Citation Nr: 20046970 Decision Date: 07/14/20 Archive Date: 07/14/20 DOCKET NO. 16-52 133 DATE: July 14, 2020 ORDER 1. Entitlement to an initial disability rating in excess of 30 percent for anxiety disorder and other specified trauma related disorder is denied. 2. Entitlement to a total disability rating based upon individual unemployability (TDIU) due to anxiety disorder and other specified trauma related disorder is denied. FINDINGS OF FACT 1. For the entire period on appeal, the Veteran’s service-connected anxiety disorder and other specified trauma related disorder was not manifested by occupational and social impairment with reduced reliability and productivity. 2. For the entire period on appeal, the Veteran has not been precluded from securing or following a substantially gainful occupation due to the service-connected anxiety disorder and other specified trauma related disorder. CONCLUSIONS OF LAW 1. The criteria for an initial disability rating in excess of 30 percent for anxiety disorder and other specified trauma related disorder have not been met for any period on appeal. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.126, 4.130, Diagnostic Code (DC) 9413 (2019). 2. The criteria for a TDIU rating due to anxiety disorder and other specified trauma related disorder have not been met for any period on appeal. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from March 1964 to March 1966. These matters were previously remanded by the Board in December 2017 for additional development, including a VA psychiatric examination, obtaining outstanding VA treatment records, and to adjudicate the issue of TDIU due to the Veteran’s psychiatric disability along with all other service-connected disabilities. The Board notes that the requested development was completed concerning the psychiatric claim, and it is properly returned to the Board for adjudication. Concerning the TDIU claim, the Board notes that the March 2018 supplemental statement of the case (SSOC) documents that the RO limited its discussion of relevant evidence and substantive consideration to whether TDIU was warranted based solely upon occupational impairment due to the Veteran’s psychiatric claim. Notably, however, the Veteran’s most recent TDIU application, received by VA in March 2018, asserts that he is precluded from securing or following substantially gainful employment due to all of his-service connected disabilities. Given the above, the Board will limit its consideration herein to whether a TDIU is warranted due to the Veteran’s psychiatric disability alone, as this has been properly developed and previously adjudicated by the RO. However, the Board notes that it remains for the RO to properly develop and adjudicate whether a TDIU rating is warranted based on all of the Veteran’s service-connected disabilities, as previously directed within the December 2017 Board remand and asserted by the Veteran within his March 2018 TDIU application. 1. Entitlement to an initial disability rating in excess of 30 percent for anxiety disorder and other specified trauma related disorder. Disability evaluations are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. Whether the issue is one of an initial rating or an increased rating, separate ratings can be assigned for separate periods of time based on the facts found, a practice known as “staged” ratings. Regarding the Veteran’s initial rating claim on appeal, the Board has considered whether any additional staged ratings periods are warranted. The Veteran’s service-connected anxiety disorder and other specified trauma related disorder is currently rated as 30 percent disabling from December 12, 2012 under DC 9413 of the General Rating Formula for Mental Disorders. Under the applicable rating criteria, a 30 percent disability rating 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). A 50 percent disability rating is warranted when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped, speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. A 70 percent disability rating is warranted 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. Finally, a 100 percent disability 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. When determining the appropriate disability evaluation to assign, the Board’s primary consideration is a veteran’s symptoms, but it must also make findings as to how those symptoms impact a veteran’s occupational and social impairment. The use of the term “such as” in the rating criteria demonstrates that the symptoms after that phrase 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. Thus, the Board need not find the presence of all, most, or even some, of the enumerated symptoms to award a specific rating. Nevertheless, all ratings in the general rating formula are also associated with objectively observable symptomatology and the plain language of the regulation makes it clear that the Veteran’s impairment must be “due to” those symptoms. A Veteran may only qualify for a given disability rating by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. In Golden v. Shulkin, 29 Vet. App. 221 (2017), the United States Court of Appeals for Veterans Claims (Court) held that since the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) abandoned the Global Assessment of Functioning (GAF) scale and VA has formally adopted the DSM-5, GAF scores are inapplicable to assign a psychiatric rating in cases where the DSM-5 applies when the appeal was certified after August 4, 2014. Because the current appeal was certified to