Citation Nr: 20046495 Decision Date: 07/13/20 Archive Date: 07/13/20 DOCKET NO. 15-01 577 DATE: July 13, 2020 ORDER An initial rating of 70 percent, but no higher, since July 20, 2010, for anxiety disorder not otherwise specified is granted. A total disability individual unemployability (TDIU) rating is granted. FINDINGS OF FACT 1. With resolution of the doubt in his favor, the Veteran’s anxiety disorder not otherwise specified has been manifested by occupational and social impairment with deficiencies in most areas since July 20, 2010. 2. With resolution of the doubt in his favor, the Veteran’s service-connected anxiety disorder renders him unemployable. CONCLUSIONS OF LAW 1. The criteria for an initial rating of 70 percent, but no higher, since July 20, 2010, for anxiety disorder not otherwise specified have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.125, 4.126(a), 4.130, Diagnostic Code 9413. 2. The criteria for entitlement to a TDIU rating have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.341, 4.16, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the United States Air Force from October 1962 through April 1966. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2010 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the issues on appeal for additional development in June 2018. The RO was requested to schedule the Veteran for a VA examination to determine the current level of severity of all functional impairment resulting from his anxiety disorder. The additional development was completed. Therefore, the Board finds the directives having been substantially complied with and the matter again is before the Board. D’Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268, 271 (1998). This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). 1. An initial rating in excess of 30 percent for anxiety disorder not otherwise specified. Disability ratings are determined by applying criteria set forth in VA’s Schedule for Rating Disabilities. Ratings are based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations should be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. In disability rating cases, VA assesses the level of disability from the initial grant of service connection or a year prior to the date of application for an increased rating and determines whether the level of disability warrants the assignment of different disability ratings at different times over the course of the claim, a practice known as “staged ratings.” See Fenderson v. West, 12 Vet. App. 119, 126 (1999); see also Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007) (holding that staged ratings may be warranted in increased rating claims). Additionally, the evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided. Separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of or overlapping with the symptomatology of the other condition. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994). In deciding claims, it is the Board’s responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104(a). Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss each and every piece of evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claims and what the evidence in the claims file shows, or fails to show, with respect to the claims. See Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). In assigning a higher disability rating, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran’s anxiety disorder not otherwise specified has been evaluated as 30 percent disabling from July 20, 2010, under the General Rating Formula for Mental Disorders, which assigns ratings based on particular symptoms and the resulting functional impairments. See 38 C.F.R. § 4.130, DC 9413. The General Rating Formula for Mental Disorders is as follows: A 100 percent rating is assigned for 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. A 70 percent rating is assigned for 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. A 50 percent rating is assigned for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. A 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 (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). 38 C.F.R. § 4.130. The symptoms associated with each rating in 38 C.F.R. § 4.130 are not intended to constitute an exhaustive list; rather, they serve as examples of the type and degree of the symptoms, or their effects, that would justify a rating. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). Thus, the evidence considered in determining the level of impairment under 38 C.F.R. § 4.130 is not restricted to the symptoms provided in the DCs. See Id. VA must consider all symptoms of a claimant’s disorder that affect his or her occupational and social impairment. See Id. at 443. If the evidence demonstrates that a claimant has symptoms or effects that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the DC, the appropriate, equivalent rating will be assigned. Id. VA shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the claimant’s capacity for adjustment during periods of remission. 38 C.F.R. § 4.126. Although VA considers the level of social impairment, it does not assign an evaluation based solely on social impairment. Id. VA must consider all the claimant’s symptoms and resulting functional impairment as shown by the evidence in assigning the appropriate rating, and will not rely solely on the examiner’s assessment of the level of disability at the moment of examination. See Id. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is for application as this appeal was pending before the AOJ on August 4, 2014. 38 C.F.R. §§ 4.125, 4.130; 79 Fed. Reg. 45093, 45099 (effective date provisions); 80 Fed. Reg. 53, 14308 (March 19, 2015) (adopting the final rule recognizing that the DSM-IV was rendered obsolete by the publication of the DSM-5 in May 2013). “Given that the DSM-5 abandoned the GAF scale and that VA has formally adopted the DSM-5, the Court holds that the Board errs when it uses GAF scores to assign a psychiatric rating in cases where the DSM-5 applies... [t]he Board should not use such evidence at all when assigning a psychiatric rating in cases where the DSM-5 applies.” Golden v. Shulkin, 29 Vet. App. 221, 225 (2018). The Veteran’s reopened claim of service connection for posttraumatic stress disorder (PTSD) was received on July 20, 2010. During the period on appeal the Veteran has continuously asserted that his depressive disorder results in familial, social, work, and mood impairment. With respect to specific symptomatology, the Veteran has reported sleep problems and flashbacks; all of which he is competent to report. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In a September 2010 psychological evaluation, a private licensed psychologist noted symptoms of depressed mood; shock; distress; overwhelming survivor-guilt; recurrent, intrusive, and distressing recollections; nightmares; psychological distress at exposure to triggers; physiological and psychological reactivity upon exposure to internal and external cues; rapid heartbeats; sweaty palms; shortness of breath; tightness in chest; avoidance of people and close relationships; feelings of detachment and estrangement from others; a range of affect, which was restricted to apathy, sadness, or anger; a sense of a foreshortened future; strong irritability and outbursts of anger; exaggerated startle response; difficulty falling and staying asleep; depressed mood; sadness; anergia; withdrawal; nervousness; and psychomotor agitation. The psychologist indicated that the Veteran appeared anxious, sad, and with some difficulty maintaining eye contact. There was evidence of frustration and agitation. The psychologist further indicated that the Veteran appeared oriented to time, person, and place; and with speech in a soft volume and tone; hesitant and interrupted vocal characteristics; and sad affect and generally anxious, apathetic, and dysphoric. The Veteran reported experiencing some difficulty concentrating. His long term, remote, and immediate memory appeared grossly intact, but impacted by emotion. He reported experiencing mild difficulties with both short and long-term memory. The psychologist noted that the Veteran evidenced a limited number of thoughts, which appeared somewhat slowed, except when he was anxious; his judgment was significantly impacted by emotion; and his anxiety and dysphoria appeared to interfere with his ability to reflect clear, logical, and goal-directed thoughts. The Veteran reported a normal temper and denied suicidal ideation. The Veteran further reported being married since 1993. The psychologist indicated that the Veteran’s condition impaired his ability to work; and impacted his family relations, judgment, thinking, mood problems, and his increasingly disrupted ability to sustain emotional control. The psychologist further indicated that his then-current condition put him and others at risk in his then-current capacity. A June 2011 VA clinical psychologist noted a diagnosis of anxiety disorder not otherwise specified. The psychologist noted symptoms of recurrent and intrusive distressing recollections of the event; intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event; efforts to avoid thoughts, feelings, or conversations associated with the trauma; efforts to avoid activities, places, or people that arouse recollections of the trauma; markedly diminished interest or participation in significant activities; feeling of detachment or estrangement from others; difficulty falling or staying asleep; difficulty concentrating; and the symptoms causing significant distress or impairment in social occupational, or other important areas of functioning. The Veteran reported symptoms of sleep disturbance; panic attacks; occasional concentration issues; self-esteem difficulties; occasionally hopeless; depression; and emotional outbursts. He denied homicidal and suicidal thoughts; hallucinations; delusions; inappropriate behavior; obsessive/ritualistic behavior; impulse control; episodes of violence; and having any problem with activities of daily living. The Veteran reported a positive relationship with his wife and good relationships with his two children. The Veteran appeared with lethargic psychomotor activity; labored speech; flat affect; dysphoric mood; a short attention span; clear thought process; worrying and ruminative thought content; but average intelligence. He was oriented to person, time, and place. He understood the outcome of behavior and that he had a problem. The psychologist noted that the Veteran’s anxiety and depressive symptoms affected his mood and sleep mildly and that his mental disorder symptoms were not severe enough to interfere with occupational and social functioning. The Veteran reported that he was self-employed and worked at least 40 hours a week. He indicated having a positive marriage, although noting marital problems; good work performance; social outlets; and hobbies. The Veteran indicated that he handled bills and was capable of managing financial affairs. The psychologist noted that there was some exaggeration with deliberate attempts to present unfavorably. In an April 2015 mental disorders (other than PTSD and eating disorders) disability benefits questionnaire (DBQ), a private psychologist noted a diagnosis of unspecified anxiety disorder. The Veteran reported being married since 1993 and having two adult children. He further reported being socially isolated and withdrawn. He indicated working as a self-employed repairman. The Veteran reported symptoms of depressed mood; anxiety; suspiciousness; panic attacks that occur weekly or less often; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; chronic sleep impairment; mild memory loss; flattened affect; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty adapting to stressful circumstances, including work or a worklike setting; and an inability to establish and maintain effective relationships. The Veteran appeared with normal attention; variable concentration; normal speech flow; appropriate thought content; goal-directed thoughts; average intellectual abilities; average capacity for abstraction; average ability to interpret proverbs; average judgment; anxious and nervous mood; and