Citation Nr: 21001296 Decision Date: 01/07/21 Archive Date: 01/07/21 DOCKET NO. 13-30 487 DATE: January 7, 2021 ORDER Entitlement to service connection for thoracolumbar spine disorder with radiculopathy affecting the left lower extremity is denied. A uniform 70 percent rating for service-connected posttraumatic stress disorder (PTSD) is granted. TDIU is granted for the period prior to August 28, 2020. FINDINGS OF FACT 1. The preponderance of the evidence is against a finding that a thoracolumbar spine disorder with left leg radiculopathy began during active service, manifested within one year of service, or is otherwise etiologically related to an in-service injury or disease. 2. For the entire appeal period, the Veteran’s PTSD has been manifested by impairment with deficiencies in most areas; total occupational and social impairment has not been shown. 3. For the period prior to August 28, 2020, the Veteran’s service-connected disabilities prevent him from obtaining and maintaining substantially gainful employment consistent with his educational and vocational experience. CONCLUSIONS OF LAW 1. The criteria for service connection for thoracolumbar spine disorder with radiculopathy affecting the left lower extremity have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.309. 2. The criteria for a rating higher than 70 percent rating, and no higher, for PTSD have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.126, 4.130, DC 9411. 3. For the period prior to August 28, 2020, the criteria for entitlement to TDIU have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from February 1988 to June 1992 and again from November 2001 to February 2002. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from August 2010 and February 2013 rating decisions of the Department of Veterans’ Affairs (VA) Regional Office (RO) from Huntington, West Virginia (hereinafter, Agency of Original Jurisdiction (AOJ)). This appeal was previously before the Board in October 2018, at which time it was remanded for further evidentiary development. Specifically, the Board instructed the AOJ to contact the Veteran and his representative and with their help, obtain the appropriate authorizations to request any outstanding private treatment records related to treatment of the disabilities on appeal. Although it appears the AOJ has obtained all outstanding VA treatment records, to include Vet Center records, the Veteran has not submitted any authorization related to any possibly relevant private treatment records despite the AOJs attempt to assist the Veteran by letter dated April 15, 2019. Based on the above, the Board finds that the AOJ has substantially complied with the remand instructions and appellate adjudication may proceed without prejudice to the Veteran. Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) (“The duty to assist is not always a one-way street. If [a claimant] wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence”); Stegall v. West, 11 Vet. App. 268 (1998). Service Connection for Spine Disability The Veteran is seeking service connection for a thoracolumbar spine disorder with radiculopathy of the left lower extremity. For the following reasons, the Board finds that service connection for a thoracolumbar spine disorder with radiculopathy is not warranted. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). For some “chronic diseases,” presumptive service connection is available. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. With “chronic disease” shown as such in service (or within the presumptive period under § 3.307), so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b). For the showing of a ‘chronic disease’ in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. 38 C.F.R. § 3.303(b). If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. Id. If not manifest during service, where a Veteran served continuously for 90 days or more during a period of war, or during peacetime service after December 31, 1946, and the ‘chronic disease’ became manifest to a degree of 10 percent within 1 year from date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 C.F.R. § 3.307. The term “chronic disease,” whether as shown during service or manifest to a compensable degree within a presumptive window following service, applies only to those disabilities listed in 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Arthritis is deemed a chronic disease under 38 C.F.R. § 3.309(a). Additionally, with chronic disease shown as such in service (or within the presumptive period) so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote are also service connected, unless clearly attributed to intercurrent causes. Moreover, if chronicity in service is not adequately supported, a showing of continuity of symptomatology after discharge is required to support the claim. 