Citation Nr: 20032437 Decision Date: 05/08/20 Archive Date: 05/08/20 DOCKET NO. 15-41 389 DATE: May 8, 2020 ORDER A rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is denied. A total disability rating due to service-connected disabilities (TDIU) prior to June 29, 2011, from June 29, 2011 through February 14, 2012, and from August 14, 2015 is denied. A TDIU from February 15, 2012 through August 13, 2015 is granted, subject to the regulations governing the payment of monetary awards. FINDINGS OF FACT 1. Throughout the appeal period, the Veteran’s service-connected PTSD has been manifested by no more than occupational and social impairment with reduced reliability and productivity; occupational and social impairment with deficiencies in most areas has not been shown. 2. Prior to June 29, 2011, the Veteran was not precluded from obtaining or maintaining substantially gainful employment due to his service-connected disabilities. 3. From June 29, 2011 through February 14, 2012 and from August 14, 2015, the Veteran has not been precluded from obtaining or maintaining substantially gainful employment due solely to his service-connected PTSD. 4. From February 15, 2012 through August 13, 2015, the competent evidence reasonably establishes that the Veteran was precluded from obtaining or maintaining substantially gainful employment due to his service-connected disabilities. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 50 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.130, Diagnostic Code 9411. 2. Prior to June 29, 2011, the schedular criteria for a TDIU were not met, and referral to the Director of Compensation for extraschedular consideration is not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. 3. From June 29, 2011 through February 14, 2012 and from August 14, 2015, the Veteran is in receipt of a 100 percent rating for his service connected heart condition; the Veteran’s PTSD rating does not meet the schedular criteria for a TDIU; and referral to the Director of Compensation for extraschedular consideration for a TDIU based solely on PTSD is not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. 4. From February 15, 2012 through August 13, 2015, the schedular requirements for TDIU have been met and a TDIU rating is warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1965 to November 1968. His decorations and awards include the Purple Heart, Combat Infantryman’s Badge, and Bronze Star Medal with “V” Device. This matter was previously remanded by the Board in September 2018. As an initial matter, the Board notes that the Veteran’s representative, National Association of County Veterans Service Officers, has waived the right to provide an informal hearing presentation. Accordingly, the Board finds there is no due process error by adjudicating the issues on appeal without an informal hearing presentation in the record. As will be explained in more detail below, the Board finds that the 100 percent rating in place for the Veteran’s service-connected heart condition does not render the issue of entitlement to a TDIU moot for the periods from June 29, 2011 through February 14, 2012 and from August 14, 2015, and the Board will consider the aforementioned periods on appeal part and parcel with the Veteran’s claim for an increased PTSD rating. Rice v. Shinseki, 22 Vet. App. 447 (2009). Increased Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 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 benefits, whether or not they were raised by the veteran, as well as the entire history of the veteran’s disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. It is not expected that all cases will show all the findings specified; however, 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. Under the General Rating Formula for Mental Disorders, to include PTSD, a 50 percent rating is warranted when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (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. 38 C.F.R. § 4.130, Diagnostic Code 9411. A 70 percent evaluation is warranted where there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical obscure, or irrelevant speech; 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. Id. A 100 percent evaluation is warranted where there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. The symptoms listed in the rating formula are examples, not an exhaustive list. Mauerhan v. Principi, 16 Vet. App. 436 (2002) (finding that “any suggestion that the Board was required... to find the presence of all, most, or even some of the enumerated symptoms is unsupported by a reading of the plain language of the regulation”). However, “a Veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration.” Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013). “The regulation’s plain language highlights its symptom-driven nature” and “symptomatology should be... the primary focus when deciding entitlement to a given disability rating.” Id. As such, consideration is given to the frequency, severity, and duration of psychiatric symptoms, the length of remission, and the Veteran’s capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment to the extent specified in the rating criteria, rather than solely on the examiner’s assessment of the level of disability at the moment of examination. See 38 C.F.R. § 4.126(a). Effective August 4, 2014, VA amended the portion of its Schedule for Rating Disabilities dealing with mental disorders and its adjudication regulations that define the term “psychosis” to remove outdated references to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and replace them with references to the recently updated DSM-5. See 79 Fed. Reg. 149, 45094 (August 4, 2014). The provisions of the interim final rule apply to all applications for benefits that are received by VA or that were pending before the Agency of Original Jurisdiction (AOJ) on or after August 4, 2014. VA adopted as final, without change, the interim final rule and clarified that the provisions of this interim final rule do not apply to claims that have been certified for appeal to the Board or are pending before the Board as of August 4, 2014, even if such claims are subsequently remanded to the AOJ. See 80 Fed. Reg. 53, 14308 (March 19, 2015). In the instant case, the Veteran’s claim was certified to the Board in December 2015; as such, DSM-5 applies. In this regard, the Board notes that the DSM-5 removed reference to Global Assessment of Functioning (GAF) scores. Accordingly, GAF scores are not relevant to the evaluation of his PTSD. Entitlement to a rating in excess of 50 percent for PTSD. The Veteran seeks a rating in excess of 50 percent for his service-connected PTSD. See October 2015 VA Form 9. In October 2012, the Veteran submitted an informal claim for an increased rating for PTSD, stating that his PTSD symptoms had worsened since his previous VA examination in October 2010. Upon review of the evidence of record, the Board finds that a rating in excess of 50 percent is not warranted for the Veteran’s service-connected PTSD at any time during the appeal period. The Veteran’s VA treatment records show that in December 2011, he reported chronic sleep impairment and nightmares. In January 2012, his depression was noted to be stable. From March 2012 through May 2012, the Veteran reported having trouble falling asleep and staying asleep, as well as flashbacks that occurred several times a day and a couple of times a week. He reported that his wife was very supportive. He also reported less frequent nightmares that were decreasing in intensity. In June 2012, the Veteran reported less frequent nightmares but stated he was still experiencing flashbacks during the day. He denied suicidal or homicidal ideation. He reported he was continuing to work on decreasing anxiety and depression. He also reported spending more time volunteering in his church. In July 2012, the Veteran reported that he had been sleeping well and that his nightmares were less frequent and less intense. He denied suicidal or homicidal ideation. He reported that he had been working on his anxiety and depression and stated that he felt more in control of his feelings. In August 2012, the Veteran reported feeling good but stated that he had trouble falling asleep. He denied symptoms of depression, anxiety, irritability, mood swings, nightmares, flashbacks, hypervigilance, paranoia, or difficulty around crowds. He reported that he was spending more time volunteering in his church. By October 2012, the Veteran reported that he had been sleeping well and that his nightmares were less frequent and less intense. He denied suicidal or homicidal ideation. The Veteran reported that he had been working on his anxiety and depression and stated that he felt more in control of his feelings. According to April 2013 VA treatment records, the Veteran reported that he was doing well overall and had no complaints. He reported that he was sleeping “okay” and denied mood swings, psychosis, or any acute PTSD symptoms. On May 2013 VA examination, PTSD was diagnosed. The VA examiner opined that the Veteran’s PTSD manifested in occupational and social impairment with reduced reliability and productivity. The Veteran’s symptoms included depressed mood, anxiety, chronic sleep impairment, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. The Veteran reported that he had continued monthly treatment for PTSD and depression since the previous October 2010 VA examination. The VA examiner opined that the evidence did not suggest that the Veteran’s PTSD symptoms had worsened since his October 2010 VA examination. VA treatment records from June 2013 through July 2013 indicate that the Veteran reported decreased nightmares but increased flashbacks. He reported that his mood had been up and down, and he felt less in control of his emotions. The VA clinician noted that the Veteran’s affect was flat. From September 2013 through October 2013, on mental status examinations, the VA clinician noted that the Veteran’s mood was sad and he had a flat affect. The Veteran reported 6 hours of sleep per night. The VA clinician noted there was no evidence of thought disorientation and the Veteran showed coherent, logical and goal-directed thought process. The VA clinician noted that the Veteran had good insight and good judgment. The Veteran reported that he was working to improve his mood and decrease his anxiety; he denied suicidal or homicidal ideation. In November 2013, the Veteran reported that he had nightmares approximately once a week and flashbacks almost daily. In December 2013, the Veteran reported that he had been getting around 6 hours of sleep per night, that his relationships were good, and that he denied any complaints or acute PTSD symptoms. The VA clinician noted that the Veteran’s mood was stable, and his thought process was linear and logical. In