Citation Nr: 21001651 Decision Date: 01/11/21 Archive Date: 01/11/21 DOCKET NO. 16-30 945 DATE: January 11, 2021 ORDER Entitlement to a 50 percent disability rating for posttraumatic stress disorder (PTSD) from June 22, 2011 is granted. Entitlement to special monthly compensation (SMC) at the housebound rate under 38 U.S.C. § 1114 (s) from January 3, 2014 to July 31, 2019 is granted. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) from June 22, 2011 to January 2, 2014 is denied. Entitlement to a TDIU from January 3, 2014 to December 27, 2015, having been rendered moot, is dismissed. FINDINGS OF FACT 1. From June 22, 2011, the Veteran’s PTSD symptoms were productive of occupational and social impairment with reduced reliability and productivity, but were not productive of occupational and social impairment with deficiencies in most areas. 2. From January 3, 2014, the Veteran has had a single service-connected disability rated as 100 percent disabling and additional service-connected disabilities independently ratable at 60 percent. 3. From June 22, 2011 to January 2, 2014, the Veteran was gainfully employed. 4. Entitlement to a TDIU from January 3, 2014 to December 27, 2015 is moot. CONCLUSIONS OF LAW 1. The criteria for a 50 percent rating for PTSD, but no higher, from June 22, 2011 have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. 2. The criteria for entitlement to SMC at the housebound rate under 38 U.S.C. § 1114 (s) from January 3, 2014 have been met. 38 U.S.C. §§ 1114 (s), 5107; 38 C.F.R. §§ 3.102, 3.350. 3. The criteria for entitlement to a TDIU for the period from January June 22, 2011 to January 2, 2014 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § § 3.340, 3.341, 4.16. 4. The claim for a TDIU for the period from January 3, 2014 to December 27, 2015 is dismissed as moot. 38 U.S.C. § 7105; Bradley v. Peake, 22 Vet. App. 280 (2008). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1968 to December 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2011 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded this case in January 2019 for further development. During the pendency of this appeal, in an August 2020 rating decision, the RO granted entitlement to a TDIU from December 28, 2015, the date of the Application for Increased Compensation Based on Unemployability. This does not constitute a full grant of the claim and it remains in appellate status as the issue of TDIU was found to be part and parcel with the increased rating claim for PTSD, which goes back to June 22, 2011. AB v. Brown, 6 Vet. App. 35 (1993). As such, the issue of entitlement to a TDIU from June 22, 2011 to December 27, 2015 is still under appeal. The Veteran testified at a videoconference hearing before the undersigned in August 2017. A transcript is of record. Pursuant to the Veterans Claims Assistance Act (VCAA), VA has duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.156(a), 3.159. Neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Increased Rating 1. Entitlement to a 50 percent disability rating for posttraumatic stress disorder (PTSD) from June 22, 2011 is granted. The Veteran contends that his PTSD is worse than his current disability rating reflects. More specifically, at the August 2017 hearing, the Veteran’s representative asserted that the Veteran’s PTSD warranted a 70 percent or 100 percent disability rating. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of, or incident to, military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. 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 veteran’s entire history is to be considered when making disability evaluations. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55 (1994). Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505, 509 - 10 (2007). The Veteran’s PTSD has been currently evaluated as 30 percent disabling under 38 C.F.R. § 4.130; Diagnostic Code 9411. Under Diagnostic Code 9411, which is governed by a General Rating Formula for Mental Disorders, a 30 percent rating is warranted for occupational and social impairment, with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). A 50 percent 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/or difficulty in establishing and maintaining effective work and social relationships. 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 work-like setting); and/or inability to establish and maintain effective relationships. 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; inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and/or memory loss for names of close relatives, own occupation, or own name. According to the applicable rating criteria, when evaluating a mental disorder, the frequency, severity, duration of psychiatric symptoms, length of remissions, and the Veteran’s capacity for adjustment during periods of remission must be considered. 38 C.F.R. § 4.126; see Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017). The rating agency shall assign an evaluation based upon all the evidence of record that bears on occupational and social impairment, rather than solely upon the examiner’s assessment of the level of disability at the moment of the examination. Id. 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. Id. The “such symptoms as” language means “for example,” and does not represent an exhaustive list of symptoms that must be found before granting the rating of that category. Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). The list of examples provides guidance as to the severity of symptoms contemplated for each rating. Id. However, this fact does not make the provided list of symptoms irrelevant. See Vasquez-Claudio v. Shinseki, 713 F.3d 112, 116 – 17 (Fed. Cir. 2013). The Veteran must still demonstrate either the particular symptoms associated with the rating sought, or other symptoms of similar severity, frequency, and duration. Id. at 117. VA must engage in a holistic analysis that assesses the severity, frequency, and duration of the signs and symptoms of the psychiatric disability; quantifies the level of occupational and social impairment caused by those symptoms; and assigns an evaluation that most nearly approximates the level of occupational and social impairment. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017). The Board notes that the Diagnostic and Statistical Manual, Fourth Edition, allowed for the assignment of Global Assessment of Functioning (GAF) scores, which are a scale reflecting the psychological, social, and occupational functioning on a hypothetical continuum of mental health illness. However, VA regulations were amended to adopt the Diagnostic and Statistical Manual, Fifth Edition (DSM-5), which eliminated the use of GAF scores for evaluating mental illness. 80 Fed. Reg. 14,308 (Mar. 19, 2015). As GAF scores are no longer held to be an effective method of evaluating the severity of psychiatric disabilities, the Board will not rely on any GAF scores in adjudicating the present claim. Golden v. Shulkin, 29 Vet. App. 221, 22426 (2018). In reaching the below conclusions, the Board has considered the Veteran’s statements regarding the severity and frequency of psychiatric symptoms. The Veteran is competent to report on factual matters of which he has first-hand knowledge, such as experiencing an increased level of psychiatric symptomatology. Washington v. Nicholson, 19 Vet. App. 362 (2005). Thus, in the assignment of each of the ratings, the Veteran’s statements have been weighed in with the medical evidence during each of the staged periods as discussed below. In a June 2011 lay statement, the Veteran contended that his work-related problems had increased. Specifically, he took eight to ten hours to perform what used to take three to four hours mostly due to having to redo his work. He stated that in 30 years of his employment, he had not damaged any equipment, but in the last two years, he had damaged approximately $8000 to $10,000 worth of new equipment. Additionally, he could not recall the line of code he just wrote or the function. The Veteran described his company as being “very kind.” He stated that he was working with the Canton clinic to improve his ability to control his anger and temper. While his life had improved, his memories of Vietnam occurred daily. He reported not his memories were “getting to true flashbacks,” in that he was in another world. The Veteran’s flashbacks were of his experiences in Vietnam. The Veteran could normally manage many tasks throughout the day, but when his Vietnam memories or depression