Citation Nr: 20021745 Decision Date: 03/26/20 Archive Date: 03/26/20 DOCKET NO. 18-27 339 DATE: March 26, 2020 ORDER An initial disability rating of 70 percent, and no higher, for an acquired psychiatric disorder diagnosed as posttraumatic stress disorder (PTSD) with bipolar disorder and alcohol use disorder (claimed as anxiety) is granted. An effective date earlier than November 25, 2013 for the grant of service connection for an acquired psychiatric disorder diagnosed as PTSD with bipolar disorder and alcohol use disorder (claimed as anxiety) is denied. A total disability rating based on individual unemployability due to service-connected disability (TDIU) is granted. FINDINGS OF FACT 1. Since the grant of service connection, the Veteran’s acquired psychiatric disorder has been manifested by occupational and social impairment with deficiencies in areas such as work, thinking and mood due to such symptoms as: depressed mood; anxiety; suspiciousness; panic attacks that occur more than once a week; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; chronic sleep impairment; mild memory loss, such as forgetting names, directions or recent events; impairment of short- and long-term memory, for example, retention of only highly learned material, while forgetting to complete tasks; impaired judgment; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances, including work or a work life setting; suicidal ideation; obsessional rituals which interfere with routine activities; and impaired impulse control, such as unprovoked irritability with periods of violence, without more severe manifestations that more nearly approximate total occupational and social impairment. 2. In a November 2007 rating decision, the RO denied service connection for bipolar disorder. The Veteran did not appeal, and the decision became final. 3. In November 2013, the Veteran submitted a claim for service connection for PTSD and, in a May 2015 rating decision, the Regional Office (RO) granted service connection for an acquired psychiatric disability, to include PTSD and bipolar disorder, assigning a 30 percent disability rating effective November 25, 2013, the date of receipt of the Veteran’s request to reopen her previously denied claim for service connection. The Veteran submitted a timely notice of disagreement as to the effective date assigned in this decision. 4. No informal claims for service connection for an acquired psychiatric disability were filed between November 2007 and November 25, 2013. 5. A claim for service connection for psychiatric disability and, by extension, a TDIU was received by the RO on November 25, 2013. 6. Pursuant to the above award of an initial 70 percent disability rating for the Veteran’s acquired psychiatric disorder effective November 25, 2013, the Veteran has met the schedular requirements for a TDIU since such date. 7. Beginning November 25, 2013, the Veteran’s service-connected disability has prevented her from securing or following a substantially gainful occupation. CONCLUSIONS OF LAW 1. The criteria for an initial disability rating of 70 percent, and no higher, for the Veteran’s acquired psychiatric disorder have been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 9411. 2. The criteria for an effective date prior to November 25, 2013, for the award of service connection for an acquired psychiatric disability have not been met. 38 U.S.C. §§ 5101, 5110, 5111; 38 C.F.R. §§ 3.151, 3.155, 3.400 3. Beginning November 25, 2013, the criteria for a TDIU have been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 3.400, 4.16(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from August 1984 to June 1991. These matters are before the Board of Veterans’ Appeals (Board) on appeal from May 2015 and April 2018 rating decisions of a Department of Veterans Affairs (VA) RO. Specifically, the May 2015 rating decision granted service connection for an acquired psychiatric disorder, assigning a 50 percent disability rating effective November 25, 2013. Subsequently, by rating decision dated in July 2017, the RO increased the Veteran’s disability rating for her psychiatric disability from 50 to 70 percent disabling effective April 17, 2017. The April 2018 rating decision denied a TDIU. With regard to the TDIU issue, a review of the record shows that the Veteran has had sporadic/marginal employment since her discharge from military service (she last worked part-time for approximately three months in 2007) and has not worked at all since her November 2013 claim for service connection for psychiatric disability. She has been in receipt of Social Security disability benefits due to psychiatric disability since June 2002. As such, while the Veteran did not submit a formal claim for a TDIU until February 2018, the issue of entitlement to a TDIU had been raised pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009) as part and parcel to the Veteran’s initial increased rating claim which has been pending since November 25, 2013. As such, the Board finds that the TDIU claim has also been pending since November 25, 2013. The Veteran testified before