Citation Nr: 21003041 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 15-36 143 DATE: January 19, 2021 ORDER Entitlement to a rating of 50 percent, but no higher, from May 31, 2013, to February 27, 2014, for the Veteran’s service-connected anxiety disorder, not otherwise specified (NOS), is granted. Entitlement to a rating in excess of 50 percent from February 27, 2014, for the Veteran's service-connected anxiety disorder NOS is denied. Entitlement to a total disability rating based upon individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. From May 31, 2013, the Veteran’s service-connected anxiety disorder NOS is most appropriately characterized by occupational and social impairment with reduced reliability and productivity with corresponding symptomatology. 2. The probative evidence of record does not show that the Veteran’s anxiety disorder NOS would alone preclude him from engaging in substantially gainful employment nor does the evidence show that his anxiety disorder NOS, in combination with his other service-connected disabilities, would prelude him from engaging in substantially gainful employment for the period from May 1, 2014, to October 16, 2019. CONCLUSIONS OF LAW 1. Resolving all reasonable doubt in favor of the Veteran, the criteria for entitlement to a 50 percent rating, but no higher, for the Veteran’s service-connected anxiety disorder NOS from May 31, 2013, to February 27, 2014, is granted. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.10, 4.126, 4.130, Diagnostic Code (DC) 9411. 2. The criteria for entitlement to a rating in excess of 50 percent for the Veteran's service-connected anxiety disorder NOS from February 27, 2014, have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.10, 4.126, 4.130, DC 9411. 3. The criteria for entitlement to a TDIU have not been met. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 3.340, 4.16, 4.18. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from July 1963 to June 1967, to include service in the Republic of Vietnam. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a November 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In August 2018 and September 2020, the Board remanded these matters to the RO for further development. 1. Entitlement to a rating in excess of 30 percent prior to February 27, 2014, and a rating in excess of 50 percent thereafter for the Veteran's service-connected anxiety disorder NOS The Veteran contends that he is entitled to an increased rating for his service-connected psychiatric disorder. As an initial matter, the Board notes that the Veteran’s non-initial increased rating claim was received by VA on February 27, 2014. Thereafter, in a July 2020 rating decision, the RO increased the Veteran’s service-connected anxiety disorder NOS to 50 percent effective February 27, 2014, the date of the Veteran’s claim. The Board notes that the grant of an increased rating during an appeal does not affect the pendency of that appeal. AB v. Brown, 6 Vet. App. 35 (1993). As the Veteran is presumed to be seeking the maximum allowable benefit and the maximum benefit has not yet been awarded, the claim is still in controversy and on appeal. Id. Additionally, because the Veteran’s increased rating claim is a non-initial claim, the Board will consider evidence of symptomatology from one year prior to when the claim was filed to determine if an increased rating is warranted from that date, i.e., from February 27, 2013. 38 C.F.R. § 3.400(o). See A.B. v. Brown, 6 Vet. App. 35 (1993) (holding that a claim remains in controversy where less than the maximum available benefit is awarded unless the Veteran expresses an intent to limit the appeal to a specific 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 (2018). 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. Evaluations for psychiatric disabilities are assigned pursuant to VA’s General Rating Formula for Mental Disorders under 38 C.F.R. § 4.130. The Veteran is currently in receipt of a 30 percent rating for his anxiety disorder NOS for the appeal period prior to February 27, 2014, and in receipt of a 50 percent rating thereafter. Under DC 9411, a 30 percent rating is warranted when there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, recent events). A 50 percent rating is warranted when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more often than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating contemplates occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships. A 100 percent disability rating is warranted for a psychiatric disorder resulting 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 minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130. The Board notes that considerations in evaluating a mental disorder include the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran’s capacity for adjustment during periods of remission. The evaluation must be based on all evidence of record that bears on occupational and social impairment rather than solely on an examiner’s assessment of the level of disability at the moment of the examination. 38 C.F.R. § 4.126(a). Further, rating evaluations under 38 C.F.R. § 4.130 is “symptom-driven,” meaning that “symptomatology should be the fact-finder’s primary focus when deciding entitlement to a given disability rating” under that regulation. