Citation Nr: 21001096 Decision Date: 01/07/21 Archive Date: 01/07/21 DOCKET NO. 12-18 856 DATE: January 7, 2021 ORDER From February 23, 2009 to September 18, 2015, entitlement to an initial evaluation of 100 percent for a service-connected posttraumatic stress disorder (PTSD) disability is GRANTED. Between September 18, 2015 and February 26, 2020, entitlement to a 100 percent rating for the service-connected PTSD disability is GRANTED. Entitlement to a total disability rating based on individual unemployability (TDIU) due to the Veteran’s service-connected disability is DENIED. FINDINGS OF FACT 1. From February 23, 2009 to September 18, 2015, the evidence is at least evenly balanced that the symptoms of the Veteran’s service-connected PTSD resulted in total occupational and social impairment. 2. Between September 18, 2015 and February 26, 2020, the evidence is at least evenly balanced that the symptoms of the Veteran’s service-connected PTSD resulted in total occupational and social impairment. 3. The Veteran’s service-connected disabilities (other than PTSD) do not preclude him from securing or following a substantially gainful occupation. CONCLUSIONS OF LAW 1. From February 23, 2009 to September 18, 2015, resolving reasonable doubt in the Veteran’s favor, the criteria for an initial 100 percent rating for PTSD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9411. 2. Between September 18, 2015 and February 26, 2020, resolving reasonable doubt in the Veteran’s favor, the criteria for a 100 percent rating for PTSD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9411. 3. The criteria are not met for entitlement to a TDIU rating. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.340, 3.341, 4.1, 4.3, 4.16(a), 4.19, 4.25 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably as a member of the United States Marine Corps from December 1999 to August 2000, and from January 2005 to January 2006. In January 2019, the Board addressed the claims listed on the title page. At that time, the Board remanded the claims to the agency of original jurisdiction (AOJ) for additional development. The Board found that a remand was required in order to obtain a new VA examination to determine the etiologically and date of onset of the Veteran’s acquired psychiatric disorder, to include PTSD. The Board remanded the Veteran’s TDIU claim because it was inextricably intertwined with PTSD increased rating claim(s). The Board directed the AOJ to furnish the Veteran a VA Form 21-8940 so that he could describe his employment history from 2012 to present. 1. From February 23, 2009 to September 18, 2015, entitlement to an initial 100 percent rating for a service-connected PTSD disability is granted. On February 23, 2009, the Veteran submitted a VA Form 21-4138. Therein, the Veteran requested to reopen his claim for service connection for PTSD. The Veteran’s PTSD disability is rated under 38 C.F.R. § 4.130, DC 9411. The relevant criteria authorize a 50 percent rating for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g. retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing effective work and social relationships. Id. A 70 percent 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 worklike setting); inability to establish and maintain effective relationships. Id. A 100 percent 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; memory loss for names of close relatives, own occupation, or own name. Id. When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran's capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment, rather than solely on the examiner’s assessment of the level of disability at the moment of the examination. When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment but shall not assign an evaluation solely on the basis of social impairment. 38 C.F.R. § 4.126. The use of the term “such as” in 38 C.F.R. § 4.130 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. Mauerhan v. Principi, 16 Vet. App. 436 (2002). In Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013), the U.S. Court of Appeals for the Federal Circuit stated that “a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration.” “Although the veteran's symptomatology is the primary consideration, the regulation also requires an ultimate factual conclusion as to the veteran’s level of (occupational and social) impairment.” Id. Prior to August 4, 2014, one factor in evaluating psychiatric disorders was the global assessment of functioning scale (GAF). The scale was meant to represent psychological, social, and occupational functioning on a hypothetical continuum of mental health illness. See Richard v. Brown, 9 Vet. App. 266, 267 (1996) (citing the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM - IV)). A GAF of 21 to 30 is defined as behavior considerably influenced by delusions or hallucinations or serious impairment in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriate, suicidal preoccupation) or an inability to function in almost all areas (e.g., stays in bed all day, no job, home or friends). A GAF of 31 to 40 is indicative of some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) or any major impairment in several areas, such as work or school, family relations, judgment, thinking or mood (e.g., depressed man avoids friends, neglects family, and is unable to work; child frequently beats up younger children, is defiant at home, and is failing at school). A GAF of 41 to 50 is indicative of serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifter) or any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job). A GAF of 51 to 60 is defined as moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers). A GAF of 61 to 70 is indicative of mild symptoms (e.g., depressed mood and mild insomnia) or some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships. A GAF of 71 to 80 indicates that if symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in schoolwork). The Board notes that an examiner’s classification of the level of psychiatric impairment by a GAF score is to be considered but is not determinative of the percentage rating to be assigned. VAOPGCPREC 10-95. Effective March 19, 2015, VA amended the portion of the Schedule for Rating Disabilities dealing with mental disorders and its adjudication regulations to remove outdated references to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), and replace them with references to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). See 80 Fed. Reg. 53, 14308 (March 19, 2015). The Veteran filed the pending claim before the effective date of the regulatory change. Since the regulatory change implementing the DSM-5 criteria applies only to applications for benefits received by VA on or after August 4, 2014, the Board may consider any global assessment of functioning scores in the Veteran’s treatment records and examination reports. In June 2009, the Veteran underwent a VA examination that addressed the severity of the service-connected PTSD disability. The examiner described the Veteran as averagely groomed, adequately dressed, and appropriate and cooperative during the interview. The Veteran reported flashbacks and regular nightmares of his experiences in Iraq. The Veteran reported that he barely slept for 3 to 4 hours a night. The Veteran reported regularly occurring intrusive thoughts and flashbacks about Iraq, relaying that “my mind is stuck over there.” The Veteran reported startle response with loud unexpected noises such as a door slamming, gunfire, and cars backfiring. The Veteran reported road rage. The Veteran reported having a short temper and becoming irritable and angry easily. The Veteran reported a hard time interacting meaningfully with other people, preferring to stay by himself. The Veteran denied any recent active suicidal or homicidal ideation. The Veteran denied auditory or visual hallucinations, paranoia, delusions, or other thought disorders. The Veteran reported current unemployment, but he was looking for a job. The Veteran described some work-related problems in the past and difficulty controlling his anger in some situations that resulted in conflicts at the job. The Veteran reported that he stayed in the house all day long and did not have a social life. The VA examiner reported a GAF score of 65. In July 2009, a Social Work Counseling Note was generated at the G.V. (Sonny) Montgomery. Therein, the VA provider relayed that, “(the Veteran) has fleeing thoughts of hurting himself . . . acknowledged homicidal thoughts all the time and carries his pistol wherever he goes . . . .” In October 2009, the Veteran underwent a VA examination that addressed the severity of the service-connected PTSD disability. The VA examiner relayed that the Veteran’s general appearance was normal, well-dressed, and groomed. The Veteran’s behavior was within normal limits with normal speech speed and amount. The Veteran’s mood was mildly depressed, but his affect was within normal limits. The VA examiner noted a 60 GAF score. The Veteran reported that he was feeling depressed and had more frequent nightmares of military combat. The VA examiner relayed that the Veteran was “very irritable.” The Veteran’s wife relayed that his hygiene was less kept up. The Veteran relayed that he suffered from low energy, lack of concentration, isolation and avoidance of large crowds. The Veteran reported that, “still has occasional thoughts of harming other people and of harming himself. He has no plan nor intent to do either one of these. These thoughts are no more or less frequent than he has been having for some months.” The Veteran relayed that he was unemployed but looking for work. Regarding employment, the VA examiner reported that irritability, decreased concentration, decreased energy, and a lack of desire to be around crowds mildly impede the Veteran’s work performance. The VA examiner reported that irritability and avoidance of groups of people mildly effected the Veteran’s social functioning. The Veteran was noted as “withdrawn socially.” In January 2012, a Psychiatric Nursing Assessment Note was generated at the Jackson VA Medical Clinic (VAMC). Therein, it was reported that the Veteran was admitted for in-patient treatment because, “I am depressed.” In June 2012, the Veteran underwent a VA examination that addressed the severity of the service-connected PTSD disability. The VA examiner relayed that the Veteran was polite, cooperative and well oriented. The VA examiner identified a GAF score of 60. The VA examiner described the Veteran as having 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. However, the VA examiner noted that the Veteran quit his job in January 2012 following his hospitalization in the acute psychiatric unit. During the examination, the Veteran reported recurrent and distressing recollections and dreams of his traumatic event. The Veteran reported intense psychological distress and reactivity at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. The