38 C.F.R. §§ 3.303(b). The Veteran has testified to chronic/recurrent back pain since service. He recalled treatment for back pain during service. He states that, after discharge in 1992, he sought treatment with several doctors and had weekly chiropractic treatment for a period of time. He described his post-service pain in the 1990s as the same type of pain he had during service. At a VA examination in 2018, the Veteran reported back pain continuing through his second tour of duty. The Veteran’s service treatment records reflect that the Veteran was diagnosed with a lumbar muscle sprain, manifested by pain and limitation in range of motion for approximately 15 days. See Service Treatment Records dated January 11, 1989 and January 19, 1989. After several followups, the Veteran’s subsequent records were silent for additional complaints or treatments related to his low back. Upon discharge, the Veteran denied recurrent back pain and upon examination, his spine was clinically normal. See Report of Medical History and Report of Examination dated May 11, 1992. He had a brief period of active duty from November 2001 to February 2002 and there are no relevant records for this period of service. In pertinent part, the Veteran first reported having low back pain in June 2005 secondary to a work-related injury. The Veteran was lifting a box and began to feel pain; diagnostic testing revealed herniated discs and neural foraminal stenosis in the Veteran’s lumbar spine. Subsequent treatment included physical therapy, steroid injections, and pain medication. During his treatment, the Veteran consistently denied having lumbar spine pain or symptoms prior to the 2005 work-related injury. At a VA examination in 2012, the Veteran described consistent back problems since 2004 with a prior history of intermittent back pain. The examiner further recorded “Does not recall a back injury. When ask, veteran denied back problems in the military -says his lawyer filed for this.” The probative value of a medical opinion comes from its reasoning. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The “factually accurate, fully articulated, sound reasoning for the conclusion” contributes probative value to a medical opinion. Id. On the other hand, a medical opinion based on an inaccurate factual predicate has reduced probative value. Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that the Board may reject a medical opinion based on an inaccurate factual basis). The Board must first determine the accurate factual history as reported by the Veteran and shown by the record. The Veteran clearly obtained treatment for lumbar muscle sprain in 1989. He has testified to recurrent back pain after this injury. However, he served on active duty for approximately 3 more years without any reference to back pain or treatment, and he specifically denied recurrent back pain at separation. The Veteran also testified to doctor and chiropractic treatment for recurrent back pain in 1992 after his discharge from service. There is no record of this treatment, and the Veteran has not responded to VA’s request to assist him in obtaining these records. There is no documentary evidence of back pain or chronic disability being present during his brief period of service from November 2001 to February 2002. On the other hand, when being evaluated for a work-related back injury in 2005, the Veteran consistently denied having lumbar spine pain or symptoms prior to the 2005 work-related injury. At the very least, the Veteran’s history of inconsistent/contradictory statements reduces the overall reliability of his assertions. See State v. Spadafore, 220 S.E.2d 655, 661 (W. Va. 1975) (observing that, when evaluating inconsistent or contradictory testimony, “[t]he fact that [a witness] has stated the matters differently on a previous occasion tends to demonstrate either a failure of memory, or a lack of integrity, and in either event it weakens and impairs the value of his testimony.”) Overall, the Board finds that the most credible version of events from the Veteran consists of his specific denial of recurrent back pain at the time of his separation from service and his similar statement to private physicians in 2005 – wherein he denied a prior history of lumbar spine pain or symptoms prior to the 2005 work-related injury. In this respect, these statements in 1992 and 2005 are documented and internally consistent. Additionally, these statements bear the indicia of reliability as they were made in the context of obtaining appropriate medical treatment and/or diagnosis. See Lilly’s An Introduction to the Law of Evidence, 2nd Ed. (1987), pp. 245- 46 (many state jurisdictions, including the federal judiciary and Federal Rule 803(4), expand the hearsay exception for physical conditions to include statements of past physical condition on the rational that statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy since the declarant has a strong motive to tell the truth in order to receive proper care). The 1992 statement is consistent with the findings from a competent examiner at that time finding a normal clinical evaluation of the spine. On the other hand, the Veteran’s recollections of recurrent back pain since the first period of active service comes several decades after his discharge from service and directly contradicts two prior documented statements from the Veteran himself. The recollection of chiropractic treatment in 1992 contradicts his statement to private examiners in 2005. As such, the Board finds that the most credible lay evidence establishes that there has not been recurrent/chronic back symptoms since the first period of active service or during the brief 2nd period of service and that chronicity of symptoms began in 2005 after a work-related back injury. Based on these factual findings, the