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed.Cir.2013). The list of symptoms under the rating criteria are meant to be examples of symptoms that would warrant the rating, but are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. Mauerhan v. Principi, 16 Vet. App. 436, 442-3 (2002). Although a veteran’s symptomatology is the primary consideration in assessing their disability rating based on a mental disorder, the regulation also requires an ultimate factual conclusion as to the veteran’s level of impairment in “most areas” for that rating. Id.; 38 C.F.R. § 4.130. Turning to the evidence of record, a February 2013 private treatment note reflects that the Veteran appeared slightly depressed and anxious while an April 2013 VA treatment note indicates that the Veteran’s emotional status was calm and that he was oriented to person, place, and time. Thereafter, during a May 31, 2013, private evaluation, the Veteran reported that he was becoming very depressed and irritated. He noticed that “a lot of stuff ha[d] been getting much worse” and felt like he was back in Vietnam again. He also reported that he did not go anywhere and had been staying at home, in part, due to urinary issues. He denied suicidal ideation, homicidal ideation, and hallucinations. Based on his reports, his private provider increased his psychiatric medication. An August 2013 follow-up private treatment record reflects that the Veteran reported “that his things have been about the same.” He stayed home most of the time and did not have much interaction with others. He also expressed that he experienced flashbacks and nightmares as well as fear related to his prostate cancer and recovery. A December 2013 VA treatment record reflects that the Veteran had no concerns with depression. However, private treatment records from January 2014 to August 2014 indicate that the Veteran continued to experience symptoms such as anxiety, depression, sleep difficulties, flashbacks, socialization problems, and hyperarousal symptoms. He continued to deny suicidal ideation and homicidal ideation. Although he reported seeing images of moving objects at the edges of his sight, he denied hallucinations and was assessed without paranoia or delusions. He appeared anxious and disheveled but had no circumstantial thought and his cognitive status did not change from previous visits. The Veteran was afforded a VA examination in September 2014. At the time of the examination, he reported getting along fairly well with his children and grandchildren. He had decreased involvement with his family but denied difficulty with activities of daily living and enjoyed fishing, hunting, and planting. He also had very few friends but was involved in his church. He reported that he chose to retire in 2006 due to worsening irritability and difficulty getting along with his supervisor. He also reported that he had nightmares a few times per month, and experienced daily Vietnam memories. He denied violent behavior, panic attacks, suicidal thoughts/behavior, or suicide attempts. His symptoms included depressed mood, anxiety, chronic sleep impairment, and difficulty adapting to stressful circumstances, including work or a worklike setting. Upon evaluation, his affect was slightly restricted but appeared organized without evidence of psychosis. The VA examiner found that the Veteran’s psychiatric disability manifested 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. Private treatment records reflect that the Veteran continued to experience easy irritation, anxiety, and withdrawal from people, including having limited interaction with friends. See October 2014 private treatment record. During a January 2015 private psychiatric treatment, the Veteran reported that sometimes he felt that he would not care if he goes but denied any intention to harm himself and denied suicidal or homicidal ideation. He felt worthless and was noted to have a high depression score. He was also restless, agitated, indecisive, moody, and irritable. He could not concentrate for a long time and experienced general discomfort when in a crowd. Upon evaluation, he had thought blocking, word searching, and delayed thought without evidence of circumstantial thought nor looseness of association. Thereafter, March 2015, April 2015, January 2016, and September 2016 VA treatment records reflect that the Veteran responded “no” to the mental health question of whether he had been feeling sad, empty, or depressed. However, an April 2015 VA treatment record also reflects that the Veteran reported that for the past two weeks, he felt little interest or pleasure in doing things and felt down, depressed, or hopeless, for several days. See April 2015 VA treatment note. Likewise, an April 2018 VA treatment record reflects that the Veteran had occasional problems with depression, would get down at times, and would feel like he did not want to associate with others at times. He reported that for the past two weeks, he felt little interest or pleasure in doing things and felt down, depressed, or hopeless, for several days. Additionally, in December 2018, the Veteran reported he had been experiencing problems with mild depression since his prostate surgery in 2012. See December 2018 VA treatment record. He had been attending group therapy over the past year and reported some thoughts of wishing he was not living but denied any thoughts of wanting to end his life. He also reported that he liked to occupy himself with household tasks, fishing, and hunting. In June 2019, the Veteran underwent