery and that he last worked in October 2005 due to an injury affecting his neck, leg, back, and knee. He reported similar facts to Dr. Brown in June 2016, wherein he stated he last worked in 2005 and was totally disabled following back surgery. This is evidence against a finding that the Veteran stopped working at Winn Dixie due to his service-connected disability of PTSD. The Board is aware that the reason one stops working does not have to be the same reason one is subsequently precluded from substantially gainful employment. However, in the November 2018 statement from the Veteran, he wrote that he had stopped working at Winn Dixie due to his PTSD symptoms, when the facts do not support such allegation. This is evidence of the Veteran providing inaccurate facts, and the Board accords such allegation no probative value. The Social Security Administration had the Veteran evaluated by James Herzog, Ph.D. in June 2008. Dr. Herzog noted that the Veteran was only “moderately limited” in the areas of ability to accept instructions and respond appropriately to criticism; ability to get along with coworkers without distracting them or exhibiting behavior extremes; and ability to respond appropriately to changes in the work setting.” Dr. Herzog concluded that the Veteran “retains the mental capacity to understand and carry out instructions for learning to perform work tasks.” Additionally, Dr. Herzog noted that mental capacity to maintain attention and concentration for two-hour periods is sufficient to complete work tasks without excessive interruptions from psychological symptoms. Finally, Dr. Herzog concluded that the Veteran could interact adequately on a limited basis and could make mental adaptations to function in a work setting. These clinical findings are evidence against a finding that the Veteran was unable to secure and maintain substantially gainful employment due to his service-connected PTSD. As discussed above, the evidence shows that the Veteran was working part time boiling crawfish 20 to 30 hours per week approximately five to six months out of the year from approximately 2009. In May 2016, he told a Vet Center employee that he was now working five days a week. This is evidence against a finding that the Veteran was unable to obtain and follow substantially gainful employment due to his service-connected PTSD, since he was able to work 20 to 30 hours for approximately seven years for five to six months out of the year, which employment increased to five days a week in approximately May 2016. The Board understands that working 20 to 30 hours per week is not necessarily indicative of substantially gainful employment; however, where the Veteran claims he has been unable to work at all since he medically retired in 2005, this is evidence that refutes that allegation. As already noted above, the Veteran provided inaccurate information on the VA Form 21-8940, which has damaged his overall credibility. Finally, in June 2019, a TDIU Vocational Assessment was solicited by the Veteran’s representative. During this evaluation, the Veteran reported he had flashbacks, intrusive thoughts, panic attacks, hypervigilance, memory and concentration impairment. The assessor, Ms. Goldrup, concluded the Veteran’s PTSD would render him off task and perform below the expected productivity level more than the acceptable industry standard allows. Ms. Goldrup stated that it was at least as likely as not that the Veteran was unable to secure and follow substantially gainful employment. However, the Board notes that Ms. Goldrup was basing her conclusions on an inaccurate factual premise. For example, she wrote that the Veteran last worked in October 2005, which, as described above, is inaccurate, as the Veteran was working for five to six months out of the year from approximately 2009 until at least 2017 for 20 to 30 hours, which hours had increased in May 2016 to five days a week. Opinions based on inaccurate facts, particularly when the inaccurate facts are directly related to the basis of the opinion, have no probative value. The Board finds that the preponderance of the evidence is against a finding that the Veteran is unable to obtain and retain substantially gainful employment due solely to service-connected PTSD at any point of the appeal period. The Board has considered the evidence of record, including the opinion of examiners and the Veteran’s lay statements. The ultimate question of whether a veteran is capable of substantially gainful employment is not a medical one; that determination is for the adjudicator not a medical examiner. The Board finds the Social Security Administration records, the evidence of the Veteran’s prior employment and current employment, and assessment by Dr. Herzog to be the most probative as to the Veteran’s ability to secure and maintain substantially gainful employment. Furthermore, the Board finds that the Veteran’s own statements conflict and do not support the inability to establish and follow substantially gainful employment due solely to the service-connected PTSD. The Veteran is capable of performing the job he had boiling crawfish, as he was able to hold this position for at least seven years. When he told the Vet Center employee in May 2016 that his hours had increased to five days a week, he did not report that he was not capable of doing the work. The Board finds that this is affirmative evidence that the Veteran is not precluded from securing and maintaining substantially gainful employment. Given the above, the Board concludes that the preponderance of evidence weighs against the Veteran’s TDIU claim. Referral for consideration of a TDIU rating on an extraschedular basis is not warranted, and the claim for a TDIU rating is denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Griffin, Associate 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.