Citation Nr: 21000057 Decision Date: 01/04/21 Archive Date: 01/04/21 DOCKET NO. 16-18 374 DATE: January 4, 2021 ORDER Entitlement to an initial disability rating in excess of 50 percent for posttraumatic stress disorder (PTSD), alcohol dependence, and unspecified depressive disorder prior to February 24, 2020 and in excess of 70 percent thereafter is denied. REMANDED Entitlement to individual unemployability due to service-connected disability (TDIU) prior to February 24, 2020 is remanded. FINDINGS OF FACT 1. For the period prior to February 24, 2020, the preponderance of the evidence shows that the symptomatology of the Veteran’s PTSD, alcohol dependence, and unspecified depressive disorder more nearly approximates occupational and social impairment with reduced reliability and productivity. 2. For the period following February 24, 2020, the preponderance of the evidence shows that the symptomatology of the Veteran’s PTSD, alcohol dependence, and unspecified depressive disorder more nearly approximates occupational and social impairment with deficiencies in most areas. CONCLUSIONS OF LAW 1. For the period prior to February 24, 2020, the criteria for a disability rating in excess of 50 percent for PTSD, alcohol dependence, and unspecified depressive disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.130, Diagnostic Code 9411. 2. For the period following February 24, 2020, the criteria for a disability rating in excess of 70 percent for PTSD, alcohol dependence, and unspecified depressive disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 2005 to March 2009 and from October 2009 to September 2010. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2011 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In March 2016 and June 2020 rating decisions, the RO increased the Veteran’s rating for PTSD, alcohol dependence, and unspecified depressive disorder to 50 percent disabling, effective September 15, 2020 and 70 percent disabling, effective February 24, 2020, respectively. As these grants did not constitute a full grant of the benefits sought, the increased rating issue remains on appeal. AB v. Brown, 6 Vet. App. 35, 39 (1993). In August 2019, the Veteran testified at a Travel Board hearing before the undersigned Veterans Law Judge (VLJ) regarding his psychiatric disability. A transcript of that proceeding has been associated with the record. The Board previously remanded the case in November 2019 for further development. The requested development has been completed to the extent possible, and no further action is necessary to comply with the Board’s remand directives. Stegall v. West, 11 Vet. App. 268 (1998). During the course of the appeal, a June 2020 rating decision granted entitlement to TDIU, effective February 24, 2020, the date the Veteran met schedular requirements for TDIU. The Board notes that TDIU is considered part and parcel of the increased rating claim on appeal and, pursuant to Harper v. Wilkie, the Board must consider whether TDIU is warranted prior to February 24, 2020. See Harper v. Wilkie, 30 Vet. App. 356 (2018) (holding that a grant of TDIU for a portion of the appeal period does not bifurcate the appeal and, therefore, is considered a partial grant of the benefit sought); see also Rice v. Shinseki, 22 Vet. App. 447 (2009). 1. Entitlement to an initial disability rating in excess of 50 percent for PTSD, alcohol dependence, and unspecified depressive disorder prior to February 24, 2020 and in excess of 70 percent thereafter is denied. The Veteran is seeking an initial disability rating in excess of 50 percent for his service-connected PTSD, alcohol dependence, and unspecified depressive disorder prior to February 24, 2020, and in excess of 70 percent thereafter. Specifically, the Veteran contends that his psychiatric disability is more severe than reflected by his assigned disability ratings. A disability rating is determined by the application of VA’s Schedule for Rating Disabilities (Rating Schedule), 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 military service and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. VA has a duty to acknowledge and consider all regulations that are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusions. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings,” whether it is an initial rating case or not. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). The regulations for mental disorders are found in 38 C.F.R. §§ 4.125-4.130. The Board notes that the Veteran’s diagnosis of PTSD, alcohol dependence, and unspecified depressive disorder is evaluated under Diagnostic Code 9411 and is rated according to the General Rating Formula for Mental Disorders. Pursuant to the rating formula, a 50 percent disability rating is warranted 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; and 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); and inability to establish and maintain effective relationships. A 100 percent disability rating is warranted 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; and 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 the veteran’s symptoms, but it must also make findings as to how those symptoms impact the veteran’s occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013); Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). Because 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, the Board need not find the presence of all, most, or even some, of the enumerated symptoms to award a specific rating. Mauerhan, 16 Vet. App. at 442; see also Sellers v. Principi, 372 F.3d 1318, 1326-27 (Fed. Cir. 2004). 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 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio, 713 F.3d at 118. Turning to the evidence of record, a January 2011 treatment record noted the Veteran was treated for PTSD in service. Following his return from deployment in July 2010, the Veteran moved in with his mother, with whom he had a good relationship. He noted that he had friends in the area and kept in touch with his Army friends. The Veteran enjoyed fishing and riding his motorcycle. He was not currently employed, as he had hoped to begin college. The Veteran denied homicidal ideation and any past or current suicidal ideation. On examination, the clinician described the Veteran as alert and oriented in all spheres. He was anxious and tense, but pleasant and cooperative. The Veteran endorsed sleep problems, combat-related nightmares, constant hypervigilance, and emotional numbness. His thoughts were clear, logical, and goal directed. Insight and judgement were adequate. A February 2011 treatment record indicated that the Veteran was unemployed but wanted to enroll in college that summer for business/management. In a subsequent February 2011 treatment record, the Veteran reported recurring nightmares and problems with crowds. He denied feelings of anxiety, depression, and suicidal and homicidal ideation. In a May 2011 mental health consult, the Veteran reported he was divorcing from his wife, but they decided to remain friends. He noted he experienced nightmares that were intermittent. The Veteran endorsed hypervigilance and depression at times, with no motivation or energy. He had flashbacks from service that were less sporadic and noted he did not think daily of his experiences in service. The Veteran noted that while he did get in trouble for anger issues in service, he was now laid back and had no anger or road rage. He stated that he had no problems connecting with people but did not have an active social life. He denied psychosis or manic symptoms. The Veteran reported he was currently unemployed but was planning to start college at Daytona State. He wanted to study business management but was unsure of what he wanted to do with his life. At times, he thought about reenlisting. In another May 2011 treatment record, the Veteran reported he was sleeping better and refused sleep aids. He added that he did not experience nightmares on a daily basis, but they could occur weeks at a time and then go away. He also noted his flashbacks were not active. The Veteran indicated some avoidance of crowded places and closed places. On examination, the clinician noted the Veteran was dressed appropriately, groomed, with good hygiene. He was restless but cooperative and distracted at times. The Veteran’s speech was normal, and his expressions were normal-relevant, coherent, and logical. His mood was calm with a restricted, complacent affect. The Veteran was fully oriented with a good fund of knowledge. His attention was distractible and hypervigilant with brief concentration. His recent memory was forgetful of daily activities and his remote memory was normal. Thought processes were normal linear and goal oriented. The Veteran experienced flashbacks and nightmares. He had fair judgement, insight, and impulse control. He denied hallucinations, and suicidal and homicidal ideation. In August 2011, the Veteran expressed his intent to return to school and requested medication treatment for his attention deficit disorder (ADD). He reported nightmares, feeling restless, and occasional panic attacks. The Veteran noted he scanned his surroundings, was jumpy, and avoided talking about his experience in Iraq. He denied depression, manic behaviors, or psychosis. On examination, the clinician noted the Veteran was dressed appropriately. He was calm and cooperative with normal speech. The Veteran’s mood was depressed, and his affect was restricted. His attention was distractible, and his concentration was brief. His recent memory was forgetful, and his remote memory was normal. The Veteran’s thought processes were normal, linear, and goal-oriented and he had full