April 2014, the Veteran’s depression was noted to be stable and his psychiatric symptoms were noted to be improved. In June 2014, he denied any complaints and denied any acute PTSD symptoms. In March 2015, he reported that he continued to do well and denied any complaints. He reported his daily activities included volunteering at his church. The VA clinician noted that the Veteran’s mood was stable and euthymic. On August 2015 VA examination, PTSD was diagnosed. The VA examiner opined that the Veteran’s PTSD manifested in occupational and social impairment with reduced reliability and productivity. His symptoms included anxiety, chronic sleep impairment, and difficulty in adapting to stressful circumstances, including work or a worklike setting. The VA examiner noted that the Veteran continued to receive monthly mental health treatment after the May 2013 VA examination through the end of 2013, but that the Veteran was only seen once in 2014 and once in 2015 for mental health treatment. The VA examiner noted that the Veteran was not prescribed any medication for PTSD at the time of examination. The VA examiner also found that the current severity of the Veteran’s PTSD symptoms was not a significant change from his earlier functioning. The VA examiner noted that the Veteran’s ability to maintain a logical thinking process appeared adequate and would not likely impact his social or vocational functioning. The VA examiner noted that the Veteran did not suffer from gross impairment in thought processes, delusions, or hallucinations, and the Veteran denied suicidal or homicidal ideation. VA treatment records show that in October 2015, the Veteran reported no complaints and no acute PTSD symptoms. He reported that his relationships with family members were in excellent condition and his daily activities included volunteering at his church. The VA clinician noted that the Veteran’s mood was stable and euthymic. In April 2016, the Veteran reported that he continued to do well and denied any complaints, except for occasional thoughts related to military trauma. He reported his relationships were excellent and denied depression, anxiety, irritability, mood swings, outbursts, or impulsive or aggressive behavior. The VA clinician noted the Veteran’s mood was stable and euthymic. In November 2016, the Veteran reported he was continuing to do well and denied any complaints. He reported that he had the ‘occasional thought about the military.’ He also reported that he was not interested in medication and his relationships were good. The VA clinician noted that the Veteran’s mood was stable and euthymic. In May 2017, the Veteran’s spouse submitted an April 2017 lay statement regarding the Veteran’s PTSD symptoms. She stated that the Veteran’s process and communications were worsening over the years; that the Veteran would say things that did not make sense; that the Veteran would start a sentence in the middle of a thought; that the Veteran’s ability to cope with stressful situations was decreasing; that he would become easily upset and shut down to the point of not being able to do or say anything. The Veteran’s spouse stated that she would often go along with the Veteran to avoid him becoming upset. She further stated that the Veteran was constantly fatigued due to lack of sleep at night due to anxiety. According to May 2017 VA treatment records, the Veteran reported that he was continuing to do well and denied any complaints, except for weekly nightmares. The Veteran reported that he felt he was able to handle the nightmares and was not interested in medication. He reported that his relationships were good. The VA clinician noted that the Veteran’s mood was stable and euthymic. In April 2018, the Veteran reported that he was continuing to do well, that his relationships were good, and he denied any complaints. The VA clinician noted that the Veteran’s mood was stable and euthymic. In December 2018, the Veteran’s depression screening was negative. On August 2019 VA examination, PTSD was diagnosed. The VA examiner found that the Veteran’s symptoms manifested in occupational and social impairment with reduced reliability and productivity. The Veteran reported experiencing nightmares and flashbacks weekly and panic attacks approximately once a week. The VA examiner noted that the Veteran’s symptoms included depressed mood, anxiety, suspiciousness, panic attacks more than once a week, chronic sleep impairment, mild memory loss, flattened affect, disturbances of motivation and mood, and difficulty in adapting to stressful circumstances, including work or a worklike setting. The Veteran reported that he had been married for 52 years and was in a stable and supportive relationship. He further reported that he had three close friendships and that he spoke with these friends approximately once a week. The Veteran reported that he was treated around once a year by his VA psychiatrist. He denied any current suicidal or homicidal ideation. Upon review of the competent lay and medical evidence for the relevant period on appeal, the Board finds that the symptoms related to the Veteran’s PTSD, including depressed mood, anxiety, suspiciousness, panic attacks more than once a week, chronic sleep impairment, mild memory loss, flattened affect, 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 more closely approximate the criteria for a 50 percent disability rating. Furthermore, the Veteran was