the Board in November 2016, the Board will not rely on GAF scores herein when considering the merits of the Veteran’s initial rating claim. To the extent that the Veteran’s representative has asserted within various submissions that the Veteran’s GAF scores warrant an increased rating for any period on appeal, the Boards that such assertions are of no probative value in light of the above. As discussed below, and following a review of the evidence of record, the Board finds that the preponderance of the evidence is against the Veteran’s claim of entitlement to an initial disability rating in excess of 30 percent for anxiety disorder and other specified trauma related disorder. Turning to the evidence of record following the Veteran’s December 12, 2012 psychiatric claim, a VA psychiatric examination in November 2013 documents a diagnosis of anxiety disorder, not otherwise specified (NOS). The examiner commented that the Veteran’s current mental health symptoms were moderate in severity and resulted in moderate functional impairment. He maintained few meaningful interpersonal relationships, but continued to engage in enjoyable leisure activities. He did not endorse any history of mental health-related occupational concerns. The examiner specifically stated that the Veteran’s anxiety disorder, with psychiatric symptoms including depressed mood, anxiety, suspiciousness, chronic sleep impairment, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships, 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. Regarding his social history, the Veteran continued to live with his wife of 45 years and noted that they were “still together” despite a relationship that “gets a little testy sometimes.” The Veteran reported positive relationships with his children and grandchildren, and stated that his grandchildren would come visit on the weekend or after school, but he denied any current friendships. He reported enjoying leisure activities including watching professional sports on television, swimming three to four times per week, and walking his two dogs. Regarding his occupational history, the examiner noted that the Veteran had previously retired from a 28-year career with Emerson Electric in 2005. Regarding his decision to retire, the Veteran stated that he was having “some problems at work” for several years with what he viewed as unfairness when others were promoted and he was not; however, the examiner again wrote that the Veteran reported no history of serious occupational concerns. Upon subsequent VA psychiatric examination in April 2015, the examiner identified the Veteran’s diagnosis as other specified trauma related disorder, previously identified as anxiety disorder, NOS. The examiner noted that the Veteran’s psychiatric symptoms of anxiety and chronic sleep impairment 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. The Veteran reported that he and his wife had been married for 47 years but noted that they continued to sleep in separate bedrooms, which he perceived was initially related to his prostate surgery, but had continued since 2007, given his ongoing avoidance of news programs that his wife enjoyed watching. Notably, he reported that he continued to have close relations with his wife, children, and grandchildren who lived nearby and that he visited with his son’s children regularly and his daughter’s children approximately once per week. However, he denied any other current friendships but stated that he visited the pool four days per week for exercise but otherwise stayed at home given his neighborhood tendency toward violence – he noted that there were regular shootings and that his truck had a hole shot in the hood. He denied any employment since the prior November 2013 examination and reported minimal activities or interests outside of visiting the pool and spending time with his dogs and grandchildren. Upon mental status examination, the Veteran appeared appropriately dressed and responded appropriately throughout the examination. There were no obvious difficulties observed with speech, concentration, gait, orientation, or fund of knowledge. A September 2016 VA mental disorders examination documented the Veteran’s mental health diagnosis of other specified trauma-related disorder. The examiner noted that the Veteran continued to endorse several trauma-related symptoms which caused him significant distress and functional impairment, and concluded that his psychiatric symptoms of anxiety, suspiciousness, chronic sleep impairment, and difficulty in establishing and maintaining effective work and social relationships 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. Regarding his social history, the Veteran reported that he continued to live with his wife and stated that their relationship was “much better” lately, though they continued to sleep in different bedrooms because it was more comfortable. He reported a good relationship with his son and grandchildren and that he got together with his son every two weeks, but stated that he did not hang out with anybody. He reported having one close friend in the past that he would spend time with at each other’s homes but that friend passed away over two years ago. He noted that in his free time he would walk his dog and continued to swim at the city pool at least three to four times per week. The examiner stated that the Veteran’s report of activities and social functioning was fairly consistent with the report he gave at the time of the most prior VA examination. Regarding his occupational history, the