orientation. He had fair judgement and insight. There was no evidence of auditory or visual hallucinations or delusional thought. Suicidal and homicidal ideation was denied. The clinician noted a diagnosis of mild PTSD. In an October 2011 treatment record, the Veteran reported he was doing well in school. He endorsed anxiety and nervousness. He noted he was having nightmares twice a week and had difficulty sleeping. He denied feeling depressed. The Veteran noted he lived with his mother but had plans to move out. On examination, the clinician noted the Veteran was dressed appropriately. He was calm and cooperative with normal speech. His mood was euthymic, and he had restricted affect. Concentration and attention were normal. The Veteran had normal recent and remote memory. His thought processes were normal linear and goal oriented. The Veteran displayed fair judgement and insight and he was fully orientated. He denied suicidal and homicidal ideation. In November 2011, the Veteran was noted as alert and fully oriented. Suicidal and homicidal ideation was denied. The Veteran was afforded a VA examination in November 2011. The Veteran reported drinking heavily over a seven-month period after his first deployment to help sleep at night. He would pass out every time he drank. Since then, the Veteran described his alcohol use as occasional and social. His use of marijuana was occasional and light. The Veteran reported experiencing panic attacks approximately three times a month, most often in public situations. The Veteran was married for three years and formally divorced in July. He noted he dated and had been in a relationship for the past one and a half months, which he described in positive terms. The Veteran had a few close friends and friends from the military. He noted he enjoyed riding his motorcycle, camping, and playing video games. The Veteran denied a history of suicide attempts or a history of violence/assaults. On examination, the VA examiner noted the Veteran was clean and casually dressed with fair grooming. His speech was soft/whispered, and his psychomotor activity was unremarkable. The Veteran was cooperative and attentive. His affect was appropriate to topic and his mood was congruent with affect. Concentration was noted as highly variable. The Veteran was fully oriented, his thought process was rambling, and his thought content was unremarkable. The Veteran understood the outcome of behavior, and delusions and hallucinations were absent. He was of average intelligence and had poor insight and fair impulse control. He suffered from waking nightmares, restless sleep, and would wake disoriented at times. The examiner noted that the Veteran had inappropriate behavior with frequent fighting after his first deployment, but nothing in the past year. The Veteran experienced approximately three panic attacks a month, often in public settings. He denied suicidal or homicidal ideation. The Veteran was able to maintain minimum personal hygiene and had no problems with activities of daily living. His remote, recent, and immediate memory were mildly impaired. The Veteran indicated he was unemployed, which was due to attending college full time and was not related to his effects of his psychiatric disability. He was noted to be capable of independent thought. The examiner determined that the Veteran’s psychiatric disability caused 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 examiner explained that the Veteran’s intrusive memories distracted him from day-to-day tasks and interfered with goal-directed activities. Hyperarousal PTSD symptoms increased his potential for assaultiveness and he had little patience for others; this led to the briefness of the Veteran’s post-service employments. His avoidant PTSD symptoms led to more social isolation and was furthered by generalized anxiety, agoraphobic symptoms, and episodic panic attacks. The examiner noted that the Veteran had few friends, engaged in mostly solitary activities, and avoided settings with crowds. A January 2012 treatment record indicated that the Veteran was accompanied by his mother to the hospital with complaints of homicidal ideation towards his ex-wife. The Veteran reported his ex-wife had called him on his birthday to tell him she was pregnant by another man. He reported insomnia and feeling as if the walls were closing in on him. The Veteran wanted to be admitted to the psychiatric floor for a PTSD evaluation. On evaluation, the Veteran reported feeling drained with an inability to sleep. He had reoccurring dreams he was stuck in a hole and could not climb out. The Veteran reported his breaking point was last month when his ex-wife told him she was pregnant. He noted he had blown it off for a while but then it began to affect his dreams, appetite, and worse. He had decreased energy and feelings of guilt. The Veteran noted he felt