a Decision Review Officer at the RO in January 2018 and before the undersigned Veterans Law Judge at a Travel Board hearing in February 2020. Transcripts of these proceedings have been associated with the claims file. 1. An initial disability rating of 70 percent, and no higher, for an acquired psychiatric disorder diagnosed as PTSD with bipolar disorder and alcohol use disorder (claimed as anxiety) is granted. By way of history, service connection for an acquired psychiatric disorder diagnosed as PTSD with bipolar disorder and alcohol use disorder (claimed as anxiety) was granted by rating decision dated in May 2015, assigning an initial disability rating of 50 percent disabling, effective November 25, 2013. The Veteran disagreed with the May 2015 rating decision and perfected this appeal. Subsequently, by rating decision dated in July 2017, the RO increased the Veteran’s disability rating for psychiatric disability from 50 to 70 percent disabling effective April 17, 2017. Disability ratings are determined by the application of the facts presented to VA’s Schedule for Rating Disabilities. 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. In rating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for the higher rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods of time, based on the facts found. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). A claim for increased rating remains in controversy when less than the maximum available benefit is awarded AB v. Brown, 6 Vet. App. 35 (1993). Reasonable doubt as to the degree of disability will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. The Veteran’s psychiatric disability is rated pursuant to 38 C.F.R. § 4.130, DC 9411, which corresponds to PTSD. Under this code, a 50 percent evaluation is warranted when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent evaluation is warranted when there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); and the inability to establish and maintain effective relationships. Id. A 100 percent evaluation 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. The “such symptoms as” language of the diagnostic codes for mental disorders in 38 C.F.R. § 4.130 means “for example” and does not represent an exhaustive list of symptoms that must be found before granting the rating of that category. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). However, as the Court also pointed out in that case, “[w]ithout those examples, differentiating a 30% evaluation from a 50% evaluation would be extremely ambiguous.” Id. The Court went on to state that the list of examples “provides guidance as to the severity of symptoms contemplated for each rating.” Id. Accordingly, while each of the examples needs not be proven in any one case, the particular symptoms must be analyzed in light of those given examples. Put another way, the severity represented by those examples may not be ignored. According to the applicable rating criteria, when evaluating a mental disorder, the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran’s capacity for adjustment during periods of remission must be considered. In addition, the rating must be based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner’s assessment of the level of disability at the moment of the examination. Further, when rating the level of disability from a mental disorder, the extent of social impairment is considered, but a rating cannot be assigned solely on the basis of social impairment. 38 C.F.R. § 4.126. Evidence relevant to the level of severity of the Veteran’s psychiatric disability includes March 2014, January 2015, April 2017, March 2018 VA psychiatric examination reports, VA treatment records dated through April 2018, transcripts from January 2018 RO and February 2020 Board hearings, and statements from the Veteran. The March 2014 VA examination report reflects a diagnosis of bipolar disorder. The Veteran’s bipolar disorder resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. She reported that she was previously married for over 12 years and had been divorced since December 2002 as her former husband was emotionally abusive toward her. She had three grown children and maintained contact with each of them. She lived alone. The Veteran left active service in approximately 1991 due to parenthood. Between 1991 and 1999, she worked part-time jobs, such as data entry and fast food on an intermittent basis due to caring for her daughters and the fact that she moved frequently because her husband was on active duty in the military. Her longest job was working in a restaurant for approximately one year in 1999 on a full-time basis. Between 1999 and 2006, she was not employed. She attended school at Hallmark College in San Antonio full-time from November 2004 to November 2005 and earned an Associate’s degrees in office business management. In 2006, she worked part-time for approximately three months at a retail store but quit when she was not given an assistant manager position she was promised. Again, in 2008, she worked part-time for approximately three months at a retail store