another VA examination. At the time of the examination, he was active in his church and had a few, but not many, friends. He was married for 53 years and enjoyed fishing, hunting, and traveling. The VA examiner noted there had been few changes in the Veteran’s disability since his VA examination in January 2009. His symptoms included depressed mood, anxiety, chronic sleep impairment, disturbances of motivation and mood, suicidal ideation, and mild memory loss, such as forgetting names, directions, or recent events. The examiner also noted that the Veteran had irritability with his wife at times as well as intrusive thoughts relating to his Vietnam experience. The Veteran also reported feeling depressed more days than not and that he felt episodically anxious an average of four days per week. He denied nightmares but woke up during the night. He reported that he had thoughts of suicide two to three times per week but denied a specific plan and denied any intention to act on those thoughts. He was motivated to live for his family and friends. His judgement and insight were assessed as adequate and he had linear and logical thought processes without evident abnormal thought content. The VA examiner also noted the that the Veteran reported a good relationship with family members and friends. The VA examiner further found that the Veteran’s psychiatric disability manifested 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. Specifically, she found that although the Veterans reported symptoms affect him, he has been able to maintain relationships and perform in a work environment. Thereafter, a January 2020 private treatment record reflects, under a review of the Veteran’s psychiatric symptoms, that he had no depressive symptoms nor current suicidal or homicidal ideation. July 2019 and September 2020 VA depression and suicide screenings also show that the Veteran responded “not at all” to questions of whether over the past two weeks he felt down, depressed, or hopeless and if he had thoughts that he would be better off dead or of hurting himself in some way. In light of the foregoing, the Board finds that that the most probative evidence of record shows that the severity, frequency, and duration, of the Veteran’s psychiatric symptomatology more closely approximates occupational and social impairment with reduced reliability and productivity from May 31, 2013. The Board also finds that the preponderance of the evidence is against the assignment of a higher rating prior to May 31, 2013, or rating in excess of 50 percent thereafter. In this regard, the Board first finds, after resolving all reasonable doubt in the Veteran’s favor, that an increase in the Veteran’s service-connected psychiatric disability, to 50 percent disabling, is first factually ascertainable from May 31, 2013, the date of the private psychiatric treatment note reflecting that the Veteran’s symptoms had worsened. Specifically, the private treatment note reflects that the Veteran reported increased depression, that he was staying at home, and that his medication would also be increased. This evidence indicates the Veteran was experiencing more frequent and severe depression as well as disturbances of motivation and mood to warrant a higher 50 percent rating. The evidence of record prior to this date does not indicate a worsening in his disability because the February 2013 private treatment record reflects that the Veteran appeared slightly depressed and anxious, which indicates more mild symptoms than that completed under a 50 percent rating. Specifically, occupational and social impairment due to mild or transient symptoms is contemplated under the 10 percent rating while symptoms such as depressed mood and anxiety are noted under the 30 percent rating criteria. As such, the Board finds that a 50 percent rating, is warranted from May 31, 2013, the date an increase in the Veteran’s disability is first factually ascertainable. Next, the Board finds that a rating in excess of 50 percent is not warranted for any portion of the appeal period from May 31, 2013. During this period, manifestations of the Veteran’s disability included chronic sleep impairment, nightmares, memory difficulties, depression, anxiety, avoidance, hypervigilance, and disturbances of motivation and mood. Significantly, the evidence throughout the appeal period suggests the Veteran was able to maintain various social and familial relationships. He reported positive family relationships and maintained friendships. He was also involved in his community with his church. Although the Veteran had problems with socializing, this evidence does not indicate an inability to establish and maintain effective relationships nor otherwise indicate occupational and social impairment with deficiencies in most areas as contemplated by the next-higher 70 percent rating. Additionally, the Veteran’s thought process was noted as linear/organized throughout the appeal period. Moreover, an April 2018 VA treatment record reflects that the Veteran had occasional problems with depression while the December 2018 VA treatment reflects the Veteran reported he had been experiencing problems with mild depression. The Board acknowledges that the severity, frequency, and duration, of the Veteran’s symptoms waxed and waned throughout the appeal period and is cognizant of medical records indicating more severe symptomatology. See September 2014 VA examination (noting the