Citation Nr: 20042343 Decision Date: 06/23/20 Archive Date: 06/23/20 DOCKET NO. 14-38 614A DATE: June 23, 2020 ORDER A rating in excess of 50 percent prior to February 14, 2020, and in excess of 70 percent thereafter for posttraumatic stress disorder with nightmares, bad memories, panic attacks, flashbacks, and sleep problems (PTSD) is denied. As of February 14, 2020, but no earlier, a TDIU is granted. FINDINGS OF FACT 1. For the appeal period prior to February 14, 2020, the Veteran’s PTSD was manifested by psychiatric symptomatology resulting in occupational and social impairment with reduced reliability and productivity, without more severe manifestations that more nearly approximate occupational and social impairment with deficiencies in most areas, or total occupational and social impairment. 2. As of February 14, 2020, the Veteran’s PTSD is manifested by psychiatric symptomatology resulting in occupational and social impairment with deficiencies in most areas, without more severe manifestations that more nearly approximate total occupational and social impairment. 3. Resolving all doubt in the Veteran’s favor, as of February 14, 2020, but no earlier, his service-connected disabilities rendered him unable to secure or follow a substantially gainful occupation consistent with his education and work history. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 50 percent prior to February 14, 2020, and in excess of 70 percent thereafter for PTSD has not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9411. 2. As of February 14, 2020, but no earlier, the criteria for a TDIU has been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.40, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1968 to December 1971. This matter comes from the Board of Veteran’s Appeals (Board) on appeal from a November 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In September 2015, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In June 2018 and January 2020, the case was remanded for additional development and it now returns for further appellate review. In this regard, while on remand, a February 2020 rating decision awarded an increased rating of 70 percent for the Veteran’s PTSD as of February 14, 2020. However, inasmuch as higher ratings are available for such disability, and the Veteran is presumed to seek the maximum available benefit for a disability, the claim for higher ratings has remained viable on appeal. See AB v. Brown, 6 Vet. App. 35, 38 (1993). Further, such issue has been characterized to reflect that a staged rating is in effect. Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. Entitlement to a rating in excess of 50 percent prior to February 14, 2020, and in excess of 70 percent thereafter for PTSD. Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant’s favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods based on the facts found - a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart, supra. Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. The appeal period before the Board begins on September 12, 2013, the date VA received his claim for an increased rating, plus the one-year look-back period. Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). The Veteran’s service-connected PTSD is evaluated as 50 percent disabling for the appeal period prior to February 14, 2020, and 70 percent disabling thereafter under the criteria of DC 9411, which provides that such disability is evaluated pursuant to the General Rating Formula for Mental Disorders. See 38 C.F.R. § 4.130. A 50 percent rating contemplates 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; impairments of short-and long-term memory; impaired judgment; impaired abstract thinking; disturbance of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent rating is warranted where there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked 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 rating is warranted when 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. As the United States Court of Appeals for the Federal Circuit explained, evaluation under 38 C.F.R. § 4.130 is “symptom-driven,” meaning that “symptomatology should be the fact-finder’s primary focus when deciding entitlement to a given disability rating” under that regulation. Vazquez–Claudio v. Shinseki, 713 F.3d 112, 116–17 (Fed. Cir. 2013). The symptoms listed are not exhaustive, but rather “serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating.” Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). In the context of determining whether a higher disability evaluation is warranted, the analysis requires considering “not only the presence of certain symptoms[,] but also that those symptoms have caused occupational and social impairment in most of the referenced areas” - i.e., “the regulation... requires an ultimate factual conclusion as to the Veteran’s level of impairment in ‘most areas.’” Vazquez-Claudio, 713 F.3d at 117-18; 38 C.F.R. § 4.130, DC 9411. Additionally, when evaluating a mental disorder, the Board must consider the “frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran’s capacity for adjustment during periods of remission,” and must also “assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner’s assessment of the level of disability at the moment of the examination.” 38 C.F.R. § 4.126(a). Furthermore, when evaluating the level of disability arising from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation solely on the basis of social impairment. 