restricted affect. The Veteran complained of increased difficulty in short-term memory. He indicated that his depression was problematic in that he felt down and didn’t want to talk to anyone. The psychologist indicated that the Veteran became upset during the interview and cried. The Veteran reported that he found it difficult at times to interact positively with others due to his anxiety and irritability issues. There was no report of hallucinations. He was able to manage his financial affairs. The psychologist indicated that the Veteran had occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood. The psychologist further indicated that it would be burdensome on any employer to expect accommodation and job flexibility to address the Veteran’s psychiatric needs and that he could not maintain structured employment schedule. In a December 2018 mental disorders (other than PTSD and eating disorders) DBQ, a VA psychiatrist diagnosed unspecified anxiety disorder. The Veteran reported that he did handywork once a week and, prior to that, he worked in construction until 2014. However, he reported difficulty dealing with people and had arguments. He further reported being socially isolated and withdrawn. He indicated working as a self-employed repairman. The Veteran reported symptoms of depressed mood; anxiety; suspiciousness; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; chronic sleep impairment; flattened affect; difficulty in establishing and maintaining effective work and social relationships; and difficulty adapting to stressful circumstances, including work or a worklike setting. The Veteran appeared well-groomed; casually dressed; oriented to person, place, and time; cooperative; and with good eye contact; rapport; normal speech for rhythm, rate, and volume; depressed and anxious mood; constricted affect; linear, logical, and goal-directed thought processes; and intact insight, judgment, and reasoning. He denied suicidal and homicidal ideations. There was no evidence of any perceptual disturbances, paranoia, or delusional thinking. He was capable of managing his financial affairs. The psychiatrist indicated that the Veteran had occupational and social impairment with occasional decrease in work efficiency and intermittent periods of ability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. The psychiatrist further indicated that the Veteran performed activities of daily living independently; engaged in a normal conversation; had good self-care; and had limitations regarding social areas, with self-report of increased anxiety and irritability when surrounded by other people, but not to the point of totally impairing him. In a June 2019 mental disorders (other than PTSD and eating disorders) DBQ, a private psychologist noted a diagnosis of unspecified anxiety disorder. The Veteran reported being married since 1993 and having two adult children. He further reported being socially isolated and withdrawn. He indicated working part-time as a handyman. The Veteran reported symptoms of depressed mood; anxiety; suspiciousness; panic attacks that occur weekly or less often; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; chronic sleep impairment; mild memory loss; impairment of short and long term memory; flattened affect; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty adapting to stressful circumstances, including work or a worklike setting; an inability to establish and maintain effective relationships; suicidal ideation; and impaired impulse control. The Veteran appeared with normal attention; variable concentration; normal speech flow; appropriate thought content; goal-directed thoughts; average intellectual abilities; average capacity for abstraction; average ability to interpret proverbs; average judgment; anxious and nervous mood; and restricted affect. The Veteran complained of increased trouble with his short-term memory. There was no report of hallucinations. He was capable of managing his financial affairs. The psychologist indicated that the Veteran’s anxiety disorder and social impairment were emotionally debilitating. The Veteran reported that his ability to handle stress and interact with employees and customers became apparent in 2013 and he lost his patience and tolerance for everything. He indicated that years of sleep deprivation and built-up stress finally “broke me.” The psychologist indicated that the Veteran had occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood. There is no evidence that the VA and private examiners are not competent and credible. As all reports noted the Veteran’s subjective reports of his symptoms and their effect on his social and occupational functioning and were based on objective psychiatric evaluations. Each is probative concerning the type and severity of the Veteran’s symptoms, as well as his overall level of social and occupational impairment, at the time they were conducted. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). In a May 2019 letter, the Veteran’s wife described the Veteran stating that he struggled with anxiety and interacting with people, had a “short fuse,” and isolated himself due to anxiety. She also stated that he focused on “the negative” and had to have everything scheduled out and organized or else he could not function and would get frustrated. She reported that while sleeping, he would toss and turn all night and would only sleep for a few hours at a time and often had nightmares, which made him tired and exhausted during the day. She indicated that he occasionally had panic attacks, when he would start sweating, shaking, and struggle to breathe. She also explained that he struggled with memory problems and he missed and/or forgot appointments. She described his anger, which caused him to become combative and aggressive for no reason, lashing out at others, and that he had no empathy. She explained that he would work two to three days a week for a couple of hours to keep him occupied and to just feel productive, and after would run to relieve anxiety and frustration. She stated that he would only take small jobs he could do alone, which also helped him cope with his mental health symptoms. She noted that sometimes he would get jobs mixed up and go to the wrong house. Further, she stated that he had his own contract company before he retired but his anger interfered with him being able to have patience for his labor crew. Given these facts, the Board finds that a 70 percent rating during the period on appeal, is warranted for the Veteran’s anxiety disorder not otherwise specified. 