Veteran symptoms included difficulty in adapting to stressful circumstances (including work or a worklike setting)); January 2015 private treatment record (indicating the Veteran had a high depression score). However, both the September 2014 and June 2019 VA examiners found, after reviewing the record, considering the Veteran’s medical history, and evaluating the Veteran, that his disability more nearly approximated 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. Indeed, the June 2019 VA examiner noted few changes in the Veteran’s disability throughout the appeal period. As such, the Board finds that the evidence does not reflect symptoms of the severity, frequency, and duration as those contemplated under the 70 percent rating, including 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; spatial disorientation; and neglect of personal appearance and hygiene. Nor does the evidence does not show impairment at a greater level (approximating the impairment contemplated by the criteria for a 100 percent rating). The Board also acknowledges that suicidal ideation may cause occupational and social impairment in most areas. See Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017) (stating the language of 38 C.F.R. § 4.130 "indicates that the presence of suicidal ideation alone, that is, a veteran's thoughts of his or her own death or thoughts of engaging in suicide-related behavior, may cause occupational and social impairment in most areas."). Here, although the December 2018 VA treatment record reflects the Veteran reported some passive suicidal ideation (he had some thoughts of wishing he was not living but denied any thoughts of wanting to end his life) and the June 2019 VA examination reflects symptoms of suicidal ideation, the evidence of record does not show that this symptom caused occupational and social impairment with deficiencies in most areas. This finding is not based on the lack of intent or plan or based on a finding that the Veteran's ideations are passive, or that they are in the past and not current. Rather, it is based on the findings of the June 2019 VA examiner, who accounted for the Veteran’s reported suicidal ideation, and assessed the Veteran with a level of impairment that did not rise to the level of occupational and social impairment with deficiencies in most areas. The Board finds that the opinion of the June 2019 VA examiner is particularly probative as she specifically explained that although the Veteran’s symptoms affected him, he had been able to maintain relationships and perform in a work environment. She also based her assessment of the Veteran’s level of occupational and social impairment on his past medical history and examination. The Board finds there is no medical evidence in the record to dispute this assessment and further notes that the Board must look at the Veteran’s disability picture as a whole and not just at one particular moment. Therefore, although serious, the Board finds when considering the overall impact of the Veteran’s disability, the noted suicidal ideation does not rise to the level that is contemplated under the 70 percent rating and is, thus, not productive of occupational and social impairment with deficiencies in most areas. The Board is sympathetic to the Veteran’s belief that he is entitled to a higher rating and has considered his statements. The Board notes that the Veteran is competent to report the symptoms associated with his service-connected disability and the Board has no reason to challenge the credibility of these contentions. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). However, the Veteran’s reports describing symptoms of depressed mood, anxiety, hypervigilance, chronic sleep impairment, irritability, and Vietnam flashbacks are already reflected by the assigned 50 percent rating. Moreover, the Board finds the objective clinical findings by medical professionals aware of his symptoms more probative than the Veteran’s general assertions that his symptoms more nearly approximate a higher rating. The examiners are medical professionals, and they were able to review the overall record, including the Veteran’s history and opinions. The examinations were provided to ensure that the record reflects the current extent of the disability, and these findings are responsive to the pertinent rating criteria. In sum, the Board finds that a 50 percent rating, but no higher, is warranted from May 31, 2013. The preponderance of the evidence, however, is against the assignment of a rating in excess of 50 percent for his anxiety disorder NOS thereafter; therefore, entitlement to a rating in excess of 50 percent for this disability must be denied. 38 U.S.C. § 5107; 38 C.F.R.