Citation Nr: 21003678 Decision Date: 01/22/21 Archive Date: 01/22/21 DOCKET NO. 16-41 203 DATE: January 22, 2021 ORDER A disability rating of 70 percent, but no higher, for service-connected posttraumatic stress disorder (PTSD) prior to January 19, 2020 is granted. A compensable disability rating for service-connected bilateral hearing loss is denied. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) since January 19, 2020 is dismissed. Entitlement to a TDIU prior to January 19, 2020 is granted. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran’s favor, prior to January 19, 2020, his service-connected PTSD symptoms more nearly approximated occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking, and mood. 2. Throughout the appeal period, the Veteran’s service-connected bilateral hearing loss has been manifested by hearing impairment corresponding to an auditory acuity of no worse than Level I in each ear, with no exceptional pattern of hearing loss shown in either ear. 3. As a total (100 percent) rating for PTSD was awarded with a January 19, 2020 effective date, the issue of entitlement to a TDIU since January 19, 2020 is rendered moot. 4. Prior to January 19, 2020, the evidence shows that the Veteran’s service-connected PTSD precluded him from securing and following substantially gainful employment. CONCLUSIONS OF LAW 1. Prior to January 19, 2020, the criteria for a 70 percent rating, but no higher, for service-connected PTSD are met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.7, 4.130, Diagnostic Code 9411. 2. The criteria for the assignment of a compensable rating for service-connected bilateral hearing loss have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.7, 4.85, 4.86, Diagnostic Code 6100. 3. The question of whether the Veteran is entitled to a TDIU is rendered moot by the award of a total (100 percent) rating for PTSD since January 19, 2020, leaving no question of law or fact to decide regarding the TDIU issue for that portion of the appeal period. 38 U.S.C. §§ 7104, 7105; 38 C.F.R. §§ 3.340, 3.341, 4.14, 4.16. 4. The criteria for a TDIU prior to January 19, 2020 are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16 (a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from May 1968 to May 1970. In February 2019, he testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. In September 2019, the Board of Veterans’ Appeals (Board) remanded this case for additional development, which has been completed. In a July 2020 rating decision, the agency of original jurisdiction (AOJ) increased the Veteran’s disability rating for his PTSD from 50 percent to 100 percent disabling, effective January 19, 2020. As such, the issue remaining on appeal concerning PTSD is whether a rating in excess of 50 percent is warranted prior to January 19, 2020. The issues of entitlement to service connection for erectile dysfunction, to include as secondary to a service-connected disability, and entitlement to service connection for hypertension will be the subject of a separate Board decision. Increased Ratings A disability rating is determined by the application of VA’s Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. VA has a duty to acknowledge and consider all regulations that are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusions. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. In addition, separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings,” regardless whether it is an initial rating case or not. Hart v. Mansfield, 21 Vet. App. 505 (2007). Where the evaluation of hearing loss is at issue, an examination for VA purposes must be conducted by a state-licensed audiologist and must include a controlled speech discrimination test (Maryland CNC) and a puretone audiometry test. Examinations are conducted without the use of hearing aids. 38 C.F.R. § 4.85(a). A rating for hearing loss is determined by a mechanical application of the rating schedule to the numeric designations assigned based on audiometric test results. Lendenmann v. Principi, 3 Vet. App. 345 (1992). Evaluations of defective hearing range from noncompensable to 100 percent. The basic method of rating hearing loss involves audiological test results of organic impairment of hearing acuity as measured by the results of controlled speech discrimination tests (Maryland CNC), together with the average hearing threshold level as measured by puretone audiometry tests in the frequencies of 1000, 2000, 3000, and 4000 Hertz. Puretone threshold average is the sum of puretone thresholds at 1000, 2000, 3000, and 4000 Hertz divided by four. To evaluate the degree of disability of service-connected hearing loss, the rating schedule establishes eleven auditory acuity levels ranging from numeric level I for essentially normal acuity, through numeric level XI for profound deafness. 