Citation Nr: 20006803 Decision Date: 01/27/20 Archive Date: 01/27/20 DOCKET NO. 16-14 699 DATE: January 27, 2020 ORDER The appeal seeking an earlier effective date for entitlement to service connection for posttraumatic stress disorder (PTSD) is dismissed. For the entire rating period on appeal, a 50 percent rating, but not higher, for PTSD is granted. Entitlement to an effective date earlier than May 3, 2016 for the grant of entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is denied. FINDINGS OF FACT 1. To the extent that the Veteran attempted to appeal the effective date assigned to the award of service connection for PTSD, such is considered a legal nullity and does not raise a claim for an earlier effective date. 2. For the entire rating period on appeal, the Veteran’s PTSD more nearly approximates occupational and social impairment with reduced reliability and productivity. 3. The Veteran was not unemployable solely due to his service-connected disabilities prior to May 3, 2016. CONCLUSIONS OF LAW 1. The Veteran’s April 2016 appeal to the Board requesting an earlier effective date for entitlement to service connection for PTSD is not a legally recognizable claim and raises no question to be decided. 38 U.S.C. §§ 7104, 7105 (2012); 38 C.F.R. § 20.1103 (2018); Rudd v. Nicholson, 20 Vet. App. 296 (2006). 2. For the entire rating period on appeal, the criteria for a 50 percent rating, but no higher, for PTSD have been approximated. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.321, 4.7, 4.130, Diagnostic Code (DC) 9411 (2018). 3. The criteria for an effective date earlier than May 3, 2016 for the grant of a TDIU are not met. 38 U.S.C. § 5110 (2012); 38 C.F.R. § 3.400, 4.16 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant in this case, served on active duty from April 1966 to February 1970. The Veteran, in his April 2016 appeal to the Board, requested a video-conference hearing, which was ultimately scheduled to be held in December 2019. However, in September 2019 the Veteran withdrew his request for a hearing. Therefore, the request is deemed withdrawn and the Board may proceed with adjudication. Preliminary Matters The Board notes that VA treatment records and an August 2019 private PTSD evaluation were added to the claims file subsequent to the February 2016 Statement of the Case (SOC), and the RO, the agency of original jurisdiction, has not had the opportunity to consider the evidence in adjudicating the Veteran’s claims. However, the Veteran’s representative has expressly waived initial RO consideration of “any evidence considered new.” See Letter from attorney C.P. dated September 27, 2019. Therefore, initial RO consideration of the evidence having been expressly waived, the Board may consider the additional evidence on appeal. 38 U.S.C. § 7105(e) (2012); 38 C.F.R. § 20.1304(c). The Board acknowledges that the Veteran has other claims in appellate status, including a claim for an earlier effective date for entitlement to a TDIU, for which the RO has not yet issued a Statement of the Case. Given that the instant appeal includes the Veteran’s claim for an increased rating for PTSD, and potential entitlement to a TDIU is an element of all increased rating requests, see Rice v. Shinseki, 22 Vet. App. 447 (2009), it is appropriate to adjudicate the claim for an earlier effective date for a TDIU in this decision. The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). Effective Date of Service Connection for PTSD The Veteran seeks an earlier effective date for service connection of PTSD. See Appeal to Board of Veterans’ Appeals received April 1, 2016. The provisions for the determination of an effective date of an award of disability compensation are set forth in 38 U.S.C. § 5110. Generally, except as otherwise provided, the effective date of an evaluation and award of pension, compensation, or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. The effective date of an original award of direct service connection is the day following separation from active service or date entitlement arose if the claim is received within one year after separation from service; otherwise, date of receipt of claim, or date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400(b)(2)(i). Notably, there can be no valid “freestanding” earlier effective date claim raised at any time after a RO decision becomes final. See Rudd v. Nicholson, 20 Vet. App. 296, 299-300 (2006). Here, service connection for PTSD was granted in a January 2013 rating decision, and the Veteran was assigned an effective date of March 15, 2012. The Veteran was notified of this decision in a letter dated in January 31, 2013. The Veteran did not appeal the effective date assigned within a year of the rating decision. The Board notes that a formal claim for an increased rating with a statement saying his condition was worse was received from the Veteran in February 2014, more than one year after notification of the January 2013 rating decision. See Application for Disability Compensation and Statement in Support of Claim received February 21, 2014. As such, the January 2013 rating decision became final as to the effective date assigned. See 38 U.S.C. § 7105(c); 38 C.F.R. § 20.1103. As a claim for an earlier effective date was not filed within a year of the January 2013 rating decision in which the effective date was assigned, the April 2016 claim is therefore considered a freestanding claim. As noted, there is no basis in law for a freestanding earlier effective date claim. Rudd, supra. Therefore, to the extent that the earlier effective date claim has been developed as part of the present appeal the Board finds that it must be dismissed as a matter of law. Increased Rating for PTSD Generally, disability ratings are determined by applying the rating criteria set forth in VA’s Schedule for Rating Disabilities (Rating Schedule) and represent the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA compensation, as well as the whole recorded history of the Veteran’s disability. 38 C.F.R. §§ 4.1, 4.2; see generally Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question of which of two evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria for that rating. 38 C.F.R. § 4.7. Otherwise, the lower rating is assigned. Id. Additionally, while it is not expected that all cases will show all the findings specified, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. The veteran’s entire history is reviewed when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). Here, the Veteran has been rated by the RO at 30 percent disabling for PTSD, effective March 15, 2012. See Rating Decision dated January 31, 2013; 38 C.F.R. § 4.130, Diagnostic Code DC 9411. The criteria for rating psychiatric disabilities, other than eating disorders, are set forth in the General Rating Formula (General Rating Formula) for Mental Disorders. See 38 C.F.R. § 4.130. Under the General Rating Formula, a 30 percent rating is warranted for occupational and social impairment with an occasional decrease in work efficiency and intermittent periods of an 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, and mild memory loss (such as forgetting names, directions, recent events). 38 C.F.R. § 4.130. A 50 percent rating is warranted for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent rating is warranted if the evidence establishes 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 a work like setting); and/or inability to establish and maintain effective relationships. Id. A 100 percent rating (total occupational and social impairment) is warranted 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. Id. When determining the appropriate disability evaluation to assign, the Board’s primary consideration is the Veteran’s symptoms, but it must also make findings as to how those symptoms impact a Veteran’s occupational and social impairment. Vazquez-Clauditory v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013). The use of the term “such as” in the rating criteria demonstrates that the symptoms after that phrase 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. