Citation Nr: 20021325 Decision Date: 03/25/20 Archive Date: 03/25/20 DOCKET NO. 15-08 726 DATE: March 25, 2020 ORDER Entitlement to an effective date earlier than December 12, 2013, for the grant of service connection for posttraumatic stress disorder with alcohol use disorder (PTSD), to include on the basis of clear and mistakable error (CUE) in an April 2010 rating decision, is denied. Entitlement to an initial 70 percent rating, but no higher, for PTSD with alcohol use disorder, is granted from December 12, 2013. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected PTSD is granted from December 12, 2013. FINDINGS OF FACT 1. In an April 2010 rating decision, the Regional Office (RO) denied the Veteran’s claim for entitlement to service connection for PTSD. The Veteran did not appeal the decision, and new and material evidence was not received within one year of its issuance. 2. At the time the RO adjudicated the April 2010 rating decision denying service connection for PTSD, the correct facts, as they were known at the time, were before the adjudicator; the statutory or regulatory provisions extant at that time were correctly applied; and there was no undebatable error in how the facts were weighed or evaluated. 3. The Veteran’s PTSD has been manifested by occupational and social impairment with deficiencies in most areas throughout the period on appeal. 4. From December 12, 2013, the Veteran met the schedular criteria for a TDIU and was unable to secure or follow a substantially gainful occupation as a result of his service-connected PTSD. CONCLUSIONS OF LAW 1. The April 2010 rating decision is final as to the matter of the assignment of an effective date for service connection for PTSD. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103; Rudd v. Nicholson, 20 Vet. App. 296 (2006). 2. The April 2010 rating decision, which denied service connection for PTSD, was not clearly and unmistakably erroneous. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 3.105. 3. The criteria for an initial 70 percent rating, but no higher, for PTSD are met from December 12, 2013. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.130, Diagnostic Code (DC) 9411. 4. The criteria for entitlement to a TDIU due to service-connected PTSD are met from December 12, 2013. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341(a), 4.3, 4.15, 4.16, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from December 1966 to November 1968. This matter comes before the Board of Veterans’ Appeals (Board) from the July 2014 and January 2015 rating decisions of the Department of Veterans Affairs (VA) RO. In June 2018, the Board remanded the issues of entitlement to a rating in excess of 50 percent for PTSD and TDIU as additional VA treatment records were added to the claims file after the issuance of April 2015 supplemental statement of the case. In March 2019, the Board again remanded the issues of entitlement to a rating in excess of 50 percent for PTSD and TDIU, along with an entitlement to an effective date earlier than December 12, 2013, for the grant of service connection for PTSD. The Veteran’s representative referenced CUE with the April 2010 rating decision denying entitlement to service connection for PTSD, and the issue required adjudication by the Agency of Original Jurisdiction (AOJ). 1. Entitlement to an effective date earlier than December 12, 2013, for the grant of service connection for PTSD, to include on the basis of CUE in an April 2010 rating decision Generally, the effective date of an evaluation and award of compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. Prior to March 24, 2015, any communication or action, indicating intent to apply for one or more benefits under the laws administered by VA could be considered an informal claim. Such an informal claim must have identified the benefit sought. 38 C.F.R. § 3.155(a) (as in effect prior to March 24, 2015). Previous determinations that are final and binding, including decisions of service connection and other matters, will be accepted as correct in the absence of CUE. Where evidence establishes such error, the prior rating decision will be reversed or amended. For the purpose of authorizing benefits, the rating or other adjudicatory decision which constitutes a reversal of a prior decision on the grounds of CUE has the same effect as if the corrected decision had been made on the date of the reversed decision. 38 C.F.R. § 3.105(a). CUE is a very specific and rare kind of “error.” It is the kind of error, of fact or of law, that when called to the attention of later reviewers compels the conclusion, to which reasonable minds could not differ, that the result would have been manifestly different but for the error. Simply to claim CUE on the basis that previous adjudications had improperly weighed and evaluated the evidence can never rise to the stringent definition of CUE. Similarly, neither can broad-brush allegations of “failure to follow the regulations” or “failure to give due process,” or any other general, nonspecific claim of “error.” Fugo v. Brown, 6 Vet. App. 40, 43-44 (1993). In addition, failure to address a specific regulatory provision involves harmless error unless the outcome would have been manifestly different. Id. at 44. The Court has held that there is a three-pronged test to determine whether CUE is present in a prior determination: (1) “[e]ither the correct facts, as they were known at the time, were not before the