Citation Nr: 20044591 Decision Date: 07/02/20 Archive Date: 07/02/20 DOCKET NO. 00-21 671 DATE: July 2, 2020 ORDER An initial disability rating of 70 percent, and no higher, for posttraumatic stress disorder (PTSD) beginning August 18, 1998 is granted. A total disability rating based on individual unemployability due to service-connected disability (TDIU) effective March 1, 2011 is granted. FINDINGS OF FACT 1. Since the grant of service connection, the evidence is in equipoise as to whether the Veteran’s PTSD 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; sleep disturbances; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances; impaired impulse control; and suicidal/homicidal ideation, without more severe manifestations that more nearly approximate total occupational and social impairment. 2. A claim for service connection for psychiatric disability and, by extension, a TDIU was received by the Regional Office (RO) on August 18, 1998. 3. Pursuant to the above award of an initial 70 percent disability rating for the Veteran’s PTSD effective August 18, 1998, the Veteran has met the schedular requirements for a TDIU since such date. 4. Beginning March 1, 2011, the Veteran’s service-connected disabilities have prevented him from securing or following a substantially gainful occupation. CONCLUSIONS OF LAW 1. The criteria for an initial disability rating disability of 70 percent, and no higher, for PTSD 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. Beginning March 1, 2011, 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 October 1966 to July 1968. This case comes before the Board of Veterans’ Appeals (BVA or Board) from a December 2001 rating decision of the Department of Veterans Affairs (VA) RO in Waco, Texas which, in part, granted service connection for PTSD, assigning an initial 10 percent disability rating effective August 18, 1998. The Veteran disagreed with the initial rating assigned and perfected this appeal. The Veteran and his wife testified before a Decision Review Officer (DRO) at a hearing held at the RO in May 2001. A transcript of the hearing has been associated with the claims file. By rating decision dated in July 2004, the RO increased the Veteran’s disability rating from 10 to 30 percent disabling effective August 18, 1998. In September 2006, April 2010, and November 2011 the Board remanded the claim for additional development. In December 2012, the Board denied the Veteran’s claim seeking an initial disability rating in excess of 30 percent for his service-connected PTSD. The Veteran filed a timely appeal with the Court of Appeals for Veterans Claims (Court), and by Order dated October 2013, the Court granted a Joint Motion for Partial Remand. In February 2014, the Board remanded the claim for further development of the record. In February 2016, the Board again denied the Veteran’s claim seeking an initial disability rating in excess of 30 percent for his service-connected PTSD, but granted a 50 percent rating from October 30, 2009, and a 70 percent rating from September 17, 2014. The Veteran filed a timely appeal with the Court. In a February 2017 Joint Motion for Partial Remand, the parties agreed that the Board failed to provide adequate reasons and bases in its explanation for the denial of entitlement to an initial rating in excess of 30 percent prior to October 30, 2009, and 50 percent from October 30, 2009 through September 16, 2014, for the service-connected PTSD. In March 2017, the Court vacated the portion of the February 2016 Board decision that denied an initial rating in excess of 30 percent prior to October 30, 2009 and a rating in excess of 50 percent for the period from October 30, 2009 through September 16, 2014, for PTSD and remanded the matter for additional consideration. The Court did not disturb the assigned 70 percent rating from September 17, 2014; therefore, that period of time is no longer before the Board and will not be addressed herein. In December 2017, the Board again denied the Veteran’s claim seeking an initial disability rating in excess of 30 percent for his service-connected PTSD, but granted a 50 percent rating from August 1, 2009. The Veteran filed a timely appeal with the Court. In an October 2019 Memorandum Decision, the Court found that the Board failed to provide adequate reasons and bases in its explanation for the denial of entitlement to an initial rating in excess of 30 percent prior to August 1, 2009, and 50 percent from August 1, 2009 through September 16, 2014, for the service-connected PTSD. As such, the Court vacated the December 2017 Board decision and remanded the matter for additional consideration. Significantly, the Veteran’s PTSD is currently rated as 30 percent disabling prior to August 1, 2009 and as 50 percent disabling from August 1, 2009 to September 16, 2014. These are the only periods of time subject of the current appeal. With