set in, he “[felt] like a third person.” Not only did he have problems daily, but also his schedule and tasks in the days or weeks ahead were lost or incomplete. In a June 2011 lay statement, the Veteran asserted that his condition had deteriorated over the last year. Specifically, his work performance had become poor. He was concerned about his ability and the advisability of keeping his job. In a July 2011 lay statement, the Veteran reported that his preoccupation with Vietnam had impaired his general mental focus and work focus to the point that in the last two years the number of errors he made at work had caused many problems. Since February of this year, he developed a phobia of traveling and had not traveled, which consisted of 60% of his job. He reported that his condition had worsened since then. Dealing with sleep and rest had also been particularly challenging. In a July 2011 VA examination, it was noted that the Veteran’s current psychiatric symptoms included fear of flying, extreme tiredness, occasional preoccupation with his experiences in Vietnam, and agitation. Fear of flying prevented the Veteran from attending conferences which were important for his job. Preoccupation and tiredness severely hindered his concentration at work. His extreme tiredness had been constant since November 2010. The Veteran reported cycles of working himself to the point of exhaustion and then crashing for one to two days. It was indicated that this pattern was similar to his work regimen in Vietnam. Although the Veteran was currently employed, he believed that his PTSD symptoms had increased in recent years to the point that had that they had significantly diminished his ability to concentrate at work. He tended to obsess on the details of Vietnam. He reported that up until now, his employers had been very “understanding.” The examiner found that the Veteran’s PTSD symptoms resulted in occasional decrease in work efficiency or intermittent periods of inability to perform occupational tasks, but generally satisfactory functioning. The examiner noted that the Veteran’s work efficiency had decreased due to his poor concentration, which typically occurred in the afternoon. His occasional poor sleep also affected his energy level at work. The examiner found that it was unknown whether the Veteran’s fear of flying was an outgrowth of his PTSD symptoms. If so, then this prevented the Veteran from attending conferences and workshops important to his occupation. After administering the PTSD checklist, the examiner noted that the Veteran was bothered quite a bit by disturbing memories of Vietnam and the feeling of reliving his Vietnam experience. The Veteran had mild to moderate symptoms that suggested avoidance and hyperarousal. He was moderately bothered by loss of interest, feeling distant from other people, feeling emotionally numb, and feeling that his future had been cut short. He had difficulty staying asleep, irritability, and difficulty concentrating. The examiner noted that the Veteran was not easily startled, nor did he have to stay “on guard.” The Veteran was currently employed designing and building machine automations in the auto industry. He had been at this job for 19 years. He reported losing 22 days of work this year and 14 days last year due to his psychiatric condition. The Veteran attended trade school for heating, refrigeration, and boilers and Akron University for electrical training. He had generally positive relationships with his family members, except with his oldest brother. When his sister had been killed in 1978, he and his wife adopted his sister's daughter. He had a positive marriage of 37 years and positive friendships. He was highly involved with a group of fellow veterans that hosted exhibitions on military history. The Veteran described himself as “right at home” when constructing and demonstrating a medical first aid site. Mental status examination showed but the Veteran did not have impairment of thought process, impairment of communication, delusions, hallucinations, inappropriate behavior, suicidal thoughts or intent, homicidal thoughts or intent, obsessive or ritualistic behavior that interfered with routine activities, irrelevant, illogical, or obscure speech patterns, panic attacks, depression, anxiety, or impulse control. The examiner noted that the Veteran reported sometimes feeling “blah” or lethargic after obsessing on his past, but found that this did not appear to be part of depression per se. The bedroom was able to maintain minimal personal hygiene at other basic activities of daily living and had normal orientation to person place and time the veteran had erratic and poor concentration which led to poor short-term memory, but this was likely due to poor attention and concentration. This occurred daily and interfered with his work efficiency. The Veteran had mild sleep impairment. Without medication, he had insomnia, but with medication, his sleep was much improved. His sleep impairment may contribute to tiredness. The examiner found that the primary negative impact of the Veteran’s PTSD was on his concentration at work. Secondly, his PTSD symptoms affected his sleep. There was no negative impact on the Veteran’s roles as husband or parent. He was also able to enjoy social activities. The Veteran’s obsession was definitely centered on his experience in Vietnam and his periodic obsession impacted his concentration at work. He had an excellent coping skill in his history program produced with other veterans. The Veteran was also writing a book on his experiences, which should prove therapeutic. In a January 2012 lay statement, the Veteran reported losing 30 to 35 days of work due to VA and Vietnam-related issues. He could no longer travel for work or personal reasons. His anxiety and intrusive thoughts would overwhelm him a week before and after his travel. He had been taking short trips with his wife, but did not know if this would help. The Veteran’s intrusive thoughts consumed him to the point that he just “shut down.” He was mostly getting six hours of sleep, but not much rest, except on weekends when he could get ten hours of sleep. He did not have a social life, only two very good friends who were also veterans. The Veteran stated that while he could cover his work issues in the past, he could no longer do so. He could only stay until someone got hurt or he got fired. He could not travel, design electrical controls, or work eight hours. He did not have confidence in his work and had given up his hobbies. He disagreed with the finding that he did not have impairment of thought process. In a January 2012 lay statement, the Veteran contended that his PTSD was worse than the 30 percent rating assigned and indicated his disagreement with the findings in the July 2011 VA examination. He indicated that he had been diagnosed with severe PTSD by the Canton Clinic in early 2010 and had to double his psychiatric visits that year. The Veteran stated that fatigue had been a main issue since 2009. He also started that his tiredness began in fall of 2007 and had worsened since then. He was reportedly at near maximum dose for Zoloft, which kept his anger in check, but caused fatigue. He indicated that his medications changed his behavior and affected his life and job. The Veteran reported having vivid and detailed memories and daily preoccupation with Vietnam-related memories. He used to be very sharp and angry with people, now was mostly “flat.” The Veteran was moderately bothered by the loss of his feelings to others and his families. He was not easily startled and did not stay on guard due to his past experiences. His wife and two very good friends watched over him all the time. His only living sister would not speak to him other than taking care of family business. He states that sometimes this was painful, but otherwise was just “dull.” The Veteran reported that after 16 years, he “gave up” on being treasurer of a nonprofit organization he had helped started, being on any committees, and any other areas of responsibilities. However, he had not given up on helping with events. The Veteran stated that he had had missed 30 to 35 days of work due to his inability to sleep, inability to focus, feeling “flat,” not caring, and confusion about what was going on in his head. His memories and fears of traveling caused him to stop traveling for his employer. However, he denied having a fear of flying and clarified that he had a fear of going somewhere, anywhere, for work or pleasure. When the plane was flying, making