Veteran stated that he had not worked outside of the home since his retirement. VA treatment records indicated that the Veteran continued to receive ongoing mental health care, although in June 2016, he elected to discontinue medication management services as he felt he was not in need of psychotropic medications. He had also participated in group psychotherapy services through the PTSD Clinic in the past and had completed a total of three time-limited groups, including Coping with Combat (a psychoeducational group regarding posttraumatic symptomology and coping), Depression & Combat PTSD (a group addressing ways of dealing with depressive and posttraumatic symptoms), and Sleep & Combat PTSD (a group with a goal of improving sleep quality/duration and reducing frequency and severity of trauma-related nightmares). The Veteran reported a desire to participate in further groups, but also noted that he found these groups to be emotionally difficult. A February 2017 Residual Functional Capacity Evaluation completed by Heather Henderson-Galligan, Ph.D., documents her conclusions that the Veteran would miss three or more days of work per month due to mental problems, that he would need to leave early from the workplace because of mental problems three or more days per month, that he would not be able to stay focused to complete simple repetitive tasks and that more than three days per month he would not stay focused for at least seven hours of an eight-hour workday, and that if the Veteran were subjected to the normal pressures and constructive criticism of a job, he would respond inappropriately more than once per month in an angry manner but would not actually became violent. Concurrently, Dr. Henderson-Galligan completed a February 2017 mental health disorders disability benefits questionnaire (DBQ) which documented the Veteran’s diagnosis of unspecified anxiety disorder and other specified trauma and stressor-related disorder. She concluded that his psychiatric symptoms, including depressed mood; anxiety; suspiciousness; near-continuous panic or depression affecting the ability to function independently, appropriately, or effectively; chronic sleep impairment; mild memory loss, such as forgetting names, directions, or recent events; 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; inability to establish and maintain effective relationships; and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene, resulted in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood. Regarding his social history, the Veteran reported that he continued to live at home with his wife and was otherwise socially isolated and withdrawn. Regarding his occupational history, the Veteran reported that his longest and last job was as a security supervisor for Emerson Electric, where he worked for 28 years until 2015. Regarding mental health treatment, the Veteran denied taking any medication for mental health due to too many side effects but he reported seeing a VA doctor every three to four months, a therapist once a week, and currently attended VA group therapy. He denied any legal, behavioral, or substance abuse history. Upon mental status examination, he displayed an anxious mood with restricted affect, normal attention, with variable concentration, and impaired short-term memory, which he reported as a struggle to remember basic information. His speech was normal and thought content was appropriate, with organized thoughts. He denied any hallucinations and displayed average knowledge and intellect. A March 2017 private opinion from Dr. Homer Skaggs, MD, concluded that the Veteran’s service-connected impairments more likely than not have rendered him unable to maintain gainful work in any employment base for several years, and that based on the severity and frequency of his symptoms and limitations, he is not expected to make a substantial recovery to the point of being able to return to work in any facet. Similarly, an April 2017 private opinion by Dr. Stephanie G. Barnes found the Veteran has “a combination of physical and emotional conditions which interact in terms of severity level” and his major limitation was “mental and physical activity involved in sustaining work.” She concluded that the Veteran is totally and permanently precluded from performing work at a substantial gainful level due to the severity of his service-connected prostate cancer, anxiety disorder NOS and other specified trauma and stress-related disorder, Non-Hodgkin’s lymphoma, diabetes mellitus type II, hypothyroidism, compression neuropathy and bilateral upper extremities, and the record supports this finding as far back as the date of filing. The most recent March 2018 VA Mental Disorders examination report documents the examiner’s finding that the Veteran’s other specified trauma-related disorder, with psychiatric symptoms including anxiety, chronic sleep impairment, disturbances of motivation and mood, ongoing emotional reactivity to trauma triggers, avoidance of some trauma triggers and of thoughts/feelings related to traumatic events, and apparent hypervigilance, 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. Regarding his social history, the Veteran reported that he continued to reside with his wife of 48 years and that his marital relationship was positive, with his wife functioning as his caretaker and handling all household responsibilities. He also reported a “pretty good” relationship with his children and visits with his grandchildren. He noted that he used to walk his dog but now did so less