38 C.F.R. § 4.85, Diagnostic Code 6100. The horizontal lines in Table VI (in 38 C.F.R. § 4.85) represent eleven categories of the percentage of discrimination based on the controlled speech discrimination test. The vertical columns in Table VI represent eleven categories of decibel loss based on the puretone audiometry test. The numerical designation of impaired efficiency (I through XI) will be determined for each ear by intersecting the horizontal row appropriate for the percentage of discrimination and the vertical column appropriate to puretone decibel loss. For example, with the percentage of discrimination of 70 and an average puretone decibel loss of 64, the numeric designation level is “V” for one ear. The same procedure will be followed for the other ear. 38 C.F.R. § 4.85(b). The percentage evaluation will be found from Table VII (in 38 C.F.R. § 4.85) by intersecting the horizontal row appropriate for the numeric designation for the ear having the poorer hearing and the vertical column appropriate to the numeric designation level for the ear having the better hearing. For example, if the better ear has a numeric designation level of “V,” and the poorer ear has a numeric designation level of “VII,” the percentage evaluation is 30 percent. 38 C.F.R. § 4.85(e), Diagnostic Code 6100. The current rating criteria include an alternate method of rating exceptional patterns of hearing as defined in 38 C.F.R. § 4.86 (puretone threshold of 55 decibels or more at 1000, 2000, 3000, and 4000 Hertz or puretone threshold of 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event; or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the Veteran. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. A rating in excess of 50 percent prior to January 19, 2020 for PTSD The Veteran contends that his PTSD symptoms were severe enough to warrant a higher rating prior to January 19, 2020. As previously stated, the Veteran’s PTSD rating was increased from 50 percent to 100 percent disabling effective January 19, 2020, based on the results of a January 2020 VA examination. For reasons indicated below, the Board finds that an increased rating of 70 percent, but no higher, is warranted prior to January 19, 2020. The Veteran’s service-connected PTSD is evaluated under the General Rating Formula for Mental Disorders. See 38 C.F.R. § 4.130, Diagnostic Codes 9411. Under these criteria, a 50 percent rating is warranted for occupational and social impairment with reduced reliability and productivity due to particular symptoms such 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; impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent rating is warranted where there is 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 rating is warranted where there is 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. In addition, when evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran’s capacity for adjustment during periods of remission. 38 C.F.R. § 4.126(a). The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner’s assessment of the level of disability at the moment of the examination. Id. However, 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 on the basis of social impairment. 38 C.F.R. § 4.126(b). The Board notes, with regard to the use of the phrase “such as” in 38 C.F.R. § 4.130 (General Rating Formula for Mental Disorders), that ratings are assigned according to the manifestations of particular symptoms. However, the use of the phrase “such as” in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve only as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). The United States Court of Appeals for the Federal Circuit emphasized that the list of symptoms under a given rating is a non-exhaustive list, as indicated by the words “such as” that precede each list of symptoms. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013). It held that a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage or others of similar severity, frequency, and duration. Other language in the decision indicates that the phrase “others of similar severity, frequency, and duration,” can be thought of as symptoms of like kind to those listed in the regulation for a given disability rating. The evidence considered in determining the level of impairment under § 4.130 is not restricted to the symptoms provided in the Diagnostic Code. VA must consider all symptoms of a claimant’s condition affecting the level of occupational and social impairment, including, if applicable, those identified in the Diagnostic and Statistical Manual of Mental Disorders (DSM). DSM-5 is applicable in the instant case as the Veteran perfected his appeal in August 2016, which is after August 4, 2014. 