hopeless about the future, but he denied suicidal ideation. The Veteran endorsed distractibility, insomnia, racing thoughts, panic attacks, irritability, spending sprees, going through a few women but getting bored and moving on. He denied euphoria/grandiosity, excessive worry, restlessness, mind going blank, and poor concentration. The Veteran denied hallucinations and suicidal or homicidal ideation, although he noted that he wished bad things for his ex-wife and had a plan to hurt her in the past when he was deployed in Iraq. On mental status examination, the Veteran presented pleasant and cooperative. His mood and affect were numb and depressed with some underlying anger. The Veteran’s thought process was linear, logical, and goal directed. His insight and judgement were good. He denied hallucinations. The Veteran was discharged from the VA hospital the next day and transferred to a private medical institution. A January 2012 intake form noted that although the VA report indicated the Veteran presented with homicidal ideation towards his wife for several days, the Veteran denied this, explaining that he went to the VA hospital because he was breaking down. The form noted that the Veteran indicated he was a full-time student and denied problems at work or school. The Veteran was not found to be a risk to himself or others. In a January 2012 psychiatric evaluation, the Veteran reported he had been “breaking down” for a month and could not hold it together any longer. Vegetative signs of depression were noted. The Veteran believed current symptoms of depression were emerging due to repressed feelings related to his PTSD. On examination, the Veteran was found to be neatly groomed with good hygiene. He had limited eye contact with anxious, sad, and somewhat constricted affect. His mood was depressed. The Veteran’s thought processes were logical, sequential, and relevant. His thought content was appropriate without distortion of reality. He had adequate capacity for abstraction and a good general fund of knowledge. Insight was noted as minimal to fair, but only at a verbal level. Judgement was notable for chronic impairment in intimate personal relationships, decreased social activity since his divorce and an inability to work or attend school effectively. A February 2012 discharge report noted that the Veteran had began his hospital stay defensive and distracting in groups. He seemed to not take his psychological problems seriously, which was understood to be a defensive mechanism. Over time, the Veteran became more engaged and his mood somewhat improved. He was still fighting to keep his emotions repressed or suppressed but had broken through the denial. The Veteran reached the point during his hospitalization where he still needed some improvements but could get the help in another setting. It was anticipated that the Veteran would followup his hospital-stay with VA outpatient therapy and medication management. In a February 2012 treatment record, the Veteran noted he was discharged from his private hospital stay yesterday and was feeling good. He reported that with the right mix of medications he was able to open up while he was hospitalized. On examination, the Veteran was noted as dressed appropriately and calm. He was cooperative with normal speech and restricted affect. The Veteran was distractible, and his concentration was brief. His recent memory was forgetful sometimes. The Veteran’s thought process was normal linear and goal oriented. His judgement was fair and insight limited. No delusional thoughts were indicated. The Veteran denied hallucinations and suicidal or homicidal ideation. The clinician noted that the Veteran was being seen status-post hospitalization for full blown PTSD symptoms with insomnia. The clinician noted that the Veteran implied he was manipulated into saying he was homicidal in order to gain admission, but he had not meant it. In August 2012, the Veteran reported he was doing okay on his medication. His mood was noted as stable overall. The Veteran denied depressed mood, anhedonia, low energy, feelings of hopelessness or worthlessness, manic symptoms, or psychotic symptoms. He endorsed flashbacks, nightmares, hypervigilance, and poor sleep. On examination, the Veteran was noted as dressed appropriately, calm, and cooperative. His speech was normal, and his mood was euthymic with broad affect. The Veteran had normal attention, concentration, and memory. His thought process was normal linear and goal directed. No hallucinations or delusions were indicated. The Veteran displayed fair judgement and insight. He denied suicidal or homicidal ideation. In October 2014, the Veteran reported he had been studying biology and was thinking about becoming a wildlife biologist but was 12 credits short of an associate’s degree. He had been living in Montana, working as a cook and