38 C.F.R. § 4.126(b). It is necessary to evaluate a disability from the point of view of the Veteran working or seeking work. 38 C.F.R. § 4.2. In Bankhead v. Shulkin, 29 Vet. App. 10 (2017), the United States Court of Appeals for Veterans Claims (Court) held that the language of the General Rating Formula “indicates that the presence of suicidal ideation alone…may cause occupational and social impairment with deficiencies in most areas.” However, as recognized by the Court, VA must engage in a holistic analysis in assessing the severity, frequency, and duration of the signs and symptoms of a veteran’s service-connected psychiatric disability, and their resulting social and occupational impairment. The Board notes that the revised DSM-5, which, among other things, eliminates Global Assessment of Functioning (GAF) scores, applies to appeals certified to the Board after August 4, 2014, as is the case here (i.e., the instant matter was certified to the Board in May 2015. See 79 Fed. Reg. 45, 093 (Aug. 4, 2014). Thus, the Board will not consider the previously assigned GAF scores in determining the outcome of this case. See Golden v. Shulkin, 29 Vet. App. 221 (2018). In this regard, VA treatment records dated through August 2013 reflect ongoing mental health treatment where the Veteran reported experiencing daily nightmares and occasional panic attacks. It was noted that his thought processes/content, insight/judgment, and speech were within normal limits. It was further noted that the Veteran was alert and oriented, and appropriately groomed. He consistently denied suicidal and homicidal ideations, and hallucinations. In October 2013, the Veteran was afforded a VA examination to assess the nature and severity of his PTSD. At such time, the examiner noted the Veteran was married and stated that “things are pretty good” at home. He socialized primarily with his family, and was involved in the care of his grandson, who was diagnosed with autism. Specifically, he helped his adopted son to school in the mornings and helped babysit an infant grandchild. Other than watching TV and interacting with his grandchildren, he was not engaged in leisure activities. The examiner noted that the Veteran had not worked since the 1990’s. It was further observed that he experienced daily nightmares, occasional panic attacks, chronic passive suicidal ideation (no plan or intent), an irritable mood, apathy and low motivation, hypervigilance, anxiety, and restless sleep. Mental status examination revealed that the Veteran’s appearance and hygiene were adequate and he was appropriate attentive and responsive to stimuli. He was lucid and fully oriented, maintained good eye contact, and was cooperative. The Veteran’s mood was mildly dysphoric with congruent affect. Speech was normal in rate and rhythm, his thought processes were well organized, and he denied any history of psychosis. The Veteran endorsed a chronic passive suicidal ideation without plan or intent, attention and memory were intact, and intelligence was average. Upon review of the record, the examiner found that the Veteran’s presentation and description of his functioning, he experienced the same number of symptoms present at the time of his last examination in November 2008, but his resulting impairment had progressed from moderate to mild in light of treatment. He further found that the Veteran’s PTSD would have a mild impact on his ability to perform in physical and/or sedentary employment settings due to his depressed mood, anxiety, suspiciousness, panic attacks occurring less than weekly, and chronic sleep impairment. Thus, the examiner concluded that Veteran’s PTSD resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, which is consistent with a 30 percent rating under the General Rating Formula. At his September 2015 Board hearing, the Veteran reported experiencing severe memory loss, to include short-term and long-term memory loss, and paranoia, sleep disturbances and nightmares, suicidal ideation, frequent panic attacks, and almost constant depression. He also indicated that he did not have any friends and his PTSD precluded any type of employment due to difficulties with his memory, concentration, and attention span. VA treatment records dated through November 2019 reflect that the Veteran continued to receive treatment for his PTSD. In this regard, such records reflect that he was noted to be oriented to person, place and time; was appropriately dressed; had normal speech and memory; had appropriate, linear, and organized thought processes and content; had no hallucinations or homicidal ideations; and was not at risk for suicide. He continued to report hypervigilance and nightmares, and varying degrees of anxiety. In February 2020, the Veteran was afforded another VA examination to determine the current nature and severity of his PTSD. At such time, he reported symptoms of anxiety, including sleep disturbances, avoidance of situations and people that remind him of past trauma exposure, reactivity (including panic attacks, irritability, and depression) when exposed to people, events, or situations that triggered traumatic memories, exaggerated startle response, and hypervigilance. It was noted that the Veteran had been married to his spouse for 47 years and described the relationship as good. He had two adult children with whom he maintained a positive relationship, and he and his spouse