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Thus, the Board need not find the presence of all, most, or even some, of the enumerated symptoms to award a specific rating. Id. at 442. Nevertheless, all ratings in the general rating formula are also associated with objectively observable symptomatology and the plain language of the regulation makes it clear that the Veteran’s impairment must be “due to” those symptoms; a Veteran may only qualify for a given disability rating by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Clauditory, 713 F.3d at 118. The Board recognizes that the Court in Mauerhan, 16 Vet. App. 436, stated that the symptoms listed in VA’s general Rating Formula for mental disorders is 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; however, the Court further indicated that, without those examples, differentiating between rating evaluations would be extremely ambiguous. As with all claims for VA disability compensation, the Board must assess the credibility and weigh all the evidence, including lay and medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert denied, 523 U.S. 1046 (1998). Rating Analysis The Veteran asserts that his PTSD is worse than the currently assigned 30 percent disability rating. For the reasons expressed below, the Board finds that the Veteran’s PTSD more nearly approximates occupational and social impairment with reduced reliability and productivity, which warrants a 50 percent rating. Turning to the evidence, the Board notes that during a March 2013 VA outpatient visit, the Veteran endorsed symptoms of depression. He denied suicidal and homicidal ideations as well as delusions and hallucinations. On examination, the Veteran was oriented to person, place, and time, and he was well groomed. His speech was described as soft, and his mood and affect were anxious. His long- and short-term memory and immediate recall were intact. His judgment was assessed to be grossly intact. April 2013 VA outpatient treatment notes reflect that the Veteran was working part-time at the time of this appointment. He endorsed symptoms of depression and PTSD. The Veteran stated he was petrified of the dark and afraid of rats. He endorsed hypervigilance, panic attacks triggered by sweating, nightmares, and low tolerance for people. The Veteran said he enjoyed a good relationship with his son and daughter in law. It was noted that the Veteran was not considered a danger to himself or others. He denied delusions and hallucinations, and his insight and judgment were grossly intact. In May 2013, the Veteran endorsed symptoms of depression. However, he denied suicidal and homicidal ideations. The Veteran reported little improvement in “breakthrough panic” symptoms using the medication Alprazolam, with better effect from a trial of Klonopin, so he was prescribed Klonopin and was to continue taking Venlafaxine. On examination, the Veteran was oriented to person, place, and time; he was well groomed; his speech was normal; his mood and affect were mildly anxious; his long- and short-term memory, including immediate recall, were intact; and his judgment was grossly intact. The Veteran was negative for delusions and hallucinations. July 2013 VA outpatient notes reflect that the Veteran endorsed symptoms of depression and it was noted that he experienced panic. However, he denied suicidal and homicidal ideations. He reported continued sequelae of PTSD including difficulty making friends, vividly recalling past emotional injury, panic with somatic presentation such as profuse sweating, derealization, and diaphragmatic pressure, feelings of disenfranchisement, anxiety, avoidance of dark places, and irritability. He noted progress in being better able to control his anger. He was not physically violent or aggressive. On examination, the Veteran was oriented in all spheres; he was well groomed; his speech was normal; his mood was anxious, and affect was angry; his long- and short-term memory were intact; and his judgment was grossly intact. The Veteran was negative for delusions and hallucinations. In December 2013, the Veteran’s mood was described as depressed. He reported having a very casual relationship with his spouse, who had moved to California, and he would maintain communication with her son. The Veteran said he was able to work through a stressful week with help from his therapist and noted that if too much time passes between therapy sessions, he is not able to cope as well, noting more irritability and reactiveness; however, he said he had recently noticed a decrease in such feelings. On examination, the Veteran’s long- and short-term memory were intact, he was negative for delusions and hallucinations, and he denied suicidal and homicidal ideations. During a VA outpatient visit in February 2014, the Veteran’s mood was depressed. He denied any suicide attempts. He reported that he was working part-time as a security guard at the entrance of a condominium community. It was noted that his past employment included police officer, retail theft, parcel working for a contractor for a parcel delivery company, and he obtained certification to work for the Transport Security Administration. His reported educational background included earning Bachelor’s and Master’s degrees in criminology. VA treatment notes dated March 2014 reflect that the Veteran’s mood was anxious, and he endorsed symptoms of depression and PTSD. He tended to isolate himself and numb out feelings to protect himself. He was learning tools to manage anxiety and cognitive-behavioral techniques to improve his mood and decrease isolation. On examination, he was oriented in all spheres; he was well groomed; his speech was normal; his mood and affect were anxious; his long- and short-term memory, including immediate recall, were observed to be intact; and his judgment were grossly intact. He denied suicidal and homicidal ideations, and he was negative for delusions and hallucinations. In June 2014, the Veteran underwent a VA PTSD examination, at which time the VA examiner rendered diagnoses of PTSD and unspecified depressive disorder, noting that the etiological relationship, if any, with PTSD was unclear. In terms of social impairment, the examiner noted that the Veteran reported that the he had been married for 20 years, that they had separated in 2012, and that they had no children. In terms of occupational impairment, the examiner noted that the Veteran said he was working part-time two days a week as a valet and security person at a condominium for two or three years. He said his job performance was good during that period. He noted that he worked full time as a police officer for over 20 years, retiring after his partner was killed, which was extremely emotionally stressful for the Veteran. On examination, the Veteran was noted to be alert and fully oriented, well groomed, his speech was normal, and his thought content and process was unremarkable. His mood presented as mildly anxious with generally somewhat constricted though reactive affect. There was no observable responsiveness to internal stimuli. The Veteran denied delusions and hallucinations, suicidal and homicidal ideation as well as planning or intent, and there was no observable impairment in attention, concentration, or memory. The examiner identified PTSD symptoms of anxiety and chronic sleep impairment. The examiner opined that the Veteran’s PTSD resulted in occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication. The examiner determined that the Veteran was capable of handling his financial affairs. See VA PTSD examination report dated June 27, 2014. Because the June 2014 VA PTSD examination reflects a thorough review of the relevant case history and because the examiner’s conclusions are consistent with the balance of the medical evidence of record, the Board assigns it significant probative weight. During a July 2014 VA intake assessment, the Veteran endorsed anger, hypervigilance, depression, anxiety, panic attacks, nightmares, intrusive thoughts, sleep impairment, and avoidance behavior. On examination, the Veteran’s mood was depressed. He denied a history of suicide attempts and current suicidal and homicidal ideations. The Veteran’s