80 Fed. Reg. 14308 (March 19, 2015). When determining the appropriate disability evaluation to assign, the Board’s primary consideration is the Veteran’s symptoms, but it must also make findings as to how those symptoms impact the Veteran’s occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013). It is the impact of the symptoms on occupational and social functioning that determines the rating. On VA examination in February 2012, the Veteran reported that he had a strain in his marriage due to his emotional detachment and irritability. He stated that he had no social life and spent his days alone by working in the yard or watching television. He reported that he was laid off from his last job where he worked for a community center due to a “reduction in force.” The examiner noted that the Veteran’s PTSD caused occupational and social impairment with reduced reliability and productivity, with symptoms of depressed mood, anxiety, chronic sleep impairment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and inability to establish and maintain effective relationships. Social Security Administration (SSA) records obtained from the Veteran show complaints and treatment pertaining to his PTSD. For instance, SSA records dated in July 2013 reveal complaints of anxiety, stress, and depression due to PTSD. The Veteran reported that he was otherwise doing okay. He denied having suicidal or homicidal ideations. There were no hallucinations. He later told the examiner that he does fairly well with his anxiety and PTSD when under no stress, while noting that he had not been able to tolerate the stress and effects of his reactions to the stress and job performance. Earlier SSA records, dated in March 2010, note that the Veteran reported having some suicidal ideation. The Veteran had also reported that he was forced to stop working due to his PTSD symptoms. Medical records obtained in May 2016 later revealed that the Veteran began receiving SSA disability benefits in March 2011 due to symptoms related to his PTSD. On a June 2016 VA examination, the Veteran described general intermittent anxiety and depression with difficulty sleeping. The examiner noted that the Veteran’s symptoms did not comport with the criteria for a PTSD diagnosis, nor did those symptoms render him unable to gain or sustain work. At the February 2019 Board hearing, the Veteran testified that his PTSD symptoms had increased in severity since his last VA examination. See Board hearing transcript at 3. He stated that he had difficulty in relationships, sleep problems, suicidal ideation, depression, feelings of being on edge, and that he sometimes feels that he is being followed. Id. He also stated he follows a medication plan, but also self-medicates with alcohol. See Board hearing transcript at 4. The Veteran indicated that he retired from his job in 2010 due to his PTSD symptoms and side-effects from medications. See Board hearing transcript at 5-10. VA outpatient treatment notes consistently show that the Veteran has experienced chronic PTSD symptoms, including frequent panic attacks, prior to January 19, 2020. There are several mental status notes, which indicate that the Veteran has regularly visited VA mental health professionals for his PTSD. Based on a review of the evidence of record, the Board finds that the Veteran’s PTSD symptoms more closely approximate a 70 percent rating prior to January 19, 2020. The Veteran’s symptoms, including depressed mood, anxiety, chronic sleep impairment, disturbances of mood and motivation, and difficulty in establishing and maintaining effective work and social relationships fall mostly within the criteria for a 50 percent rating. However, the totality of the evidence indicates that his PTSD symptoms continued to increase in severity, more closely approximating occupational and social impairment reflecting deficiencies in areas such as work, family relations, judgment, thinking, and mood, to warrant a 70 percent rating. Notably, SSA medical records show past suicidal ideation, near-continuous depression, and difficulty adapting to stressful circumstances at work. The February 2012 VA examiner noted the Veteran’s inability to establish and maintain effective relationships. The medical records corroborate the Veteran’s February 2019 hearing testimony, where he stated that his symptoms had increased in severity to include suicidal ideation and more frequent feelings of being depressed. Thus, as these symptoms fall within the criteria for a 70 percent rating, the Board resolves reasonable doubt in the Veteran’s favor and finds that a 70 percent rating is warranted. Specifically, the Board finds that his PTSD symptoms more closely approximated occupational and social impairment with deficiencies in most areas. However, while the record reflects that the Veteran’s PTSD symptoms had increased in severity, the first evidence of total occupational and social impairment is reflected in the January 19, 2020 VA examination report. As such, the Veteran was awarded a 100 percent disability rating with a January 19, 2020 effective date. At no point prior to January 19, 2020 has the Veteran’s overall symptomatology more nearly approximated the criteria for a 100 percent rating as that rating requires evidence of total occupational and social impairment. Neither the lay nor medical evidence of record, prior to January 19, 2020, shows that the Veteran had total occupational and social impairment. Specifically, there is no evidence prior to