VA examiner noted that the Veteran had a sense of a foreshortened future. The VA examiner noted that the Veteran’s noted persistent symptoms included difficulty falling or staying asleep, irritability, difficulty concentrating, hypervigilance and exaggerated startle response. The VA examiner reported that the PTSD symptoms included depressed mood, anxiety, panic attacks that occurred weekly or less often, and chronic sleep impairment. In April 2015, a report was generated at the G.V. (Sonny) Montgomery VAMC. Therein, a VA provider noted that the Veteran reported difficulty sleeping as well as feeling of paranoia. The Veteran also reported that he sleeps with a gun, which disturbs his wife. In May 2015, the Veteran and his spouse supplied sworn testimony to the undersigned Veterans’ Law Judge (VLJ). The Veteran testified that he saw a VA mental health specialist every two or three months. The Veteran testified that he was currently a 6th grade schoolteacher, and he got very nervous to the point of not being able to breath. The Veteran testified that he endured panic attacks three or four times each week. The Veteran testified that he spent a week in the VA psychiatric ward because of panic attacks in early 2012. The Veteran testified that prescribed medications did not stop the panic attacks. The Veteran’s wife testified that she endured periods of unprovoked anger from her husband “(a)ll the time.” The Veteran’s wife testified that her husband experienced nightmares and periods of interrupted sleep. The Veteran testified that PTSD symptoms affected his ability to concentrate and complete tasks at work. When questioned by the undersigned, the Veteran testified that he endured weekly flashbacks that last about 5 to 10 minutes. The Veteran also testified that he endured hallucinations. The Veteran testified that he had endured suicidal thoughts. The Veteran testified that “every year or so” he would associate with a friend (to watch a boxing match), “(b)ut, besides that, I just sit in the house with the windows and shades closed and just be to myself. I prefer it like that.” The Veteran testified that, “my short-term memory is like totally gone, like totaled.” In July 2015, a Mental Health E&M Note was generated at the G.V. (Sonny) Montgomery VAMC. Therein, a VA provider noted that the Veteran reported nightmares almost every night and daily flashbacks. On September 18, 2015, the Veteran underwent a VA examination that addressed the severity of the service-connected PTSD disability. The VA examiner reported a current diagnosis for severe PTSD. The VA examiner relayed that the Veteran demonstrated occupational and social impairment with reduced reliability and productivity. The Veteran continued to experience recurrent and distressing recollections and dreams of his traumatic event, as well as, dissociative reactions in which he felt or acted as if the traumatic event was recurring. The Veteran reported intense psychological distress and reactivity at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. The Veteran reported avoidance or efforts to avoid external reminder, distressing memories, thoughts, or feelings about or closely associated with the traumatic event. The Veteran relayed persistent negative emotional state, markedly diminished interest or participation in significant activities, feelings of detachment or estrangement from others, and a persistent inability to experience positive emotions. The Veteran’s persistent symptoms included sleep disturbance, irritability, hypervigilance and exaggerated startle response. Additional symptoms included depressed mood, anxiety, suspiciousness, panic attacks more than once a week, chronic sleep impairment, impairment of short-and long-term memory, flattened affect, impaired judgment, disturbance of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, including work or a worklike setting and suicidal ideation. The VA examiner did not note evidence of hallucinations, delusion, loose associations, or flight of ideas. The Veteran did not report any current thoughts of harming himself, others, or property. The Veteran relayed that, “I am paranoid, and it is hard to sleep at night. . . . I isolate and want to be by myself. I get irritated and agitated for no reason. I am pretty much running my wife crazy. I hope I don’t lose my job. I can’t remember anything.” In July 2017, the Board granted an initial rating of 50 percent, but no higher, for the service-connected PTSD disability for the period February 23, 2009 to September 18, 2015. In May 2018, the United States Court of Appeals for Veterans’ Claims (Court) granted a Joint Motion for Partial Remand (JMPR), which vacated the July 2017 Board decision denying the Veteran entitlement to an initial rating in excess of 50 percent for PTSD. In the JMPR, the parties determined that the Board erred when it did not provide adequate reasons or bases for its determination that the Veteran was not entitled to a higher rating for PTSD. The parties concluded that the Board must articulate reasons or bases for its decision that address the particular symptoms associated with a percentage rating, or others of similar severity, frequency, and duration, as well as the social and occupational impairment that is caused by these symptoms. The Court relayed that, “(t)he Board’s analysis should focus on the duration, frequency, and severity of Appellant’s suicidal ideation and on whether the symptom of suicidal ideation has an impact on Appellant’s occupational and social impairment in most areas. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); Vazquez-Claudio, 713 F.3d at 117.” The Court also noted that, “the 70% criteria does not distinguish between passive and active suicidal ideation.” In September 2018, the Veteran submitted a VA Form 21-4138. Therein, the Veteran posited that, “I have to miss work due to anger issues. I am a teacher and a lot of times I feel I’m a threat to the kids.” The Veteran relayed that, “(my wife) and my counselor are so afraid I am gonna hurt or kill a child at my job.” The Board notes that suicidal ideation is one of the criteria for consideration of the assignment of a 70 percent disability rating for mental disorders. See 38 C.F.R. § 4.130. The July 2009 Social Work Counseling Note relayed that the Veteran had thoughts of hurting himself. The October 2009 VA examiner noted that the Veteran had occasional thoughts of harming himself. The June 2012 VA examiner noted that the Veteran relayed a sense of a foreshortened future. In May 2015, the Veteran testified that he endured suicidal thoughts. The September 2015 VA examiner noted that the Veteran’s PTSD symptoms included suicidal ideation. In Bankhead v. Shulkin, 29 Vet. App. 10 (2017), the Court reviewed recent literature concerning suicide among veterans, noting that both passive and active suicidal ideation are comprised of thoughts: passive suicidal ideation entails thoughts such as wishing to be dead, while active suicidal ideation entails thoughts of self-directed violence and death. Id. at 20. The Court explained that because suicidal ideation appears only in the 70 percent evaluation criteria, with no less severe analogues at a lower level of evaluation, the language of the regulation indicates that the presence of suicidal ideation alone, that is, a veteran’s thoughts of his or her own death or thoughts of engaging in suicide-related behavior, may cause occupational and social impairment with deficiencies in most areas. Id. The Board notes that the Veteran’s VA mental health treatment records and examination reports include notes indicating that he denied suicidal ideation. Based on the wording of the questions it is possible that the reason for this inconsistency is the distinction described by the Court in Bankhead . But, even if the Board were to ignore suicidal ideation, the Veteran’s VA examination notations/reports and hearing testimony reflect that the additional criteria for a 70 percent rating have been demonstrated, to include poor hygiene and difficulty in adapting to stressful circumstances (including work or a worklike setting). Importantly, the Veteran has reported that he felt like a threat to the children he instructed as a schoolteacher. The Veteran relayed that his counselor and wife also thought he was a threat to the children. During the claim period, the Veteran reported homicidal and suicidal thoughts, road rage, isolation and avoidance of large crowds, difficulty sleeping, paranoia, panic attacks, nightly and daily flashbacks, hallucinations, and a sense of foreshortened future. The Veteran’s wife relayed that her husband’s hygiene was “less kept up” during the claim period. The Veteran testified that short-term memory was absent. The record reflects that the Veteran also underwent in-patient psychiatric care during the claim period. Based on the competent reports of the Veteran’s danger to himself and others, intermittent inability to perform personal hygiene, memory loss, inpatient psychiatric treatment, and its duty to resolve reasonable doubt in his favor, see 38 C.F.R. § 4.3, the Board concludes that a 100 percent rating is warranted for the Veteran’s service-connected PTSD between February 23, 2009 and September 18, 2015. 2. Between September 18, 2015 and February 26, 2020, entitlement to a 100 percent rating for the service-connected PTSD disability is granted. In July 2017, the Board denied a rating in excess of 70 percent for the service-connected PTSD disability from September 18, 2015. In May 2018, the Court granted a JMPR, which vacated the July 2017 Board decision denying the Veteran entitlement a rating in excess of 70 percent after September 18, 2015 for PTSD. In the JMPR, the parties determined that the Board erred when it did not provide adequate reasons or bases for its determination that the Veteran was not entitled to a higher rating for PTSD. The parties concluded that the Board must articulate reasons or bases for its decision that address the particular symptoms associated with a percentage rating, or others of similar severity, frequency, and duration, as well as the social and occupational impairment that is caused by these symptoms. Again, the Veteran’s PTSD disability is rated under 38 C.F.R. § 4.130, DC 9411. The relevant criteria authorize a 100 percent rating for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. In June 2018, a Mental Health Impatient Admission Evaluation Note was generated at the Houston VAMC. The Veteran reported sadness, excessive guilt, decreased interest, insomnia, fatigue / low energy, lack of pleasure / enjoyment / interest, worthlessness, helplessness, and hopelessness. The Veteran did not report suicidal or homicidal ideation within the prior six-month period. The Veteran denied delusions, auditory hallucinations, visual hallucinations, tactile hallucinations, and disorganized speech. The VA provider noted that the Veteran demonstrated