frequently due to arthritis in his right hip and hands. He reported trying to engage in some physical activity daily and noted that he continued to go to the pool three to four days per week “to keep [his body] moving.” He reported that in addition to his arthritis, he sustained damage to both shins in a car accident about one year before. He reported that he would read the paper or watch television but stated that his wife managed the bill payments and shopping for the household. He stated that he was too forgetful to handle the finances, and when asked to provide examples of his forgetfulness, he noted that on two consecutive days over the past week, he forgot to turn off the outdoor faucet, and in the past noted that he was inconsistent with taking his medications due to forgetfulness, although he had been better about this of late. He reported that he chose not to use a computer due to his belief that the unfamiliarity of the task would overwhelm him, but also noted that he was able to successfully utilize a computer at work prior to his retirement. Regarding his occupational history, and in particular his historical occupational functioning and what led to his decision to retire, the Veteran stated that he was “very dependable” and “good [at] doing the job,” though he stated that towards the end of his employment, when he was working as a supervisor and manager, he became increasingly tired and that coworkers had on occasions caught him nodding off, which led him to retire for fear of endangering his pension. He also reported that he drove a school bus part-time towards the end of his career at Emerson and stated that this job was stressful because the children would get into conflicts. He denied any further history of noteworthy occupational difficulties or trouble getting along with others at work and stated that he believed he was a good worker, which was the reason he was promoted throughout his career. When directly asked what led to his decision to file a claim for unemployability, the Veteran reported that his attendance at PTSD groups reminded him of what he had gone through, and when asked what it is that he feels renders him unable to work, he discussed his reluctance to use and understand technology, including the computer and phone. Based upon a review of the record, including as discussed above, the Board concludes that while the evidence of record documents some impairment resulting from the Veteran’s service-connected anxiety disorder and other specified trauma related disorder, the preponderance of evidence is against a finding that the Veteran’s psychiatric disorder has resulted in occupational and social impairment with reduced reliability and productivity for the entire period on appeal. In order to warrant an increased 50 percent disability rating, the Veteran’s service-connected psychiatric symptoms would need to result in 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. Significantly, in each of the November 2013, April 2015, September 2016, and March 2018 VA examination reports throughout the appeal period, when the examiners were asked which of the following criteria best summarized the Veteran’s level of occupational and social impairment, each examiner checked “occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although he was generally functioning satisfactorily, with normal routine behavior, self-care, and conversation,” which is the specific criteria for a 30 percent disability rating. While the adjudicator makes the determination of what evaluation is warranted for the service-connected psychiatric disorder, the consistent conclusion by multiple VA examiners throughout the appeal period that the Veteran’s psychiatric disorder was best summarized by the criteria described under the 30 percent disability rating is evidence against a finding that the Veteran’s psychiatric disorder has resulted in occupational and social impairment with reduced reliability and productivity for any period on appeal. The Veteran has positive relationships with his wife, his two children, and his four grandchildren. He reported his children come to see him and his wife on the weekend, and he sees his son every two weeks. This is evidence against social impairment with reduced reliability and productivity and evidence against difficulty in establishing and maintaining effective relationships. In reading through the examination reports and the VA treatment records, the Veteran answered questions appropriately, which is evidence against circumstantial, circumlocutory, or stereotyped speech. The Veteran has not reported experiencing panic attacks throughout the appeal period. The preponderance of the evidence is against the Veteran’s overall occupational and social impairment being indicative of reduced reliability and productivity. To the extent that the February 2017 Residual Functional Capacity Evaluation from Dr. Henderson-Galligan would appear to warrant an increased disability rating, the Board finds that the conclusions made in this report are of lessened probative value, as the conclusions contained therein are not supported by a rationale or reference to other evidence of record. They are also inconsistent with other evidence of record, including the VA psychiatric examinations discussed above. For example, Dr. Henderson-Galligan checked the box that the Veteran’s symptoms were indicative of “inability to establish and maintain effective relationships.” She also wrote the Veteran was “socially isolated and withdrawn.” It is unclear from what facts