afforded multiple VA examinations during the relevant period on appeal, and each of these VA examiners opined that the Veteran’s PTSD manifested in occupational and social impairment with reduced reliability and productivity. The record does not reflect that, at any time during the appeal period, the Veteran has exhibited symptoms of the type, extent, frequency, or severity indicative of those identified as warranting a 70 percent rating, such 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; or inability to establish and maintain effective relationships. Moreover, the evidence does not show that the Veteran demonstrated symptoms of similar severity, frequency, and duration, that cause occupational or social impairment equivalent to a 70 percent disability rating. See Mauerhan, 16 Vet. App. at 443. The Board notes that the only symptom from the 70 percent rating criteria that the Veteran reported during the relevant period on appeal was difficulty in adapting to stressful circumstances (including work or a worklike setting). However, the Board finds that the reporting of this symptom fails to demonstrate that the Veteran’s service-connected PTSD results in occupational and social impairment with deficiencies in most areas, such as work, family relations, judgment, thinking and/or mood. The preponderance of the evidence of record suggests the effects of the Veteran’s symptoms result in no more than occupational and social impairment with reduced reliability. The record does not reflect that the Veteran’s symptoms result in social and occupational impairment with deficiencies in most areas. The Board has also considered whether a 100 percent rating is warranted and finds that it is not shown that the Veteran has total occupational and social impairment from his PTSD either. During the relevant period on appeal, the Veteran consistently reported good or excellent relationships with his wife, sons, grandchild, sisters, and close friends. The Veteran further reported multiple times that his daily activities included volunteering at his church. These indicate that, during the period on appeal, the Veteran did not have total occupational and social impairment from his PTSD. It is also not shown during the period on appeal that the Veteran suffered from gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, disorientation to time or place, or other symptoms comparable to total occupational and social impairment. While the Veteran’s attorney at the time of the May 2017 correspondence indicated that the Veteran was entitled to a higher rating on the basis of Global Assessment of Functioning (GAF) scores, “[a]n adjudicator is not permitted to rely on evidence that the American Psychiatric Association itself finds lacking in clarity and usefulness.” Golden v. Shulkin, 29 Vet. App. 221, 225 (2018). Accordingly, the Board finds that the Veteran’s PTSD does not warrant a rating in excess of 50 percent, and the Veteran’s claim is denied. As the preponderance of the evidence is against an increased rating, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). TDIU Total ratings based on individual unemployability, referred to as TDIU, may be assigned in the first instance by the Board or the RO when the disabled person is determined to be unable to secure or follow a substantially gainful occupation as a result of service-connected disability or disabilities, provided that, if there is only one such disability, this disability shall be as ratable at 60 percent or more, and that, if there are two or more disabilities, here shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. See 38 C.F.R. § 4.16(a). For purposes of determining if the schedular threshold is met, “one disability” is defined as disabilities of one or both upper or lower extremities, including the bilateral factor; disabilities resulting from common etiology or a single accident; disabilities affecting a single body system; multiple injuries incurred in action; or multiple disabilities incurred as a prisoner of war. 38 C.F.R. § 4.16(a). In order to be awarded TDIU, the Veteran’s service-connected disabilities, alone, must be sufficiently severe to produce unemployability. Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). In cases where these percentages are not met, but the disabled person is unable to secure and follow a substantially gainful occupation by reason of service-connected disability or disabilities, the case should be submitted to the Director, Compensation Service, for consideration of extra-schedular TDIU. See 38 C.F.R. § 4.16(b). “Substantially gainful employment” is that employment “which is ordinarily followed by the non-disabled 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). As further provided by 38 C.F.R. § 4.16(a), “Marginal employment shall not be considered substantially gainful employment.” The central inquiry is, “whether the veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability.” Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Neither nonservice-connected disabilities nor advancing age may be considered in the determination. 