a banking turn, or descending, he would reach for his pistol. He also had a daily preoccupation with Vietnam related memories, which he tried to suppress. The Veteran also stated that he had to redo his work three to four times, but still “burn[ed] stuff up.” He could not write reports due to his inability to focus and at times typed his thoughts about Vietnam into his report. When he got excited, he blurted out radio calls from Vietnam. The Veteran was no longer the Machine Controls Manager for [REDACTED], which he indicated was due to his inability to travel and write reports, and diminished ability to supervise and design. He was very concerned for safety and had caused approximately $10,000 worth of damages in equipment in the past three years. His employer was described as “very kind,” and were stopping just short of asking him to retire. In a January 2012 lay statement, the Veteran related the circumstances of his in-service stressor. He reported having a lot of emotions in his memories, specifically getting angry then depressed. This would go on for 20 minutes to an hour all night. He stated that he could look back and understand logically what had happened and place no fault except on combat and war. However, he could not do that for his emotions. The Veteran had difficulties sleeping to his Vietnam experiences and was only rested on the weekends when he could take a nap. He reported having lost 20 days of work that year. In an August 2014 VA examination, the examiner found that the Veteran’s respiratory conditions impacted his ability to work in that he had to retired as a repair engineer due ot generalized fatigue and left-sided chest pain on January 2014. He underwent a lower left lobectomy on November 22, 2013. In a September 2014 lay statement, the Veteran reported living with the stress from his year in Vietnam for 45 years until it became such a problem that he could no longer travel or focus on work. He lost his management position. In a November 2015 VA examination, the examiner found that the Veteran’s PTSD resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. His PTSD symptoms included anxiety, chronic sleep impairment, mild memory loss, such as forgetting names, directions, or recent events, and difficulty in adapting to stressful circumstances, including work or a worklike setting. Upon behavioral observations, the examiner found that the Veteran was alert, cooperative, and oriented, with good eye contact, normal speech, normal psychomotor activity, euthymic mood, congruent affect and mood, and goal-oriented thought process. There were no signs of delusional or paranoid belief systems, and he denied suicidal or homicidal ideation. It was noted that the Veteran was still married to his wife of 42 years and that he got along well with her. He had one living sister who he did not see very often. Apparently, there was some issue about how she handled their mother’s affairs. It was noted that the Veteran’s parents and three of his siblings had passed away well before the time of the last examination. In the summer, the Veteran ran a historical medical hospital at MAPS three to four times a week. He felt this was helpful for him. He was planning on additional volunteer pursuits in the winter. The Veteran had been working full time at the time of the last VA examination, but had difficulties working full time due to multiple medical and mental health complaints. Finally, he tired in July 2014, primarily due to medical issues and fatigue. The examiner found that while the Veteran had reported enough symptoms to meet the criteria for a PTSD diagnosis, the frequency and intensity of the symptoms did not appear markedly different than at time of his last PTSD examination. However, his symptoms could become temporarily exacerbated when he was anxious about his medical issues. The examiner also found that the Veteran’s mental health symptoms would likely cause mild or no discomfort when interacting with other people, and mild or no reduction in communication effectiveness. His level of concentration would likely cause moderate work inefficiency and lack of productivity, but this was not a significant change from his earlier functioning. His ability to maintain a logical thinking process appeared adequate and would not likely impact his social or vocational functioning. He had some mild to moderate reduction in ability to adapt to stressful circs, such as workplace and other social environments (i.e., flying). Gross impairment in thought process, delusions, and hallucinations were not noted. In November 2015, the Veteran indicated his disagreement with the November 2015 VA examiner’s findings. He stated that he did not believe that the examiner did not take into account his inability to watch movies or television, having to step down as manager and design engineer, and concerns for others at work due to his psychiatric symptoms when evaluating the social and occupational impairment. He contended that the examiner’s opinion as to his occupational impairment was based on poor and unresolved review and speculated that that the examiner had not been provided any history to review. He disagreed with the examiner’s finding that he retired in July 2014 primarily due to medical issues and fatigue and stated that he retired due to both mental and physical problems. He also contended that while his trauma symptoms were still present during the summer albeit more manageable. The Veteran took issue with the examiner not further discussing his PTSD problems increasing after his surgery and finding that he was capable of managing his financial affairs. He stated that his wife handled the bills and kept up with the needs of the house, because he could not remember to do so. At a November 2015 hearing, the Veteran’s representative contended that since the June 2011 VA examination, the Veteran had lost his full-time substantially gainful employment due to his PTSD, specifically due to difficulties sleeping, difficulties concentrating, and intrusive thoughts. The months of October to January were very difficult for the Veteran because they were anniversary dates of many various casualties and combat stressors. The Veteran was being treated at the Canton VA medical center (VAMC). It had taken him a number of years to figure the right amount of Zoloft to stop his anxiety without making him a “dud,” and monthly counseling had allowed him to reduce the dosage. Understanding his PTSD and its effects helped him manage it a little better, but it did not help too much with his memories and all the ill and strange feelings. He described how his PTSD symptoms affected his daily life, to include intrusive memories of Vietnam and thinking about the memories about every 20 minutes all day. This could last for most of the day to two days. Sometimes, it would trigger further details in a particular mission. When experiencing memories, the Veteran stated that he was “stalled,” during which he lost focus on what he was doing and had the memory run through his mind. At some point he would catch himself, but that could be a minute to 15 minutes later. He was aware of his surroundings, but his thoughts were elsewhere. The thoughts that stalled his activities occurred on a daily basis and were worse when he was driving a car. He stated that he was once an electrical engineer. There were many instances when he was responsible for approximately $10,000 worth of equipment being damaged or destroyed. The Veteran reported that his PTSD symptoms precluded him from substantial gainful employment, to include typing something from his Vietnam experience into his reports for work and blurting out radio calls or coordinates. He retired from [REDACTED] on June 14, 2014. He left his employment in stages by stepping down from different jobs, going from the highest position at the engineering level to the lowest. However, he kept the same salary. Eventually he retired because after his surgery for lung cancer he realized that he could not work a full day. For example, he went back to work for five hours a day and was not able to do so. He realized he was making several mistakes in 2010 and 2011 and stepped away from being a manager. In 2011 or 2012, he was missing 38 to 40 days of work every fall. Every fall he remembered his military experience. He did not dream because he was awake all night which made it difficult to go to work the next day. After a couple of days, he would crash. The Veteran realized that his company was keeping him because he was a veteran and a long-time