Board places great probative weight to the opinion of the July 2018 VA examiner who found that, given the single episode of muscle strain in 1989 and absence of documentation or recurring or persistent back pain from 1989 until the 2005 back injury, it was less likely that the Veteran’s back disability with herniation and degenerative changes were related to military service and more likely sustained during the 2005 back injury. The Board finds that this VA medical opinion is based on an accurate factual history as determined by the Board and provides an explanation that contains a clear conclusion and supporting data. Nieves-Rodriguez, 22 Vet. App. at 304. Furthermore, there is no objective medical evidence to contradict the negative nexus opinion of record. The only evidence in favor of the Veteran’s claims are his own lay statements. The Veteran believes his thoracolumbar spine disorder with left leg radiculopathy is related to an in-service injury, event, or disease. As a lay witness, the Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires medical training and knowledge of anatomical relationships and pathology. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the well-reasoned VA examinations and opinions of record. In addition, the Board finds that service connection on the basis of continuity of symptomatology alone is not warranted under 38 C.F.R. § 3.303(b) as the most credible lay evidence establishes that chronicity first began in 2005. Similarly, there is also no credible lay or medical evidence establishing the onset of arthritis within one year of service discharge of either period of service. As such, service connection on a presumptive basis under 38 C.F.R. § 3.309(a) is also not warranted. Accordingly, the preponderance of the evidence is against the claim and entitlement to service connection for a thoracolumbar spine disorder with left leg radiculopathy is not warranted. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 49. Increased Rating for PTSD Disability evaluations are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. Staged ratings are appropriate for any rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran’s PTSD is currently rated under Diagnostic Code 9411. All psychiatric disorders are evaluated under a general rating formula for mental disorders. 38 C.F.R. § 4.130. Under the general rating formula, a 50 percent rating is assigned for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. A 70 percent evaluation 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 situations (including work or a work-like setting); and inability to establish and maintain effective relationships. Finally, a total schedular rating of 100 percent is warranted when the disorder results in 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 mental and personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. The symptoms listed in the rating schedule are not intended to constitute an exhaustive list, but rather serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436 (2002). Nevertheless, all ratings in the general rating formula are associated with objectively observable symptomatology, and “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.” Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013). Further, “§ 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas.” Thus, “[a]lthough the veteran’s symptomatology is the primary consideration, the regulation also requires an ultimate factual conclusion as to the veteran’s level of impairment in ‘most areas.’” Id. at 118. As such, the Board will consider both the Veteran’s specific symptomatology as well as the occupational and social impairment associated with the rating code to determine whether an increased evaluation is warranted. Turning to the facts of the case, the Veteran filed for service connection for PTSD in February 2010. At the August 2010 VA examination, the Veteran reported having constant, severe depression, along with panic attacks twice a month. He experienced increased anger and irritability and avoided contact with people. Socially, he stated that he lost interest in his hobbies and was married and divorced three times. He was unable to get along with his previous wives and was often angry and irritable. The Veteran often felt detached and estranged from most people and avoided crowds and interacting with others. Upon mental examination, the Veteran’s mood was depressed, and his affect was significantly constricted. He described having significant problems with attention and concentration. His memory was intact, and he demonstrated good insight and thinking. There was no evidence of issues with impulse control, inappropriate behavior, or compulsive, ritualistic behavior. While there was no indication of psychoses, delusions, or hallucinations, the examiner noted suicidal thoughts. Based on this examination, the AOJ granted service connection for PTSD and assigned a 30 percent disability rating. The Veteran timely appealed for a higher rating. At the July 2011 VA examination, the Veteran’s PTSD symptoms included depressed mood, anxiety, suspiciousness, panic attacks once a week at most, difficulty understanding complex commands, impaired judgment, impaired abstract thinking, intermittent inability to perform activities of daily living, and difficulty