judgment was observed to be good. In his August 2014 Notice of Disagreement, the Veteran emphasized that he disagreed with the June 2014 rating decision that continued his PTSD rating at 30 percent, asserting that his symptoms warrant a 50 percent rating, endorsing occupational and social impairment with reduced reliability and productivity due to panic attacks more than once a week; impairment of short- and long-term memory; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. The Veteran alleged that the June 2014 VA examiner was biased and less than thorough in evaluating the Veteran, and he attached a letter he sent to his Congressman in which he complained that the VA evaluation was “geared toward what is happening now, not since 1967” when he was in service. He asserted that an increased rating was justified because of panic attacks that occurred once a week if not more, he experienced disturbances of motivation and mood, and he lacked the ability to maintain any close relationships. He also stated he was forgetful, and he had memory problems and difficulty concentrating. He noted that he seldom left his home, struggled with authority, and only continued to work because he could not afford to stop working. He said his only close friends were his wife and her son. As the Veteran’s assertions of memory impairment and concentration difficulties are inconsistent with objective observations recorded in his treatment records, the Board assigns these statements low to no probative weight. See Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (claimant’s statements were not credible because they were inconsistent with the more probative information in records for treatment and evaluation). Notes associated with VA outpatient visits in in August, September, and October 2014, the Veteran denied suicidal and homicidal ideations, and he was noted to be negative for delusions and hallucinations. VA treatment records dated December 2014 reflect that the Veteran had been on a psychotropic medication regimen for three years that included taking Venlafaxine XR and Alprazolam and Clonazepam for anxiety and insomnia. The Veteran acknowledged that his symptoms had improved, although it was not determined whether improvements were due to medication, counseling, or other factors. The Veteran reported that he continued to work part time as security guard. On examination, the Veteran was alert and oriented in all spheres; he was well groomed with good hygiene, his mood was characterized as “alright” and his affect was congruent with his mood; and his speech was normal in tone, rate, and volume. The Veteran’s thought processes were logical and goal-directed with intact associations. There was no evidence of thought disorder or perceptual disturbances. There was no expressed delusional content. His immediate, recent, and remote memories were grossly intact as were his attention and concentration. His insight was observed to be good, and his judgment and impulse control were adequate. The Veteran denied suicidal and homicidal ideations and there were no indications of self-injurious behavior. A suicide risk assessment noted protective factors that included supportive relationships. In January 2015, the Veteran presented at an outpatient visit with a depressed mood. He endorsed panic attacks, anxiety, and depressed mood. In March, the Veteran reported that his anxiety was more intense, and that he was feeling more depressed. He denied suicidal and homicidal ideations and he was negative for delusions and hallucinations. Notably, in late March 2015, the Veteran reported that he had stopped taking prescribed psychotropic medications “due to not getting an increase in his [service connected] disability,” theorizing that perhaps he did not need the medications as much as he thought he did, “but has found out otherwise.” A mental status examination reflects that the Veteran was clean and dressed appropriately, and he was alert and oriented in all spheres. His mood was described as “good” and his affect was congruent with his mood. There was no obvious psychomotor abnormality; his speech was normal in tone, rate, and volume; his thought processes were logical and goal-directed with intact associations; and there was no evidence of thought disorder or perceptual disturbances. The Veteran expressed no delusional content. His immediate, recent, and remote memories were grossly intact as was his attention and concentration. His insight was good and judgment, and impulse control were described as adequate. He denied suicidal and homicidal ideations, and no self-injurious behavior was indicated. He was assessed a low suicide risk, with noted protective factors including supportive relationships. During a VA primary care visit in April 2015, which included a psychiatric assessment, the Veteran was alert and oriented to person, place, and time, he was negative for symptoms of depression and memory loss. His mood was euthymic, his judgment good, his affect appropriate, and his speech was normal. He denied suicidal and homicidal ideations. Later that month, the Veteran reported being more depressed. Nevertheless, he denied suicidal and homicidal ideations, and it was noted that he was negative for delusions and hallucinations. During a June 2015 VA outpatient mental status examination, the Veteran was clean and appropriately dressed. He was alert and oriented in all spheres and there were no obvious psychomotor abnormalities. His mood was described as “okay” and his affect was congruent with his mood; his speech was normal in tone, rate, and volume; his thought processes were logical and goal-directed with intact associations; and there was no evidence of thought disorder, perceptual disturbances, or delusional content. His memory was grossly intact as were his attention and concentration. The Veteran’s insight was good, and judgment and impulse control were described as adequate. He denied suicidal and homicidal ideations and no self-injurious behavior was indicated. He was assessed to be a low suicide risk, due in part to protective factors that included supportive relationships. In September 2015, the Veteran denied feeling down, depressed, or hopeless. A depression screening was negative (score 0). However, later that month, the Veteran complained of anxiety. On examination, the Veteran was appropriately oriented; he was well-groomed; his psychomotor activity was negative for abnormalities; his speech was fluent and normal in tone, rate, and volume; his mood was described as “alright” and affect was congruent with mood; and his thought process was logical and goal directed with intact associations. There was no evidence of thought disorder or perceptual disturbances, and no expressed delusional content. His immediate, recent, and remote memories were grossly intact as was his attention and concentration. His insight was good, and his judgment and impulse control were adequate. The Veteran denied suicidal and homicidal ideations. Also, in September 2015, the Veteran reported that he adopted a puppy. In October 2015, the Veteran reported that he was doing well, and he would be visiting California for three or four months, possibly remaining there. The therapist noted that over the course of the treatment sessions the Veteran had achieved moderate success in more openness and genuinely communicating with others, and his prognosis was good due to his high level of motivation, his above average level of intelligence, and “good social skills.” In January 2016, the Veteran complained of experiencing anxiety. It was noted that he developed an “immense hatred for the Vietnamese” which resulted in feelings of guilt during and after his military service in Vietnam. One of the challenges the Veteran faced was isolation. However, he said he was a member of The American Legion and he was planning to move to California to be closer to friends and family. A mental status examination revealed that the Veteran was appropriately oriented, he was well-groomed, his psychomotor activity was negative for abnormalities, his speech was fluent and clear, his mood was anxious, and his affect was “well-modulated.” The Veteran’s