continued to raise their grandson who was a senior in high school. The Veteran continued to avoid social contacts outside his immediate family. It was further noted that the Veteran had not worked since 1990 after he injured his back. He denied having any hobbies and indicated that he spent most of his time watching TV or interacting with his grandchildren. It was noted that the Veteran endorsed the following symptoms: depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, chronic sleep impairment, disturbances of motivation and mood, and suicidal ideation. Upon mental status examination, the Veteran was appropriately dressed and groomed, oriented to person, place and time, and in no obvious distress. He was cooperative and pleasant throughout the examination and responded well to redirection and reassurance. The Veteran had a somewhat flat affect with congruent affect, but his speech was relevant, clear, and without defect, and he displayed no unusual behavioral anomalies. Thought process was relevant, linear, and without evidence of disturbances. He was oriented to person, place, and time, denied current suicidal and homicidal ideation, and was able to articulate his emotions, history, and concerns adequately. The examiner found that the Veteran’s PTSD and ongoing medical conditions significantly impair his ability to function in an occupational environment. In this regard, he indicated that the Veteran reported that his chronic anxiety, fatigue, irritability, reduced concentration, and social avoidance significantly impaired his ability to sustain physical activities both when working with others and when working alone. Thus, the examiner concluded that Veteran’s PTSD resulted in occupational and social impairment with deficiencies in most areas, which is consistent with a 70 percent rating under the General Rating Formula. Based on the foregoing, for the appeal period prior to February 14, 2020, the Board finds that a rating in excess of 50 percent for the Veteran’s PTSD is not warranted. In this regard, the record, to include lay statements, VA treatment records, and VA examination reports reflect that such disability was manifested by psychiatric symptomatology consisting of daily nightmares, occasional panic attacks, chronic passive suicidal ideation, irritable mood, apathy and low motivation, anxiety, suspiciousness, hypervigilance, and sleep impairment, almost all of which are contemplated in the currently assigned 50 percent rating. In this regard, the Board observes that, while the Veteran has reported chronic suicidal ideation at the October 2013 VA examination and September 2015 hearing, he has consistently denied having a plan or intent, and has denied experiencing such symptomatology throughout the remainder of the appeal period, to include during his VA treatment sessions that occurred multiple times a year. Furthermore, while he reported severe memory loss, to include short-term and long-term memory loss, and difficulty with concentration and attention span, mental status examinations conducted throughout the appeal period fail to reveal objective evidence of such symptomatology. In this regard, his thought processes and content, insight and judgment, and attention and memory were intact. Furthermore, even in light of the Veteran’s chronic passive suicidal ideation and reported subjective symptomatology, the evidence does not show that the nature, frequency, severity, and duration of such symptoms result in occupational and social impairment in most areas, or total occupational and social impairment. In this regard, the evidence shows that, during the relevant appeal period, the Veteran has consistently maintained positive relationships with his family members and is actively engaged in his family life. Specifically, he has been married for many decades and described his relationship as “pretty good” at the October 2013 VA examination. Additionally, he socialized with his family, and was involved in the care of his grandchildren. Moreover, while the Veteran had not worked since the 1990’s, such was attributed to his nonservice-connected back disorder and the October 2013 VA examiner found that his psychiatric symptomatology would only result in mild occupational impairment. Furthermore, in consideration of the totality of the Veteran’s psychiatric symptomatology, to include his chronic passive suicidal ideation, the October 2013 VA examiner, a psychologist, found that his PTSD resulted in, at most, occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, which is consistent with a 30 percent rating under the General Rating Formula. Consequently, the Board finds that, prior to February 14, 2020, a rating in excess of 50 percent for the Veteran’s PTSD is not warranted. However, as such date, which coincidences with the February 2020 VA examination, the evidence shows that the Veteran’s PTSD is manifested by psychiatric symptomatology consisting of anxiety, including sleep disturbances, avoidance of situations and people that remind him of past trauma exposure, reactivity (including panic attacks, irritability, and depression) when exposed to people, events, or situations that triggered traumatic memories, exaggerated startle response, hypervigilance, suspiciousness, disturbances of motivation and mood, and suicidal ideation, all of which are contemplated in his currently assigned 70 percent rating. Furthermore, the evidence does not show that the nature, frequency, severity, and