but, again, quit because her boss “kept making passes at her.” The Veteran received outpatient psychiatric treatment both during her military service and for over a year in 2001. She was involuntarily psychiatrically hospitalized in May 2002 for 14 days due to a “nervous breakdown” and hospitalized again in June 2002 on a voluntary basis due to depression. She was psychiatrically hospitalized again for 14 days in October 2013 due to depression and suicidal thoughts. This was a voluntary admission. With regard to drug/alcohol abuse, it was noted that the Veteran drank excessively from approximately 1985 to 2001 but significantly reduced her drinking in 2002 due to the responsibility of taking care of her daughters. She had been abstaining from alcohol since 2013. Her symptoms included depressed mood; anxiety; panic attacks that occur weekly or less often; chronic sleep impairment; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances, including work or a worklike setting. On mental status examination, she had fair grooming, hygiene, and eye contact. She was oriented to person, place, date, and situation. She was attentive and cooperative. Her speech was of regular rate and rhythm and her mood was both anxious and dysphoric. Her affect was congruent and appropriate and her thought process was coherent, logical, and goal oriented. She denied both suicidal ideation and hallucinations. Her insight and judgment were fair. The January 2015 VA examination report reflects diagnoses of alcohol use disorder, bipolar disorder, and PTSD and the examiner noted that it was not possible to differentiate what symptoms are attributable to each diagnosis. The Veteran’s psychiatric disability resulted in occupational and social impairment with reduced reliability and productivity. She continued to be single and maintained a good relationship with her grown daughters and some of her siblings and mother. She moved to El Paso, Texas in June 2013 where she volunteered at a school and at the local VFW, approximately 8 hours per day, 2 days per week. She drank alcohol last in November/December 2014, saying that she continued to use alcohol as a means of coping with her psychiatric symptoms. Her symptoms included depressed mood; anxiety; suspiciousness; chronic sleep impairment; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Additional symptoms included restlessness, reduced self-esteem and self-worth, appetite changes, as well as tiredness/fatigue (which also could be related to medications and/or physical conditions). On mental status examination, she was pleasant and friendly and greeted the examiner warmly, extending her hand. She made and maintained excellent eye contact with the examiner. She was willing to respond to the examiner’s questions and was full cooperative with the examination. The Veteran exhibited no abnormalities regarding psychomotor movements, thought process, or thought content. She had normal speech and intact language. Her typical mood was “blah, not wanting to do much.” She had appropriate affect. She was tearful on a few occasions during the interview. She did not appear psychotic or paranoid and appeared to be of average intelligence. The Veteran had adequate insight and judgment. The Veteran reported that she had previously attempted suicide in 1997 when she tried to “drink herself to death”. She had experienced suicidal ideation, off and on, since 1991, typically with no plans or intentions. She said that she last experienced suicidal ideation, with no plans or intentions, in January 2015 when she returned from being away over the holiday. During the examination, she denied any current suicidal ideations, plans, or intentions and indicated that she would never actually commit suicide as she had “three daughters and three awesome grandkids” that loved her. With regard to hallucinations, she reported that she sometimes sees shapes out of the corner of her eye, but could not make out what they were. She said that this typically occurs three to five times per week and last occurred two days earlier. With regard to paranoia, the Veteran indicated that she sometimes felt suspicious when she was shopping as she felt that people were looking at her. With regard to activities of daily living, the Veteran indicated that she lived alone and had no pets. She did not drive regularly and felt anxious in stores and around a lot of people so she put off shopping. She reported that she does her own cleaning and laundry and that, while she loved to clean, she hated her place so much that she felt unmotivated to do so. She had regular contact with her daughters, grandchildren, mother, and some of her siblings. She enjoyed watching television and listening to music and said that she managed her own finances. She did volunteer two days each week and sometimes went out to ear, most recently with a friend in January 2015. She denied any significant memory problems but reported some difficulty with concentration and attention. However, the examiner found that she had adequate concentration and attention on examination. The April 2017 VA examination report