38 C.F.R. §§ 3.341, 4.19; Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). a. Entitlement to a TDIU prior to June 29, 2011. The Veteran contends that a TDIU is warranted prior to June 29, 2011. The record shows that the Veteran’s service-connected disabilities prior to June 29, 2011 were PTSD, rated 30 percent from September 11, 2008 and increased to a 50 percent disability rating from July 29, 2010, and a scar of the left lower leg, rated noncompensable. Therefore, the schedular rating requirements for TDIU under 38 C.F.R. § 4.16(a) are not satisfied prior to June 29, 2011. The Veteran has a high school education and trained as a millwright prior to military service. See October 2010 VA examination. The Veteran reported that he held approximately 4 full-time jobs in different steel mills within the previous 39 years. The Veteran reported that in 2007, the Packard Electric plant shut down, and he was forced to take a reduced pension. The Veteran has further reported that he worked part-time as an aid driving a school bus after he retired and he officially stopped working in March 2011. See March 2013 VA examination. The Veteran’s VA treatment records show that he reported in March 2009 that he had been sleeping better, in part because of his part-time employment as a bus driver. On July 2009 VA examination, the Veteran reported that prior to his retirement, he was successful in his place of employment and experienced very few difficulties in getting along with coworkers or meeting his work-related challenges. The Veteran reported that he found the work and the friendships he made with his coworkers to be rewarding. He also that he had no trouble getting or keeping a job, no problems with negative evaluations, and stated that he had perfect attendance for 25 out of the 27 years he worked for Packard Electric, a subsidiary of General Motors. He reported he was offered early retirement, which he accepted, but then that his increased free time allowed PTSD symptoms to have a more significant impact on him. The Veteran reported that he experienced suicidal ideation in 2008 which prompted him to seek counseling services with VA. The VA examiner noted that the Veteran’s thoughts of suicide in 2008 were transient, appeared to have been adequately treated through counseling, did not progress to suicidal gestures or behaviors, and had not been repeated. The VA examiner noted that the Veteran’s symptoms of PTSD appeared to be mild, were being effectively treated, and had minimal impact on his day to day functioning prior to 2008; the VA examiner noted that the treatment that the Veteran sought out in 2008 was successful and that his high level of functioning seemed to have returned. Regarding the effects of PTSD on occupational and social functioning, the VA examiner noted that the Veteran was highly functional in a work setting, did not isolate from others, had little difficulty forming meaningful and lasting connections with others, reported high levels of satisfaction with his family, to include his wife, children, and siblings, and had a close and supportive group of friends. On October 2010 VA examination, the Veteran reported that he began to have suicidal ideation in 2008 after he suffered a job loss in 2007 when his employing company went bankrupt. The Veteran’s symptoms were noted to include hypervigilance, avoidance, recurrence of nightmares, flashbacks, sleep impairment, and moments of detachment. The VA examiner concluded that the Veteran’s psychiatric condition was related to his military service. The VA examiner noted that the Veteran was beyond the age of competitive employment at age 63 and was therefore unemployable. Following a review of the evidence of record, the Board finds that referral of the TDIU claim to the Director of VA Compensation Service for extraschedular consideration is not warranted. The Board acknowledges the Veteran’s contention that he could not maintain any substantial gainful activity because of his service-connected psychiatric disorder during the relevant period on appeal. However, the preponderance of the evidence establishes that the while the Veteran did have limitations as a result of his psychiatric disability, those limitations did not prevent him from securing or following a substantial gainful occupation. Specifically, the Veteran reported in July 2009 that he retired early because his place of employment went bankrupt, not because of his PTSD symptoms. Furthermore, the VA examiner noted that after the Veteran underwent initial PTSD treatment, his high level of functioning returned. The Board notes that the impact of the Veteran’s occupational and social functioning was contemplated by the relevant rating criteria for PTSD during the relevant period on appeal. The July 2009 VA examiner noted that the Veteran was highly functional in a work setting, did not isolate from others, had little difficulty forming meaningful and lasting connections with others, reported high levels of satisfaction with his family, to include his wife, children, and siblings, and had a close and supportive group of friends. The Veteran was also employed for approximately 39 years without any problems due to his service-connected psychiatric disorder and did not miss any work due to his psychiatric symptoms. The Board notes that, while the October 2010 VA examiner found the Veteran was unemployable, this finding was based on the Veteran’s age being beyond the age of competitive employment. As such, this opinion is afforded little probative value. The Board accords great weight to the opinion of the July 2009 VA examiner and finds it highly probative. The opinion is based on a thorough review of the Veteran’s claims file, an in-person examination and has a rationale based on