38 C.F.R. § 4.7. See Hart v. Mansfield, 21 Vet. App. 505 (2007). The September 2010 psychologist indicated that the Veteran’s increasingly disrupted ability to sustain emotional control significantly impacted his judgment and his ability to reflect clear, logical, and goal-directed thoughts. The psychologist further indicated that his then-current condition put him and others at risk in his then-current capacity. The April 2015 and June 2019 psychologist indicated that the Veteran had near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; difficulty adapting to stressful circumstances, including work or a worklike setting; an inability to establish and maintain effective relationships; suicidal ideation; and impaired impulse control. Specifically, the Veteran’s anxiety and depression symptoms worsened resulting in the Veteran’s increased difficultly interacting positively with others. The Veteran reported that his anxiety and irritability issues began affecting his employment in 2013. The December 2018 VA examiner noted increased anxiety and irritability when surrounded by other people, but not to the point of totally impairing him. The Veteran, however, does not warrant a higher disability rating. Although the Veteran demonstrates signs and symptoms of total occupational impairment, he does not demonstrate signs and symptoms of total social impairment such as gross impairment in thought or communication, persistent delusions or hallucinations, grossly inappropriate behavior, intermittent inability to perform activities of daily living, disorientation to time or place, or severe memory loss. The Veteran does not appear to be a persistent threat to others or himself. He has made no attempt to commit suicide and there is no evidence to support that he has ever had a plan to commit suicide. Although the Veteran indicated his marital problems with his wife, they have been married since 1993. Additionally, staged ratings are not warranted, as the Veteran has had a relatively stable level of symptomatology throughout the appeal. Any other increases in severity were not sufficient for a higher rating. See Fenderson, 12 Vet. App. at 126–27. 2. Entitlement to a TDIU rating. VA regulations allow for the assignment of TDIU when a Veteran is unable to secure or follow a substantially gainful occupation due to service-connected disabilities, and the Veteran has certain combinations of ratings for service-connected disabilities. If there is only one such disability, that disability must be ratable at 60 percent or more. If there are two or more disabilities, there must 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). Disabilities of one or both upper or extremities or one or both lower extremities (to include the bilateral factor), disabilities resulting from a common etiology or a single accident, and disabilities affecting a single body system (such as orthopedic disabilities) are considered as one disability for TDIU purposes. Id. The central inquiry is “whether a Veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability.” Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Consideration may be given to the Veteran’s education, special training, and previous experience, but not to his or her age or to the impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19; see also Van Hoose v. Brown, 4 Vet. App. 361 (1993). The Veteran’s only service-connected disorder is 70 percent for anxiety disorder not otherwise specified. The Veteran contends that he is unable to maintain substantially gainful employment due to his service-connected anxiety disorder not otherwise specified. The Veteran indicated that he completed one year of college and vocational technical school. He further indicated working in construction since 1994 and that he stopped working full-time in 2014. In the September 2010 psychological evaluation, the Veteran indicated that he started his own construction company in 1995 and was self-employed. He further indicated that he experienced difficulty in occupational settings. He explained that he barely slept and that it effected the rest of his days. In the June 2011 VA examination, the psychologist noted that the Veteran’s anxiety and depressive symptoms affected his mood and sleep mildly and that his mental disorder symptoms were not severe enough to interfere with occupational and social functioning. The Veteran indicated having good work performance, social outlets, and hobbies. The Veteran reported that he was self-employed and worked at least 40 hours a week. He denied missing work. He indicated working to excess and admitted to work stress with some difficult customers, but he indicated being able to walk away from stress. He denied problems that would place him at risk. In the April 2015 mental disorders DBQ, the Veteran indicated working as a self-employed repairman. He reported owning his own business and having a large crew working on building projects. He indicated that as he started having problems with sleep, concentration, and focus that he made poor business decisions. He described his decision-making process being impaired and he found his distraction lead to many on-the-job injuries. The psychologist indicated that the Veteran struggled sustaining the stress from a competitive work environment due to his anxiety disorder. The Veteran reported being self-employed and did not take jobs when he did not feel up to it. He reported making limited income from his repairman work and that he worked two- or three-days weekly for a period of four to five hours on those days he was able to work. He indicated that he could not sleep, so on days when he was not rested, he would not work and that