employee even though he could not do the work. In a December 2015 Request for Employment Information, [REDACTED] stated that the Veteran had lost 117 workdays due to his disability. [REDACTED] adjusted the work level and length of the workday based on the Veteran’s stamina and adjusted hourly maintenance employees to cover his responsibilities. It was noted that the Veteran retired so the company could hire a full-time person to perform the required functions of the job. In a December 2015 VA examination, the examiner found that ever since the Veteran’s lung surgery, post-thoracotomy pain had been triggering vivid dreams related to his military service. In a May 2016 addendum opinion, the examiner reviewed the additional information from the November 2015 hearing and lay statements. It was noted that at the hearing, the Veteran specifically highlighted sleep, concentration issues, intrusive thoughts, dissociative episodes, and certain times of year being worse (anniversary dates). It was also noted that the Veteran reported loss of job largely due to PTSD symptoms, to include those noted at the 2015 VA examination and additional symptoms. The examiner found that the statement from [REDACTED] was consistent with the statements the Veteran made during the 2015 VA examination (i.e., stamina and fatigue) and that PTSD was no mentioned. Additionally, at the hearing, the Veteran reported reduction in mental health medications which continued to this day. As such, the examiner found that the new evidence did not suggest any changes to the original examination. At the June 2016 VA 9, the Veteran reported that his PTSD symptoms had increased since his lung surgery, to include a decrease in memory and cognition. His wife now handled rhe bills and kept up with the house. In a January 2017 lay statement, J. M., the Veteran’s former employer at [REDACTED] (now [REDACTED]), stated that the Veteran had been one of his first hires when he started the Engineering and Technology Center for [REDACTED] in 1997. As President, he personally supervised, worked with, and knew the Veteran for 18 years as an employee. The Veteran was hired as a facilities/plant engineer and during the first few years, he was a great hire. As [REDACTED] grew, the Veteran was promoted which required him to travel to division and customer 75 to 80 percent of the time. The Veteran expressed his gratitude for the promotion, but expressed his reservations as to the required travel given his tour of duty in Vietnam and did not know how well he would handle flying. Over time, the Veteran developed issues with his ability to focus and perform his work. He was always taking extended breaks and often was found staring into space. J. M. realized that the Veteran was preoccupied with something other than the task at hand. The Veteran’s demeanor also started to change and when he was confronted with his inability to maintain focus, he became very argumentative and despondent. On several occasions, J. M. was asked, or on one occasion told, by other division presidents to no longer send the Veteran to their facilities as no one wanted to deal with his mood swings and him being argumentative over every little issue. The Veteran was soon demoted to facilities/plant engineer due to being argumentative, missing work, inability to prioritize tasks, and inability to focus. On several occasions after having private conversations with the Veteran about his struggles to perform his duties satisfactorily, J. M. would receive emails from the Veteran outlining how he was dealing with his PTSD symptoms and how he felt they were interfering with his ability to focus. By the time J. M. left [REDACTED], the Veteran had been demoted again. During 2014, the Veteran was only working a few hours a day. The Veteran’s new manager was very understanding of the Veteran’s personal issues and reluctant to make any changes to his employment status, as was J. M., and kept the Veteran on as a part-time employee until his retirement. In a January 2017 lay statement, the Veteran reported that the sharp pain in his left ribs triggered memories and dreams of his experiences in Vietnam. This stopped about one day after the pain subsided. The dreams would occur when he went to bed with pain. He reported that when he got depression and chest pain, it was “real bad.” In a March 2017 lay statement, the Veteran indicated that he was severely triggered after his surgery, which resulted in a vivid dream. Memories and dreams occurred when he had chest pain. He stated that due to his PTSD and exposure to Agent Orange, he had to step down from manager, design engineer, and finally to maintenance before he was forced to retire. He could not get close to his family and friends and it was hard to have feelings. In an August 2017 lay statement, the Veteran’s wife reported not being able to recall exactly when the Veteran finally explained what he was going through; however, she did notice that he was starting to withdraw. In the years after their marriage, she started to notice that the Veteran was changing. He was becoming moody, short tempered, and distracted, never wanted to do anything socially with friends and family, and lacked empathy and sympathy, to include when she underwent surgery. Holidays were difficult because he did not want to be around people or celebrate anything. He would have his “medic moments” when she needed him and he treated her like one of his soldiers on the combat field. The Veteran became so immersed in his hobbies and interests that he did nothing around the house or with her. If things did not go his way, he would get an “attitude.” She could tell by his voice and when he would physically start shaking. However, they never argued or yelled at each. Instead, the Veteran shut down and walked away from her. The Veteran’s wife could not recall the Veteran getting a good night’s sleep. In an August 2017 lay statement, the Veteran contended that his PTSD should be rated as 70 or 100 percent disabling. He contended that he was in persistent of hurting himself at work, specifically in that he continued to be distracted which was going to lead to an accident. He also reported having memory loss of names of close relatives, his own occupation, the name of his company, who he was going to meet, and what day of the week it was. He also had difficulties remembering to turn off the car after it was parked. The Veteran had difficulties with work, to include mishaps, incomplete projects, inability to deal well with schedule changes, or missing items on projects. If he took a break or looked at another project, it would take 30 to 45 minutes to find his place on the project he just left. He spent a number of times staring at a machine or computer screen thinking about something pertaining to his experiences in Vietnam. When he thought about something in Vietnam, he would get depressed or excited as if it just happened. At the August 2017 Board hearing, the Veteran’s representative contended that the Veteran had significant impairment due to his PTSD which warranted a 70 or 100 percent disability rating based on his testimony and statements in medical records. The Veteran reported that he did not get flashbacks as most people did as he did not see himself as being in Vietnam, but described it like a constant daydream. After his surgery in 2014 for his cancer, he was left with pain when he breathed in which took him back to when he treated chest wounds in Vietnam. This would ease until he felt pain again. He still got angry and was occasionally short-tempered; however, he stated that he was much improved from how he was in 2008. The Veteran also had feelings of survivor’s guilt due ot his brothers, sisters, and Vietnam. He denied feelings of hopelessness or helplessness. He understood that PTSD was not curable and was just trying to have some measure of quality of life again. The Veteran reported that one the biggest changes in his life was in July 2014 when he retired and found that if he was awake all night thinking about Vietnam, he could sleep all day. Him staying up at night thinking about Vietnam was happening more frequently and continued to present date. He just spent eight days without sleep and the only that “saved” him was that he could nap in the middle of the day. When he was working, he might be up for two or three nights straight and would still need to work. He would spend the weekends in bed and be tired. The Veteran retired due to his surgery and PTSD symptoms. He reportedly could deal with one or the