establishing and maintaining effective relationships. Ultimately, the examiner found that the Veteran’s PTSD was manifested by occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. However, the Veteran was generally functioning satisfactorily with normal routine behavior, self-care, and conversation. Based on this examination, the AOJ partially granted the Veteran’s claim for increase and granted a 50 percent rating for the entire appeal period. At the April 2013 VA examination, the PTSD symptoms included depressed mood, anxiety, suspiciousness, panic attacks weekly, and chronic sleep impairment, along with mild memory loss, sleep impairment, anger, irritability, hypervigilance, and difficulty concentrating. Socially, the Veteran reported getting along with his family. He visited with family and friends once or twice a week but did not pursue romantic relationships. The examiner opined that the Veteran’s PTSD caused impairment with an occasional decrease in work efficiency and intermittent periods of inability to perform tasks; however, the Veteran was generally functioning satisfactorily. In February 2017, the Veteran underwent a private psychiatric examination. At that time, the Veteran described having nightmares, flashbacks, and panic attacks about three to four times per month. He continued to avoid socializing with others, stating that he felt “nobody could be trusted.” He endorsed feelings of detachment and alienation from others. He demonstrated a pronounced loss of interest in activities he used to enjoy, such as hunting and fishing. He currently enjoyed going to his garage and restoring old toys. He constantly felt paranoid around others, thinking that others were judging him. He also described feeling angry and irritable; he stated that he would raise his voice, cuss, or yell. In the past, he would throw things, break things, and hit things, but never demonstrated any violence toward others. His mental status examination was relatively normal. While the Veteran’s self-presentation was vague, irritable, and reckless, there was no evidence of delusions, hallucinations, or obsessions or compulsions. The Veteran denied any suicidal or homicidal ideations. Ultimately, the examiner found that the Veteran’s PTSD caused impairment in most areas of his life. At the July 2018 VA examination, the Veteran reported the following symptoms: depressed mood, anxiety, panic attacks once a week, chronic sleep impairment, disturbances in motivation and mood and difficulty establishing and maintaining effective relationships. The Veteran maintained a good relationship with his family but stated that he did not have close friends and preferred to keep to himself. He denied having recreational interests but endorsed daily depression and episodic anxiety. While he had feelings of worthlessness and hopelessness, he denied suicidal ideation and intrusive trauma-related thoughts. He stated that he was hypervigilant in public but was generally comfortable at home. He also said he was sometimes irritable and reported minor verbal altercations, along with mild difficulty concentrating. The Veteran’s mental status examination was within normal limits. In August 2020, the Veteran was afforded a VA examination to determine the nature and severity of his PTSD. At that time, the Veteran’s symptoms included depressed mood, anxiety, suspiciousness, panic attacks at most weekly, chronic sleep impairment, disturbances in motivation and mood and difficulty establishing and maintaining effective relationships and difficulty adapting to stressful circumstances. The Veteran’s treatment included counseling and prescription medication as needed. Because of his anxiety, he stayed home unless he had to run errands. He only slept about five hours per night and experienced nightmares. He stated that he felt like people were watching him at times and stated the he saw movement in his peripheral vision. He denied issues with irritability but stated that he had difficulty concentration. Socially, the Veteran did not have close friends and did not pursue romantic relationships; however, the Veteran remained in regular contact with his mother, siblings, children, and grandchildren. The Veteran’s mental status examination was within normal limits; there was no evidence of hallucinations or psychoses. Ultimately, the examiner found that the Veteran’s PTSD manifested in occupational and social impairment with deficiencies in most areas. Based on the August 2020 examination, the AOJ granted a 70 percent rating effective August 2020. See September 2020 Rating Decision. Upon review of the evidence, the Board finds that a uniform 70 percent rating is warranted for the entire appeal period. The Board notes that the September 2020 rating decision awarded a 70 percent rating based on the findings of the August 2020 VA examination. A review of the Veteran’s medical records and reports demonstrate that the frequency, severity, and duration of symptoms the Veteran endorsed during the August 2020 VA examination were present at the beginning of the appeal period. The Veteran consistently reported irritability, anger, continuous depression, paranoia, panic attacks and suicidal ideation as early as August 2010. There is no significant change in the Veteran’s symptomatology during the appeal period. In short, the