objective findings contained in the record. The Board finds that the Veteran’s disability picture does not warrant a grant of a TDIU for the period prior to June 29, 2011, nor does the evidence warrant referral to the Director for extraschedular consideration for this period on appeal. b. Entitlement to a TDIU from June 29, 2011 through February 14, 2012. From June 29, 2011 through February 14, 2012, the Veteran was rated 100 percent for coronary artery disease (CAD) status post coronary artery bypass graft (CABG), 50 percent for PTSD, and noncompensable for the left lower leg scar and residual scars associated with CAD status post CABG. A TDIU is considered a lesser benefit than the 100 percent scheduler rating, and the grant of a 100 percent scheduler rating generally renders moot the issue of entitlement to a TDIU for the period when the 100 percent rating is in effect. The Board acknowledges, however, that a 100 percent disability rating does not necessarily render the issue of a TDIU moot. In that regard, in Bradley v. Peake, 22 Vet. App. 280, 293-94 (2008), the United States Court of Appeals for Veterans Claims (Court) determined that there could be a situation where a veteran has a schedular total rating and could also be entitled to a TDIU for purposes of meeting the requirements for Special Monthly Compensation (SMC) pursuant to 38 U.S.C. § 1114(s). Under 38 U.S.C. § 1114(s), SMC is warranted for housebound status if a veteran has a single service-connected disability rated as total and additional service-connected disabilities that are independently rated at more than 60 percent combined. See 38 U.S.C. § 1114(s). A TDIU satisfies the total (100 percent) rating requirement if the TDIU evaluation was, or can be, predicated upon a single disability and there exists additional disability or disabilities independently ratable at 60 percent or more. Id. at 293. In other words, a TDIU rating based on a single disability, but not multiple disabilities, is permitted to satisfy the statutory requirement of a total rating under 38 U.S.C. § 1114(s). Bradley, 22 Vet. App. at 293. Accordingly, the issue during the relevant period on appeal is whether the Veteran’s PTSD alone rendered him unable to maintain substantially gainful employment. However, the schedular rating requirements for TDIU under 38 C.F.R. § 4.16(a) are not satisfied by the Veteran’s PTSD rating alone. As such, the Board will consider whether referral of the TDIU claim to the Director of VA Compensation Service for extraschedular consideration is warranted. The Veteran’s VA treatment records indicate that in July 2011 and October 2011, his psychiatric condition was noted to be improving, and his depression was noted to be stable. In December 2011, the Veteran reported chronic sleep impairment and nightmares. In January 2012, his psychiatric condition was noted to be improving, and his depression was noted to be stable. The Board acknowledges the Veteran’s contention that he could not maintain any substantial gainful activity because of his service-connected psychiatric disorder during the relevant period on appeal. However, the preponderance of the evidence establishes that the while the Veteran did have limitations as a result of his psychiatric disability, those limitations did not prevent him from securing or following a substantial gainful occupation. Accordingly, the Board finds that referral of the TDIU claim to the Director of VA Compensation Service for extraschedular consideration during the relevant period on appeal is not warranted. The Board notes that the Veteran’s PTSD symptoms were adequately contemplated by the rating criteria during the appeal period. As such, the Veteran’s disability picture does not warrant a grant of a TDIU for the relevant period on appeal, nor does the evidence warrant referral to the Director for extraschedular consideration for this period on appeal. c. Entitlement to a TDIU from February 15, 2012 through August 13, 2015. During the relevant period on appeal, the Veteran was rated 60 percent for coronary artery disease (CAD) status post coronary artery bypass graft (CABG), 50 percent for PTSD, and noncompensable for the left lower leg scar and residual scars associated with CAD status post CABG. The combined evaluation is 80 percent during the relevant period on appeal. Therefore, the schedular rating requirements for TDIU under 38 C.F.R. § 4.16(a) are satisfied. The Veteran contends his service-connected ischemic heart disease and PTSD have rendered him unable to maintain substantially gainful employment. On review of the record, the Board finds that such is reasonably shown. As noted in the decision above, the Veteran’s VA treatment records document ongoing treatment for his service-connected PTSD. On February 2012 VA ischemic heart disease examination, the VA examiner noted that the Veteran was unable to do hard manual labor because of his ischemic heart disease. The VA examiner noted that the Veteran could walk about a half of a mile or down a flight of stairs, but no more than that. The VA examiner noted that the Veteran’s left ventricular ejection fraction (LVEF) was 31 percent and explained that a LVEF of 25 percent usually leaves a person chair bound, so the Veteran’s ability to walk as much as he could showed that he was doing well. The Veteran submitted a November 2014 private medical opinion in which his physician reported that in an 8 hour workday, the