adjudicator (i.e., more than a simple disagreement as to how the facts were weighed or evaluated) or the statutory or regulatory provisions extant at the time were incorrectly applied,” (2) the error must be “undebatable” and of the sort “which, had it not been made, would have manifestly changed the outcome at the time it was made,” and (3) a determination that there was CUE must be based on the record and law that existed at the time of the prior adjudication in question. Damrel v. Brown, 6 Vet. App. 242, 245 (1994) (quoting Russell v. Principi, 3 Vet. App. 310, 313-14 (1992) (en banc)). VA’s failure to comply with the duty to assist cannot constitute CUE. C.F.R. § 20.1403(d)(2); see also Cook v. Principi, 318 F.3d 1334, 1344-45 (Fed. Cir. 2002) (“[A] breach of the duty to assist cannot constitute CUE.”). Analysis The Veteran filed his initial claim for entitlement to service connection of PTSD in July 2009. In August 2009, VA requested the Veteran to complete VA Form 21-4138 to provide details of in-service stressors. See August 2009 VCAA Correspondence. In December 2009, VA informed the Veteran the information received, “being a combat medic and performing surgeries in the field under combat situations,” did not meet the minimum level of details required for VA to seek assistance from the U.S. Army and Joint Services Records Research Center (JSRRC). See December 2009 VA MAP-D Development Correspondence. Additionally, VA advised a decision would be made on the evidence of record should the requested information not be received within 30 days. Id. Although the Veteran provided information regarding medical treatment, no additional details regarding in-service stressors were submitted before the April 2010 rating decision. See October 2009 VA 21-4138, Statement in Support of Claim. The April 2010 rating decision denied entitlement to service connection for PTSD due to the Veteran not establishing a clear diagnosis, nor providing credible supporting evidence of in-service stressors or combat service. The Veteran did not submit a Notice of Disagreement (NOD) with the April 2010 rating decision, nor did he provide any additional evidence concerning his claim within one year of that rating decision. Thus, the decision became final. 38 U.S.C. § 7105; see also Bond v. Shinseki, 659 F.3d 1362 (Fed. Cir. 2011); 38 C.F.R. §§ 3.104, 3.156(a)-(b), 20.302, 20.1103. In December 2013, the Veteran requested a reopening of his claim for entitlement to service connection for PTSD. In support of the reopening, he provided evidence of detailed in-service stressor occurrences and a current diagnosis of PTSD, for which a June 2014 VA PTSD examination confirmed under DSM-5 criteria as PTSD with mild alcohol use disorder. See December 2013 VA 21-526b, Veteran’s Supplemental Claim; June 2014 Veteran’s Correspondence; June 2014 VA Initial PTSD Examination. In a July 2014 rating decision, the RO reopened the claim and granted service connection for PTSD with alcohol use disorder and assigned a 50 percent disability rating, with an effective date of December 12, 2013, the date of receipt of the claim. In September 2014, the Veteran submitted a NOD stating his PTSD should be at a higher evaluation to include 100 percent, indicating he is unemployable due to his PTSD symptoms. The Board acknowledges that although the addition of the Veteran’s service medical records (SMRs) to the record occurred in January 2014, the Board finds there is no indication of treatment or diagnosis of any acquired psychiatric disorder. See January 2014 SMRs. Additionally, the Veteran’s military personnel records (MPRs) were added to the claims file in January 2014 and July 2015, indicating service in Vietnam with an engineer battalion as a medical specialist. However, the records do not provide details of in-service stressors or evidence of combat service. As such, the SMRs and MPRs are not relevant, and the provisions under 38 C.F.R. § 3.156(c) do not apply to the acquired psychiatric claim. 38 U.S.C. §§ 5108, 7103, 7104(b); 38 C.F.R. §§ 3.156, 20.1100. The Board further finds there is no other correspondence or communication received by VA before December 12, 2013, that can be reasonably construed as an intent to file a formal or informal claim to reopen his previously denied claim of entitlement to service connection for PTSD. Accordingly, the Board finds that an earlier effective date for the grant of service connection for PTSD is not warranted. The Board recognizes that the Veteran filed a prior claim for his PTSD. However, that claim was denied, and the Veteran did not perfect an appeal of that issue. Thus, the April 2010 rating decision is final. As the Veteran raises a CUE with the April 2010 rating decision, the Board will address the same below. Once a rating decision is final, it may not be revised except on the basis of CUE. 38 U.S.C. § 7105(c); 38 C.F.R. § 3.105(a). The Veteran, through his representative, asserts that the April 2010 rating decision was based on the Veteran’s lack of combat medic badge, rather than considering the fact the Veteran was an army medic, and his stated stressors were consistent with the type of service performed. See June 2015 Veteran’s Representative’s Correspondence. The second assertion is the Veteran screened positive for PTSD at a VA facility and was not provided an examination that might later indicate a diagnosis of PTSD and grant service connection. Id. As a threshold matter, the Board finds that