thought process was observed to be coherent, and he was negative for hallucinations and delusions. There was no indicated memory impairment and his attention and concentration were adequate. His insight, judgment, and impulse control were noted to be adequate. The Veteran denied suicidal and homicidal ideations, and it was noted during a suicide risk assessment that protective factors included supportive relationships. The Veteran denied having sleep difficulties. Following his move to California, the Veteran was seen during June 2016 on a VA outpatient basis. The Veteran noted that his son and ex-wife, with whom he was reconciling, lived in the area. He said he was looking forward to upcoming travel with his son to go kayaking, and he wanted to learn to play golf. He also said he enjoyed seeing his grandchildren who were ages 6 and 11. The Veteran endorsed “intermittent” panic attacks and said he felt depressed at times, and it was noted that the Veteran had some chronic PTSD symptoms and associated anxiety as well as mild depressive symptoms. Notably, the Veteran said he had had thoughts that he would be better off dead, but he denied having suicidal ideation, intent or plan, and it was noted that there was no history of actual suicide intent or attempts. On examination, the Veteran was well groomed with good hygiene; his psychomotor activity was normal; his speech was clear and coherent with normal rate and volume; and his mood was stable, and his affect was appropriate to thought content, although his thought process was tangential at times. The Veteran was negative for auditory and visual hallucinations, delusional thinking, and other psychotic thinking. There were no gross cognitive deficits noted. He was observed to have good judgment and insight. The Veteran indicated that his current medications were beneficial to him. He was instructed to continue taking Venlafaxine daily for PTSD, anxiety, and mood, and he would continue taking Xanax as needed up to twice day for anxiety/panic attacks. In July 2016, the Veteran reported experiencing panic attacks “occurring once per month, lasting 20 minutes each, and rated 8 on scale of 10 (10 most severe).” The VA clinician observed that the Veteran seemed disorganized but noted that it was unclear whether the Veteran’s memory was impaired and said what he was observing may be anxiety. The Veteran denied suicidal ideation. Later that month, the Veteran reported continued anxiety and panic attacks, but did not indicate how often the attacks occurred. The Veteran was instructed to continue taking Venlafaxine daily for anxiety/panic attacks and mood and Xanax up to twice daily for anxiety/panic attacks. On examination, the Veteran was well groomed with good hygiene; normal psychomotor activity was observed; and his speech was clear, coherent, and at a normal rate and volume. The Veteran’s mood was stable, and his affect was appropriate to thought content, although his thought process was at times observed to be somewhat tangential. No gross cognitive deficits were noted. He was negative for auditory and visual hallucinations as well as delusional and psychotic thinking. His judgment and insight were observed to be good. He denied suicidal and homicidal ideations, intent, or plan. During an August 2016 VA outpatient visit, the Veteran said he had experienced “several panic attacks lately” and the medication he takes for panic attacks did not help. The Veteran said he continued to take Xanax as needed for anxiety/panic attacks, but it was noted that the Veteran did not take Xanax every day. The Veteran was to continue taking Venlafaxine daily for anxiety/panic attacks and mood and Xanax as needed for anxiety/panic attacks. The Veteran underwent a depression screen, which was positive, in part, due to the Veteran indicating that he was feeling down, depressed, or hopeless at times. On examination, mild depressive symptoms were observed. The Veteran reported that his current medications were helping with symptoms. The Veteran was well groomed with good hygiene. His psychomotor activity was normal; his speech was clear, coherent, and at a normal rate and volume; his mood was described as “some stress” regarding his wife’s health; and his affect was appropriate to thought content. The Veteran’s thought process was fairly goal directed. He was negative for auditory and visual hallucinations, delusional thinking, and other psychotic thinking. He denied suicidal and homicidal ideations, intent, or plan. There were no gross cognitive deficits observed and his judgment and insight were good. In September 2016, the Veteran again underwent a VA PTSD examination, at which time the VA examiner rendered diagnoses of PTSD and panic disorder. The examiner noted that it was not possible to differentiate which symptoms were attributable to either diagnosis, emphasizing that the service-connected PTSD was the more severe disability and was “responsible for his level of impairment” and the panic disorder was likely caused by the Veteran’s chronic PTSD symptoms. See VA PTSD examination report dated September 29, 2016 at pgs. 1-2. In terms of social impairment, the examiner noted that the Veteran reported that he lived with his wife of 29 years. His wife, who attended the examination, acknowledged that they had separated and were reconciling. The Veteran said he has trouble sleeping and gets up late, is house-bound a lot, but he tries to shave and clean up. He said he spent the vast majority of his time at home watching television, interacting with his dog, and being on the computer, and he was involved with his grandchildren. In terms of occupational impairment, the examiner noted that the Veteran said he was last employed in February 2016 working in security when he lived in Florida. He said he typically worked for an employer for two to three years and then would either get fired or leave. He said he has not tried to find employment since 2016 and had not attended college for several years. The examiner identified PTSD symptoms of depressed mood; anxiety; panic attacks more than once a week; chronic sleep impairment; mild memory loss, such as forgetting names, directions or recent events; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; and difficulty in adapting to stressful circumstances, including work or a worklike setting. The examiner concluded that the Veteran’s PTSD resulted in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. The examiner determined that the Veteran was capable of handling his financial affairs. See VA PTSD examination report dated September 29, 2016. The Board finds the September 2016 VA examination report inconsistent in some respects with the lay and medical evidence of record, particularly the Veteran’s treatment records. For example, the notation indicating that the Veteran was last employed in February 2016 is contradicted by his prior statements and objective employment data showing that he worked until May 2016. His claim that he was often housebound spending the majority of his time watching television or on a computer is contradicted by the Veteran’s statements during prior VA outpatient visits that he enjoys spending time with his son, his grandchildren, and visiting his mother-in-law. Objective observations of mild memory loss and impaired judgment during the examination are inconsistent with VA treatment records dated prior to the examination reflecting unimpaired immediate, recent, and remote memory. Notably, the examiner’s opinion that the Veteran’s PTSD causes occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood, is not reflected in prior treatment records. Indeed, while the Veteran reported depressed mood during outpatient visits, objective observation revealed that no gross cognitive deficits observed, and his judgment and insight were routinely characterized as good. Moreover, the VA examiner made no attempt to reconcile these inconsistencies in his report. The Board, therefore, assigns the September 2016 VA examination report low to no probative weight. See Madden, 125 F.3d at 1481 (recognizing the Board’s “authority to discount the weight and probity of evidence in light of its own