other, but not the both of them. The Veteran stated that his symptoms were about the same as they were at the November 2015 VA examination. However, the Veteran had issues with the results of the November 2015 VA examination. His representative stated that the Veteran had indicated issues with the examiner not listening to all his statements or documenting the frequency and duration of his symptoms. He could not recall the November 2015 VA examination, but stated that he did outline his disagreements in writing. Much of his issues were with how the examiner asked a question to get an answer from him and did not expand on things that were important to him. The representative contended that the Veteran’s testimony showed more severe symptoms and indicated a more severe level of PTSD going back to November 2015. Further, the representative asserted that the Veteran battled with PTSD every day and that his daily activities had been significantly affected. The representative believed that the Veteran’s symptoms were very similar to those at the 70 percent or 100 percent rating, particularly in terms of occupational impairment. The representative also contended that the November 2015 VA examiner had downplayed or ignored the Veteran’s statements regarding the frequency, severity, and duration of his PTSD symptoms. In a February 2018 VA examination, the examiner found that the Veteran’s PTSD resulted in occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medication. The Veteran’s symptoms included depressed mood, anxiety, near-continuous panic or depression affecting ability to function independently, appropriately, and effectively, chronic sleep impairment, mild memory loss, such as forgetting names, directions, and recent events, flattened affect, difficulty in understanding complex commands, and disturbances of motivation and mood. It was noted that the Veteran had a strained relationship with sister and a positive relationship with his wife. The examiner found that the Veteran would likely have difficulty in noise and crowded environments and that he did not appear to pose a threat of danger or injury to himself or others. In a July 2019 lay statement, the Veteran reported chest and rib pain due to difficulties breathing which triggered his PTSD and memories of chest wounds he treated in Vietnam. In a September 2020 lay statement, the Veteran indicated that he had been having problems with work every year. He was getting very afraid of hurting someone due to mistakes at work because in 2008 he could not keep focus. His mind would drift to Vietnam for 30 to 40 minutes at a time. He indicated his belief that the VA examiners did not understand his medical or military history, to include the nature of his symptoms. In September 2020, the Veteran provided a correspondence he gave the VA clinic in July 2011. In this correspondence, the Veteran provided details of his service and in-service stressors. He reported that he did not know what triggered his latest round of memories, but that it had been building since at least February 2011. With each of these memories were “a lot of emotions.” He would get angry and then depressed, which could go on for 20 minutes to an hour all night. At least every hour, he could look back and understand logically what happened and place no fault except combat and war. However, he could not do so with emotions. He only got rest on the weekends when he could take a one to three-hour nap at 2 PM. He lost 20 days of work in 2011. Due to the aforementioned symptoms, he did not want to go or was too tired to do so when his flashbacks started and he did not sleep. The Veteran stated that he felt sheer fear for 30 minutes before it eased. This occurred many times, but mostly when he was about to fall asleep and then his whole body would stiffen up and he would be wide awake. In a September 2020 lay statement that was dated November 2015, the Veteran reported that he had been “putting a lid back” on his memories and experiences in Vietnam. He relived most of these events from October to January. He realized in 2007 that he was blurting out radio calls and map coordinates. There were many times when his mind was in Vietnam. He would also write statements pertaining to his military experiences when writing a quote for work. There had also been times when he went to lunch and returned to work and he forgot to turn off his vehicle. He had many lapses of memory because his mind was “14,000 miles away.” When he was out with friends, they would keep an eye on him about his forgetfulness. Since 2009, when a plane turned and descended, the Veteran would check his pistol because he felt like he was on a mission. When he drove down a hill, he did not see the road, but saw the front window of a helicopter and felt like he was making an assault into a clearing. He had to take someone with him on a long drive. His fear of flying was not about the flying, but about sinking further back into Vietnam. The Veteran stated that he did not have any outward feelings about family or friends. As a medic, he had to be strong, so he found it difficult to talk about himself as he was never allowed to have problems. He noted that this had taken a toll on his wife because he cared, but could not show it. He was also a “downer” during the holidays because he stared into space and did not listen. Every day his wife reminded him about his appointments and when to take his medicine and change his clothes. She paid all the bills and kept up with the house. The Veteran reported having job-related problems due to his PTSD prior to 2009, but 2009 was when he realized the mistakes he was making. At that point, he went to VA and spoke with the engineering president about his issues. He could only focus on computers or tasks for about 15 to 20 minutes at a time and was unable to schedule work or supervise. He stated that he could not focus because the memories and feelings he had in Vietnam distracted him. In a very short amount of time he would get depressed and feel total exhaustion. By late 2010, he was unable to fly. In 2011, he was unable to drive for more than 30 to 45 minutes. He was making many mistakes at work and risking the safety of the employees. He also ruined $5,000 worth of equipment. In 2011, the Veteran stepped away from his management position to a design position, which only lasted six months. He then took a maintenance position. There were many days when he was awake all night and could not work. His sleeplessness would last for days until he crashed for two to three days. This occurred weekly from October to January every year since 1994. He missed 38 days of work in 2012. After his November 2013 surgery, he tried to return to work at five hours a day, but was unable to do so due to chest pain. He got new sharp and vivid memories and felt the pain of “[his] wounded” whenever he got chest pain, which occurred three to four times a week. He could not go to the movies or watch television except for the History Channel because he was unable to watch violent shows or even the news. He reported that he did not feel like he was being watched and that he did not have many dreams. However, the latter was due to the fact that he lay awake at night and experienced memories all day. He also had “medic moments” for a long time in which nothing was fast enough and that was problematic when he was a supervisor. The Veteran stated that PTSD cost him his friends, family, job, and career. The Veteran did not believe that the VA examinations adequately evaluated him because he did not understand how anyone could evaluate a person’s life after “meeting them for the first time in a 20 [to] 30 minute…asking 5 to 8 questions.” He continued to express concerns about his work causing injuries to employees and took issue with VA not considering him a danger to others when he was by nature of his job. He contended that the July 2011 VA examination was the “most misinterpreted” writing he had seen, particularly the diagnosis of “moderate.” The Veteran reported that he was doing everything he could do manage his PTSD, which had a huge effect on his physical health. He volunteered at the MAPS Air Museum teaching in a field hospital. He could come and go as needed, which was approximately five to twelve hours a week. He described the field hospital as a safe place. Talking to veterans helped him and them. It was the only relief he had from his surgery. The Veteran stated that he needed rest and sleep to stay functional and that he could only be involved with activities