reflects diagnoses of PTSD, bipolar disorder, and alcohol use disorder in partial remission and the examiner noted that it was not possible to differentiate what symptoms are attributable to each diagnosis. The Veteran’s psychiatric disability resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. She continued to be single and maintained a good relationship with her grown daughters and some of her siblings and mother. She lived by herself and spent her days volunteering and doing crafts. Her symptoms included depressed mood; anxiety; suspiciousness; 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; difficulty in adapting to stressful circumstances, including work or a work life setting; inability to establish and maintain effective relationships; obsessional rituals which interfere with routine activities; impaired impulse control, such as unprovoked irritability with periods of violence. On mental status examination, the Veteran was extremely verbal, alert, and fully oriented to person, place, time, and situation. She was pleasant and cooperative. She spoke in normal conversational tones and her speech was neither over nor under productive. She was logical, coherent, articulate, and relevant. Her mood was euthymic and her affect was appropriate to her mood as well as the content and context of her interview. She denied, and there was no evidence of, hallucinations, delusions, and/or suicidal/homicidal ideations. Her immediate recent and remote memory functions were intact. She was polite and cooperative. The March 2018 VA examination report reflects diagnoses of PTSD and bipolar disorder, and the examiner noted that it was not possible to differentiate what symptoms are attributable to each diagnosis. The Veteran’s psychiatric disability resulted in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood. She continued to be single, although she had recently been engaged for 10 weeks. She was extremely upset over the breakup, became suicidal, and was hospitalized. She was currently living with her daughter, her daughter’s fiancé, and their children and was not working. Her symptoms included depressed mood; anxiety; suspiciousness; panic attacks that occur more than once a week; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; chronic sleep impairment; mild memory loss, such as forgetting names, directions or recent events; impairment of short- and long-term memory, for example, retention of only highly learned material, while forgetting to complete tasks; impaired judgment; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances, including work or a work life setting; suicidal ideation; obsessional rituals which interfere with routine activities; and impaired impulse control, such as unprovoked irritability with periods of violence. On mental status examination, the Veteran was oriented and somewhat tangential in her presentation. No acute distress was noted. The Veteran was in receipt of Social Security disability benefits and would often go two to three days without sleeping, even with medications. During the January 2018 RO hearing, the Veteran testified that she was hospitalized for several days in November/December 2017 following a suicide attempt, had recently moved in with her daughter, and was feeling lost and confused. During the February 2020 Board hearing, the Veteran testified that she had problems with concentration and focus. She must sit facing the door and often checks the locks in her apartment. She had trouble maintaining personal hygiene and had not had a full-time job since her military service. She last worked part-time in 2007. She experienced depression, anxiety, difficulty sleeping, fatigue, and impulse control. While she currently was living in her own apartment, she had previously lived in a homeless shelter for approximately 6 months. VA treatment records dated through April 2018 as well as lay statements from the Veteran’s friends and family show findings similar to those noted above. After resolving any reasonable doubt in favor of the Veteran, the Board finds that, prior to April 17, 2017, an initial rating of 70 percent, but no higher, is warranted for the Veteran’s service-connected psychiatric disability. As above, she was psychiatrically hospitalized again for 14 days in October 2013 due to depression and suicidal thoughts. As the Court has affirmed, suicidal ideation does not require suicidal intent, a plan, or preparatory behavior. Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017). Suicidal ideation is a serious symptom. In Bankhead, the Court indicated that the Board must consider the severity, frequency, and duration of the signs and symptoms of a mental disorder when determining the appropriate rating. Further, the Court held that the presence of suicidal ideation alone might cause occupational and social impairment with deficiencies in most areas. Also, the Veteran has not been employed, either full-time or part-time, since 2007, prior to the appeal period beginning November 2013, and has been in receipt of Social Security disability benefits due to psychiatric disability since June 2002. Moreover, as early as the March 2014 VA examination, the Veteran has shown difficulty in adapting to stressful circumstances, including work or a worklike setting. As such, the Board assigns a 70 percent rating prior to April 17, 2017, based on the frequency, severity, and duration of the Veteran’s symptoms. As for the potential of a disability rating higher than 70 percent throughout the appeal, the Board finds that the evidence does not show symptomatology that warrants a 100 percent rating. Significantly, while the above medical evidence generally shows that the Veteran’s psychiatric disorder results in occupational and social impairments with significant deficiencies in all areas of her life, including work, family, and social relationships, and other activities of daily living, which supports a 70 percent disability rating, there is no evidence of total occupational and social impairment. Although the Veteran is currently single, she maintains significant relationships with her sisters, daughters, and grandchildren. As such, there is no indication that she has total social impairment. Additionally, there is no evidence of gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; disorientation to time or place; memory loss for names of close relatives, own occupation, or own name; or other manifestations on par with the level of severity contemplated by those symptoms. Rather she is consistently oriented to person, place, time, and situation; and denied hallucinations, paranoia, and suicidal and homicidal ideations. Additionally, she had spontaneous, logical, and coherent speech; linear, logical, and goal-directed thought process and content; and grossly intact memory. As such, the already assigned 70 percent disability rating is appropriate. As required by Mauerhan, the Board has looked at all the factors and evidence identified above to determine whether the Veteran has met or more closely approximated the criteria for a maximum 100 percent rating. However, when considering the overall evaluation of the examples which may support the 100 percent rating, the frequency, duration and severity of symptoms, the Veteran’s capacity for adjustment, and the examiner’s assessments of the Veteran’s overall psychological, social and occupational functioning, the Board must conclude that the Veteran’s psychiatric disability has not met or more closely approximated the criteria for a 100 percent rating at any relevant time. In this respect, the Veteran, even at her worst, can effectively converse with the VA examiner/private physician, and can generally manage her daily activities on her own. She is not psychotic or out of touch with reality. Overall, her psychiatric disability is not shown to manifest the type, extent and severity of symptoms demonstrating “total occupational and social impairment” within the meaning of the rating schedule at any point pertinent to this appeal. In so holding, the Board has generally found the statements of the Veteran to be truthful and credible evidence in support of this claim, which has been relied upon in awarding further compensation. However, even when taking into account these statements, the Board finds that the criteria for a rating greater than 70 percent have not been met. To the extent that the descriptions provided by the Veteran can be construed as supporting a higher rating still, the Board places greater probative weight to the clinical findings of the VA physicians who have greater expertise and training than the Veteran in evaluating the extent and severity of a psychiatric disability. There is no doubt of material fact to be resolved in her favor. 38 U.S.C. § 5107(b). As such, an initial disability rating of 70 percent, and no higher, is warranted. 2. An effective date earlier than November 25, 2013 for the grant of service connection for an acquired psychiatric disorder diagnosed as PTSD with bipolar disorder and alcohol use disorder is denied. Generally, the effective date for an award of service connection and disability compensation is the day following separation from active service, or the date entitlement arose if the claim is received within one year after separation from service; otherwise, for an award based on an original claim, a claim reopened after a final allowance, or a claim for an increase, the effective date 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. An application for VA compensation must generally be a specific claim in the form prescribed by the VA Secretary (i.e., VA Form 21-526). 