duration of such symptoms result in total occupational and social impairment. In this regard, the record shows that, during the relevant appeal period, while the Veteran continued to avoid social contacts outside his immediate family, he had a good relationship with his spouse of 47 years, maintained a positive relationship with his two adult children, and continued to raise his grandson with his spouse. Additionally, while he had not worked since 1990 after he injured his back, the examiner found that his PTSD in combination with his ongoing medical conditions significantly impaired his ability to function in an occupational environment. Furthermore, in consideration of the totality of the Veteran’s psychiatric symptomatology, to include his chronic passive suicidal ideation, the February 2020 VA examiner, a psychologist, found that his PTSD resulted in, at most, occupational and social impairment with deficiencies in most areas, which is consistent with a 70 percent rating under the General Rating Formula. Thus, the Board finds that, as of February 14, 2020, a rating in excess of 70 percent for the Veteran’s PTSD is not warranted. The Board has considered whether additional staged ratings under Hart, supra, are appropriate for the Veteran’s service-connected PTSD; however, the Board finds that his symptomatology has been stable throughout each stage in the appeal period. Therefore, assigning additional staged ratings is not warranted. Further, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, in regard to the increased rating claim adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). In sum, the Board finds that the preponderance of the evidence is against a rating in excess of 50 percent prior to February 14, 2020, and in excess of 70 percent thereafter for the Veteran’s PTSD. Therefore, the benefit of the doubt doctrine is not applicable to the instant claim and his claim for higher ratings must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 2. Entitlement to a TDIU. The Veteran contends his service-connected disabilities of PTSD and diabetes mellitus type II render him unable to secure or follow a substantially gainful occupation. Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when a veteran 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, such disability shall be ratable as 60 percent or more, and if there are two or more disabilities, there 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. 38 C.F.R. § 4.16(a). Rating boards should submit to the Director of Compensation Service for extra-schedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities but who fail to meet the percentage standards set forth in 38 C.F.R. § 4.16(a). See 38 C.F.R. § 4.16(b). 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 (2009). Therefore, when adjudicating a TDIU claim, VA must take into account the individual veteran’s education, training, and work history. Hatlestad v. Derwinski, 1 Vet. App. 164 (1991) (level of education is a factor in deciding employability); Friscia v. Brown, 7 Vet. App. 294 (1994) (considering Veteran’s experience as a pilot, his training in business administration and computer programming, and his history of obtaining and losing 19 jobs in the previous 18 years); Beaty v. Brown, 6 Vet. App. 532 (1994) (considering Veteran’s 8th grade education and sole occupation as a farmer); Moore v. Derwinski, 1 Vet. App. 356 (1991) (considering Veteran’s master’s degree in education and his part-time work as a tutor). Age may not be considered as a factor when evaluating unemployability or intercurrent disability, and it may not be used as a basis for a total disability rating. 38 C.F.R. § 4.19. There must be a determination that the service-connected disabilities are sufficient to produce unemployability without regard to advancing age or a non-service-connected disability. 38 C.F.R. §§ 3.340, 3.341, 4.16. The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. A high rating in itself is recognition that the impairment makes it difficult to obtain or keep employment. The ultimate question, however, is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether he or she can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Recently, in Ray v. Wilkie, 31 Vet. App. 58 (2019), the Court held that the initial extra-schedular referral decision under § 4.16(b) should address whether there is “sufficient evidence to substantiate a reasonable possibility that a veteran is unemployable by reason of his or her service-connected disabilities”. Moreover, the Court defined the term “unable to secure and follow a substantially gainful occupation” in § 4.16(b) to include two components: one economic and one noneconomic. The economic component means an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. The non-economic component includes consideration of the veteran’s history, education, skill, and training; whether the veteran has the physical ability to perform the type of activities required by the occupation at issue; and whether the veteran has the mental ability to perform the activities required by the occupation at issue. For the entire appeal period stemming from the Veteran’s September 12, 2013, date of claim for a TDIU, he is service-connected for PTSD, evaluated as 50 percent disabling prior to February 14, 2020, and 70 percent disabling thereafter; diabetes mellitus type II, evaluated as 20 percent disabling; peripheral neuropathy of the right and left lower