multiple, current PTSD symptoms, to include: persistent negative emotional state, feeling of detachment or estrangement from others, persistent inability to experience positive emotions, irritability or outbursts of anger, reckless or self-destructive behavior, hypervigilance, and exaggerated startle response. The VA provider noted a diagnosis for chronic PTSD and assigned an estimated GAF score of 30. At that time, the Veteran reported that, “(c)ombat changed me dramatically. I used to be so alive and full of joy. Now I have a whole new look on life. I feel like I hide myself from the world.” In July 2018, a Report of Hospitalization was generated at a Houston VA medical center (VAMC). Therein, a VA provider noted that the Veteran underwent one month of psychiatric treatment for PTSD in June and July 2018. In September 2018, the Veteran submitted a VA Form 21-4138. Therein, the Veteran posited that, “I get so upset I go into combat mode and all I think is kill. It’s only a matter of time before I lose this job too. . . . I have trouble communicating with people. I avoid stuff and people so I won’t hurt them. . . . I so afraid I may hurt someone or myself at time.” The Veteran relayed that, “I go and get my guns and hide in the closet. My family has removed all my firearms because I hallucinate more and more. I hate being around large crowds or people in general.” The Veteran relayed that, “I hate to shower and shave. My wife gets upset because my body odors are unbearable at times. She refuses to sleep with me because I smell so bad. . . . I planning on getting more counseling for PTSD with a 12 week program. I’m trying but I’m totally out (of) my mind with PTSD. It has destroyed my family and my life.” In September 2018, a VA Form 21-4138 was associated with the claims file. An unidentified individual relayed that, “I witness (the Veteran) sleepwalking, and hallucinating while sleeping on several different occasions. I tried to wake him up during each episode, and he becomes very combative. . . . . We had to remove weapons from his home because he wakes up sleepwalking, grabs his guns, proceeds to the windows, and states he have kill them, they keeping talking to me, they won’t let me rest. (The Veteran) is only getting worse, and it is scary because he could harm his family, or himself. (The Veteran) has become very antisocial, He has become very depressed, and withdrawn from everyone. He is easily angered, have panic attacks, and hostile most of the time. The small things cause him to flip out. (The Veteran’s) mood goes up and down. (The Veteran) is a schoolteacher, and his behavior effects his job and family.” In January 2020, the Veteran’s records from the Jackson VAMC were associated with the claims file. After deliberate review, the Board notes that the records do not support that the Veteran endorsed suicidal or homicidal intentions between September and December 2019. On February 26, 2020, the Veteran underwent a VA examination that considered the severity of the service-connected acquired psychiatric disorder, to include PTSD. The VA examiner noted a diagnosis for PTSD. The VA examiner opined that the Veteran’s PTSD resulted in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. The Veteran reported persistent auditory and visual hallucinatory experiences. The VA examiner noted the following symptoms were demonstrated and/or reported: depressed mood, anxiety, suspiciousness, panic attacks more than once per week, chronic sleep impairment, mild memory loss, impairment of short- and long-term memory, flattened affect, disturbance of motivation and mood, difficulty in establishing and maintaining effective work and socia relationships, difficulty in adapting to stressful circumstances, and persistent delusions or hallucinations. The VA examiner noted that the Veteran was alert and orientated, dressed in casual attire, displayed flat affect, was cooperative, and denied suicidality. In August 2020, the AOJ issued a rating decision. Therein, the AOJ increased the disability rating for the service-connected PTSD from 70 to 100 percent, effective February 26, 2020. Between September 18, 2015 and February 26, 2020, the Board notes that the Veteran’s VA mental health treatment records and examination reports include notes indicating that the Veteran was not a danger to himself or others. However, the September 2018 VA Form 21-4138s depict an entirely different disability picture. Therein, the Veteran and an unidentified individual (the Board suspects the Veteran’s spouse or close family member) relayed that it was necessary to remove guns from the Veteran’s residence for the safety of those that reside there. Moreover, the June 2018 Mental Health Impatient Admission Evaluation Note relayed that the Veteran demonstrated multiple, current PTSD symptoms, to include: persistent negative emotional state, feeling of detachment or estrangement from others, persistent inability to experience positive emotions, irritability or outbursts of anger, reckless or self-destructive behavior, hypervigilance, and exaggerated startle response. The June 2018 VA provider also noted a diagnosis for chronic PTSD and assigned an estimated GAF score of 30. Additionally, the Veteran underwent one month of in-patient psychiatric treatment for PTSD in June and July 2018. Based on the competent reports of the Veteran’s danger to himself and others, his month of inpatient psychiatric treatment for PTSD, the reported GAF score of 30, and its duty to resolve reasonable doubt in his favor, see 38 C.F.R. § 4.3, the Board concludes that a 100 percent rating is warranted for the Veteran’s service-connected PTSD between September 18, 2015 and February 26, 2020. 