that he could walk away from at any time. It took him a very long time to master new tasks. In a September 2020 lay statement, the Veteran reported that during service he would get blood splatters on this clothes that turned black. In the early morning or the moonlit night, he would stare at the spot and think of the wounded. After service, he worked in manufacturing and oil splatters were routine, which was difficult for him as he was reminded of blood and the eyes of the wounded. The Veteran related that riding in helicopters was calm and peaceful, but the insertion was sometimes under fire and you would not know until your feet hit the ground. It was a mad minute and the feeling of panic would last all day. When he woke up thinking about helicopters, his whole day was in a panic. The Veteran reported that writing had helped with his PTSD symptoms by removing the feeling of burden. His memories still returned with or without reason and lasted longer. The Veteran also submitted logs he had written pertaining to his PTSD symptoms; however, since these were written from December 2009 to May 2010, they are outside of the period on appeal. Post-service VA treatment records from June 2011 to July 2019 show that the Veteran’s PTSD symptoms included nightmares, intrusive thoughts and memories, flashbacks, preoccupation with experiences in Vietnam, anxiety, some anger, difficulties sleeping, difficulties concentrating and focusing, fatigue, limited energy, some confusion, and feelings of guilt. It was noted that October to December was the most difficult time for the Veteran due to combat trauma and difficult anniversaries. Some symptoms, such as nightmares, temporarily worsened after surgery. Pain triggered intrusive memories. He described periods of waking up with feelings related to events in Vietnam (i.e., nervousness) without memories. He had difficulties at work due to anger, anxiety, and difficulties concentrating and focusing. He reported “near flashbacks” which ruined the rest of his workday and being confused and unable to focus by the afternoon. The Veteran was constantly worried about someone getting injured or dying from a mistake he made at work. He described having “crashes” related to being back in combat, specifically going “full tilt” until he used up all his energy. He reported having problems when he drove. For example, he would see himself looking out of a helicopter when driving on certain roads. He would also have the sensation of being in a helicopter if he drove by himself for over half an hour. While driving downhill, he would blurt out radio calls. He expressed ambivalence at the thought of making friends. In December 2011, he reported feeling closer to his family and grandchildren as a result of groupwork and individual counseling. In December 2012, he reported that his oldest grandson had moved in with him and his wife. The Veteran stated that it helped to help his grandson. In January 2015, he indicated having difficulty showing empathy for his wife who had severe lower back problems and would be having surgery. He processed that he had been trained and well-practiced in not “freaking out” at bad news. March 2015 and April 2016 VA treatment records showed that the Veteran was his wife’s caretaker following her back surgery and that he had been working with his wife, who had developed chronic pain, to include family therapy. The records show that the Veteran consistently volunteered, especially at MAPS giving tours, lectures, and presentations, and working with children. He also taught Boy Scouts. The Veteran appeared to enjoy his volunteering and it helped him cope with his PTSD. Further, in February 2015, the Veteran reported that he had been asked to teach a course at the local college to senior nursing students and in March 2015, he did several presentations of the aid station and field dental clinic, including to NEOMED students. He reported having come to a point of acceptance and that he would keep engaging with other veterans and the public in outreach. The Veteran also had hobbies which kept him preoccupied, to include building a model T ambulance and researching on how to set up and make aid stations real. In June 2011, he stated that he was in charge of cooking at an event with military vehicles and rifle demonstrations. He felt calm and comfortable and nothing was triggered. In August 2017, he reported that he took the field hospital to a tank show and won best display. In June 2011, he stated that he had not been able to travel much due to his PTSD symptoms. In August 2011, the Veteran spent a weekend in Dayton for a military event to try to work through his traveling issues. As a result, he had diarrhea and nausea for several days. In September 2011, the Veteran went on his first business trip since February 2011. He was very tense the week prior to and felt “out of sync” during the trip. He was exhausted upon his return. The trip triggered intense thoughts and he did not perform his job well. Mental status examinations generally showed that the Veteran was well-groomed, cooperative, alert, and oriented with no cognitive deficits, and had good insight, good judgment, intact memory, and no unusual thought content, suicidal ideation, homicidal ideation, hallucinations, or delusions. They also showed that the Veteran had low energy and variable sleep. His mood ranged from stable to anxious and angry to depressed, his affect, which was consistently appropriate or congruent with his mood, ranged from fair to anxious and sad, to blunt, restricted, and constricted, and his thought processes indicated mostly logical, coherent, and normal speech, with occasional somewhat pressured speech. Initially, the Board acknowledges the arguments presented in the November 2015 lay statement and August 2017 Board hearing contending that the November 2015 VA examination was inadequate. However, the Board finds that the examiner did provide the relevant symptomatology and functional impairment as needed to address the criteria for rating the Veteran’s service-connected PTSD. While the Board understands the Veteran’s concerns, the November 2015 examination report provides sufficient detail responsive to the rating criteria to rate the Veteran’s PTSD. Further, it appears that most of the Veteran’s and his representative’s concerns related to their contentions that the examiner did not adequately consider the Veteran’s statements as to the frequency, duration, and severity of his PTSD symptoms. The Board has considered these statements in evaluating the Veteran’s PTSD. Based on a careful review of the subjective and clinical evidence, the Board finds that from June 22, 2011, the Veteran’s PTSD warrants a higher 50 percent rating. In other words, his symptoms manifested in the frequency, severity and duration consistent with the symptoms identified in the next higher evaluation which requires occupational and social impairment with reduced reliability and productivity. In this regard, the Board finds that the following provides the most probative evidence demonstrating the extent of the Veteran’s mental health symptomatology: (1) VA examination findings that the Veteran’s PTSD symptoms included, chronic sleep impairment, fatigue, low energy level, anxiety, irritability, near-continuous panic or depression affecting his ability to function independently, appropriately, and effectively, depressed mood, mild memory loss, intrusive thoughts, difficulties concentrating and focusing, difficulty in adapting to stressful circumstances, including work or worklike setting, difficulty in understanding complex commands, disturbances of motivations and mood, and flattened affect; (2) lay statements and VA treatment records showing that the Veteran was unable to travel by plane or by car (by himself for over 30 minutes), which affected his work; (3) lay statements and treatment records indicating that his fairly frequent intrusive thoughts, memories, and emotions and difficulties concentrating and focusing affected his productivity at work; (4) lay statements and VA treatment records showing that the Veteran had cycles in which he would go “full tilt” for days until he exhausted all his energy; and (5) the January 2017 lay statement by J. M., the Veteran’s former employer, reporting that the Veteran’s PTSD symptoms affected his ability to do his job eventually causing him to resign. The symptoms reported during this time period are clearly indicative of a 50 percent rating. However, there is no evidence of record which indicated that the