§§ 4.3, 4.7; Gilbert v. Derwinski, 1 Vet. App. at 53 2. Entitlement to a TDIU The Veteran contends that he is entitled to a TDIU as due to his service-connected anxiety disorder NOS. As an initial matter, the Board notes that entitlement to a TDIU was raised as part and parcel of the Veteran’s increased rating claim for his service-connected anxiety disorder NOS. See Rice v. Shinseki, 22 Vet. App. 447 (2009). Additionally, the Board notes that the Veteran’s service-connected prostate cancer status post prostatectomy is rated as 100 percent disabling from December 1, 2011, to May 1, 2014, and from October 16, 2019. The Board notes the award of a 100 percent disability rating does not necessarily render moot a claim of entitlement to a TDIU. See Bradley v. Peake, 22 Vet. App. 280 (2008). Instead, a TDIU claim can be granted, despite the existence of a schedular total rating, for the purpose of establishing entitlement to an award of SMC. See id. In this regard, although no additional disability compensation may be paid when a total schedular disability rating is already in effect, the United States Court of Appeals for Veterans Claims’ (Court's) decision in Bradley recognizes that a separate award of a TDIU predicated on a single disability may form the basis for an award of SMC. As such, and pursuant to VA’s duty to maximize benefits, the Board will consider whether the Veteran’s anxiety disorder NOS alone precluded him from engaging in substantially gainful employment for the appeal period, as well as whether his anxiety disorder NOS, in combination with his other service-connected disabilities, precluded him from engaging in substantially gainful employment for the appeal period where the Veteran’s schedular rating is less than total, i.e., from May 1, 2014, to October 16, 2019. VA will grant a TDIU when the evidence shows that a veteran is precluded, by reason of his service-connected disabilities, from securing and following “substantially gainful employment” consistent with his education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. 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). TDIU may be assigned where the schedular rating is less than total and it is found that the Veteran is unable to secure or follow a substantially gainful occupation as a result of either (1) a single service-connected disability ratable at 60 percent or more, or (2) two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). If the veteran does not meet the required percentage standards set forth in 38 C.F.R. § 4.16(a), as in this case, he still may receive a TDIU on an extraschedular basis if it is determined that he is unable to secure or follow a substantially gainful occupation by reason of his service-connected disabilities. 38 C.F.R. § 4.16(b). In cases where extraschedular consideration is warranted, referral to the Director of Compensation Service is necessary prior to a determination on eligibility. In determining unemployability for VA purposes, consideration may be given to a veteran’s level of education, special training, and previous work experience, but not to age or any impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19; Hersey v. Derwinski, 2 Vet. App. 91, 94 (1992); Faust v. West, 13 Vet. App. 342 (2000). The sole fact that a veteran is unemployed or has difficulty obtaining employment is not enough, as a high rating in itself is a recognition that the impairment makes it difficult to obtain and keep employment. The question is whether the veteran is capable of performing the physical and mental acts required by employment, not whether he or she can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993) (citing 38 C.F.R. §§ 4.1, 4.15, 4.16(a)). Medical evaluations are probative to understanding the level of functional impairment; however, the ultimate determination of unemployability is a legal question, not a medical one. See Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013). Recently, in Ray v. Wilkie, 31 Vet. App. 58 (2019), the Court defined the term “unable to secure and follow a substantially gainful occupation” in § 4.16(b) to include two components: one economic and one noneconomic. The economic component means an occupation earning more than marginal income (outside of a protected environment) as determined by the United States Department of Commerce as the poverty threshold for one person. The non-economic component includes consideration of: the Veteran’s history, education, skill, and training; whether the veteran has the physical ability to perform the type of activities required by the occupation at issue; and whether the veteran has the mental ability to perform the activities required by the occupation at issue.   When there is an approximate balance in the evidence regarding the merits of an issue material to the determination of the matter, the benefit of doubt shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. In the present case and for the appeal period, the Veteran’s service-connected disabilities include prostate cancer status post prostatectomy (rated as 100 percent disabling from December 1, 2011, to May 1, 2014, noncompensable (0 percent) from May 1, 2014, to October 16, 2019, and 100 percent disabling thereafter); anxiety disorder NOS (rated as 30 percent disabling from June 27, 2007, to May 31, 2013, and 50 percent disabling thereafter); erectile dysfunction (rated as noncompensable from January 28, 2013); and residual surgical scar status post prostatectomy associated with prostate cancer (rated as noncompensable from January 28, 2013). As such, the Veteran’s combined ratings are 100 percent from December 1, 2011, 50 percent from May 1, 2014, and 100 percent from October 16, 2019. Thus, the threshold service connection requirements for a TDIU rating on a schedular basis are not met from May 1, 2014, to October 16, 2019, nor for any service-connected disabilities, other than the Veteran’s prostate cancer status post prostatectomy, for the entire appeal period. As noted above, even if the Veteran fails to meet the schedular requirements, if the evidence raises a reasonable possibility that the Veteran is unable to secure and follow a substantially gainful occupation due to service-connected disabilities, an extraschedular rating is for consideration. In the present case, the Board finds that referral for extraschedular TDIU consideration is not warranted. In this regard, the evidence reflects that the Veteran completed a high school education. See August 2014 VA Form 21-8940. He also attended community college and worked towards a business administration degree before he switched to a farm program. See September 2014 VA examination. Thereafter, he completed one year of industrial maintenance technology to help with his job. Id. He last worked for Railroad Friction Products where he worked for 38 years at the same location with 18 years in production and 20 years in the maintenance department.   