Board finds that based on the consistency demonstrated by the frequency, severity, and duration of the Veteran’s disability picture as early as August 2010, a 70 percent disability rating is warranted for the entire appeal period. The Veteran’s symptoms are more characteristic of a disability picture that is contemplated by a 70 percent rating and no more as the Veteran’s PTSD does not meet, or more nearly approximate total occupational and social impairment. Specifically, the evidence of record does not show that the Veteran has total social and occupational impairment. The clinical evidence of record does not establish, and the Veteran does not allege, gross impairment in thought processes or communication, delusions, hallucinations, grossly inappropriate behavior, intermittent inability to perform activities of daily living or disorientation to time or place. Although he does not have many close friends, the Veteran maintains a good relationship with his family and at times, he tries to keep busy with different activities. The Board acknowledges that the Veteran endorses depression, anxiety, chronic sleep impairment, and difficulty adapting to stressful circumstances. However, the Board finds that his symptoms adequately contemplated within the currently assigned 70 percent rating. Moreover, there is no evidence of homicidal or suicidal ideation and there is no evidence of delusions, hallucinations, or psychoses. See Vazquez-Claudio, 713 F.3d at 116-17. In conclusion, the Veteran does not manifest either symptomatology or the impairment required for a 100 percent rating for the service-connected PTSD at any time during the appeal period since August 28, 2020. In so concluding, the Board finds that the Veteran’s report of symptomatology to be credible, and the Board has resolved inconsistencies in his favor. However, when it comes to the overall impact of his occupational and social functioning, the Board places greater probative weight to the lay and medical evidence, including expert examiner opinions as to occupational and social impact, which reflects that the overall frequency, severity, and duration of the Veteran’s symptoms from August 28, 2020 does not meet or more nearly approximate the criteria for a 100 percent schedular rating. As such, a rating in excess of 70 percent is not warranted for the period beginning August 28, 2020. TDIU 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 because of service-connected disabilities. If there is only one such disability, this disability shall be ratable as 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. §§ 3.340, 3.341, 4.16. For TDIU purposes, marginal employment is not to be considered substantially gainful employment. 38 C.F.R. § 4.1. Factors to be considered, however, will include the Veteran’s employment history, educational attainment, and vocational experience. 38 C.F.R. § 4.16. Here, the Veteran’s compensable service-connected disabilities include PTSD, now rated 70 percent for the entire appeal period, and tinnitus and asthma, both rated 10 percent disabling. The Veteran meets the criteria for a schedular TDIU rating under 38 C.F.R. § 4.16(a) In Moore v. Derwinski, 1 Vet. App. 356, 359 (1991), the U.S. Court of Veterans Appeals (now the U.S. Court of Appeals for Veterans Claims) (Court) discussed the meaning of “substantially gainful employment.” In this context, it noted the following standard announced by the United States Federal Court of Appeals in Timmerman v. Weinberger, 510 F.2d 439, 442 (8th Cir. 1975): It is clear that the claimant need not be a total 'basket case' before the courts find that there is an inability to engage in substantial gainful activity. The question must be looked at in a practical manner, and mere theoretical ability to engage in substantial gainful employment is not a sufficient basis to deny benefits. The test is whether a particular job is realistically within the physical and mental capabilities of the claimant. However, to receive TDIU, the Veteran’s service-connected disabilities, alone, must be sufficiently severe to produce unemployability. Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). The record reflects that the Veteran has an eighth-grade education. Upon discharge from service, the Veteran worked as a laborer until 2004. In his application for Increased Compensation Based on Unemployability, the Veteran indicated that his PTSD significantly impacted his ability to work. Notably, the AOJ has already found that the Veteran’s PTSD and asthma impacted his ability to work and thus, granted TDIU, effective August 28, 2020. The effective date of TDIU was primarily based on the date the Veteran’s combined disability rating met the schedular requirements as outlined above. Given the favorable nature of the increased rating claim for PTSD above, and resolving all reasonable doubt in the Veteran’s favor, the Board finds that TDIU is warranted for the entire appeal period. The evidence reflects, and the AOJ has found, that the Veteran’s service-connected PTSD and asthma significantly impact his ability to obtain or maintain substantially gainful employment consistent with his vocational background. The claim, therefore, is granted. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Orie, Chinyere 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.