regard to the TDIU issue, by rating decision dated in April 2015, the RO granted a TDIU effective July 1, 2014 through December 29, 2014. Notably, this award appears to be based, primarily, on the Veteran’s combined disability rating of 80 percent effective July 1, 2014 which, conversely, is the date that the Veteran met the criteria for a schedular TDIU pursuant to 38 C.F.R. § 4.16 (a). The end date of December 29, 2014 for the TDIU award appears to be based on the fact that the Veteran is in receipt of a 100 percent combined disability rating effective December 29, 2014. However, a review of the record shows that the Veteran last worked full-time as an electrician, due, at least in part, to his service-connected PTSD in March 2011. The October 2019 Memorandum Decision found that the Board should have taken jurisdiction of the issue of entitlement to a TDIU prior to July 1, 2014 as “part and parcel” of the Veteran’s increased-rating claim for PTSD. See Rice v. Shinseki, 22 Vet. App. 447, 453-55 (2009) (“TDIU, whether expressly raised by a veteran or reasonably raised by the record, is not a separate claim for benefits, but rather involves an attempt to obtain an appropriate rating for a disability or disabilities, [including] as part of the initial adjudication of a claim.”). Specifically, it was noted that the Board failed to address the matter of a TDIU despite evidence of concentration issues, angry outbursts with supervisors, an incident of a physical altercation with a supervisor leading to a 10-month period of unemployment during the period on appeal, and evidence that his commercial license was suspended due to anxiety medication that he took for PTSD. With regard to representation, a review of the record shows that the Veteran was originally represented in this matter by the Vietnam Veterans of America (VVA). See VA Form 21-22, dated September 2009. That representation was then revoked when the Veteran executed another VA 21-22 in July 2012 that designated the Texas Veterans Commission as his representative. The Veteran was represented by Amie Leonard, Esquire, at the Court, and in October 2017 submitted a VA Form 21-22 to be represented by Gail Hyman, Esquire, under 38 C.F.R. § 14.630 to be limited to the issue on appeal. See 38 C.F.R. § 14.630. However, in April 2018 correspondence, Gail Hyman revoked her representation of the Veteran. As such, the Veteran is currently unrepresented. Increased Rating 1. An initial disability rating of 70 percent, and no higher, for PTSD beginning August 18, 1998 is granted. 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. As above, this appeal stems from an initial claim of service connection for PTSD dated in August 1998. He is currently in receipt of a 30 percent disability rating effective August 18, 1998, a 50 percent disability rating effective August 1, 2009, and a 70 percent disability rating effective September 17, 2014. However, as above, the issue on appeal is limited to the period of time prior to September 17, 2014. The Veteran’s PTSD is rated pursuant to 38 C.F.R. § 4.130, DC 9434, which corresponds to PTSD. Under this code, a 30 percent evaluation is warranted when there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily with routine behavior, self-care, and conversation normal), due to such symptoms as depressed mood, anxiety, suspiciousness, panic attacks occurring weekly or less often, chronic sleep impairment, and mild memory loss (i.e. forgetting names, directions, or recent events). 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 nomenclature employed in the portion of VA’s Rating Schedule that addresses service-connected psychiatric disabilities is based upon the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, of the American Psychiatric Association (DSM-IV). 38 C.F.R. § 4.130. DSM-IV contains a Global Assessment of Functioning (GAF) scale, with scores ranging between 0 and 100, representing the psychological, social, and occupational functioning of an individual on a hypothetical continuum of mental health-illness. Higher scores correspond to better functioning of the individual. GAF scores from 51 to 60 are indicative of moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers). GAF scores from 41 to 50 reflect serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job). Scores from 31 to 40 indicate impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) or major impairment in several areas, such as work or school, family relations, judgment, thinking or mood (e.g., depressed man avoids friends, neglects family, and is unable to work). VA regulations require the use of DSM-5, effective August 4, 2014. Among the changes, DSM-5 eliminates the use of the GAF score in the evaluation of psychiatric disorders. The change was made applicable to cases certified to the Board on or after August 4, 2014, and is not applicable to cases certified to the Board prior to that date. As this case was certified to the Board before August 4, 2014, GAF scores will be used in the evaluation of the psychiatric disorder. Symptoms listed in VA’s general rating formula for mental disorders are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). 