dishwasher, but decided to move last month to have an adventure. The Veteran endorsed periodic nightmares and flashbacks. The Veteran reported he was hospitalized in Florida. He had been seen at the VA hospital and transferred to a private hospital. He noted he was admitted because he had not slept in four whole days. The Veteran noted he currently drank eight beers a week, primarily on the weekend and smoked marijuana to fall asleep. On examination, the Veteran was noted as casually groomed, alert and oriented. His mood was okay with periodic anxiety. The Veteran’s affect reflected positive eye contact, mild anxiety, and some nervous social smiling. His speech was normal and his thought processes were grossly organized and goal directed with complains of moderate impairment in attention span and concentration. The Veteran denied suicidal ideation but noted vague thoughts of violence towards others with no plan or intent. He denied hallucinations or delusions but reported some hypervigilance, nightmares, flashbacks, and some panic attacks. The Veteran reported that he has moved here a month ago and although he was not currently working or in school, hopes to find work soon. A GAF of 45 to 50 was noted. An August 2015 treatment record noted that the Veteran was staying busy to control his PTSD. He was noted as stable and not on medication. The Veteran denied suicidal or homicidal ideation. The Veteran was afforded a VA examination in September 2015. The VA examiner confirmed diagnoses of PTSD, moderate to severe, unspecified depressive disorder, and alcohol use disorder, severe and noted it was not possible to differentiate what symptoms were attributable to each diagnosis. The examiner noted that the last VA examination afforded to the Veteran in November 2011 noted a diagnosis of PTSD with a GAF of 60. Two months after the exam, the Veteran was hospitalized due to severe depression, due to communication from his ex-wife alerting him she was pregnant with another man’s baby. The Veteran stopped attending college. From 2012 to 2014, the Veteran worked as a seasonal dishwasher and cook for his brother who managed a resort in Montana. He got tired of being bossed around by his brother and moved to Virginia. The Veteran began a treatment program with the local VA medical center (VAMC) but never moved on to one on one counseling. Since moving to Virginia, the Veteran noted he had not attempted to find work due to lack of motivation. He lived in his mother’s old trailer on her property. The Veteran noted he spoke to his mother every day for up to an hour until one of them would get angry and hang up. He also noted he spoke weekly to an old girlfriend who lived in Michigan and had monthly calls with his military friends. On weekends, the Veteran went to parties and clubs with his friends. He had a sexual partner that he had met in a bar. The Veteran reported averaging a 12-pack of beer on weekends but often blacked out from drinking a 20-pack of beer a day. He noted he felt panicky nearly every day. The examiner noted that the Veteran’s psychiatric disability caused depressed mood, anxiety, suspiciousness, panic attacks more than once a week, chronic sleep impairment, impairment of short- and long-term memory, flattened affect, difficulty in understanding complex commands, impaired judgement, impaired abstract thinking, disturbances of mood and motivation, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, including work or a worklike setting, and spatial disorientation. The Veteran was noted to be capable of managing his financial affairs. The examiner determined that the Veteran’s psychiatric disability caused occupational and social impairment with reduced reliability and productivity. A September 2015 treatment record noted the Veteran was oriented in all spheres with pleasant mood and affect. An August 2016 treatment record noted the Veteran was alert and fully oriented. Suicidal and homicidal ideation was not present. An April 2019 treatment record noted the Veteran’s PTSD was stable on his medication. He denied suicidal or homicidal ideation. In an August 2019 Board hearing, the Veteran testified that he experienced trouble with sleep and irritability. He explained that his irritability was easily triggered, causing him to become moody. He kept to himself when he was in a mood and stayed home and avoided people. The Veteran testified that he drank to sleep well. He had night terrors and would sometimes jump out of his bed and sleepwalk. The Veteran’s girlfriend, who had accompanied him to the hearing, testified that he had hurt her before in his sleep. She had also witnessed him acting out his nightmares. She added that being around groups of people made the Veteran nervous. The Veteran noted he took different daily medications for his sleep, nightmares, anxiety, and mood swings. The Veteran affirmatively