inherent characteristics and its relationship to other items of evidence”). During a VA outpatient visit in November 2016, the Veteran said he enjoyed spending time with his grandchildren, and his wife recently arranged a cruise as a birthday present for him. He said he continued to experienced panic attacks sometimes, but that medication helped. It was noted that a trial substitution of the medication Hydroxyzine for Xanax for anxiety did not help, that he was prescribed Gabapentin as needed for anxiety, which had helped somewhat, but that “when he has a bad panic attack, he still needs to take the Xanax.” He was not taking Xanax every day. Despite the Veteran’s medication regimen, he continued to have some chronic PTSD symptoms and associated anxiety as well as panic attacks but was observed to be overall “psychiatrically stable at this time.” On examination, the Veteran was well groomed with good hygiene. He exhibited normal psychomotor activity; his speech was clear and coherent with normal rate and volume; his mood was “okay,” and his affect was appropriate to thought content. His thought process was fairly goal directed and he was negative for auditory and visual hallucinations, delusional thinking, and other psychotic thinking. No gross cognitive deficits were observed, and his judgment and insight were good. The Veteran denied suicidal and homicidal ideations, intent, or plan. In February 2017, the Veteran noted that he and his wife were to go on a cruise to the Bahamas that week, which he was looking forward to. He said he had recently bought a used Corvette, he was very pleased with the purchase and was enjoying the car, and he planned to join a Corvette club. The Veteran continued to take Xanax for panic and anxiety attacks. It was noted that the Veteran continued to experience chronic some PTSD symptoms and associated anxiety and panic attack, but he was taking Venlafaxine regularly, his symptoms were manageable and less severe than in the past, and overall, he was said to be “psychiatrically stable” at that time. The Veteran noted sleep problems and requested an increase in Trazedone to help him sleep. On examination, the Veteran was well groomed, his hygiene was good, his psychomotor activity and speech were normal, his mood was described as “okay,” and his affect was appropriate to thought content. The Veteran’s thought process was fairly goal directed, and he was negative for auditory/visual hallucinations, delusional thinking, and other psychotic thinking. He denied suicidal and homicidal ideation, intent or plan. No gross cognitive deficits were observed, and his judgment and insight were good. In May 2017, the Veteran said he recently visited his elderly mother in law and enjoyed seeing her. The Veteran said he continued to experience panic attacks, but how often he experienced the attacks was not noted. The Veteran was taking Venlafaxine daily for anxiety/panic attacks and mood. He was also taking Gabapentin as needed for anxiety which helped somewhat but he still needed to take Xanax for a bad attack. It was noted that the Veteran did not take Xanax every day. Overall, the Veteran was “psychiatrically stable” at that time. On examination, he was well groomed, and his hygiene was described as good. His psychomotor activity was normal, and his speech was clear and coherent, with normal rate and volume. The Veteran’s mood was described as “okay” but with some stress and his affect was appropriate to thought content. His thought process was fairly goal directed, and negative for auditory/visual hallucinations and delusional thinking or other psychotic thinking. No gross cognitive deficits were observed, and his judgment and insight were characterized as good. The Veteran denied suicidal and homicidal ideations, intent, or plan. August 2017 VA treatment notes reflect that the Veteran continued to experience some chronic PTSD symptoms and associated anxiety and panic attacks, as well as intermittent sleep problems. However, overall, he was said to be “psychiatrically stable.” The Veteran said that when he had a bad panic attack, “he still needed to take Xanax,” although he was not taking it every day. Additionally, he reported that he enjoyed working on his old Corvette, he recently met his god-daughter for the first time, and he was enjoying a good relationship with his son although the Veteran’s relationship with his wife was strained, in part due to her suffering a job-related head injury which he said resulted in personality changes. He reported that he sometimes had problems sleeping but found that taking Doxepin was helpful. He continued to take Gabapentin for anxiety and occasionally was taking Xanax as needed for severe anxiety. On examination, the Veteran was observed to be well groomed with good hygiene. His psychomotor activity and speech were normal. His mood was described as “okay” and his affect was appropriate to thought content. His thought process was observed to be fairly goal directed and he was negative for auditory/visual hallucinations, delusional thinking, and other psychotic thinking. No cognitive defects were indicated, and his judgment and insight were good. The Veteran denied suicidal and homicidal ideation, intent, or plan. In December 2017, the Veteran reported an increase in intrusive thoughts and sleep disturbances after he stopped taking Venlafaxine. He continued to take Xanax for bad panic attacks, although he said he did not take it every day. The Veteran reported that he had been taking Hydroxyzine as needed for anxiety instead of Xanax without effect but returned to taking Xanax for bad panic attacks. Nevertheless, the Veteran said he enjoyed spending Christmas with his family. He said he had lately been thinking a lot about his experiences in Vietnam, but after calling a fellow veteran with whom he served in Vietnam he felt better after talking with him. On examination, good grooming and hygiene were observed, the Veteran’s psychomotor activity was normal, and his speech was clear and coherent, with normal rate and volume. His affect was appropriate to thought content, and his thought-processing was fairly goal directed. There were no indications of auditory/visual hallucinations and no delusional or other psychotic thinking. The Veteran was negative for gross deficits in cognition, and his judgment and insight were observed to be good. He denied suicidal and homicidal ideation, intent or plan. March 2018 VA treatment notes reflect that the Veteran’s mood was stable. He reported that his current psychiatric medications were helpful to him. He said his anxiety and panic symptoms increased when he stopped taking Venlafaxine for about a month from November to December 2017, but he noticed an improvement in symptoms after he started taking the medications again. The Veteran said he continued to take Xanax when he experienced a bad panic attack, although he said he had not taken any Xanax “at all lately.” The Veteran was to continue taking Venlafaxine daily for anxiety/panic attacks, mood, and PTSD symptoms, and to continue taking Gabapentin up to twice a day as needed for anxiety and continue to try Gabapentin first before Xanax, which was to be used for severe episodes of anxiety. On examination, the Veteran’s hygiene was good, he was well groomed, and he exhibited normal psychomotor activity and normal speech. His mood was “okay,” and his affect was appropriate to thought content. The Veteran’s thought process was fairly goal directed, and negative for auditory and visual hallucinations, delusional thinking, and other psychotic thinking. His judgment and insight were observed to be good. He denied suicidal and homicidal ideation, intent, or plan. In late March, the Veteran denied symptoms of depression and anxiety. His mood was observed to be euthymic, his judgment good, his affect appropriate, speech normal, and he denied suicidal and homicidal ideation. VA treatment notes dated June 2018 reflect that a depression screening was negative. The Veteran said he was doing okay and spending time working on his Corvette. He was attending weight loss meetings and had lost 10 pounds, and he was planning to visit his mother in law