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 PTSD prior to September 17, 2014 includes VA psychiatric examination reports dated in July 1999, May 2001, February 2003, November 2004, January 2008, April 2010, and January 2012. Also of record are VA and Vet Center treatment records dated from September 1998 through September 2014. VA outpatient treatment records disclose that the Veteran was seen in September 1998 and reported he has dreams of his Vietnam experiences about three times a week. He related he had lots of stress, and described difficulty getting along with his supervisor and colleagues. On mental status evaluation, the Veteran was neatly dressed and well-groomed. He was alert and oriented to time, place and situation. His mood was somewhat euphoric and his affect was appropriate. There was no evidence of a thought disorder, and his cognitive functions were intact. He denied suicidal or homicidal ideation, and his insight and judgment seemed good. The diagnoses were possible depressive disorder, not otherwise specified, and rule out PTSD. The Axis IV diagnoses were job and marital stress. The GAF score was 70. Medication was prescribed. When seen the following month, the examiner noted that the Veteran was having problems sleeping and added another medication. It was indicated he had a new supervisor and things were better at work, but his relationship with his spouse was strained. In May 1999, the Veteran asserted he was doing fairly well. Although he still had nightmares, he said they were much less frequent. He noted he liked his job and he and his wife had a good relationship. During the July 1999 VA psychiatric examination, the Veteran reported that he was having problems with his supervisor at work. He noted his initial psychiatric treatment was in 1998. He related he had a confrontation with a supervisor and, after a heated exchange of words, began to obsess about the man’s death. He felt this was not right so he went to the VA for treatment. He reported the medications that had been prescribed were helpful, and he no longer had any disturbing thoughts relating to his supervisor. A mental status evaluation revealed the Veteran was neatly groomed. He talked at a normal rate. His answers were logical, relevant and coherent. He was oriented to person, place and time. He said his memory was not what it used to be, but the examiner said it was in the normal range. He said his former supervisor was an enemy. The Veteran admitted to anger and impulses to hurt others, but had no current plan. He admitted to depression, but denied past thoughts of suicide. He denied having hallucinations. The diagnostic impression was adjustment disorder with mixed disturbance of emotions and conduct. The GAF score was 75. On VA psychiatric examination in May 2001, the examiner noted that the Veteran was being treated for his psychiatric symptoms by the VA. He indicated that as the Veteran’s treatment progressed, he gradually improved regarding PTSD, and the treatment subject shifted to marital mal-adjustment. He was being seen every four months. On mental status evaluation, the Veteran was well-oriented. He said he still had some nightmares, but it was difficult to obtain a precise frequency. He also described sleep disturbance, awakening with heavy sweating. He did not talk about survivor guilt and it did not appear he had compensatory intrusive thoughts returning to his Vietnam experiences. He had some mild depression which was probably associated with his marital situation. The diagnostic impressions were mild PTSD, not truly disabling, minimal depression and dysthymia. The GAF score was 75. VA outpatient treatment records reflect that the Veteran was seen from 2000 to 2002. In August 2000, the Veteran indicated he still had some nightmares, but not on a regular basis. He had insomnia on certain days. He said he was handling things okay in spite of a lot of stress. He related he had a very good relationship with his wife and they had been married for 26 years. He denied suicidal thoughts or ideations. In October 2001, the Veteran reported he had nightmares approximately two to three times a week. When seen in March 2002, he asserted that a psychiatrist who had examined him had been in Vietnam with him. After seeing him, the Veteran maintained he started having a lot of memories of his Vietnam experiences and said he was having frequent nightmares. The dosage of one of his medications was increased. When seen about two months later, the Veteran stated he was feeling better. The examiner noted he seemed much more relaxed and in better spirits. The Veteran