that date reflecting symptoms such 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; disorientation to time or place; or memory loss for names of close relatives, own occupation, or own name. Consequently, prior to the January 19, 2020 VA examination, the Veteran had not reported having any PTSD symptoms that reflect total occupational and social impairment; thus, the evidence does not more nearly approximate the criteria for total occupational and social impairment prior to that date. A Compensable Rating for Bilateral Hearing Loss The Veteran contends that his service-connected bilateral hearing loss has increased in severity to warrant a compensable disability rating. The relevant medical evidence of record includes a June 2011 private audiogram, reports of VA audiological examinations conducted in July 2016 and January 2020, as well as VA treatment records and the Veteran’s lay statements. On the June 2011 private authorized audiological evaluation, puretone thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 Average RIGHT 30 30 35 35 33 LEFT 30 35 35 30 33 Speech audiometry revealed speech recognition ability of 96 percent in the right ear and 94 percent in the left ear. The average puretone threshold was 33 decibels in each ear. The audiologist indicated that there was no change in the Veteran’s prior diagnosis of bilateral sensorineural hearing loss. She noted that the Veteran’s hearing loss did not affect his usual occupation, but that the Veteran experienced difficulty hearing others while conducting daily activities. On the July 2016 authorized audiological evaluation, puretone thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 Average RIGHT 30 25 35 25 29 LEFT 15 25 25 20 21 Speech audiometry revealed speech recognition ability of 100 percent in each ear. The average puretone threshold was 29 decibels in the right ear and 21 decibels in the left ear. The examiner noted that the Veteran had mild hearing loss in the right ear and normal hearing in the left ear. She remarked that the Veteran’s hearing loss in the right ear should have no impact on his ability to function in an occupational environment. At the February 2019 Board hearing, the Veteran testified that his hearing loss had worsened since his last hearing evaluation. As such, VA requested a new audiological examination to determine the severity of the Veteran’s hearing loss. That VA examination was conducted in January 2020. On the January 2020 authorized audiological evaluation, puretone thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 Average RIGHT 20 40 45 40 36 LEFT 25 35 40 35 34 Speech audiometry revealed speech recognition ability of 94 percent in the right ear and 96 percent in the left ear. The average puretone threshold was 36 decibels in the right ear and 34 decibels in the left ear. The Veteran reported that his hearing loss impacted his ability to hear others clearly from a distance. The Veteran also reported that he has greater than normal difficulty in noisy or reverberant environments. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the assignment of a compensable disability rating for the service-connected bilateral hearing loss at any time during the appeal period. Applying the clinical findings of the June 2011, July 2016, and January 2020 VA audiological examinations, separately, to Table VII, respectively, a zero percent evaluation is warranted. Specifically, the point where the Roman numeral designations for each ear (at each examination) intersect, indicates a zero percent evaluation. The findings of the June 2011, July 2016, and January 2020 evaluations each translate to Level I hearing loss in each of the Veteran’s ears when applied to Table VI of the rating schedule. This level of hearing loss warrants a zero percent rating and no higher under Table VII of the rating schedule. Therefore, a compensable disability evaluation is not warranted based upon this evaluation under Diagnostic Code 6100. 38 C.F.R. § 4.85. in reaching this conclusion, the Board also notes that exceptional hearing loss patterns have not been shown in either ear. Throughout the appeal period, the Veteran has asserted that his service-connected bilateral hearing loss has worsened. The Board has also considered the various lay statements from the Veteran attesting to the impact of his hearing loss, e.g., his difficulty hearing others. However, the Veteran, while competent to report symptoms associated with hearing loss, is not competent to report that his hearing acuity is of sufficient severity to warrant a higher (compensable) evaluation under Diagnostic Code 6100, because such an opinion requires medical expertise, i.e., training in evaluating hearing impairment, which the Veteran has not shown. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). As such, the Board finds the medical evidence of record to be more probative. Indeed, and in this regard, the Board notes that the Veteran underwent a very recent audiological examination in January 2020. Accordingly, the Board is confident that the Veteran’s service-connected bilateral hearing loss was adequately evaluated by this recent audiological evaluation. To the extent the Veteran contends that the above symptoms are not contemplated by the schedular criteria, the Board points out that his reported symptoms are all essentially well-recognized as the natural effect of decreased hearing, which is what the rating criteria are designed to compensate. Further, VA treatment records indicate that the Veteran was prescribed hearing aids to help alleviate some of the difficulties he experiences with his hearing loss. The Board does not discount the difficulties the Veteran has with his hearing loss. However, the Board must base its determination on the results of the audiological examinations of record. Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Accordingly, based on a review of the foregoing evidence, and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the claim for a compensable rating for the service-connected bilateral hearing loss. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not helpful to him. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). TDIU From January 19, 2020 A TDIU may be assigned “where the schedular rating is less than total” and 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 regulations provide that if there is only one such disability, it must be rated at 60 percent or more; and if there are two or more disabilities, at least one disability must be rated at 40 percent or more, and sufficient additional disability must bring the combined rating to 70 percent or more. Disabilities resulting from common etiology or a single accident or disabilities affecting a single body system will be considered as one disability for the above purposes of one 60 percent disability or one 40 percent disability. 38 C.F.R. § 4.16 (a). In this case, the Board has awarded a total (100 percent) rating for PTSD effective January 19, 2020. Hence, the schedular rating is not “less than total” for this appeal period. See 38 C.F.R. § 4.16 (a). The Board is cognizant of the fact that the receipt of a 100 percent schedular disability rating for a service-connected disability or disabilities does not necessarily moot the issue of entitlement to a TDIU because a TDIU rating based on a single service-connected disability may still form the basis for assignment of special monthly compensation (SMC) pursuant to 38 U.S.C. § 1114(s). See Bradley v. Peake, 22 Vet. App. 280 (2008). Regardless, the 100 percent rating which has been awarded for PTSD since January 19, 2020 specifically contemplates total unemployability (i.e., total occupational impairment) due to PTSD. Aside from PTSD (now rated as 100 percent disabling since January 19, 2020), service connection is in effect for bilateral hearing loss (rated noncompensable) and tinnitus (rated 10 percent disabling). The evidence of record does not reflect that the Veteran is unable to work due any disability(ies) other than his service-connected PTSD. At the very least, the evidence reflects that the impairment caused by his service-connected PTSD or all of his service-connected disabilities, in combination, is sufficient to preclude all substantially gainful employment. In light of the above, the facts presented in this case are distinguishable from those in Bradley v. Peake, 22 Vet. App. 280 (2008). Under the facts presented in Bradley, there was no “duplicate counting of disabilities.” Bradley, 22 Vet. App. at 293. If the Veteran were to be awarded a TDIU (“total” rating) based on service-connected PTSD since January 19, 2020, it would impermissibly result in the same disability being “counted twice” in the assignment of a total rating, as it would be rating the “total occupational impairment” twice. See generally 38 C.F.R. § 4.14. As the Veteran is precluded from securing and following substantially gainful employment due solely to his service-connected PTSD or a combination of his PTSD and his other service-connected disabilities, the Board finds that the issue of entitlement to a TDIU from January 19, 2020 must be dismissed as moot. Prior to January 19, 2020 The Board acknowledges that the Veteran has asserted that his PTSD symptoms prevented him from obtaining and maintaining substantially gainful employment prior to January 19, 2020. As such, the issue of whether he is entitled to a TDIU prior to January 19, 2020 will be discussed herein. In this regard, the Veteran contends that his service-connected disabilities rendered him unable to obtain and maintain substantially gainful employment during the period prior to January 19, 2020. Specifically, he asserts that his PTSD symptoms significantly impacted his ability to obtain and maintain employment. A total disability rating for compensation purposes may be assigned where the schedular rating is less than total and where it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a service-connected disability ratable at 60 percent or more or as a result of 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. § 4.16(a). As previously discussed, the Veteran has been in receipt of a TDIU as of January 19, 2020. Prior to this date, the Veteran had a rating of 50 percent for PTSD, 10 percent for tinnitus, and a noncompensable rating for bilateral hearing loss, for a combined rating of 60 percent. However, as already discussed herein, the Veteran is now in receipt of a 70 percent rating for his PTSD prior to January 19, 2020. Thus, he has met the schedular criteria for a TDIU prior to January 19, 2020. See 38 C.F.R. § 4.16(a). The question at issue is whether the Veteran is unable to secure or follow a substantially gainful occupation as a result of his service-connected disabilities. 