she based these conclusions, when the Veteran has been married for more than 45 years and has consistently expressed having positive relationships with his wife, his two children, and their four grandchildren throughout the appeal period. Additionally, she wrote that the Veteran remarked he could no longer enjoy the simplest of activities. However, throughout the appeal period, the Veteran has reported he “greatly enjoys” watching professional sports on television, and, in 2018, he reported he and his son watch sports together. He has been swimming for exercise throughout the appeal period. In November 2013, the Veteran reported swimming was the “best medicine” for him, and in April 2015, he told the examiner that swimming was his “greatest joy” and reiterated that it was his “medicine.” In September 2016, he reported he liked to swim and would try to go to the city pool three to four times a week. He also reported he liked watching football. At the time of the March 2018 examination, the Veteran reported he continued to go to the pool three to four times a week and would work out at a gym. 2019 VA treatment records document the Veteran is reporting that he is still swimming multiple times a week and going to the gym. This is not consistent with a finding that he cannot enjoy simple activities. Dr. Henderson-Galligan also wrote that the Veteran had near-continuous panic or depression affecting his ability to function effectively and intermittent inability to perform activities of daily living including maintenance of minimal personal hygiene. As to the former clinical finding, that finding is not supported by the evidence. As noted above, the Veteran has not reported experiencing panic attacks throughout the appeal period. Additionally, he has not reported continuous depression. For example, in April 2013, he denied depression and anxiety. In November 2016, when it asked about “depression,” the response was “No.” In April 2017, the examiner documented there was no “anxiety, depression.” In May 2017, when it asked about “depression,” the response was “No.” A July 2017 depression screen was positive, but then was negative in September 2017 and again in February 2018. In October 2017 and May 2018, when asked about “depression,” the response was “No.” In July 2018, the examiner documented that the Veteran denied “anxiety, depression.” A depression screen in January 2020 was negative. These facts refute the description by Dr. Henderson-Galligan of near continuous panic or depression. As to the latter finding of minimal personal hygiene, the VA treatment records and the examination reports do not support his clinical finding. None of the VA examiners documented hygiene concerns, and the VA treatment records also do not document hygiene concerns, which the Board finds is indicative of this not being a concern, as it likely would have been documented in the record. Additionally, someone who swims four times a week and goes to a gym is unlikely to have hygiene problems, when this is someone who cares about keeping fit. Thus, while Dr. Henderson-Galligan stated that the Veteran’s psychiatric symptoms included those contained within the rating criteria for an increased disability rating, such as near-continuous panic or depression affecting the ability to function independently, appropriately, or effectively; 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; inability to establish and maintain effective relationships; and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene, the Board finds that the preponderance of the evidence is against this level of symptomatology for the reasons described above. Dr. Henderson-Galligan noted that the Veteran remained married and committed to his wife of many years, and, although he lacked other friendships, the Veteran reported that he continued to engage with others, including his VA doctor every three to four months, a therapist once a week, and current attendance at VA group therapy. This is evidence against severe social impairment and is against the inability to establish and maintain effective relationships. Additionally, there is no probative evidence that the Veteran experienced near-continuous depression or panic attacks that prevented him from functioning independently, as the Veteran himself did not report this while seeking treatment or during the VA examinations during the appeal period. The Veteran’s reported attendance of multiple forms of treatment are also evidence which weigh against this finding; moreover, he reported that he continued to walk his dog and swim without the assistance of others. As such, the February 2017 evaluation and private opinion by Dr. Henderson-Galligan does not establish a credible basis to warrant an increased disability rating, as the preponderance of the evidence is against the clinical findings she documented in her report and opinion. Similarly, the March 2017 private opinion from Dr. Homer Skaggs, and the April 2017 private opinion by Dr. Stephanie G. Barnes have also been considered by the Board; however, they do not weigh in favor of an increased rating for the Veteran’s psychiatric disability, as they attribute the Veteran’s resulting occupational impairment to all of his service-connected impairments, rather than solely to his psychiatric disability. The Board has also considered an article submitted by the Veteran from the Journal of Mental Health Policy and Economics in 2000 entitled, “The Civilian Labor Market Experiences of Vietnam-Era Veterans: The Influence of Psychiatric