answered when he was asked by his representative if he had ever felt like hurting himself or others. He stated that he tried to keep to himself and had called crisis lines in the past. The Veteran endorsed panic attacks. A December 2019 treatment record noted that the Veteran presented with his girlfriend to a VAMC to reestablish care. He noted he was instructed by a judge and his attorney to establish care with the medical center as a part of his appeal for a higher disability rating for PTSD. The Veteran was noted to have last been seen by the facility in 2015. He denied any acute complaints at the time. The clinician noted that the Veteran presented neat with fair hygiene. He was awake and alert with normal speech. The Veteran’s mood was “okay,” and his affect was congruent and restricted. His thought processes were linear and organized and he denied suicidal and homicidal ideation, paranoia, and hallucinations. The Veteran displayed fair impulse and judgement with fair attention and concentration. His impulsivity was low. In a January 2020 treatment record, the Veteran presented for a mental health appointment on the advice of his attorney. The Veteran reported a lack of desire to engage in activities. He stated he did not think of the future and had no goals or motivations. The Veteran noted he had a brother with whom he did not have a relationship. He had limited family contact and support and his two best friends had died. He reported having a girlfriend of three years. The clinician noted the Veteran presented appropriately dressed, with euthymic mood and flat, restricted affect. Communication was blunted and he was detached from the content of discussion, which presented a problem for the appointment. The Veteran indicated he was not interested in receiving mental health counseling. The clinician noted the Veteran was detached from emotions and his connection to depressive episodes lacked awareness and relayed as nonchalant. His presentation demonstrated a dark personality, expressing low motivation to live, and no goals or optimism toward the future. The Veteran denied suicidal and homicidal ideation and noted he was coping well without focusing on his military past. The Veteran was afforded another VA examination in February 2020. The Veteran reported he separated from the military in 2012 and began going to college. He lived in Montana for a time and then returned to Louisiana three years ago. He reported he was divorced, currently unemployed, and lived with his girlfriend. The Veteran reported working as a cashier and in construction prior to his enlistment. He had an associate’s degree. The Veteran described bursts of anger, horrible nightmares, and an inability to sleep without drinking. He noted he had a “mental breakdown” with screaming and crying and was taken to the emergency room for mental health services. The Veteran began sleep walking and was unable to sleep in a dark room. He noted he was easily irritated and had anger reactions and punched things. The Veteran noted he stopped counseling in Florida in 2012. He reported he was a homebody and only left his house when necessary. His girlfriend of two and a half years described him as a hermit. The Veteran and his girlfriend went out now and then for dinner and the Veteran engaged in fishing as a hobby. He reported that he drank daily and could not sleep well without alcohol. The VA examiner confirmed diagnoses of PTSD, unspecified depressive disorder, and alcohol dependence. The examiner noted that PTSD was normally comorbid with alcohol use disorder and the Veteran’s unspecified depressive disorder was secondary to his PTSD also as a byproduct. Symptoms of the Veteran’s psychiatric disorder included depressed mood, anxiety, suspiciousness, near continuous panic or depression affecting the ability to function independently, appropriately, and effectively, chronic sleep impairment, flattened affect, disturbances in mood and motivation, difficulty in establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, including work or a work like setting, and an inability to establish and maintain effective relationships. On examination, the examiner noted the Veteran presented with mixed affect comprised of anxiety and depression. He was stiff and maintained emotional distance. The Veteran scanned the room and appeared on-guard and reactive. He did not volunteer information and responded tersely to questions. The examiner noted the Veteran was nonspontaneous and emotional numbing was prevalent. His interpersonal skills and energy were adequate. Thought processes were logical and linear and language skills were within normal limits. The Veteran was polite and cooperative and his cognition appeared intact with no obvious problems to executive functions. Suicidal and homicidal ideation were absent. The examiner indicated the Veteran