See September 2014 VA Form 21-4192; see also June 2019 VA examination. The Veteran retired from this position in 2006 and there is no indication in the record that the Veteran has attempted to procure any other employment since his retirement. The Veteran has stated that he chose to retire in 2006 because his irritability worsened, and he was having trouble getting along with his supervisor. See September 2014 VA examination. First, the Board finds that although the evidence shows some occupational impairment, it does not show the Veteran was precluded from substantially gainful employment as due to his anxiety disorder NOS. The Board does not dispute that the Veteran’s anxiety disorder NOS somewhat impairs his occupational abilities or that he feels uncomfortable in crowds and sometimes struggles with his irritability. However, the Veteran’s occupational history shows that he was able to maintain employment for over 30 years and the medical evidence of record does not otherwise show that any increase in severity in his disability during the appeal period resulted in an inability to maintain and secure substantially gainful employment. In this regard, even though the Veteran had mild memory loss, there is not any showing that his anxiety disorder NOS would have precluded him from showing up on time or would have caused him to forget his occupational skills and/or remember his duties. Additionally, even when considering that a symptom of the Veteran’s anxiety disorder NOS included difficulty adapting to stressful circumstances (including work or a worklike setting), the September 2014 VA examiner found that the Veteran’s psychiatric disability collectively manifested 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. Indeed, at the time of the September 2014 VA examination, the Veteran denied that his anxiety disorder NOS resulted in difficulty with activities of daily living. Critically, the June 2019 VA examiner also determined that the Veteran’s psychiatric disability manifested 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. Specifically, she found that although the Veterans reported symptoms affected him, he had been able to maintain relationships and perform in a work environment. She noted that the Veteran’s sleep issues and having to wear pads/urinary and bowel incontinence may impact his functioning in a work environment (e.g. decreased efficiency due to fatigue or needing more frequent restroom breaks), but the Veteran stated he did not want to work and was enjoying his retirement. Again, the Board finds this probative evidence against the Veteran’s claim because the VA examiner considered the Veteran’s symptoms throughout the course of the appeal, provided rationale, and had the benefit of personally examining the Veteran. For the appeal period that the Veteran is not in receipt of a 100 percent rating (from May 1, 2014, to October 16, 2019), the Veteran’s service-connected prostate cancer was noted to be in remission and did not appear to have presented substantial impacts to his employability based on his statements and the medical evidence of record. Specifically, the August 2014 prostate cancer VA examination reflects that the Veteran had a voiding dysfunction, which caused urine leakage but did not require the use of absorbent material. He had no urinary frequency and the VA examiner found that the Veteran’s disability did not impact his ability to work. Although a January 2015 private psychiatric treatment record reflects that the Veteran had episodes of urinary leakage and bed wetting, the Board finds this evidence does not show he would be precluded from substantially gainful employment due to these symptoms, or in combination, with his anxiety disorder NOS symptoms discussed above. Finally, the evidence also does not reflect that the Veteran’s other service-connected disabilities, his erectile dysfunction and residual surgical scar, had any impact on his ability to work. Accordingly, the Board finds that for the appeal period, the probative evidence does not show that the Veteran’s anxiety disorder NOS would alone him from engaging in substantially gainful employment nor does the evidence show that his anxiety disorder NOS, in combination with his other service-connected disabilities,   would prelude him from engaging in substantially gainful employment for the period from May 1, 2014, to October 16, 2019. As a result, the Board finds that referral for consideration of an extraschedular TDIU under 38 C.F.R. § 4.16(b) is not warranted. The Veteran’s claim for a TDIU is denied. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Amanda Purcell, 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.