said he had not had nightmares recently. The Veteran was seen at a Vet Center in July 2002. He presented with problems of recurrent dreams two to three times a night, intrusive thoughts, flashbacks, sleep disturbance, depression, feelings of anger and irritability. A mental status evaluation disclosed he was neat and friendly. His speech and affect were appropriate. He was oriented to time, place and person. He was noted to be tense. His memory was normal, and his judgment fair. It was reported he had delusions, disorganized thinking and hallucinations. He denied suicidal thoughts. It was indicated he had homicidal thoughts, but was not considered a risk. The examiner indicated the Veteran’s thought content and process and perception indicated some paranoia and suspiciousness, and that he appeared to be distrustful. The Veteran reported he heard sounds and noises that were incomprehensible and indistinguishable to him. The assessment was PTSD symptoms. During the February 2003 VA psychiatric examination, the Veteran related that he was working full time. He stated he was losing interest in his hobbies and had lost concentration at work several times. He said he found himself thinking about Vietnam at work. A mental status evaluation demonstrated that the Veteran was cleanly dressed and very meticulous, probably with some obsessive compulsive elements in his personality. He was well oriented and had good contact with outside reality. He had no anxiety, abnormal thinking or delusions. He appeared to be on the down-hearted side. He had goal-directed thinking. He reported nightmares about two or three times a week. The examiner stated he had the impression this was a mild overstatement. The Veteran awakened from his dreams with sweating and upset. The examiner also noted in looking at the Veteran’s previous counseling records, he had treatment often, but it was not always for PTSD. The diagnosis was PTSD, mild to moderate in severity, and not interfering with employment. The GAF score was about 60 to 65. VA outpatient treatment records disclose that the Veteran was seen in January 2003 when he reported feeling better. He had been very irritable during his previous visit and had been having problems at work. He was started on medication that was very calming, and he was getting along better with people and work was better. It was noted a relative had been killed in an accident. The Veteran was noted to be doing very well in September 2003 and March 2004. At the latter visit, his main problem was marital in nature. He denied recent nightmares or flashbacks. On VA psychiatric examination in November 2004, the Veteran related he continued to have nightmares about twice a week. He said he could not remember things and that he got lost when driving. He asserted he had had thoughts of suicide and of homicide, but had no plan to hurt anyone. A mental status evaluation revealed the Veteran had occasional eye contact. He claimed a helper at work was an enemy and he was angry with that person. He reported he had obsessive thoughts about his wife and his work. He was occasionally circumstantial to questions. There were no loose thought associations. He said he heard voices talking at times, but could not understand anything that was said. He maintained that he heard voices when no one was there. The Veteran reported panic attacks and had fears of being closed in. His mood was mildly depressed. The diagnostic impression was PTSD. The GAF score was 65. VA outpatient treatment records disclose that the Veteran was seen in September 2004 and reported that he was doing “fairly well.” He reported that his job was stressful. He was getting along okay with his wife most of the time and his main conflict was with his stepchildren. He was doing well when seen in March 2006. He was working full time and liked his job. His relationship with his wife was good. He again indicated he was doing well in September 2006. He had some family issues but said he was dealing with it okay. He had a lot of concerns regarding his children, but also had some positive things. His relationship with his wife was good. The Veteran denied suicidal thoughts or ideations. He said he still had nightmares about his Vietnam experiences, but was dealing with them okay. Vet Center treatment records disclose that the Veteran was seen in January 2005 and complained of anxiety, saying that it might be related to ongoing job and family stressors. When he was seen two months later, he noted he had continued job stressors and increased anger. He related that he had to continually keep himself from getting triggered. During a July 2005 couples counseling session, he reported he had experienced an injury to his finger, and he was told he had experienced a panic attack with a possible psychotic episode. The assessment was PTSD. It was indicated that there were medical and situational stress, possibly