Veteran would be able to stand, walk, or sit less than 2 hours; lift and carry less than 10 pounds; miss or leave work early 3 or more days per month; would need an average of one or more extra breaks per day of at least 15 minutes to regain focus; and is unable to maintain substantially gainful employment. The Veteran also submitted a February 2016 private medical opinion in which the private physician found that the Veteran’s service-connected coronary artery disease caused him to only be able to do the following in an 8 hour workday: stand for 15 minutes; walk for 30 minutes; sit for 1 hour; stoop for less than 2 hours; lift and carry less than 10 pounds; miss or leave work early 3 or more days per month; need more than one additional break per day; and for more than 3 days per month, he would not be able to stay focused for at least 7 hours of an 8 hour workday. The private physician concluded that the Veteran’s service-connected coronary artery disease would preclude him from performing any level of substantial gainful activity from the date of his claim in August 2011 to the present, which encompasses the relevant period on appeal. The Veteran further submitted a February 2016 vocational opinion in which the vocational consultant found that the Veteran’s service-connected disabilities, which were a combination of physical and emotional conditions, interacted in such a way that the Veteran was totally and permanently precluded from performing work at a substantial gainful level during the relevant period on appeal. After weighing all the evidence of record, reported earlier in this decision, and resolving all doubt in the Veteran’s favor, the Board finds that the Veteran’s service-connected condition rendered him unable to secure and follow a substantially gainful occupation during the relevant period on appeal. The Veteran’s service-connected ischemic heart disease caused severe physical limitations for performing substantial gainful activity during the relevant period on appeal, and the Veteran’s service-connected PTSD symptoms included depressed mood, anxiety, chronic sleep impairment, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. Accordingly, the Board resolves all reasonable doubt in the Veteran’s favor and finds that his service-connected disabilities rendered him unable to secure and follow a substantially gainful occupation during the relevant period on appeal. Therefore, a TDIU rating from February 15, 2012 to August 14, 2015 is granted. 38 C.F.R. §§ 3.341(a), 4.16, 4.18, 4.19. d. Entitlement to a TDIU from August 14, 2015. From August 14, 2015, the Veteran has been rated 100 percent for coronary artery disease (CAD) status post coronary artery bypass graft (CABG), 50 percent for PTSD, and noncompensable for the left lower leg scar and residual scars associated with CAD status post CABG. As previously noted, a 100 percent disability rating does not necessarily render the issue of a TDIU moot. Accordingly, the issue during the relevant period on appeal is whether the Veteran’s PTSD alone rendered him unable to maintain substantially gainful employment. However, the schedular rating requirements for TDIU under 38 C.F.R. § 4.16(a) are not satisfied by the Veteran’s PTSD rating alone. As such, the Board will consider whether referral of the TDIU claim to the Director of VA Compensation Service for extraschedular consideration is warranted. As noted in the decision above, the Veteran’s VA treatment records document ongoing treatment for his service-connected PTSD. Furthermore, there is a February 2016 vocational opinion in which the vocational consultant found that the Veteran’s service-connected disabilities, which are a combination of physical and emotional conditions, interact in such a way that the Veteran is totally and permanently precluded from performing work at a substantial gainful level during the relevant period on appeal. Notably, this opinion does not refer to the functional impairment of the Veteran’s PTSD separately from his heart condition. As such, the opinion holds no probative value in this respect. The Board acknowledges the Veteran’s contention that he could not maintain any substantial gainful activity because of his service-connected psychiatric disorder during the relevant period on appeal. However, the preponderance of the evidence establishes that the while the Veteran did have limitations as a result of his psychiatric disability, those limitations did not prevent him from securing or following a substantial gainful occupation. Significantly, while the August 2019 VA examiner found that the Veteran’s PTSD symptoms included difficulty in adapting to stressful circumstances, including work or a worklike setting, the VA examiner ultimately opined that his PTSD manifested in occupational and social impairment with reduced reliability and productivity. The Board finds this to be highly probative of the functional impairment rendered by the Veteran’s PTSD symptoms during the relevant period on appeal. After weighing all the evidence of record, reported earlier in this decision, the Board finds that the Veteran’s disability picture does not warrant a grant of a TDIU for the relevant period on appeal, nor does the evidence warrant referral to the Director for extraschedular consideration for this period on appeal. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Griffin, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.