was capable of managing his financial affairs. With regards to the Veteran’s employability, the examiner indicated that the Veteran’s PTSD caused anxiety and suspiciousness. The Veteran scanned the room for most of the examination and was unable to relax. He was socially awkward with issues of emotional dysregulation where he repressed emotions with outbursts from time to time with little to no provocation. The examiner noted the Veteran seemed highly suspicious which could impede his ability to interact or operate in a team fashion in the workplace. Further, he could exhibit poor conflict resolution skills. Due to the Veteran’s unspecified depressive disorder, the Veteran did not appear to be motivated to interact direct. He was numb-like and quite distant. The examiner noted the Veteran may not reach out to people when necessary and may reject or overreact when they reached out to him. The Veteran’s alcohol dependence caused secondary fatigue and cognitive issues such as concentration and focus. The examiner noted possible low frustration tolerance, easily upset with a poor ability to modulate his reactions. The examiner determined that the Veteran’s psychiatric disability caused occupational and social impairment with reduced reliability and productivity. In weighing the evidence, the Board finds that prior to February 24, 2020, the symptomatology associated with the Veteran’s PTSD, alcohol dependence, and unspecified depressive disorder more closely approximates occupational and social impairment with reduced reliability and productivity, consistent with a 50 percent disability rating. In this regard, the evidence reflects that the Veteran’s disability during this period was predominately manifested by trouble sleeping/nightmares, hypervigilance, occasional panic attacks and flashbacks, issues with concentration and memory, and lack of motivation and energy. The preponderance of the evidence demonstrates that the criteria for a disability rating in excess of 50 percent for the Veteran’s PTSD, alcohol dependence, and unspecified depressive disorder have not been met for the period prior to February 24, 2020. The Veteran’s PTSD, alcohol dependence, and unspecified depressive disorder has not been manifested by symptomatology more nearly approximating occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgement, thinking, or mood. The evidence of record does not support findings of suicidal ideation, obsessional rituals that 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, spatial disorientation, neglect of personal appearance and hygiene, difficulty adapting to stressful circumstances, and an inability to establish and maintain effective relationships. Prior to February 24, 2020, the Veteran was consistently noted as appropriately groomed with normal hygiene and normal speech. His thought processes were described as linear, logical, goal-oriented, sequential, and relevant, with only one occasion noting rambling with unremarkable thought content. Further, the Veteran was consistently found to be fully oriented and absent delusions and hallucinations. Although a January 2012 treatment record noted chronic impairment in personal relationships, treatment records from 2011 noted that the Veteran had local friends and friends from the miliary with whom he kept in contact. A god relationship with his mother was noted. The Veteran reported he had no problems connecting with people. A late 2011 treatment record noted the Veteran had been in a relationship for a month and a half. The Veteran enjoyed hobbies such as riding his motorcycle, fishing, camping, and playing video games. A 2015 treatment record noted the Veteran spoke to his mother daily, an old girlfriend weekly, and had monthly calls with his military friends. The Veteran reported spending weekends with friends going to parties and that he had a sexual partner. By 2020, the Veteran noted he lived with his girlfriend of approximately three years and went out to eat occasionally and enjoyed fishing as a hobby. The Board notes that although the Veteran mostly denied suicidal and homicidal ideation, the evidence of record does indicate some endorsement. Specifically, in January 2012, records noted that the Veteran presented to a VA hospital with complaints of homicidal ideation towards his wife; however, the Veteran subsequently clarified on two different occasions that he did not visit the VA hospital due to homicidal intent and was pressured into providing a reason for admission. An October 2014 treatment record noted vague thoughts of violence towards others with no plan or intent. In the August 2019 Board hearing, the Veteran affirmed feelings of wanting to hurt himself or others when questioned by his representative. However, this contradicts the Veteran’s numerous denials of suicidal and homicidal ideation noted in treatment records prior