Disorders.” The article and resulting study found that PTSD significantly lowered the likelihood of working and, for those veterans who were working, their hourly wages. Additionally, other psychological diseases, in particular anxiety disorders and major depression, were found to have nearly as large an effect on employment rates as does PTSD. Notably, this article is of a generalized nature and does not apply to the particular facts of the Veteran’s case; therefore, it does not weigh in favor of an increased rating for his psychiatric disability. Moreover, the Board notes that the article admitted that “[p]sychiatric health may assume added importance in the labor supply decisions of veterans as opposed to the general population because of the availability of VA disability compensation.” The Board has also considered the relevant lay evidence of record, including the Veteran’s general lay statements asserting entitlement to an increased disability rating, and a December 2016 statement from the Veteran’s wife which reported that for the time they had known each other, and during their 48 years of marriage, the Veteran had always been irritable, anxious, and socially withdrawn. She noted that he did not want to be around people and had trouble sleeping at night. She reported that he had tried to work as a security guard, but that it did not last due to his anxiety and nervousness, and stated that she knew he would be unable to return to work. The Veteran’s anxiety, depressed mood, and chronic sleep impairment are contemplated by the 30 percent rating. While the Veteran’s wife wrote the Veteran did not want to be around people, the evidence shows he wants to be around her, their two children, and their four grandchildren. For all the reasons described above, the Board finds that the preponderance of the evidence is against entitlement to an evaluation in excess of 30 percent for the service-connected psychiatric disorder. Additionally, as the Veteran’s anxiety disorder and other specified trauma related disorder symptoms do not meet the rating criteria for an increased 50 percent disability rating for any period on appeal, it follows that his anxiety disorder and other specified trauma related disorder symptoms also do not meet the more severe rating criteria for an increased 70 or 100 percent disability rating for the entire period on appeal. Significantly, he has not shown the required severity of occupational and social impairment necessary for an increased 70 or 100 percent disability rating during the rating period, and his symptoms as a whole are not of similar severity, frequency, and duration as those particular symptoms associated with a 70 or 100 percent disability rating. In conclusion, the preponderance of the evidence is against the Veteran’s claim of entitlement to an initial disability rating in excess of 30 percent for anxiety disorder and other specified trauma related disorder, as his service-connected psychiatric disorder is not more closely approximated by occupational and social impairment with reduced reliability and productivity. As the preponderance of the evidence is against the Veteran’s claim, there is no reasonable doubt to be resolved, and the claim is denied. 2. Entitlement to a TDIU due to anxiety disorder and other specified trauma related disorder. As noted in the Introduction above, the Board will limit its consideration herein to whether a TDIU is warranted due solely to the Veteran’s service-connected psychiatric disability, while it remains for the RO to properly develop and adjudicate whether a TDIU rating is warranted based on all of the Veteran’s service-connected disabilities. A TDIU rating may be granted upon a showing that the Veteran is unable to secure or follow a substantially gainful occupation due solely to impairment resulting from his service-connected disabilities. There are minimum disability rating percentages that must be shown for the service-connected disabilities, alone or in combination, to even qualify for consideration for a TDIU award under the schedular criteria. Indeed, if there is only one such disability, it must be rated at 60 percent or more; if instead there are two or more disabilities, at least one disability must be rated at 40 percent or more, with sufficient additional disability to bring the combined rating to 70 percent or more. In determining whether a veteran is unemployable for VA purposes, consideration may be given to the veteran’s level of education, special training, and previous work experience, but not to age or any impairment caused by nonservice-connected disabilities. The central inquiry in determining whether a Veteran is entitled to a TDIU rating is whether service-connected disabilities alone are of sufficient severity to produce unemployability. The sole fact that a Veteran is unemployed or has difficulty obtaining employment is not enough; a high disability rating 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 can find employment. The ultimate question of whether a Veteran is capable of substantial gainful employment is not a medical one; rather, it is a determination for the adjudicator. A review of the record reflects that the Veteran’s combined disability rating during the relevant temporal period is 80 percent. As such, the Veteran meets schedular percent requirements for a TDIU for the entire period on appeal from December 12, 2012. However, following a review of the evidence of record, and as discussed below, the Board finds that the preponderance of evidence weighs against