extremities, evaluated as 10 percent disabling as of December 10, 2014, and 20 percent disabling as of September 26, 2017; tinnitus, evaluated as 10 percent disabling; scar of the lower abdominal area, evaluated as noncompensably disabling as of September 26, 2017; and gastrointestinal stromal tumor, evaluated as 100 percent disabling as of September 26, 2017, and noncompensable disabling as of January 1, 2018. Thus, the Veteran had a combined disability rating of 60 percent for the appeal period prior to December 10, 2014; 70 percent as of December 10, 2014; 100 percent with special monthly compensation (SMC) at the housebound rate as of September 27, 2017; 80 percent as of January 1, 2018; and 90 percent as of February 14, 2020. However, as the Veteran’s service-connected disabilities may not be considered one for TDIU purposes, he does not meet the schedular threshold for such a rating prior to December 10, 2014. Nonetheless, if his service-connected disabilities render him unemployable prior to such date, the case may be referred to the Director of Compensation Service for extra-schedular consideration. Further, as the Veteran has been awarded SMC at the housebound rate from September 27, 2017, to January 1, 2018, his claim for a TDIU is moot for such time period. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); Bradley v. Peake, 22 Vet. App. 280 (2008). Thus, the remaining inquiry is whether his service-connected disabilities render him unable to secure or follow a substantially gainful occupation consistent with his education and work history for the appeal period prior to December 10, 2014, such that referral to the Director of Compensation Service is warranted, or as of such date, exclusive of the period where he is in receipt of SMC at the housebound rate, such that an award of a TDIU is warranted. In regard to the Veteran’s education, he reported in his September 2013 Veteran’s Application for Increased Compensation Based on Unemployability (VA Form 21-8940) that he completed two years of high school. A March 2009 PTSD consultation indicates that he dropped out of high school due to a suspension and his educational background suggests he has significant difficulties in math as documented at a November 2008 VA examination. Nonetheless, records from the Social Security Administration (SSA) reflect that the Veteran ultimately obtained his GED. In regard to the Veteran’s work history, he reported in his September 2013 VA Form 21-8940 that he last worked in August 1990 at Ready Mix as a mechanic and driver. Similarly, VA treatment and SSA records indicate that he became too disabled to work in 1990 following an accident that resulted in a severe injury to his back, to include ruptured discs requiring surgery and manifesting with nerve damage in the leg and hip. Other records indicate that, after his military service, he spent several years working in a shipyard, construction, and coal mines until 1992. See March 2009 PTSD Psychologist Consultation. Further, at his September 2015 Board hearing, the Veteran reported that his prior work experience was in construction, and he had no training in clerical work or using a computer. Thus, the record is clear that the Veteran has not been employed at any time proximate to his September 2013 claim, and has worked primarily in a physical capacity. In regard to the impact the Veteran’s service-connected disabilities have on his ability to secure or follow a substantially gainful occupation, the October 2013 VA examiner found that the resulting impairment related to his PTSD had progressed from moderate as noted in November 2008 to mild. In this regard, it was determined that such disability resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, and the examiner ultimately opined that it would have a mild impact on his ability to perform in physical and/or sedentary employment settings due to his depressed mood, anxiety, suspiciousness, panic attacks occurring less than weekly, and chronic sleep impairment. Additionally, a October 2013 VA examiner found that the Veteran’s diabetes mellitus type II, which was managed by restricted diet and oral hypoglycemic agents, did not result in a need for regulation of activities, associated complications, and did not impact his ability to work in a physical or sedentary capacity. Similarly, in October 2013, an audiologist found that the Veteran’s tinnitus did not impair an individual’s ability to engage in physical and/or sedentary employment, and cannot be considered as an unemployable ailment. While treatment records reflect the progression of the Veteran’s diabetic neuropathy affecting the right and left lower extremities, a February 2018 VA examination noted that such was manifested by burning pain in the feet and numbness and tingling in the feet and lower leg. He reported that he could no longer drive as he could not feel the pedals. However, following strength, reflex, and sensation testing, the examiner found that such disabilities resulted in no more than mild incomplete paralysis of the affected nerve, and impact the Veteran’s ability to work only insofar as he reported pain with prolonged walking and standing. A June 2018 VA examination reflects that the Veteran’s gastrointestinal stromal tumor and associated scar did not impact his ability to work. At a February 2020 VA examination, the examiner found that that Veteran’s PTSD resulted in occupational and social impairment with deficiencies in