38 C.F.R. § 4.16(a). Consideration may be given to the Veteran’s level of education, special training, and previous work experience in arriving at a conclusion, but not to his age or to the impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 4.16, 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). The evidence shows that the Veteran graduated from high school, but he did not obtain any tertiary education or pursue any special training. See June 2011 Veteran’s Application for Increased Compensation Based on Unemployability (VA Form 21-8940). His reported work history, as noted on his VA Form 21-8940, shows that he last worked as a maintenance mechanic for a government organization, from July 2006 to March 2011. In June 2011, VA received information from the Veteran’s last employer, showing that the Veteran was discharged. The last date of employment is indicated as March 10, 2011. This information corroborates what the Veteran reported. Regarding whether the Veteran is unemployable due to his service-connected PTSD, the evidence overwhelming indicates that he has been unable to work in any capacity prior to January 19, 2020. Information received from SSA in May 2016 shows that the Veteran was determined to be disabled under Social Security law as of March 12, 2011, due to PTSD symptoms. SSA medical records dated in March 2010 show a note from a clinical psychologist, who opined that the Veteran would likely not return to work, but if he did, he would likely have some significant difficulty obtaining and maintaining employment due primarily to psychiatric symptoms. The Veteran had reported to the psychologist that he was forced into retirement in approximately 2010 because he had significant difficulties getting along with other people, and stated that he had not been able to tolerate the stress and effects of his reactions to the stress and his job performance. He indicated that he likely would have been terminated had he not resigned. The Veteran reiterated this information at the February 2019 Board hearing, testifying that he retired from his job in 2010 due to chronic PTSD symptoms. In addition, at a January 2020 VA examination for PTSD, the Veteran reported that he last worked in 2010 as an assistant at a community center, where he was terminated after three years due to his impaired performance, attendance, and interpersonal issues secondary to his PTSD. The January 2020 VA examiner remarked that the Veteran appeared to be a reliable historian. As previously discussed, during the period prior to January 19, 2020, the Veteran’s PTSD symptoms more closely approximated occupational and social impairment reflecting deficiencies in areas such as work. Notably, the Veteran’s symptoms included difficulty in adapting to stressful circumstances, including work or a worklike setting; and the inability to establish and maintain effective relationships. The January 2020 VA examiner, who also examined the Veteran in February 2012, concluded that, due to the Veteran’s irritability, poor concentration, insomnia, anhedonia, interpersonal issues, low motivation, and severe anxiety, it is at least as likely as not that he would be unable to function effectively in a typical work environment, including one of a sedentary nature. The Board has carefully reviewed and considered statements from VA examiners, the Veteran, and the Veteran’s representative regarding the effects of the Veteran’s disabilities on his employability. However, the ultimate TDIU determination is the responsibility of a VA adjudicator. Geib v. Shinseki, 733 F.3d 1350 (Fed. Cir. 2013). In this regard, the Board finds that the positive and negative evidence regarding the Veteran’s TDIU claim is in relative equipoise. Thus, by resolving reasonable doubt in the Veteran’s favor, the Board concludes that his service-connected disabilities have rendered him unable to obtain and maintain substantially gainful employment prior to January 19, 2020, when his educational and work background are taken into consideration. The claim for a TDIU prior to January 19, 2020 is, therefore, granted. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). THERESA M. CATINO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Trowers, 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.