the Veteran’s claim of entitlement to a TDIU rating due to anxiety disorder and other specified trauma related disorder for the entire period on appeal. Within his February 2018 TDIU application, the Veteran asserted that “all” of his service-connected disabilities prevented substantially gainful employment. He reported that his disability affected full-time employment on May 30, 2005, which was also the date he reported that he last worked full-time and the date he became too disabled to work. He noted that the most he ever earned in one year was $28,000, in 2005 while working in security for Emerson Electric. Regarding his employment history, he reported working in security for Emerson Electric full-time from February 1990 to May 2005 and that he lost approximately 100 days during that time due to illness. His highest reported gross earnings per month was $2,300. He also reported employment at Ryder as a school bus driver for approximately 10 to 15 hours per week from January 2002 to January 2005, during which time he lost approximately 15 days from illness and reported his highest gross earnings per month were $400. Notably, the Veteran stated that he did not leave his last job because of disability and that he did not expect to receive disability or Workers Compensation benefits. Finally, he reported an educational history including four years of high school, without any additional education or training. A February 2017 private opinion from Dr. Heather Henderson-Galligan, Ph.D., HSPP, concluded that the Veteran cannot sustain the stress from a competitive work environment or be expected to engage in gainful activity due to his anxiety disorder and other specified trauma disorder and stressor related disorder. She stated that his chronic sleep impairment would be a safety issue in the workplace and that his impaired short-term memory would affect his employment. She wrote the Veteran had difficulty maintaining and sustaining a steady mood and this inconsistent mood leads to problems in his social and work life. She documented the Veteran 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 issues with trust. She documented the Veteran remarked that he felt nervous and worried and struggled with ongoing anxiety, which she wrote is a safety hazard on the job. She concluded that with poor interpersonal skills and workplace trust issues, the Veteran would have an increase in paranoia and would struggle with appropriate work interaction. She described the Veteran having physical signs of depression that interfered with daily work as these signs manifest as extreme fatigue, hypersomnia, appetite issues, weight fluctuation, and emotional outbursts. She noted that employers note higher distractibility, absenteeism, and emotional turmoil as inappropriate in the workplace. It was her opinion that the Veteran suffered from unspecified anxiety disorder and other specified trauma and stressor related disorder that prevented him from maintaining substantially gainful employment. The Board has laid out its reasons above for why it has accorded Dr. Henderson-Galligan’s opinion lessened probative value, as her description of the level of severity of the Veteran’s psychiatric disorder are not consistent with the other evidence of record, such as the multiple VA examinations of record which document the consistent finding from multiple VA examiners that the Veteran’s psychiatric disability results in no worse than occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although he was generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. This consistent conclusion by multiple VA examiners throughout the appeal period that the Veteran’s psychiatric disorder was best summarized by the criteria described under the 30 percent disability rating is highly probative evidence against a finding that the Veteran’s psychiatric disorder, especially when considered alone, has precluded him from securing or following a substantially gainful occupation for any period on appeal. As noted above, a March 2017 private opinion from Dr. Homer Skaggs, M.D., concluded that the Veteran’s service-connected impairments more likely than not have rendered him unable to maintain gainful work in any employment base for several years, and that based on the severity and frequency of his symptoms and limitations, he is not expected to make a substantial recovery to the point of being able to return to work in any facet. Similarly, an April 2017 private opinion by Stephanie G. Barnes found the Veteran has “a combination of physical and emotional conditions which interact in terms of severity level” and his major limitation was “mental and physical activity involved in sustaining work.” She concluded that the Veteran is totally and permanently precluded from performing work at a substantial gainful level due to the severity of his service-connected prostate cancer, anxiety disorder NOS and other specified trauma and stress-related disorder, Non-Hodgkin’s lymphoma, diabetes mellitus type II, hypothyroidism, compression neuropathy and bilateral upper extremities, and the record supports this finding as far back as the date of filing. The Board has considered these private opinions; however, they do not weigh in favor of a finding that the Veteran’s psychiatric disability alone precludes substantially gainful employment, as they each attribute the Veteran’s resulting occupational impairment to all of his service-connected impairments, rather than solely to his psychiatric disability. The Board has also considered