3. Entitlement to a total disability rating based on individual unemployability (TDIU) due to the Veteran’s service-connected disability is denied. In a May 2012, a Report of General Information was associated with the claims file. Therein, the Veteran pursued a claim for a TDIU rating. In August 2013, the AOJ issued a rating decision. Therein, the AOJ denied the Veteran’s claim for a TDIU rating. After review of the claims file, the Board observes that the Veteran did not file a Notice of Disagreement (NOD) with the August 2013 AOJ rating decision. However, the Board notes that the Veteran continued to pursue a claim for an increased rating for the service-connected PTSD disability. When the issue of TDIU is raised by the record during the appeal of a claim for an increased rating, the issue of TDIU is considered part of the pending claim for an increased rating. Rice v. Shinseki, 22 Vet. App. 447, 454 (2009). Consequently, the Board finds that Veteran raised the issue of a TDIU rating on February 23, 2009. Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities (Rating Schedule), which is based on the average impairment of earning capacity. 38 U.S.C. § 1155 (West 2014). Total disability is considered to exist when there is any impairment which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340 (a)(1). Total disability may or may not be permanent. Id. Total ratings are authorized for any disability or combination of disabilities for which the Rating Schedule prescribes a 100 percent evaluation. 38 C.F.R. § 3.340 (a) (2). A TDIU may be assigned 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. 38 C.F.R. § 4.16 (a). If there is only one such disability, it must be rated at 60 percent or more; if 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. Id. For the above purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable, (2) disabilities resulting from common etiology or a single accident, (3) disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric, (4) multiple injuries incurred in action, or (5) multiple disabilities incurred as a prisoner of war. Id. Entitlement to a total rating must be based solely on the impact of the Veteran’s service-connected disabilities on his ability to keep and maintain substantially gainful employment. See 38 C.F.R. §§ 3.340, 3.341, 4.16. In reaching such a determination, the central inquiry is “whether the Veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability.” Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). For VA purposes, the term “unemployability” is synonymous with an inability to secure and follow a substantially gainful occupation. VAOPGPREC 75-91; 57 Fed. Reg. 2317 (1992). Consideration may be given to the Veteran’s level of education, special training, and previous work experience in arriving at a conclusion. However, individual unemployability must be determined without regard to any nonservice-connected disabilities or the Veteran’s advancing age. 38 C.F.R. §§ 3.341 (a), 4.16, 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). A high rating in itself is recognition that the impairment makes it difficult to obtain or keep employment, but the ultimate question is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether he can find employment. Van Hoose, 4 Vet. App. at 363. Ultimately, the Board must evaluate whether there are circumstances in the Veteran’s case, apart from any non-service-connected conditions and advancing age, which would justify a TDIU rating. 38 C.F.R. §§ 3.341 (a), 4.16(a), 4.19. See Van Hoose v. Brown, 4 Vet. App. 361 (1993); see also Hodges v. Brown, 5 Vet. App. 375 (1993); Blackburn v. Brown, 4 Vet. App. 395 (1993). The Veteran’s service-connected disabilities, employment history, educational and vocational attainment, and all other factors having a bearing on the issue must be addressed. 38 C.F.R. § 4.16 (b). The ability to work sporadically or obtain marginal employment is not substantially gainful employment. 38 C.F.R. § 4.16 (a); Moore v. Derwinski, 1 Vet. App. 356, 358 (1991). Marginal employment, i.e., earned annual income that does not exceed the poverty threshold for one person, is not considered substantially gainful employment. 38 C.F.R. § 4.16 (a). When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. In June 2009, the Veteran underwent a VA examination that addressed the severity of the service-connected PTSD disability. At that time, the Veteran reported current unemployment, but he was looking for a job. The Veteran described some work-related problems in the past and difficulty controlling his anger in some situations that resulted in conflicts at the job. In May 2012, the Veteran submitted a VA Form 21-4138. Therein, the Veteran relayed that he had been unemployed since January 2012. The Veteran relayed that, “(a)long with my depression, anxiety formed which both made it very difficult to work or go to school.” The Veteran also relayed that, “I also spent a week on mental health ward at the Jackson VA. So all this contributed to my unemployability.” In July 2012, the Veteran submitted a VA Form 21-8940. Therein, the Veteran relayed that PTSD, hypertension, and anxiety prevented him from securing or following any substantially gainful occupation. The Veteran