that summer. On examination, the Veteran’s grooming and hygiene were good and his psychomotor activity and speech were normal. His mood was described as “okay” and his affect was appropriate to thought content. His thought process was fairly goal directed, and he was negative for psychotic thinking as well as auditory and visual hallucinations. His judgment and insight were good, and he denied suicidal ideation. In October 2018, the Veteran reported that he had been very busy lately traveling to Florida to ensure that storm damage to a home he owns there was repaired. He was worried about his wife and their dog due to their respective health problems. He said he was doing okay and taking his medications as prescribed. He was to continue taking Venlafaxine for anxiety/panic attacks, mood, and PTSD symptoms. On examination, the Veteran’s grooming and hygiene were observed to be good. His speech and psychomotor activity were good, his mood was “okay,” and his affect was appropriate to thought content. The Veteran’s thought process was fairly goal directed and there were no indications of auditory/visual hallucinations, delusional thinking, or other psychotic thinking. His judgment and insight were observed to be good and he had no gross cognitive deficits. He denied suicidal and homicidal ideation, intent, or plan. In January 2019, the Veteran complained that he had trouble falling asleep and only slept about four hours, noting that he was afraid of having nightmares he had for years, but had diminished to occurring only infrequently. On examination, the Veteran’s speech was clear and coherent, with normal rate and volume. His mood was “okay” and his affect appropriate to thought content. His thought processing was fairly goal directed and there was no indication he experienced auditory or visual hallucinations, delusions, or other psychotic thinking. He denied suicidal and homicidal ideation, intent, or plan; and there were no gross deficits in cognition indicated. His judgment and insight where observed to be good. His grooming and hygiene were good. April 2019 VA treatment notes reflect that the Veteran continued to report having panic attacks, although how often was not noted. He said he was taking Xanax as needed, but rarely now. It was noted that the Veteran continued to have chronic PTSD symptoms and anxiety, but his mood was stable, and he said the psychiatric medications he was taking were helpful to him. He was to continue taking Venlafaxine daily for anxiety and panic attacks, as well as mood and other PTSD symptoms, with instructions to take Xanax for severe episodes of anxiety if taking Gabapentin was not effective. On examination, the Veteran’s grooming and hygiene were observed to be good. Psychomotor activity and speech were normal. His mood was noted to be “okay” and his affect was appropriate to thought content. His thought process was fairly goal directed, and he experienced no auditory or visual hallucinations, delusions, or other psychotic thinking. There were no gross cognitive deficits observed, and his judgment and insight were characterized as good. The Veteran denied suicidal and homicidal ideations, intent, or plan. In a July 2019 statement, the Veteran asserted, in part, that he has trouble interacting with people, groups of people make him uncomfortable, he has a difficult time trusting people, his relationship with his wife is contentious, he becomes so sad at times he cries, he has a hard time recalling peoples’ names, and he bathes and brushes his teeth only if he has a doctor appointment or therapy. Notably, the Veteran indicated that he has behaved as described since he returned from Vietnam. Lastly, the Veteran said that despite going to therapy for years, which was helpful, he said he still thoughts about harming himself over guilt brought on from yelling at others, and that he thought “ending my life would fix my problems.” See Veteran’s statement received July 30, 2019. While the Board acknowledges the Veteran’s July 2019 statement detailing behavioral deficits throughout the period on appeal, and some of his remarks are consistent with the record, a number of his July 2019 assertions are inconsistent with information reflected in his treatment records. For example, the Veteran’s assertion that he has trouble interacting with or being around people is contradicted by his statements noted during outpatient appointments reflecting that he enjoys spending time with his mother-in-law and grandchildren, that he went on a cruise arranged by his wife as a birthday gift, that he attended weight loss meetings, and that he had an interest in joining a Corvette owners group. His assertion of memory impairment is contradicted by consistent, objective observations by VA clinicians during outpatient appointments that the Veteran had no memory or cognitive deficits. Also, his assertion that he observes good hygiene only when attending doctor or therapy appointments is not noted anywhere in his treatment records during the period on appeal. Notably, the Veteran’s assertion that he has thoughts about harming himself and that he thought “ending my life would fix my problems” is entirely inconsistent with treatment records, which universally reflect that during the period on appeal he has consistently denied suicidal ideation, intent, or plan, and any prior attempts. While the Veteran is competent to describe symptoms he has experienced first-hand, because the July 2019 statement is inconsistent with objective information in his treatment records and was made in furtherance of his claim for increased compensation and is inconsistent with his statements and objective observations for treatment purposes, the Board assigns the July 2019 statement low to no probative weight. See Buchanan, supra.; Harvey v. Brown, 6 Vet. App. 390, 394 (1994) (Board decision properly assigned more probative value to a hospital record that included lay history that was made for treatment purposes than to subsequent statements made for compensation purposes). In August 2019, the Veteran submitted a PTSD evaluation penned by private clinical psychologist J.S., which consists of what initially appears to be a comprehensive retrospective evaluation of the evidence and medical opinions, asserting, among other things, that the Veteran’s PTSD symptoms are severe, resulting in impaired memory, focus, and perception that have led to errors in assessing the severity of his disorder, and that his symptoms cause occupational and social impairment with deficiencies in most areas, neglect of personal appearance and hygiene, impaired impulse control, inability to establish and maintain effective relationships, and obsessional rituals (leaving lamps on at night) or near-continuous panic or depression affecting his ability to function independently. Notably, J.S. opined that the Veteran’s symptoms have remained essentially the same since 2010. See, e.g., Private medical evaluation dated August 2, 2019 (hereinafter, “2019 Private Evaluation”) at pgs. 8, 10, 13. The Board finds the 2019 Private Evaluation inconsistent in some respects with the lay and medical evidence of record, particularly the Veteran’s treatment records. For example, in terms of social impairment, the 2019 Private Evaluation shows that the Veteran has tremendous difficulty effectively and appropriately engaging in interpersonal, social, familial, and recreational activities. See, e.g., 2019 Private Evaluation at pg. 10. However, as shown above, the Veteran’s treatment records reveal that throughout the rating period he was able to maintain good hygiene and grooming; he had good relationships with his son and grandchildren; for part of the period on appeal he remained employed on at least a part-time basis; and in October 2018, he traveled to Florida to ensure that storm damage to a home he owns there was repaired. See, e.g., VA treatment records dated July 24, 2014, December 30, 2014, March 31, 2015, September 15, 2015, January 28, 2016, November 1, 2016, February 1, 2017, August 22, 2017, March 16, 2018, June 15, 2018, October 22, 2018, January 23, 2019, and April 23, 2019. Additionally, the Veteran’s treatment records