Veteran had suicidal intentions, obsessional rituals which interfered with routine activities, impaired impulse control (such as unprovoked irritability with periods of violence), spatial disorientation, or neglect of personal appearance and hygiene or more severe symptomatology such as to warrant at least the next higher 70 percent rating. Indeed, the evidence of record, to include VA treatment records, consistently show that the Veteran did not have suicidal or homicidal ideations or intent, obsessive rituals, impaired impulse control, or neglect of personal appearance and hygiene. Bowling v. Principi, 15 Vet. App. 1 (2001); Vazquez-Claudio v. Shinseki, 713 F. 3d 112 (Fed. Cir. 2013) (70 percent rating requires sufficient symptoms of the kind listed in the 70 percent requirements, or others of similar severity, frequency, or duration, that cause occupational and social impairment with deficiencies in most areas such as those enumerated in the regulation). Additionally, VA treatment records show that the Veteran had a consistent history of volunteering at MAPS, teaching and working with children and students, which he enjoyed. While the Veteran has indicated his belief that he is a danger to others specifically because his mistakes at work could cause injury or death, he did not demonstrate homicidal ideation or intent, which refers to an individual having the thoughts of or desire to harm or kill another person. However, it is clear that the Veteran does not demonstrate homicidal thoughts or ideation as he has shown consistent concern for the well-being and safety of others, particularly his employees. Accordingly, the Board finds that the criteria for a rating of 50 percent, but no higher, for PTSD from June 22, 2011 is warranted. Special Monthly Compensation Entitlement to SMC is an “inferred issue” in the context of an increased rating claim that must be considered when the record indicates that it may be available, even if the claimant does not place eligibility for this ancillary benefit at issue. Akles v. Derwinski, 1 Vet. App. 118, 121 (1991); see also Bradley v. Peake, 22 Vet. App. 280 (2008). SMC is payable at the housebound rate where the Veteran has a single service-connected disability rated at 100 percent and one or more distinct service-connected disabilities, which are independently ratable at 60 percent and involve different anatomical segments or bodily systems. 38 U.S.C. § 1114 (s); 38 C.F.R. § 3.350 (i). In this case, the Board’s decision above grants a 50 percent evaluation for PTSD from June 22, 2011. Further, as of this decision, and from January 3, 2014 for July 31, 2019, the Veteran is service-connected for lung cancer at 100 percent disabling; PTSD at 50 percent disabling; diabetes mellitus, type II, at 10 percent disabling; tinnitus at 10 percent disabling, and bilateral hearing loss at noncompensably disabling. Thus, for the period from January 3, 2014 to July 31, 2019, the Veteran has had a service-connected disability rated at total (lung cancer) and additional anatomically distinct service-connected disabilities (PTSD, diabetes mellitus, type II, tinnitus, and bilateral hearing loss), which are independently ratable at 60 percent or above. Accordingly, entitlement to SMC at the housebound rate under 38 U.S.C. § 1114 (s) is granted from January 3, 2014 to July 31, 2019. TDIU 1. Entitlement to a TDIU from June 22, 2011 to January 2, 2014 is denied. Total disability means that there is present any impairment of mind or body sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. §§ 3.340, 4.15. A substantially gainful occupation has been defined as “an occupation that provides an annual income that exceeds the poverty threshold for one person, irrespective of the number of hours or days that the Veteran actually works and without regard to the Veteran’s earned annual income.” Faust v. West, 13 Vet. App. 342 (2000). Marginal employment shall not be considered substantially gainful employment. Substantially gainful employment is defined as work that is more than marginal, which permits the individual to earn a “living wage.” Id. Marginal employment is defined as an amount of earned annual income that does not exceed the poverty threshold determined by the Census Bureau. 38 C.F.R. § 4.16 (a). When jobs are not realistically within his or her physical and mental capabilities, a veteran is determined unable to engage in a substantially gainful occupation. Moore v. Derwinski, 1 Vet. App. 356 (1991). In making this determination, consideration may be given to factors such as the veteran’s level of education, special training, and previous work experience, but not to age or impairment caused by non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). 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 such 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. For the purpose of one 60 percent or one 40 percent disability in combination, disabilities resulting from a common etiology or a single accident will be considered as one disability. 38 C.F.R. § 4.16 (a). If a sufficient rating is present, then it must be at least as likely as not that the Veteran is unable to secure or follow a substantially gainful occupation as a result of that disease. See 38 C.F.R. § 4.16 (a). 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). The issue is not whether the Veteran can find employment generally, but whether the Veteran is capable of performing the physical and mental acts required by employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Consideration may be given to the Veteran’s education, special training, and previous work experience, but not to his or her age or to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19; see also Van Hoose, 4 Vet. App. at 363. The phrase “unable to secure and follow a substantially gainful occupation” has been interpreted to consist of two components: one economic and one noneconomic. Ray v. Wilkie, 31 Vet. App. 58, 72 – 74 (2019). The economic component means an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. Id. at 73. With respect to the noneconomic component, when determining whether a veteran can secure and follow a substantially gainful occupation, consideration should be given to the following: (1) the veteran’s history, education, skill, and training; (2) whether the veteran has the physical ability (both exertional and non-exertional) to perform the type of activities required; and, (3) whether the veteran has the mental ability to perform the activities required by the occupation at issue. Id. at 73 – 74. The Board notes that the ultimate question of whether a Veteran is capable of substantially gainful employment is not a medical one; that determination is for the adjudicator. Geib v. Shinseki, 773 F.3d 1350, 1354 (Fed. Cir. 2013). Thus, the VA examiners’ conclusions are not dispositive. However, the observations of the examiners regarding functional impairment due to the service-connected disability go to the question of physical or mental limitations that may impact his or her ability to obtain and maintain employment. As an initial matter, the Board finds that the Veteran’s TDIU claim is part and parcel with the increased rating claim that is on appeal, which was filed on June 22, 2011. See Rice v. Shinseki, 22 Vet. App. 447 (2009). As of this decision, from June 22, 2011 to January 2, 2014, the Veteran was service connected for PTSD at 50 percent disabling, diabetes mellitus, type II, at 10 percent disabling, tinnitus at 10 percent disabling, and bilateral hearing loss at noncompensably disabling. Therefore, the Veteran’s service-connected disabilities does not meet schedular criteria for TDIU under 38 C.F.R. § 4.16 (a). However, it is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. 38 C.F.R. § 4.16 (b). Rating boards should refer to the Director of the Compensation and Pension Service for extraschedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities but who fail to meet the percentage requirements set forth in 38 C.F.R. § 4.16 (a). 