reported the following employment history: salesman from March 2004 to May 2009, manager from June 2009 to February 2011, and a stocker from May 2012 to July 2012. The Veteran reported that he earned $8400 during the prior twelve-month period. The Veteran remarked that, “my doctors at the VA said my depression due to PTSD caused severe depression and anxiety and that I needed to quit or stop working and attending school because I was facing death.” In July 2015, a Mental Health E&M Note was generated at the G.V. (Sonny) Montgomery VAMC. Therein, a VA provider relayed that the Veteran will start teaching next week in Yazoo City. The VA provider noted that the Veteran reported nightmares almost every night and daily flashbacks. In November 2015, a Mental Health E&M Note was generated at the G.V. (Sonny) Montgomery VAMC. At that time, the Veteran reported current full-time employment as a seventh-grade teacher. In July 2016, a Mental Health E&M Note was generated at the G.V. (Sonny) Montgomery VAMC. Therein, the VA provider relayed that the Veteran was changing to a new job as a middle school computer teacher. In May 2018, the Court granted a JMPR, which vacated the July 2017 Board decision. In the JMPR, the parties agreed that the Board needed to address and adjudicate the issue of TDIU. In June 2018, a Social Work Psychosocial Assessment was generated. At that time, the VA provider noted that the Veteran was a middle school teacher, earning $2000 per month. In July 2018, a Report of Hospitalization was generated at a Houston VA medical center (VAMC). Therein, a VA provider noted that the Veteran underwent one month of psychiatric treatment for PTSD. In September 2018, the Veteran submitted a VA Form 21-4138. Therein, the Veteran posited that, “I have lost several jobs due to emotional break downs or complications from PTSD. I am barely holding on to the job I have. I have to miss work due to anger issues. I am a teacher and a lot of times I feel I’m a threat to the kids.” The Veteran relayed that, “(my wife) and my counselor are so afraid I am gonna hurt or kill a child at my job.” In November 2018, an Appellant’s Brief was associated with the claims file. Therein, the Veteran’s representative relayed that, “(t)he record reflects that Appellant was unemployed during at least part of the appeal period and this was due at least in part to his service-connected disabilities.” In January 2019, the Board considered the Veteran’s claim for a TDIU rating. At that time, the Board noted that evidence supported an unclear employment history during the appellate period; consequently, the Veteran was asked to comment on his employment history. The Board specifically directed the AOJ to furnish the Veteran and his representative a VA Form 21-8940 so that the Veteran could describe his employment history during the appellate period. In November 2019, the AOJ notified the Veteran that it was working on his claim for a TDIU rating. The AOJ supplied a VA Form 21-8940, asking the Veteran to describe his employment history from 2012 to present. The Veteran was also asked to complete a VA Form 21-4192 for each of the employers identified in the employment history identified. In February 2020, the Veteran underwent a VA examination that considered the severity of the service-connected acquired psychiatric disorder, to include PTSD. The Veteran reported that he received a bachelor’s degree in Physical Education & Health with a teaching certification. The Veteran reported the following occupational history: “employed as a teacher. He teaches 6th grade students computer skills. He has been employed as a teacher for six years. He reportedly has taken FMLA in 2018 (3-4 months) & again in 2019 (March through August). He reported having been inpatient in 2018 at the Rover Program in Houston for 30 days. He is reportedly considering taking another FMLA currently secondary to mental health concerns.” In February 2020, a VA-generated Individual Unemployability Statement was associated with the claims file. The VA examiner noted that the Veteran had intrusive thoughts which interfere with the ability to stay focused on the task at hand. The VA examiner also noted that the Veteran has other mental health problems or symptoms, e.g., panic attacks, irritability, suspiciousness, etc., that interfere significantly with the ability to work. The VA examiner relayed that, “(t)he Veteran has reported experiencing visual and auditory hallucinatory experiences which contribute to difficulty with normative behavior within the work environment at times. He experiences intrusive thoughts which may result in being distracted or a change in his overall demeanor or behavior in the classroom, where he is teaching 6th grade students computer skills currently.” The VA examiner noted that, during the last year, the Veteran missed significant periods of work due to the service-connected PTSD disability. The VA examiner relayed that, “(h)e reported taking a leave of approximately 3-4 months (FMLA) in 2018 and again taking FMLA in 2019 from March to August. He is currently considering taking another FMLA and possibly going inpatient treatment for mental health, TRP.” In July 2020, the AOJ notified the Veteran that it was working on his claim for a TDIU rating. The AOJ supplied a VA Form 21-4192, asking the Veteran to provide his employment history during the appeal period. The Veteran was notified that failure to provide the requested information could cause the