reflect that he was on sufficiently amicable terms with his wife to remain in their home even during periods when their relationship was extremely contentious; he went on a sea cruise with his wife, which she arranged as a gift for him; he enjoyed spending time with family, including his mother-in-law and grandchildren; he enjoyed kayaking with his son; he is a member of The American Legion; and he bought a Corvette and was planning to join a Corvette club. See, e.g., VA treatment records dated June 3, 2016, November 1, 2016, February 1, 2017, May 18, 2017, and August 22, 2017. While the treatment records reflect that the Veteran disliked being in the dark, he preferred to leave lamps on at night, none of the treatment records indicate that the Veteran engaged in obsessional rituals or experienced near-continuous panic. Additionally, in several instances J.S. ignored objective evidence or described it in such a way to suggest that the Veteran’s symptoms are more severe than reflected in the objective treatment records. For example, J.S. construed as suicidal ideation a June 2016 VA outpatient treatment record reflecting that the Veteran thought he would be better off dead; however, J.S. chose not to mention notations from that same treatment record, stating that the Veteran denied suicidal ideation, intent, or plans and that he denied ever having attempted suicide. See VA treatment record dated June 3, 2016. Indeed, the Veteran has consistently denied suicidal ideation, plan, or intent throughout the period on appeal. J.S. also asserts that the Veteran’s PTSD symptoms are broad and persistent despite taking psychotropic medications, indicating that the Veteran’s symptoms are not mild and transient and have been poorly controlled by medications since 2012. See 2019 Private Evaluation at pg. 12. While the ameliorative effects of medications must be taken into account in assessing the severity of the Veteran’s symptoms, discussed below, the Veteran’s treatment notes actually reflect that the Veteran’s prescribed medications have been effective, and where medication was not effective, VA caregivers would prescribe higher dosages or different medications, and, except when the Veteran chose not to take his prescribed medications, his compliance with the prescribed medication regimen generally coincided with stable or improved PTSD symptoms. See, e.g., VA treatment records dated May 29, 2013, December 30, 2014, March 31, 2015, August 29, 2016, May 18, 2017, March 16, 2018, and April 23, 2019. In so much as the 2019 Private Evaluation is based on factual inaccuracies, the evaluation, including its opinions, cannot be assigned probative weight in its current form. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (A medical opinion based on an inaccurate factual premise is not probative; Madden, supra. Nevertheless, review of the probative evidence indicates that throughout the period on appeal that the Veteran consistently reported experiencing panic attacks. Although the records do not specifically reflect that the Veteran experienced continuous panic or panic attacks more than once a week, symptoms and treatment were frequently discussed during almost every outpatient visit during the period on appeal, and, as discussed above, VA clinicians devoted considerable attention to prescribing effective medication to help mitigate the Veteran’s panic and anxiety symptoms. As noted above, the ameliorative effects of medication must be considered in assessing the severity of these symptoms. See Jones v. Shinseki, 26 Vet. App. 56 (2012) (holding that the ameliorative effects of medication may not be considered in assigning a disability rating where such effects are not explicitly contemplated by the rating criteria). As the Veteran is competent to describe panic and anxiety attacks, Layno v. Brown, 6 Vet. App. 465, 470 (1994), and the objective treatment records reflect the Veteran’s description of panic attacks throughout the period on appeal and his taking medications for these symptoms, the effects of which were routinely evaluated by VA caregivers, and resolving reasonable doubt in the Veteran’s favor, the Board finds that the competent lay and medical evidence demonstrates that the Veteran experienced panic attacks more than once a week during the period on appeal, which approximates the criteria for a 50 percent rating. A higher rating of 70 percent is not warranted as the evidence does not reflect that the Veteran has displayed gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; or intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene). To the contrary, the competent, credible evidence of record demonstrates that the Veteran has been found throughout the period on appeal to be capable of managing his own financial affairs, he has continuously appeared alert, oriented, and well-groomed, his thought processes have been logical with intact associations, there is no evidence of thought disorder, perceptual disturbances, delusions, or hallucinations, and he has consistently denied suicidal and homicidal ideations and there have been no objective indications of self-injurious behavior. Although not clear, the Veteran’s April 2016 appeal to the Board could be construed as a claim for an earlier effective date for the PTSD rating. VA law and regulation provide the effective date of an award of increased compensation may be established at the earliest date as of which it is factually ascertainable that an increase in disability had occurred, if the application for an increased evaluation is received within one year from that date. 38 U.S.C. § 5110 (b) (2); 38 C.F.R. § 3.400 (o) (2). As shown above, the finds that it is not factually ascertainable in the one year prior to the February 2014 claim that the severity of the Veteran’s PTSD met or approximated a rating in excess of 50 percent. Finally, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). TDIU Prior to May 3, 2016 The Veteran filed a formal claim for a TDIU during the pendency of the appeal, which was received by VA on April 29, 2016. In an October 2016 rating decision, the RO granted entitlement to a TDIU based on the Veteran’s service-connected PTSD and peripheral neuropathy of the bilateral upper and lower extremities, effective May 3, 2016, the day following the Veteran’s last date of employment. The Veteran contends that an earlier effective date for a TDIU is warranted. See Notice of Disagreement (NOD) received February 20, 2017. It is the established policy of VA that all veterans who are unable to secure and maintain substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. 38 C.F.R. § 4.16. A finding of total disability is appropriate “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.” 38 C.F.R. §§ 3.340(a)(1). Controlling laws provide that a TDIU may be assigned when a veteran has one service-connected disability rated at 60 percent or more, or two or more service-connected disabilities where at least one disability is rated at 40 percent or more and the combined rating is at least 70 percent. 