the arguments advanced by the Veteran’s attorney allege CUE with the requisite specificity. Simmons v. Principi, 17 Vet. App. 104 (2003). Therefore, the Board will adjudicate the merits of this claim. The laws and regulations that govern the award of service connection for PTSD are basically unchanged since April 2010. Under 38 C.F.R. § 3.304(f) service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. Additionally, if the evidence establishes that the veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran’s service, the veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f)(2). After careful review of the April 2010 rating decision, the Board must conclude that it does not contain CUE. The April 2010 denial was on the basis that the Veteran did not have a current diagnosis of PTSD, and he did not provide sufficient details regarding his claimed in-service stressors. Here, the Veteran’s representative argues that VA failed to provide a VA examination, even though the Veteran tested positive in a PTSD screening at a VA treatment facility and that the RO relied heavily on the non-existence of a combat medic badge versus the Veteran’s MOS and the statements provided by the Veteran. Unfortunately, the argument that the RO relied heavily on the non-existence of a combat medic badge versus the Veteran’s MOS and his provided in-service stressors is an argument of incorrectly applied statutory-regulatory provisions. The record of evidence at the time of the April 2010 denial indicates the Veteran provided in-service stressors of being a combat medic and being in the “…thick of combat many times having to perform surgery or temporary repair in the field under combat situations...” See July 2009 and September 2009 VA 21-4138, Statements in Support of Claim. Additionally, medical evidence existed of a past anxiety diagnosis in 2005 and a January 2010 VA treatment note of positive screening for PTSD. See January 2010 VA Preventive Medicine Note; February 2005 Dr. V.H. Private Treatment Records. Although the RO requested the Veteran to provide detailed descriptions of any event, including dates of combat and locations of assigned duty stations in August and December 2009, no additional details were submitted. See August 2009 VCAA Correspondence; December 2009 MAP-D Development Letter. Without evidence of combat service, VA could not rely upon the Veteran’s lay testimony alone to establish an in-service stressor occurrence. 38 C.F.R. § 3.304(f)(2). Additionally, without detail descriptions of in-service stressor occurrences, VA could not provide the minimum level of details required by JSRRC for establishing credible supporting evidence. 38 C.F.R. § 3.304(f). Moreover, the Veteran did not establish the necessary medical evidence of a diagnosis of PTSD. Id. However, even if it were determined that the failure to concede the Veteran’s stressors based upon the Veteran’s reports in conjunction with his DD-214 of record at that time, the Board finds that it would not rise to the level of CUE as it would not have manifestly changed the outcome of the claim at the time it was made. As noted above, the second prong of a CUE claim states that the error must be “undebatable” and of the sort “which, had it not been made, would have manifestly changed the outcome at the time it was made.” See Damrel. Here, the evidence of record from the time of the April 2010 decision did not include a current diagnosis of PTSD. Without evidence of a current disability due to disease or injury, service connection for a disability is not warranted. Brammer v. Derwinski, 3 Vet. App. 223 (1992). The Board finds that based on the facts available to the RO at the time of the April 2010 rating decision, it is undebatable that the evidence of record at that time did not establish that the Veteran had a current diagnosis of PTSD. VA treatment records indicated only a positive screening test, not a diagnosis, and private treatment records did not show a current diagnosis of anxiety. See January 2010 VA Preventive Medicine Note; February 2005 Dr. V.H. Private Treatment Records. The Veteran’s representative argues that VA failed to provide a VA examination, even though the Veteran tested positive in a PTSD screening at a VA treatment facility. However, VA’s failure to comply with the duty to assist cannot constitute CUE. Cook, supra. Therefore, the Veteran’s contention that VA failed to provide an examination cannot be a basis for a CUE finding. Accordingly, the Board finds that CUE did not exist with the April 2010 rating decision, and the earliest possible effective date for the award of service connection for the Veteran’s PTSD is December 12, 2013, the date of the request to reopen the previously denied claim. The effective date of a claim received after a final disallowance is the date of receipt of the new claim or the date entitlement arose, whichever is the later. 38 C.F.R. § 3.400(q)(1)(ii). Therefore, the Veteran’s claim for an earlier effective date for a grant of service connection for PTSD is denied. Finally, to the extent that the Veteran's representative generally asserts that he preserves for appeal “all legal errors, errors in fact-finding, failure to follow Manual M21-1…failure to discharge the duty to assist, and other due process errors,” such vague assertions do not amount to a specific procedural argument in this case and thus need not be addressed. Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (the Board’s obligation to read filings in a liberal manner does not require the Board or the Veterans Court to search the record and address procedural arguments when the claimant fails to raise them before the Board). 2. Entitlement to an initial 70 percent rating, but no higher, for PTSD Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The percentage ratings represent, as far as can practicably be determined, the average impairment in earning capacity in civil occupations. 38 U.S.C. § 1155. The disability must be viewed in relation to its history. 38 C.F.R. § 4.1. If two disability ratings are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Reasonable doubt as to the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3. The Veteran’s PTSD is currently rated at 50 percent disabling pursuant to 38 C.F.R. § 4.130, DC 9411, which is rated under the General Rating Formula for Mental Disorders. 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. A 70 percent rating is assigned when there is occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships. 38 C.F.R. § 4.130, DC 9411. A 100 percent rating is warranted if 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. Id. When determining the appropriate disability evaluation to assign, the Board’s primary consideration is a veteran’s symptoms, but it must also make findings as to how those symptoms impact a veteran’s occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013); Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). Initially, the Board notes that the Veteran has a diagnosis of alcohol use disorder. See June 2014 VA Initial PTSD Examination. While the June 2014 VA examiner distinguished the symptoms of this disorder from his service-connected PTSD, the examiner found both conditions were the result of his military service. Id. Upon review of the totality of the record, the Board finds that a higher rating of 70 percent is warranted for the Veteran’s PTSD for the entire appeal period, effective December 12, 2013. This is based on symptoms such as: impaired impulse control (such as unprovoked irritability with periods of violence) (road rage); difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships; isolative behaviors (stays at home and avoids public places); intrusive thoughts; difficulty with memory and remembering names; flashbacks (occurring with the slightest event or statement); and nightmares (physically placing spouse in a headlock). See September 2015 Spouse’s Statement (dated 07/21/2015); September 2015 C.B. Correspondence (dated 06/16/2015); June 2014 VA Initial PTSD Examination; August 2019 Mental Health Consult. Additionally, the Veteran reported flashbacks have increased and become “more vivid, more real,” causing his fight or flight instincts to take over, leaving him anxious. See July 2019 VA Psychiatry Note. He stated noise, now and in the past workplaces, made him “freak out” thinking an attack was happening. Id. He described feeling emotionally numb and questioning why he is unable to care or love his children. See November 2010 VA Mental Health Outpatient Note. On several occasions, the Veteran admitted to being paranoid. See August 2014 Psychiatry Outpatient Note; August 2014 Mental Health Outpatient Note. Such symptoms support an award of a 70 percent rating for the entire appeal period. Although the VA examiner found that the Veteran’s social and occupational impairment was reduced reliability and productivity, this finding is in conflict with other, more severe symptoms noted by his treating VA mental health team and his spouse of 16 years with over 40 years of experience as a registered nurse and as a director of an emergency department with supervision over a regional psychiatric catchment facility. See September 2015 Spouse’s Statement (dated 07/21/2015). The knowledge and treatment by these individuals report more severe symptoms such as exaggerated startle response, anger, aggression, irritability, lack of daily hygiene, loss of interest, along with regular flashbacks causing his service-connected dysesthesia to react, all noted in the VA treatment records and statements. The Board will resolve the benefit of the doubt in favor of the Veteran; accordingly, the Board finds that the Veteran’s service-connected PTSD results in impairment that has been manifested by occupational and social impairment with deficiencies in most areas throughout the period on appeal. 38 C.F.R. §§ 4.3, 4.7, 4.130, DC 9411. A higher, 100 percent rating is not warranted at any point during the appeal period because the Veteran has never demonstrated total occupational and social impairment or symptoms of similar severity, frequency, or duration as to those contemplated by the 100 percent criteria. There have been no deficiencies identified in the Veteran’s communication, nor has there been any indication of disorientation, delusions, or grossly inappropriate behavior, and the Veteran has never reported memory loss of the severity contemplated by a 100 percent rating. Suicidal ideation was not endorsed; the Veteran has consistently denied any intent or attempts of hurting himself; thus, the evidence does not demonstrate a persistent danger of the Veteran hurting himself. There are no other symptoms throughout the appeal period reflective of total social impairment. Therefore, the Board finds that a rating higher than 70 percent is not warranted during the period on appeal. 38 C.F.R. §§ 4.3, 4.130, DC 9411. 