most areas, and such disability, as well as his ongoing medical conditions, significantly impair his ability to function in an occupational environment. In this regard, he indicated that the Veteran reported that his chronic anxiety, fatigue, irritability, reduced concentration, and social avoidance significantly impaired his ability to sustain physical activities both when working with others and when working alone. Based on the foregoing, the Board finds that, prior to February 14, 2020, the date of the aforementioned VA examination, the Veteran’s service-connected disabilities did not render him unable to secure or follow a substantially gainful occupation consistent with his education and work history. In this regard, the record reflects that, prior to such date, the Veteran’s PTSD resulted in no more than mild occupational impairment, described as an occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks due to depressed mood, anxiety, suspiciousness, panic attacks occurring less than weekly, and chronic sleep impairment. Furthermore, at no time pertinent to the appeal does the evidence demonstrate that the Veteran’s diabetes mellitus type II, tinnitus, and gastrointestinal stromal tumor and associated scar impacted his ability to work. Finally, while he was found to have diabetic neuropathy affecting the right and left lower extremities since December 2014 and reported burning, numbness, and tingling in his legs and feet, to include an inability to feel the pedals when he drove, the February 2018 VA examiner found that, upon objective examination, such disability only impact his ability to work in that he had pain with prolonged walking and standing. Thus, as the Veteran experienced only mild occupational impairment related to his PTSD and discomfort with prolonged standing and walking due to his diabetic neuropathy affecting the right and left lower extremities, such would not preclude his ability to work in his prior fields, to include as mechanic, or performing work in shipyards, construction sites, and coal mines, which is consistent with his high school education and lack of clerical or computer training. In this regard, while the Veteran reported that he no longer drove due to his diabetic neuropathy of the bilateral lower extremities, he would not be precluded from performing his other work duties consistent with such positions, i.e., working on cars, carrying tools and materials, setting up equipment, doing fabricating and carpentry, placing flooring, drywall, roofing, etc., and transporting coal. In reaching such determination, the Board notes that, in a September 2017 letter, the Veteran’s private physician, Dr. J.M., opined that his medical conditions, to include diabetes mellitus, coronary artery disease, and cancer of the kidney and gastrointestinal tract, rendered him unable to work. However, Dr. J.M. attributed such inability to work to both service-connected and non-service-connected disorders, and did not explain how such disabilities impacted his employability. Further, such opinion is contradicted by the foregoing VA examinations, which took into consideration the Veteran’s reported symptoms and resulting impairment, his medical history, and appropriate clinical evaluations, SSA records showing that he was rendered unemployable due to a severe back injury, and the Veteran’s own statements in which he only reported functional impairment associated with his diabetes mellitus type II and PTSD. See September 2013 VA Form 21-8940; September 2015 Board hearing testimony. Thus, the Board affords no probative weight to Dr. J.M.’s opinion. Therefore, based on the foregoing, the Board finds that the Veteran’s service-connected disabilities, alone or in combination, did not render him unable to secure or follow a substantially gainful occupation consistent with his education and work history prior to February 14, 2020. However, as of such date, the Board finds that such disabilities rendered him unemployable. Specifically, the February 2020 VA examiner found that that Veteran’s PTSD resulted in occupational and social impairment with deficiencies in most areas, and such disability, as well as his ongoing medical conditions, significantly impair his ability to function in an occupational environment. In this regard, he indicated that the Veteran reported that his chronic anxiety, fatigue, irritability, reduced concentration, and social avoidance significantly impaired his ability to sustain physical activities both when working with others and when working alone. Thus, as the Veteran has only a high school education and has worked primarily performing physical duties, the Board resolves all doubt in his favor and finds that, as of February 14, 2020, his service-connected disabilities rendered him unable to secure or follow a substantially gainful occupation consistent with his education and work history. Thus, a TDIU is warranted as of such date. In reaching the foregoing determinations, the Board has resolved all doubt in favor of the Veteran, which resulted in the award of a TDIU as of February 14, 2020. However, insofar as the Board has denied a TDIU prior to such date, the preponderance of the evidence is against such aspect of the Veteran’s claim. Therefore, the benefit of the doubt doctrine is not applicable in such regard and his claim must otherwise be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. M. Kelly, 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.