38 C.F.R. § 4.16(a). The record must also show that the service-connected disabilities alone result in such impairment of mind or body that the average person would be precluded from securing or maintaining a substantially gainful occupation. Id. 38 U.S.C. § 1155. The Veteran in this case has been in receipt of service connection for PTSD, rated at 30 percent disabling, effective March 15, 2012; diabetes mellitus Type II (DMII), rated at 20 percent effective March 15, 2012; peripheral neuropathy of the left upper extremity associated with DMII, rated at 20 percent effective April 29, 2016; peripheral neuropathy of the right upper extremity associated with DMII, rated at 20 percent effective April 29, 2016; tinnitus, rated at 10 percent from March 15, 2012; peripheral neuropathy of the right lower extremity sciatic nerve associated with DMII, rated at 10 percent effective October 28, 2013; peripheral neuropathy of the left lower extremity associated with DMII, rated at 10 percent effective October 28, 2013; peripheral neuropathy of the right lower extremity femoral nerve associated with DMII, rated at 10 percent effective April 28, 2016; peripheral neuropathy of the left lower extremity femoral nerve associated with DMII, rated at 10 percent effective April 28, 2016; erectile dysfunction associated with DMII, rated noncompensable effective April 29, 2016. Thus, considering the bilateral factor regarding the Veteran’s service-connected neuropathies, 38 C.F.R. § 4.26, and the Board’s grant herein of an increased rating for PTSD to 50 percent, the Veteran met the schedular percentage requirement for a TDIU under 38 C.F.R. § 4.16(a) as of February 21, 2014, the commencement of the period on appeal. The remaining question is whether his service-connected disabilities precluded the Veteran from securing and following a substantially gainful occupation prior to May 3, 2016. See 38 C.F.R. § 4.16(a). The fact that a veteran is unemployed or has difficulty finding employment does not alone warrant assignment of a TDIU, as a high rating itself establishes that her disability makes it difficult for her to obtain and maintain employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Rather, the evidence must show that he or she is incapable “of performing the physical and mental acts required” to be employed. Id. at 363. Thus, the central question is whether a veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability, and not whether a veteran could find employment. Id. Consideration may be given to a veteran’s education, training, and special work experience, but not to his or her age or to impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. In this regard, the Board notes that in a recent precedential decision, in Ray v. Wilkie, the Court defined the term “unable to secure and follow a substantially gainful occupation” in § 4.16(b) to have two components: one economic and one noneconomic. The economic component means 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. The non-economic component includes consideration of: The Veteran’s history, education, skill, and training; whether the veteran has the physical ability to perform the type of activities required by the occupation at issue; and whether the veteran has the mental ability to perform the activities required by the occupation at issue. See Ray v. Wilkie, U.S. App. Vet. Claims LEXIS 386 (2019). Here, the Veteran asserts that because of his service-connected PTSD, he has not been able to secure and maintain gainful employment since 2010. See Veterans Application for Increased Compensation Based on Unemployability received April 29, 2016. However, after a careful review of the record, the Board finds that entitlement to a TDIU is not warranted prior to May 3, 2016. The record reflects that the Veteran’s military occupational specialty (MOS) was Aircraft Mechanic. According to the various medical treatment records and claims documents that have been associated with the Veteran’s claims file, the Veteran has consistently asserted that after separation from the Air Force, he earned a Masters’ degree in criminology, worked as a police officer for a number of years for the Los Angeles Police Department, then approximately 20 years ago he left police work and was employed in fraud investigations, parcel delivery, and lastly as a condominium security guard. The Veteran’s work as a condominium security officer prior to May 3, 2016 involved checking guests entering the property through a gate, patrolling the property by foot, and handling guest emergencies when the property office was closed. As discussed above, the Veteran’s VA treatment records indicate that he routinely experienced panic and anxiety attacks during the period on appeal. During the June 2014 VA PTSD examination, during which the examiner noted symptoms of anxiety and chronic sleep impairment, the Veteran reported that at the time of the examination he had been working part-time two days a week for two or three years as a valet and security person at a condominium and that his job performance “has been fine during that period.” The examiner concluded that the Veteran’s PTSD caused occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication. The Veteran underwent VA diabetes and VA peripheral neuropathy examinations in August 2016. The examiner concluded that the Veteran’s service-connected diabetic peripheral neuropathy limited prolonged standing, balancing, handling small objects and tools because of sensory loss, and cautioned that the Veteran should not work at heights or around moving parts or machinery. The examiner noted that the Veteran’s service-connected diabetes mellites impacted his ability to work only in that he must manage his blood sugar levels to avoid ketoacidosis. As discussed above, the September 2016 VA PTSD examiner concluded that the Veteran’s PTSD resulted in occupational and social impairment with deficiencies in most areas, and the 2019 Private Evaluation reflects the private psychologist’s opinion that the Veteran’s PTSD has rendered him unable to secure or follow substantially gainful employment in any occupation since 2010. However, for reasons discussed above, both reports are assigned little, if any, probative value. Employment information submitted by the Veteran’s last employer, Jetty East, reflects that the Veteran worked two to three eight-hour shifts per week from April 2012 until May 2016 when he quit. The employer also provided payroll data covering pay periods from December 30, 2014 to May 2, 2016, which generally bears out the Veteran’s claim that he worked up to 24 hours a week, although in several instances he worked up to 30 hours a week. A Social Security Administration Earnings statement received in April 2019 shows that the Veteran’s earnings were: $11,692 in 2014; $13,319 in 2015; and $4,141 in 2016. According to the U.S. Census Bureau Housing and Household Economics Statistics Division, the poverty thresholds for one person from 2014 to 2016 were as follows: $12,071 in 2014; $12,082 in 2015; and $12,486 in 2016. Based on this information, it is indisputable that the Veteran’s part-time earnings in 2014 and 2016 were below the poverty threshold for a single person. His earnings in 2015 were slightly higher (by only $1,237) than the poverty threshold. Nevertheless, the record does not demonstrate that the Veteran was not able to obtain or maintain any type of gainful full-time employment due to a service-connected disability prior to May 3, 2016. The Veteran has asserted that he is highly educated, and he has considerable experience in law enforcement as well as fraud investigations and security work. His last employer, Jetty East, reported that the Veteran did not miss time from work due to disability, nor were any concessions made for him during his employment due to disability, which would include any panic or anxiety attacks, assuming he experienced such symptoms while on duty, which is not indicated in the record. There is also no indication in the record that he was fired by Jetty East or was refused employment elsewhere, due to a service-connected disability. Notably, the Veteran’s VA outpatient treatment records reflect that his departure from Jetty East coincided with his move to California near the end of May 2016, which he had been planning for several months. See VA treatment records dated January 7, 2016 and January 28, 2016. The fact that the Veteran chose to work part-time for Jetty East, as opposed to working full-time for the company or any other employer, does not establish that he was not able to obtain or maintain any type of gainful full-time employment, due to a service-connected disability, prior to May 3, 2016. For these reasons, the Board finds that there is no basis upon which to justify granting an effective date earlier than May 3, 2016, for an award of TDIU. See 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400(o). (Continued on the next page)   In arriving at the decision to deny the claim, 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. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). As such, the appeal is denied. L. Chu Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Brad Farrell, Associate Attorney 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.