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 Board incorporates here the factual background pertaining to the Veteran’s service-connected PTSD detailed above. The evidence shows that the Veteran was employed by [REDACTED] ([REDACTED]) from January 1997 to July 2014. VA Forms 21-4192 (Request for Employment Information in Connection with Claim for Disability Benefits) completed by [REDACTED] and [REDACTED] also show that the Veteran was employed full time. Further, the Veteran himself stated he was employed from 1997 to 2014 in his VA Forms 21-8940 (December 2015 and January 2018). Thus, the evidence clearly establishes that the Veteran was employed from June 22, 2011 to January 2, 2014. However, as noted full-time employment, in and of itself, does not preclude the award of a TDIU. 38 C.F.R. § 4.16 (a). Instead, a Veteran who is engaged in employment which is not substantially gainful may still be awarded a TDIU. Id. Employment is not considered to be substantially gainful if a Veteran’s annual earned income does not exceed the amount established by the U.S. Department of Commerce as the poverty threshold for one period. Id. Employment may still be considered to not be substantially gainful despite earned income excessing the poverty threshold when such employment is in a protected environment, such as a family business or sheltered workshop. Id. In this case, the Veteran has not provided any supporting evidence to show that his employment is not substantially gainful, i.e. that his earnings are below the poverty threshold. Id. In fact, according to VA Forms 21-4192 show that the Veteran was either earning $78,600.00 or $81,093.71 during the twelve months preceding the last date of employment. However, the Veteran has indicated in his lay statements that his employer was “very kind” despite him making many mistakes at work, seemingly indicating that his employment was somehow equivalent to protected. The phrase “protected environment” or “in a protected environment” is not specifically defined in either the statutes or regulations governing the award of VA compensation benefits. See Cantrell v. Shulkin, 28 Vet. App. 382, 392 (2017). Relevant dictionary definitions of the pertinent terms reflect that “protect” is defined as “to cover or shield from exposure, injury, damage or destruction; to maintain the status or integrity of especially through financial or legal guarantees; or to provide a guard or shield.” Merriam-Webster’s Collegiate Dictionary 999 (11 ed. 2003). “Environment” is further defined as “the circumstances, objects, or conditions by which one is surrounded.” Id. at 418. Thus, based on these two definitions a protected environment is one where the Veteran’s circumstances are shielded or where such circumstances are maintained through guarantees. Further, the examples of “a family business” and a “sheltered workshop” are provided to illustrate the concept of a protected environment. 38 C.F.R. § 4.16(a); see Ortiz-Valles v. McDonald, 28 Vet. App. 65, 70 (2016). Both of these examples suggest a workplace or environment where the Veteran’s position or employment is the product of the employer’s benevolence or well-meaning, as opposed to any actual value provided by the Veteran in that particular position. Indeed, a “sheltered workshop” is a specifically defined term, meaning “a workshop or training center for handicapped persons, where they can earn wages but are free from the competitive stress of the usual job.” Webster’s New World Dictionary 1081 (3rd coll. ed. 1994). In a protected environment then, the well-meaning or benevolence on the part of the employer is the primary, if not sole, reason for a Veteran’s continued employment, as without it the Veteran would otherwise be objectively unable to perform the job to a sufficient degree to avoid termination. While the Board notes that the use of the phrase “such as” implies that the examples given are not an exhaustive list, this fact does not make the examples provided irrelevant. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002) (noting that the phrase “such symptoms as” used in the rating criteria for psychiatric disabilities means “for example” and is not exhaustive); see also Vasquez-Claudio v. Shinseki, 713 F.3d 112, 116–17 (Fed. Cir. 2013) (noting that while the list of symptoms provided in the diagnostic criteria for psychiatric disability is not exclusive it is also not irrelevant, and demonstrated symptoms must be of similar severity to those listed). Thus, while a “protected environment” is not exclusively limited to either a family business or sheltered workshop, other employment situations must be similar to those examples to qualify as “protected employment” for the purposes of awarding a TDIU. In this case, as discussed above the evidence reflects that the Veteran was employed by a company, and thus on its face the Veteran’s employment is in no way akin to employment at a family business or sheltered workshop. While the Veteran has indicated that he has been moved to positions of less responsibility due to his psychiatric disability, the evidence does not show that he was unable to perform the responsibilities of these positions in an adequate manner. While the evidence shows that the Veteran’s employer provided accommodations (i.e., adjusting his work level, length of his workday, and hourly maintenance employees to cover his responsibilities), the evidence does not show that the Veteran’s employment was assured regardless of his performance due to the well-meaning of his employer. The fact that the Veteran was moved to positions of less responsibility due to his psychiatric symptoms indicate as much. As such, the Board finds that the preponderance of the evidence is against a finding that the Veteran’s employment is protected, and therefore not substantially gainful. Taking into consideration the totality of the evidence of record, the Board finds that the evidence does not demonstrate that the Veteran was precluded from securing or maintaining substantially gainful employment due to his service-connected disabilities from June 22, 2011 to January 2, 2014. In fact, the record shows that the Veteran was gainfully employed at [REDACTED] during this time. While the Board acknowledges that the Veteran’s service-connected disabilities resulted in some level of occupational impairment, such as having to take leave due to his PTSD, the occupational impairment resulting from these disabilities is contemplated by the ratings assigned for each individual disability. 38 C.F.R. § 4.1 (stating that the purpose of the rating schedule generally is to provide compensation for the average impairment in earning capacity resulting from a specific disability in civilian occupations). In summary, the preponderance of the evidence weighs against finding in favor of the Veteran’s claim for a TDIU from June 22, 2011 to December 2, 2014. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. § 3.102. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule is not applicable. 38 C.F.R. § 4.3. 2. Entitlement to a TDIU from January 3, 2014 to December 27, 2015, having been rendered moot, is dismissed. The claim of entitlement to a TDIU from January 3, 2014 to December 27, 2015 has been rendered moot by the award of SMC at the housebound rate. See Bradley v. Peake, 22 Vet. App. 280 (2008). The Board notes that the Veteran is in receipt of a 100 percent disability rating (lung cancer) and SMC at the housebound rate from January 3, 2014 to July 31, 2019. The United States Court of Appeals for Veterans Claims 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 the Veteran totally disabled on any other basis. See Herlehy v. Principi, 15 Vet. App. 33, 35 (2001) (finding a request for a TDIU moot where 100 percent schedular rating was awarded for the same period). However, a grant of a 100 percent disability does not always render the issue of a TDIU moot. VA’s duty to maximize a claimant’s benefits includes consideration of whether his disabilities establish entitlement to 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). In this case, the Veteran is, as of this decision, in receipt of both a 100 percent disability rating (lung cancer) and SMC at the housebound rate from January 3, 2014 to July 31, 2019. As this reflects the maximum available benefit, the issue of entitlement to a TDIU from January 3, 2014 to December 27, 2015 is moot. See Bradley, 22 Vet. App. at 293. Accordingly, there is no question or controversy for consideration by the Board with regard to entitlement to a TDIU from January 3, 2014 to December 27, 2015. As no allegation of error of fact or law remains for appellate consideration, the Board has no jurisdiction to review the appeal of the issue for entitlement to a TDIU from January 3, 2014 to December 27, 2015, and it is dismissed as moot. See 38 U.S.C. § 7105 (d)(5); 38 C.F.R. § 20.202; see also Sabonis v. Brown, 6 Vet. App. 426 (1994). LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Ko, 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.