resulting from an inability of the Veteran and his wife to communicate their needs to each other. The Veteran reported a decrease in anxiety since getting a new supervisor and a reliable helper at work. The following month, his major complaint was an inability to communicate with his spouse. He said mood swings caused conflict between them. Later in February 2006, the Veteran referred to improved communication and that tension had lessened. He shared his recall of military incidents in which he witnessed the death of fellow soldiers. He related his experience without being overpowered by his emotions. The assessment was PTSD. In January 2007, the Veteran presented as alert, well-oriented and friendly. He noted problems with PTSD symptoms, but added he was handling them by staying busy at work and home. He referred to family issues. During the September 2007 VA psychiatric examination, the examiner reviewed the electronic medical records and stated that most of the notes indicated that the Veteran was doing well on medication. The Veteran described an altercation with a supervisor at work in which he sustained a hand injury. He stated his nightmares had been increasing since the hand injury, and were occurring nightly. He described flashbacks and anger problems. A mental status evaluation disclosed the Veteran’s thought process was logical, coherent and relevant. His affect was spontaneous, and he showed no signs of anxiety or depression, but he reported some depressive symptoms. He was well-oriented to time, place, person and situation. He showed mild difficulty with concentration and memory. The Veteran indicated that he had one panic attack and went to the hospital because he thought he was having heart trouble. He reported significant problems with anger and irritability. He also said he had some guilt about his alleged actions in Vietnam. He described flashbacks, and showed signs of mild persecutory themes, but did not appear to have full paranoia or persecutory delusions. He denied suicidal ideation, but indicated he had homicidal thoughts, particularly towards the supervisor with whom he had the altercation. He added that he would not act on these thoughts. The diagnoses were PTSD, chronic, mild, and antisocial personality traits. The GAF score was 60. The examiner commented that a review of the treatment records suggested the Veteran’s global level of functioning had remained about the same since the last examination and he had been able to maintain stable employment. The recent altercation had triggered some additional symptoms, but this appeared to be a transient, situational phenomenon. He added that the Veteran showed signs of antisocial personality traits and these contributed to some degree to his conflicts and altercations, as well as his lack of close relationships. In January 2008, the VA psychologist who conducted the September 2007 VA psychiatric examination provided an addendum to his report following a review of the claims folder. He noted that the record did not reveal any evidence of the “special missions” the Veteran described at the time of the examination and there was no mention of a court-martial. He had no changes in his previous opinions or diagnoses. The Veteran was examined by a private physician in October 2009. The examiner asserted that the Veteran had a longstanding history of PTSD secondary to his “rather horrific experiences” in Vietnam. It was noted that the Veteran had recently separated from his wife. It was indicated he had recently undergone back surgery and had recently been diagnosed with prostate cancer. The examiner said it was not surprising that the Veteran was depressed. He added it was difficult to determine if the depression was part of PTSD or new onset depression. A mental status evaluation showed that the Veteran was oriented times three. His insight, while limited in certain areas, was basically intact, as was his judgment. His affect was replete with significant depressive symptoms and some decreased self-worth, some anhedonia and malaise. He denied suicidal or homicidal ideation. No hallucinations or delusions were present. His memory was intact. The examiner stated the Veteran had PTSD, atypical depression, and dysthymia. The GAF score was 33 to 35. On VA psychiatric examination in March 2010, the Veteran reported that he had thought about shooting himself in August of 2009, going so far as to go to a park with a gun. He reported that he decided not to go through with it, and claimed that his religious beliefs prohibit him from acting on those thoughts. He also reported fleeting homicidal thoughts in anger, but none that had been recent. On VA psychiatric examination in April 2010, the Veteran reported that he was in the process of a divorce. He had just gone back to work after being off for 10 months due to a back condition. The examiner, who also conducted the September 