38 U.S.C. § 5101(a); 38 C.F.R. § 3.151(a). However, prior to March 24, 2015, a claim could be either a formal or informal written communication “requesting a determination of entitlement, or evidencing a belief in entitlement, to a benefit.” See 38 C.F.R. § 3.1(p) (2014). But see 38 C.F.R. § 3.1(p) (2015) (now providing that a “claim” must be submitted on an application form prescribed by the Secretary); 79 Fed. Reg. 57,696 (Sept. 25, 2014) (eliminating informal claims by requiring that, effective March 24, 2015, claims be filed on standard forms). A review of the record shows that the Veteran submitted an initial claim for service connection for bipolar disorder in August 2002. By rating decision dated in November 2007, the RO denied service connection for bipolar disorder, finding that there was no nexus between the Veteran’s current bipolar disorder and her military service. The Veteran did not perfect an appeal of this decision and it became final. The Veteran submitted a second claim for service connection for an acquired psychiatric disability, specifically PTSD, on November 25, 2013. While this claim was initially denied in August 2014, the RO ultimately granted service connection for an acquired psychiatric disability to include PTSD, bipolar disorder, and alcohol use disorder, by rating decision dated in May 2015, assigning a 50 percent disability rating effective November 25, 2013. The RO based the effective date on the date VA received the Veteran’s claim to reopen. Thereafter, the Veteran disagreed with the effective date assigned and perfected an appeal with regard to this issue. Because the Veteran did not appeal the November 2007 decision, nor did she submit new and material evidence within one year of this decision, it became final. See 38 U.S.C. § 7104. Based on the law cited above, the appropriate effective date of reopened claims shall be the date of receipt of claim or date entitlement arose, whichever is later. 38 C.F.R. § 3.400 (r). Here, the RO received the Veteran’s request to reopen her claim for service connection for PTSD on November 25, 2013. There is no evidence that she filed a claim to reopen prior to that date. Given the finality of the November 2007 rating decision, the assignment of an effective date prior to November 25, 2013 for the award of service connection for an acquired psychiatric disability is prohibited by law unless there is a showing of clear and unmistakable error (CUE) in a previous decision. Where evidence establishes such error, the prior decision will be reversed or amended. See 38 U.S.C. § 5109A; Cook v. Principi, 318 F.3d 1334 (Fed.Cir.2002) (en banc). In this case, there has been no allegation of CUE in the November 2007 rating decision. Thus, there is no entitlement to an effective date earlier than November 25, 2013. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). 3. A TDIU is granted. A veteran may be awarded a TDIU rating if the evidence shows that he or she is unable to secure or follow a substantially gainful occupation due solely to impairment resulting from his or her service-connected disabilities. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. A total disability rating may be assigned where the schedular rating is less than total when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that, if there is only one such disability, this disability shall be ratable as 60 percent disabling or more, or, if there are two or more disabilities, there shall be at least one disability ratable as 40 percent disabling or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). In determining whether the Veteran is entitled to a TDIU, neither her nonservice-connected disabilities nor her age may be considered. Van Hoose v. Brown, 4 Vet. App. 361 (1993). The Court has held that the central inquiry in determining whether a veteran is entitled to a TDIU is whether service-connected disabilities alone are of sufficient severity to produce unemployability; that is, whether the Veteran is unable to secure or follow any form of substantially gainful occupation consistent with her education and occupational experience. Hatlestad v. Brown, 5 Vet. App. 524 (1993). As above, a review of the record shows that the Veteran has had sporadic/marginal employment since her discharge from military service (she last worked part-time for approximately three months in 2007) and has not worked at all since her November 2013 claim for service connection for a psychiatric disability. She has been in receipt of Social Security disability benefits due to psychiatric disability since June 2002. Significantly, the Veteran has had numerous psychiatric hospitalizations following suicide attempts since her November 2013 claim and, her most recent March 2018 VA psychiatric examination shows impaired judgment; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances, including work or a work life setting; suicidal ideation; obsessional rituals which interfere with routine activities; and impaired impulse control, such as unprovoked irritability with periods of violence. Such findings suggest that the Veteran is not employable. Pursuant to the above award of an initial 70 percent disability rating for the Veteran’s PTSD effective November 25, 2013, the Veteran has met the schedular requirements for a TDIU since such date. Furthermore, the evidence demonstrates that the Veteran has not been gainfully employed since this date due, primarily, to her psychiatric disability. As such, the Board finds that a TDIU is warranted effective November 25, 2013. Bethany L. Buck Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board April Maddox, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.