he had to downsize his job. He reported often having to reschedule jobs or cancel work projects secondary to chronic anxiety, stress, irritability, and lack of sleep. Additionally, he reported that his psychiatric symptoms preclude interpersonal relationships with others in that he got in too many fights with coworkers. The psychologist indicated that the Veteran must work in an isolated environment without coworkers. The psychologist indicated that the Veteran had occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood. The psychologist further indicated that it would be burdensome on any employer to expect accommodation and job flexibility to address the Veteran’s psychiatric needs and that he could not maintain structured employment schedule based on his frequent yet unpredictable bouts of anxiety and irritability. In an April 2015 medical opinion on service connected impairments, a psychologist indicated that the Veteran would miss three or more days per month due to mental problems; would need to leave early from the workplace three or more days per month due to mental problems; and would have trouble with concentration more than three days per month and would not stay focused for at least seven hours of an eight-hour workday. The psychologist further indicated that if the Veteran were subjected to the normal pressures and constructive criticisms of a job, he would respond inappropriately more than once per month in an angry manner, but would not actually become violent. In a December 2018 mental disorders (other than PTSD and eating disorders) DBQ, the Veteran reported that he did handywork once a week and prior to that he worked in construction until 2014; however, he had issues dealing with people and arguments. He indicated working as a self-employed repairman. He admitted to work stress with some difficult customers, but indicated that he was able to walk away from stress and denied problems that would place him at risk. The psychiatrist indicated that the Veteran had occupational and social impairment with occasional decrease in work efficiency and intermittent periods of ability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. The psychiatrist further indicated that the Veteran had limitations regarding social areas, with self-report of increased anxiety and irritability when surrounded by other people, but not to the point of totally impairing him. The psychiatrist indicated that the Veteran’s work history showed an ability to stay in a gainful working environment despite suffering symptoms of anxiety and noted that the Veteran did not have any history of being terminated or inpatient psychiatric hospitalizations. The June 2019 mental disorders examination is reported above. However, as to his employability, the psychologist indicated that the Veteran struggled sustaining the stress from a competitive work environment due ot his anxiety disorder. The Veteran reported that his ability to handle stress and interact with employees and customers became an issue in 2013 and he lost his patience and tolerance for everything. He indicated that years of sleep deprivation and built-up stress finally “broke me.” He further indicated that dealing with depression, partly due to his lack of sleep, was constantly aggravated over small things and that depressed him more. The Veteran indicated that he worked alone and refused to hire help, had to interact with homeowners so he would take on jobs that last an hour to two so he did not have to interact with people for long periods of time. He further indicated attempting to keep the socializing to a minimum, so he did not get upset by anything that was said as he gets upset easily. He indicated that if he does not feel well, he will reschedule a job. He further indicated that he does not plan many jobs at a time, giving himself plenty of flex time when he tells a homeowner how long it will be before he can get the job done. The Veteran indicated that he cannot work with anyone else and that it was an issue when he had his own company and it got to a point that he could not get along with anyone. He further indicated that he found himself always on edge and lashed out at others. He indicated that having someone around him while he works makes him more irritable and that he feels better when he is productive, so working alone, part-time helps with his anxiety and depression. The Veteran reported not getting enough restful sleep and feeling fatigued nearly every day which would be a safety issue in the workplace. He reported difficulty remembering events, requests, and occasionally forgetting details or sequencing that would affect his employment. He further reported difficulty maintaining and sustaining a steady mood and that his inconsistent mood leads to problems in his social and work life. He reported that he has not been able to have meaningful occupational or social relationships and believes that he could not let others into his life because of trust issues. He further reported that he feels nervous and worried and struggles with ongoing anxiety issues; and the psychologist indicated that this sort of anxiety is a safety hazard on the job. The psychologist indicted that with poor interpersonal skills and workplace trust issues, the Veteran would have an increase in paranoia and would struggle with appropriate work interaction. The psychologist further indicated that the Veteran has physical signs of depression that interfere in daily work as these signs manifest as extreme fatigue, hypersomnia, appetite issues, weight fluctuation, and emotional outbursts. Additionally, suicidal ideation causes problems within the workplace through a manifestation of fatigue and lack of concentration. The psychologist indicated that individuals with higher distractibility, absenteeism, and emotional turmoil could be deemed as inappropriate in the workplace. The Board will grant a total rating based on the benefit-of-the-doubt doctrine. Therefore, a TDIU is warranted and the claim is granted. Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. McLendon, 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.