the article submitted by the Veteran from the Journal of Mental Health Policy and Economics in 2000 entitled, “The Civilian Labor Market Experiences of Vietnam-Era Veterans: The Influence of Psychiatric Disorders.” The article and resulting study found that PTSD significantly lowered the likelihood of working and, for those veterans who were working, their hourly wages. Additionally, other psychological diseases, in particular anxiety disorders and major depression, were found to have nearly as large an effect on employment rates as does PTSD. As noted previously, this article is of a generalized nature and does not apply to the particular facts of the Veteran’s case; therefore, it does not weigh in favor of his TDIU claim. The Board has also considered the relevant lay evidence of record, including the Veteran’s general lay statements asserting an inability to work, and a December 2016 statement from the Veteran’s wife which reported that she knew he would be unable to return to work due to his psychiatric symptoms. While the lay statements of record of probative evidence insofar as they report observable symptomatology, the Board finds that their lay statements do not weigh in favor of a TDIU rating. Moreover, as discussed above, the Board has limited its consideration herein to whether the Veteran is precluded from substantially gainful employment due to his psychiatric disability alone, and the Veteran himself has asserted within his February 2018 TDIU application that “all” of his service-connected disabilities have prevented substantially gainful employment. Additionally, the Veteran’s report to the March 2018 VA examiner that he retired out of concern for endangering his pension after coworkers caught him dozing off on several occasions does not support that he retired due occupational impairment from his psychiatric disability Moreover, the Veteran also denied a history of noteworthy occupational difficulties or trouble getting along with others at work and stated that he believed he was a good worker, which was the reason he was promoted throughout his career, and when directly asked what led to his decision to file a claim for unemployability, the Veteran indicated that his attendance at PTSD groups, and apparently from the other people involved, reminded him of what he had gone through. Similarly, when asked what it is that he feels renders him unable to work, he discussed his reluctance to use and understand technology, including the computer and phone. This is at least some probative evidence that the Veteran has made the conscious choice not to work, which weighs against a finding that the Veteran’s psychiatric disability alone has precluded him from securing or following a substantially gainful occupation for any period on appeal. Based upon a review of the record, including as discussed above, the Board concludes that while the evidence of record documents some impairment resulting from the Veteran’s service-connected anxiety disorder and other specified trauma related disorder, the preponderance of evidence is against a finding that the Veteran’s anxiety disorder and other specified trauma related disorder resulted in occupational and social impairment with reduced reliability and productivity for the entire period on appeal. As discussed above, the consistent findings of the November 2013, April 2015, September 2016, and March 2018 VA examiners throughout the appeal period do not support a finding that the Veteran’s psychiatric disorder has precluded him from securing or following a substantially gainful occupation for any period on appeal. Indeed, the Board is mindful that the 30 percent disability rating already assigned for the Veteran’s psychiatric disability contemplates his level of occupational impairment. Moreover, the Veteran’s admission to the March 2018 VA examiner that he had previously used a computer and telephone in his employment indicates that there are jobs that could be performed from home for which the Veteran is already qualified, such as a telemarketer, where the employee makes calls and reads a script, which type of job does not require a lot of experience and could be done with a high school education and military training. The Veteran has stated that he was a good and dependable worker in the past, which indicates that he would be able to perform this type of job from home. Additionally, the Veteran has consistently reported that he enjoys swimming at a local pool and walking his dog, which indicates that there are potential other occupations that he could perform, such as swim coach or dog walker. The Board finds that the preponderance of the evidence is against a finding that the Veteran is precluded from all substantially gainful employment due to the service-connected psychiatric disorder. In sum, while the evidence discussed herein documents some functional impact upon the Veteran’s ability to work based upon his service-connected anxiety disorder and other specified trauma related disorder, the Board concludes that the preponderance of evidence weighs against the Veteran’s claim for entitlement to a TDIU rating due to anxiety disorder and other specified trauma related disorder for the entire period on appeal. As such, there is no reasonable doubt to be resolved, and the claim for a TDIU rating based solely on the service-connected anxiety disorder and other specified trauma related disorder is denied. A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Chad Johnson, 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.