2007 VA psychiatric examination, reviewed the claims folder and the electronic medical records. He noted that the treatment records since his previous examination showed GAF scores steadily around 60, and then a sudden decline to 45 in September 2009. That was right after the Veteran had been diagnosed with prostate cancer, his wife left him, and his mother died. The decline in functioning appeared to be related to those stressors, as opposed to progression of PTSD. The examiner further stated that despite the report of worsening of the Veteran’s depressive symptoms, most of the treatment notes suggested a positive mood and stable condition. With respect to his PTSD symptoms, the Veteran related that he often thought about having killed a lieutenant who went AWOL (absent without leave), but he described feelings of guilt, not fear in relation to that. The examiner commented that this was not a confirmed event. The Veteran stated he tried to avoid thinking about those issues, but was vague about other avoidance symptoms of PTSD. He reported significant problems with anger, but this more likely than not related to his antisocial personality traits. He described insomnia and hypervigilance. He said there was a ghost living in his house. He did not describe actually seeing a “ghost” or focal hallucinations, but said he heard noises he could not account for and assumed it was a ghost. He did not appear fully psychotic, but had some possible psychotic tendencies, which the examiner said could be associated with his depression and appeared to have increased in severity since his previous evaluation. A mental status evaluation disclosed that the Veteran was well-groomed and cooperative. Rapport was somewhat difficult to establish. Thought processes were logical and coherent, with no overt signs of psychosis. His affect was primarily irritable and depressed. The Veteran was well oriented to time, place, person and situation. Reasoning and judgment were fair. The Veteran reported subjective decline in concentration and memory. The examiner commented that the impact of PTSD itself on the Veteran’s social and occupational functioning had not changed significantly since the previous examination. The Veteran described worsening mood and a decline in his marriage, but it was not solely attributable to PTSD, and the Veteran’s problematic personality traits impacted both social and occupational functioning. The diagnoses were adjustment disorder, with depressed mood, secondary to recent stressors; PTSD, at least as likely as not; and antisocial personality traits. The GAF score was 50. The examiner commented that the most disruptive diagnosis in terms of the Veteran’s social and occupational functioning over the years has been the antisocial personality traits. The examiner reiterated he had some concern about the diagnosis of PTSD, but was continuing it. He noted that although the Veteran’s overall functioning had declined since the last evaluation, PTSD remained stable. In fact, he added that the Veteran did not report many PTSD specific symptoms and had to be prodded to get information about those symptoms that were listed. The Veteran’s primary issue was his adjustment disorder which related to multiple factors. It was also noted that the Veteran described worsening overall because of increasing depression. The Veteran’s claims folder and medical records were reviewed by a VA psychologist in January 2012. She stated that the April 2010 examiner’s report of antisocial personality traits was in response to the Veteran’s report of his behavior in Vietnam as a “soldier hunter” which the examiner in April 2010 found was not supported in the records. She noted that the previous examiner attributed the Veteran’s anger to personality traits, and not PTSD. With respect to the diagnosis of adjustment disorder, the reviewing psychologist noted that it is, by definition, situationally-related and when the specific stressor is resolved, the diagnosis no longer applies, unless the stressor is ongoing/unresolved. She also indicated that a review of treatment records showed that the Veteran was reporting improvement in his symptoms as his psychosocial stressors had abated in four mental health visits since the April 2010 VA psychiatric examination. The VA psychologist summarized two visits. It was indicated that in January 2011, the Veteran said he had been doing very well and planned to retire the next month. He was happy that his divorce would be over very soon. He denied suicidal thoughts or ideations. He again stated he was well in July 2011, and pointed out he was getting along better with his ex-wife since the divorce. He denied nightmares or flashbacks, as well as suicidal thoughts or ideations. The psychologist diagnosed PTSD. She noted that depression/anxiety was medically considered a secondary manifestation of the Veteran’s mental health condition rather