3. Entitlement to a TDIU due to service-connected PTSD A TDIU may be assigned where the schedular rating is less than total if it is found that the Veteran is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there are sufficient additional service-connected disabilities to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.34l, 4.16(a). “Substantially gainful employment” is that employment, “which is ordinarily followed by the nondisabled to earn their livelihood with earnings common to the particular occupation in the community where the veteran resides.” Moore v. Derwinski, 1 Vet. App. 356, 358 (1991). “Marginal employment shall not be considered substantially gainful employment.” 38 C.F.R. § 4.16(a). The determination of whether a veteran is unable to secure or follow a substantially gainful occupation due to service-connected disabilities is a factual rather than a medical question. Geib v. Shinseki, 733 F.3d 1350 (Fed. Cir. 2013). In determining whether unemployability exists, consideration may be given to the Veteran’s level of education, special training, and previous work experience, but not to his age or to any impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. Unlike the regular disability rating schedule, which is based on the average work-related impairment caused by a disability, entitlement to a TDIU is based on an individual’s particular circumstances. Rice v. Shinseki, 22 Vet. App. 447, 452. A high rating in itself is recognition that the impairment makes it difficult to obtain or keep employment, but the ultimate question is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether he or she can find employment. Id. The Veteran asserts his unemployability is due to his PTSD symptoms of daily flashbacks, panic attacks, anxiety, loss of sleep, and his inability to establish and maintain relationships. See September 2014 NOD; September 2015 Veteran’s Correspondence. The Veteran has a master’s degree in public administration with prior work as a city manager. See June 2014 VA Initial PTSD Examination; November 2014 VA 21-8940, Veteran’s Application for Increased Compensation Based on Unemployability. He last worked full time in January 2012 as a city manager. See November 2014 VA 21-8940, Veteran’s Application for Increased Compensation Based on Unemployability. The Veteran is service-connected for PTSD with alcohol use disorder now rated at 70 percent disabling from December 13, 2013, and dysesthesias secondary to PTSD with alcohol use disorder rated at 10 percent disabling from September 18, 2019. He thus meets the schedular criteria for a TDIU from December 12, 2013, the award date of his 70 percent rating for PTSD. The Board finds that the functional impairment associated with the Veteran’s service-connected PTSD is of such nature and severity as to preclude substantially gainful employment effective from December 12, 2013. Gilbert v. Derwinski, 1 Vet. App. 49, 54 (1990) (holding that a veteran need only demonstrate an approximate balance of positive and negative evidence to prevail). Specifically, one of his long treating VA mental health clinicians, C.B., found the Veteran’s PTSD symptoms affect his day to day functioning, and he is unable to work due to flashbacks occurring, causing an inability to focus. See September 2015 C.B. Correspondence (dated 06/16/2015). Additionally, C.B. reported the Veteran’s symptoms of difficulties with establishing and maintaining social relationships; memory, including forgetting names; exaggerated startled response; avoidance of public places and his hyper-alertness also affect his ability to work. Id. His spouse noted the Veteran has held three government manager positions over the past 13 years and was fired from two and forced to leave the other. See September 2015 Spouse’s Statement (dated 07/21/2015). She further reported that the Veteran held dozens of jobs over his working years and was either fired or terminated from nearly all of them. She indicated that most of the firings came after physical altercations with other employees or superiors. She informed that when the Veteran’s exaggerated startle response occurs, it releases adrenaline making his demeanor to be angry, aggressive, and irritable. The evidence of records indicates the firing of the Veteran from his last city manager was due to, among other reasons, his habitual neglect and failure to direct and supervise. See November 2014 Resolution to Terminate City Manager (dated 01/17/2012). The Board is unable to comprehend a city management work environment consistent with his work history and occupational experience that would not trigger the Veteran’s exaggerated startle response causing his anger, aggression, and irritably, along with his suspiciousness and hypervigilance, and daily use of alcohol for self-medication for his flashbacks. Further, the Board finds probative the opinion of C.B. that the Veteran’s PTSD symptoms would affect his day to day functioning, and he is unable to work any substantial gainful activity due to an inability to focus and problems with anger and aggression towards potential co-workers or clients. Thus, given the totality of the evidence, the Board finds the Veteran is unable to secure and maintain substantially gainful employment due to his service-connected PTSD, and a TDIU is supported from December 12, 2013. Patrick M. Johnson Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Victoria L. Stephens 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.