to February 24, 2020. Further, the record does not show that any suicidal or homicidal ideation were of such frequency, severity, or duration to cause occupational and social impairment with deficiencies in most areas at any point prior to February 24, 2020. Accordingly, the Board finds that a disability rating in excess of 50 percent prior to February 24, 2020 is not warranted. For the period following February 24, 2020, in weighing the evidence, the Board finds that the symptomatology associated with the Veteran’s PTSD, alcohol dependence, and unspecified depressive disorder more closely approximates occupational and social impairment with deficiencies in most areas, which is consistent with a 70 percent disability rating. Specifically, the Veteran’s PTSD, alcohol dependence, and unspecified depressive disorder has not been manifested by symptomatology more nearly approximating total and occupational social impairment. The evidence of record does not support findings of gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; disorientation to time or place; or memory loss for names of close relatives, own occupation, or own name. Specifically, the February 2020 VA examination noted that the Veteran was polite and cooperative with adequate interpersonal skills and normal language skills. The Veteran’s thought processes were logical and linear, and cognition was noted as basically intact. Further, the Veteran reported living with his girlfriend of two and a half years, demonstrating that the severity of his disability fell short of total social impairment. Accordingly, the Board finds that a disability rating in excess of 70 percent following February 24, 2020 is not warranted. In sum, the Board finds that the preponderance of the evidence is against a disability rating for the Veteran’s service-connected PTSD, alcohol dependence, and unspecified depressive disorder in excess of 50 percent prior to February 24, 2020, and in excess of 70 percent thereafter. Accordingly, the claim is denied. REASONS FOR REMAND 1. Entitlement to TDIU prior to February 24, 2020 is remanded. The Veteran contends that he is entitled to TDIU because his service-connected disabilities preclude him from maintaining substantially gainful employment. Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, 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 at 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). For the period prior to February 24, 2020, the Veteran was service connected for PTSD, alcohol dependence, and unspecified depressive disorder at 50 percent; L1 anterior wedge deformity at 10 percent from September 15, 2010 and at 20 percent from October 2, 2019; tinnitus at 10 percent, and hearing loss, left ear rated as noncompensable. His combined total rating prior to February 24, 2020 was 60 percent. Therefore, the schedular criteria for TDIU under 38 C.F.R. § 4.16(a) are not met. However, even when the criteria under 38 C.F.R. § 4.16(a) are not met, entitlement to TDIU on an extraschedular basis may be considered when the veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities. 38 C.F.R. § 4.16(b). The Board cannot, in the first instance, award an extraschedular TDIU, but must remand the matter to the VA’s Director of Compensation Service for consideration. Bowling v. Principi, 15 Vet. App. 1, 10 (2001). Here, based upon the Veteran’s medical treatment history, employment history, and level of education, there is an indication that the Veteran may not have been employable as a result of his service-connected disabilities for the period prior to February 24, 2020. He did not complete college and has an insignificant work history with large gaps of unemployment. Further, a January 2012 treatment record noted the Veteran’s inability to work or attend school effectively. The Board is compelled to remand the claim for entitlement to TDIU on an extraschedular basis as a result of service-connected disabilities for referral to the Director of Compensation in accordance with 38 C.F.R. § 4.16(b) for consideration of whether this benefit is warranted on an extraschedular basis. The Board notes that such a referral merely indicates that there is evidence sufficient to substantiate a reasonable possibility that the Veteran is unemployable due to his service-connected disabilities and does not bind the Board to grant an extraschedular TDIU. Ray v. Wilkie, 31 Vet. App. 58 (2019). The matter is REMANDED for the following action: Pursuant to 38 C.F.R. § 4.16(b), refer the claim for entitlement to TDIU prior to February 24, 2020 on an extraschedular basis to VA’s Director of Compensation for extraschedular consideration as to whether the Veteran is unemployable due to his service-connected disabilities. KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Silverblatt, 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.