than a separate mental disability. She opined that the Veteran’s PTSD 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 added she would not provide a diagnosis of antisocial personality traits, and that the diagnosis of adjustment disorder with depressed mood no longer pertained as noted in the two most recent mental health attending notes. She assigned a GAF score of between 60 and 64, indicating PTSD remains in the mild to moderate range and, based upon the recent notes documenting the Veteran’s reported improvement, the PTSD was more likely in the mild range. In July 2014, the Veteran reported to his attending psychiatrist that when he had undergone surgery for his back, that he was not given his PTSD medication and had a flashback and became violent. He reported that when the doctor restarted his medication he had not had an incident or side effects since that time. While this instance of impaired impulse control appears to have been serious, it also appears to have been an isolated incident due to a gap in the Veteran’s medication. Prior to and after this incident, the Veteran was compliant with his prescribed medication and denied any side effects from his medication. There is no probative evidence that his PTSD caused other instances of impulse control or violent outbursts. The Board finds that the evidence supports the grant of an initial 70 percent disability evaluation for the Veteran’s PTSD effective August 18, 1998. The evidence shows the Veteran to be severely disabled as a result of his service-connected psychiatric disability. Significantly, as was noted in the October 2019 Memorandum Decision, the Veteran was experiencing homicidal ideation at the time of filing his claim in August 1998. As the Court has affirmed, suicidal ideation (to include homicidal ideation) does not require intent, a plan, or preparatory behavior. Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017). Suicidal/homicidal 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 (homicidal) ideation alone might cause occupational and social impairment with deficiencies in most areas. Also, as was noted in the October 2019 Memorandum Decision, since the initial claim, the Veteran’s marriage began to fall apart, resulting in divorce after years of fighting. Furthermore, the Veteran reported social withdrawal, distancing himself from loved ones and being a loner. While the medical evidence prior to September 17, 2014 primarily shows mild symptoms, the occasional findings of severe symptoms suggests a more significant disability warranting a 70 percent disability rating. As for the potential of a disability rating higher than 70 percent, 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 his 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. As above, the Veteran can function independently and maintained a significant relationship with his children during the appeal period prior to September 17, 2014. 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 PTSD 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 his worst, can effectively converse with the VA examiner/private physician, and can generally manage his daily activities on his own. He is not psychotic or out of touch with reality. Overall, his PTSD 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 his favor. 38 U.S.C. § 5107(b). As such, an initial disability rating of 70 percent, and no higher, is warranted. 2. A TDIU effective March 1, 2011 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 his nonservice-connected disabilities nor his 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 last worked fulltime as an electrician in approximately March 2011. The October 2019 Memorandum Decision noted evidence of concentration issues, angry outbursts with supervisors, an incident of a physical altercation with a supervisor leading to a 10-month period of unemployment during the period on appeal, and evidence that his commercial license was suspended due to anxiety medication that he took for PTSD. Pursuant to the above award of an initial 70 percent disability rating for the Veteran’s psychiatric disability effective August 19, 1998, the Veteran has met the schedular requirements for a TDIU since such date. Furthermore, the evidence demonstrates that the Veteran has been unemployed since March 1, 2011 due, at least in part, to his PTSD. While the Veteran may have had difficulty at work prior to March 1, 2011, he was still able to maintain a substantially gainful employment prior to that date. Also, while the record does show a 10-month period of unemployment prior to March 1, 2011, the April 2010 VA psychiatric examination report shows that this period of unemployment was due to the Veteran’s nonservice-connected back disability and not his PTSD. As such, the Board finds that a TDIU is warranted effective March 1, 2011. 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.