continued denial of his claim. In January 2019, the Board asked the Veteran to describe his employment history during the appellate period. In November 2019 and July 2020, the AOJ requested that the Veteran identify his employment history during the appellate period. To date, the Veteran has not submitted the supplied VA Forms 21-8940 or -4192. Consequently, the Board cannot verify the Veteran’s employment history during the appellate period (prior to his current, substantially gainful employment as a schoolteacher). The Board notes that, during the appellate period, the Veteran has claimed that his service-connected PTSD disability prevented him from obtaining and maintaining substantially gainful employment. To the extent that the Veteran contends that a TDIU is warranted based on the symptoms attributable to his PTSD, the United States Court of Appeals for Veterans Claims (Court) has recognized that a 100 percent rating under the Schedule for Rating Disabilities means that a Veteran is totally disabled. Holland v. Brown, 6 Vet. App. 443, 446 (1994), citing Swan v. Derwinski, 1 Vet. App. 20, 22 (1990). Thus, if VA has found a veteran to be totally disabled as a result of a particular service-connected disability or combination of disabilities pursuant to the rating schedule, there is no need, and no authority, to otherwise rate that veteran totally disabled on any other basis. See Herlehy v. Principi, 15 Vet. App. 33, 35 (2001) (finding a request for TDIU moot where 100 percent schedular rating was awarded for the same period). Accordingly, assignment of a TDIU based on the Veteran’s PTSD is not warranted. However, a grant of a 100 percent disability does not always render the issue of TDIU moot. VA’s duty to maximize a claimant’s benefits includes consideration of whether his disabilities establishes entitlement to special monthly compensation (SMC) under 38 U.S.C. § 1114. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); Bradley v. Peake, 22 Vet. App. 280, 294 (2008). Specifically, SMC may be warranted if the Veteran has a 100 percent disability rating for a single disability, and VA finds that TDIU is warranted based solely on the disabilities other than the disability that is rated at 100 percent. See Bradley, 22 Vet. App. 280 (analyzing 38 U.S.C. § 1114 (s)); See also 75 Fed. Reg. 11, 229-04 (March 10, 2010) (withdrawing VAOPGCPREC 6-1999 ). In addition to the Veteran’s PTSD, service connection has been established for status post anterior transposition of the left ulna nerve with some residual ulna neuropathy and tenderness (rated as 20 percent disabling); residual scar, status post anterior transposition left ulnar nerve (rated as 10 percent disabling); tinnitus (rated as 10 percent disabling); and mild muscle dystrophy associated with status post anterior transposition left ulna nerve with some residual ulna neuropathy and tenderness (rated as 10 percent disabling. The Veteran has not contended, nor does the evidence show, that he is unemployable as a result of his service-connected disabilities other than PTSD. Furthermore, despite a need to utilize FMLA for the service-connected PTSD disability, the Veteran still maintains current employment as a schoolteacher. The Board notes that the Veteran has reported periods of unemployment prior to becoming a schoolteacher; however, the Veteran has not submitted the supplied VA Forms to support his employment history during the remainder of the appellate period (before becoming a schoolteacher in 2014). The duty to assist is a two-way street. If the Veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the relevant evidence. Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Without the Veteran’s submission of VA Forms 21-8940 or -4192, VA could not ascertain the extent of the Veteran’s employment history during the appellate period. Consequently, there was no avenue to determine the effect of the Veteran’s service-connected disabilities on the ability to obtain and maintain substantially gainful employment at the beginning of the appellate period. As such, the Board finds that VA has satisfied its duty to assist. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) (VA’s duty to assist in developing the pertinent facts and evidence in connection with a claim is not a one-way street, and the Veteran has a responsibility to cooperate in such development). In February 2020, the Veteran reported that he had been a 6th grade teacher for the last six years to a VA examiner. Before becoming a schoolteacher in 2014, the Veteran reported sporadic periods of unemployment; however, the Veteran failed to submit VA Forms 21-8940 or -4192 to identify his employment history during the employment period prior to 2014. Based on the information in the claims file, the Board concludes that the Veteran’s service-connected disabilities other than PTSD did not preclude substantially gainful employment during the appellate period, February 23, 2009 to present. Ultimately, the Board finds that the preponderance of the evidence stands counter to the Veteran’s claim for a TDIU rating. Since the preponderance of the evidence is against this TDIU rating claim, the provisions of 38 U.S.C. § 5107(b), regarding reasonable doubt, are not applicable. The Veteran’s claim for a TDIU rating must be denied, because the preponderance of the evidence weighs against his claim. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board RLBJ, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.