Citation Nr: 21004607 Decision Date: 01/27/21 Archive Date: 01/27/21 DOCKET NO. 16-08 101 DATE: January 27, 2021 ORDER Entitlement to service connection for hypertension is denied. Entitlement to a 70 rating for service-connected posttraumatic stress disorder (PTSD) is granted from December 1, 2010 to October 22, 2012; and since March 1, 2013. Entitlement to a total disability rating based upon unemployability (TDIU) is granted for the period from December 1, 2010 until October 22, 2012. FINDINGS OF FACT 1. The probative evidence of record does not demonstrate that the Veteran’s hypertension is etiologically related to service, to include as secondary to his service-connected PTSD; it first manifested more than one year after separation. 2. From December 1, 2010 to October 22, 2012; and since March 1, 2013, the probative evidence of record demonstrates that the Veteran’s anxiety disorder manifested in occupational and social impairment with deficiencies in most areas. 3. For the period from December 1, 2010 until October 22, 2012, the Veteran’s service-connected disabilities have prevented him from obtaining and maintaining employment consistent with his occupational and vocational experience. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 2. From December 1, 2010 to October 22, 2012; and since March 1, 2013, the criteria for a 70 percent rating for PTSD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. 3. For the period from December 1, 2010 until October 22, 2012, the criteria for entitlement to a TDIU have been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.10, 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the Army from October 1984 to February 1991; and from January 2005 to June 2006. The Veteran’s claims were most recently before the Board of Veterans’ Appeals (Board) in May 2020. As explained in that document, by way of history, in September 2010, the Veteran informed VA that he was going to inpatient treatment for PTSD. In November 2010, the Veteran filed for an increased rating for PTSD, service connection for “acid reflux,” and to reopen his claim for service connection for hypertension. Thereafter, in November 2011, the agency of original jurisdiction (AOJ) granted a temporary 100 percent rating for PTSD based on in-patient stay from September 29, 2010 to December 1, 2010. Further, the AOJ granted an increased rating of 50 percent effective December 1, 2010. In that same rating decision, the claims of entitlement to service connection for GERD and reopening of service connection for hypertension were denied. While the Veteran’s claims were pending, the Veteran informed VA that once again he was to be admitted for in-patient treatment. In addition, he applied for a TDIU because of his service-connected back and PTSD conditions. In a February 2014 rating decision, the AOJ granted a 100 percent rating for PTSD based on in-patient treatment from October 22, 2012 to March 1, 2013 and continued a 50 percent rating thereafter. The Veteran was granted entitlement to a TDIU effective November 15, 2012, special monthly compensation based on Housebound criteria being met from November 15, 2012 to February 28, 2013, and entitlement to Dependent’s Educational Assistance effective November 15, 2012. The Veteran’s claims were before the Board in December 2014 wherein the claims for an increased rating for PTSD and whether to reopen the claims for service connection for GERD and hypertension were remanded for the issuance of a statement of the case (SOC). In February 2019, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at a video hearing. A transcript of this hearing has been associated with the claims file. In May 2020, the undersigned reopened the Veteran’s claims for hypertension and GERD. Further, the Board remanded the claims for entitlement to service connection for hypertension and GERD; an increased rating for PTSD; and entitlement to a TDIU for additional development. This development was completed. In an August 2020 rating decision, the Veteran’s claim for service connection for GERD was granted. Therefore, as the issue of entitlement to service connection for such disability has been granted in full, it is no longer before the Board. Grantham v. Brown, 114 F.3d 1156, 1159 (Fed. Cir. 1997). In a September 2020 rating decision, the Veteran’s rating for PTSD was increased to 70 percent effective September 16, 2020. As this does not represent a full grant of benefits, the claim remains on appeal. After the most recent Supplemental SOC (SSOC), the Veteran submitted additional medical evidence. The Veteran waived AOJ review of this evidence. Service Connection 1. Entitlement to service connection for hypertension The Veteran asserts that he has “high blood pressure” that is related to his service-connected PTSD condition. Specifically, he contends that his symptoms caused his blood pressure to rise and he is on medication for it. An October 2010 VA medical record provides a diagnosis of hypertension, “etiology unknown, may be stress related or early coronary artery disease.” See Medical Treatment Record—Government Facility, page 85-100, received November 22, 2010. The Veteran has also asserted that he had high blood pressure readings during service and that this would cause his current high blood pressure. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Certain chronic diseases (like hypertension) will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service (typically one year); or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). In addition to direct service connection, service connection may be established on a secondary basis for a disability which is caused or aggravated by a service-connected disability. However, the Veteran may only be compensated for the degree of disability over and above the degree existing prior to the aggravation. See Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. 38 C.F.R. § 3.310 (b). The Veteran has a current diagnosis of hypertension, he had blood pressure readings during service, and he is service-connected for PTSD. Thus, the question now turns to whether his hypertension is etiologically related to service. The file contains one VA medical opinion related to hypertension during the period on appeal. The Board asked a clinician to provide an opinion on whether the Veteran’s hypertension is etiologically related to service or to his service-connected PTSD. In June 2020, a clinician rendered the following opinion: “Review of the Veteran’s [service treatment records (STRs)] does not reveal significantly elevated blood pressures. Isolated high blood pressure readings are possible without having chronic hypertension. However, borderline elevations over time are considered pre-hypertensive. The veteran did not exhibit such a pattern in service. There is no evidence of hypertension while in service, and the first documentation of hypertension treatment is May 2009. Blood pressure in January 2007 was 124/76, and July 2007 was 120/80. These represent normal blood pressures in the interval from service until developing hypertension. Therefore, it is less likely than not that the veteran’s hypertension had its nexus in service or is due to events in service. Furthermore, it is not due to PTSD. The Veteran’s diagnosis is benign, essential hypertension, and is considered a stand-alone diagnosis. Psychological diagnoses, such as PTSD, do not cause or aggravate hypertension. Stress and anxiety may temporarily elevate blood pressure but will not cause it to remain chronically so, nor will it dramatically alter the natural course of the hypertension. This is accepted medical knowledge and practice. The comments in the 2010 note [referenced by the Board above] regarding stress and coronary artery disease as possible causes are hypothetical opinions and not supported by the Veteran’s current diagnosis.” The Board gives the opinion great probative weight because it is based on a review of the record and the clinician has the medical expertise required to make such a determination. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board has reviewed the medical record and finds that it supports the clinician’s opinion; the STRs do not support a diagnosis of hypertension during service. As the opinion stated, elevated blood pressure is different than the diagnosis of hypertension: chronically high blood pressure. The Board has considered the Veteran’s lay opinion that his hypertension is related to service or his PTSD. Lay witnesses are competent to provide testimony or statements relating to symptoms or facts of events that the lay witness observed and is within the realm of his or her personal knowledge, but not competent to establish that which would require specialized knowledge or training, such as medical expertise. Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay evidence may also be competent to establish medical etiology or nexus. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). However, “VA must consider lay evidence but may give it whatever weight it concludes the evidence is entitled to.” Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). In the instant case, the Board finds that the Veteran is competent to report his blood pressure readings and feeling stressed. See Jandreau v. Nicholson, 492 F.3D. 1372, 1377 (Fed. Cir. 2007). However, the Board finds the question of the exact diagnosis and the potential relationship between the Veteran’s blood pressure and service to be complex in nature. Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). Therefore, while the Veteran is competent to describe his symptoms, he cannot, as a layperson, provide competent medical evidence establishing a diagnosis or connection between the two. Since the Veteran separated in May 2006, and the first documented diagnosis of hypertension is in May 2009, presumptive service connection for a chronic disability is also not warranted. Thus, the weight of the evidence is against the claim for service connection for hypertension. Accordingly, the claim is denied. Absent a relative balance of the evidence for and against the claim, the evidence is not in equipoise and the benefit of the doubt doctrine does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Increased Ratings 2. Entitlement to a rating in excess of 50 percent for service-connected PTSD from December 1, 2010 to October 22, 2012; and since March 1, 2013 The Veteran contends that he is entitled to an increased rating for his service-connected PTSD. Specifically, in a September 2012 brief and affidavit, the Veteran and his representative assert that he should be entitled to a 70 percent rating. However, the Board will evaluate the file to determine if a higher benefit may be awarded to the Veteran. Because the Veteran was awarded periods of temporary disability wherein he received 100 percent ratings, the Board may only review the periods on appeal when the 100 percent ratings do not apply: from December 1, 2010 to October 22, 2012; and since March 1, 2013. Disability ratings are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects her ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. The percentage ratings in the Rating Schedule represent the average impairment in earning capacity resulting from service-connected diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The percentage ratings are generally adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the disability. Id. Where the appeal is from the initial rating assigned with the award of service connection, separate ratings can be assigned for separate periods of time based on the facts found-a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999). The Veteran’s symptoms have been consistent such that staged ratings do not apply. The disability is currently rated as 50 percent disabling pursuant to 38 C.F.R. § 4.130, Diagnostic Code 9411. This diagnostic code provides that PTSD is to be rated under the General Rating Formula for evaluating psychiatric disabilities other than eating disorders. A 50 percent rating is assigned for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is assigned for occupational and social impairment with deficiencies in most areas, such as work, school, family relationships, 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 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 inability to establish and maintain effective relationships. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of closes relatives, own occupation, or own name. When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment, rather than solely on the examiner’s assessment of the level of disability at the moment of the examination. When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment but shall not assign an evaluation solely on the basis of social impairment. 38 C.F.R. § 4.126. The specified factors for each incremental psychiatric rating are not requirements for a particular rating but are examples providing guidance as to the type and degree of severity, or their effects on social and work situations. Analysis should not be limited to whether the symptoms listed in the rating scheme are exhibited; rather, consideration must be given to factors outside the rating criteria in determining the level of occupational and social impairment. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Under the General Formula for Mental Disorders (General Formula), the Board must conduct a “holistic analysis” that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, including degree of disability, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 3.102, 4.3. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The Veteran had a VA examination in February 2011. He reported that he had few friends and he doesn’t “do fun” because of physical pain. He reported no history of suicidal ideations or attempts, but did report a history of physical aggressiveness/violence/assaultiveness, but no additional information regarding his aggressiveness was obtained. He reported a sleep impairment, but his objective examination was otherwise within normal limits. There was no mention of hallucinations, impulse control issues, and suicidal or homicidal ideations. Overall, the examiner found that the Veteran was functioning within the 30 percent range of symptomology. The Veteran had another VA examination in December 2013. The Veteran reported a limited social circle, saw his children “sparingly”, and did not socialize. He reported a prescription routine and that he improved with in-patient treatment. The examiner assessed the following symptoms: anxiety; suspiciousness; chronic sleep impairment; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. His mental status examination was within normal limits and the examiner found the Veteran to be “pleasant and sincere.” Overall, the examiner found his presentation to be consistent with a 30 percent range of symptomology. The Veteran submitted two disability benefit questionnaires (DBQs) from his treating VA doctor, dated August 2017 and January 2019. The DBQs are essentially identical except for the last (date and signature) page. The doctor reported that the Veteran had several psychiatric diagnoses, to include PTSD, and that the symptoms could be differentiated from each other, but didn’t explain how. The Veteran reported many anxieties due to driving, unfamiliar people and places, and he was avoidant of trauma triggers. The Veteran had been engaged in a residential treatment program three times in the past. The doctor found the following symptoms to be present: depressed mood; anxiety; suspiciousness; chronic sleep impairment; mild memory loss; memory impairment; impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty adapting to stressful circumstances; inability to establish and maintain effective relationships; suicidal ideation; impaired impulse control, such as unprovoked irritability with periods of violence; neglect of personal appearance and hygiene; and intermittent inability to perform activities of daily living, including maintaining minimal personal hygiene. In addition, he had heightened fears and phobias; general anxiety; dissociative episodes with visual distortions and exaggerated reactions; intrusive fears of explosives being detonated; heightened fear of death; and easily distracted, diminished attention and memory. Overall, the VA doctor found the Veteran to be functioning within the 70 percent rating symptomology. The Veteran’s most recent VA examination for PTSD came in September 2020. The Veteran reported passive SI within last two weeks. He denied plan and intent. He stated he attempted suicide a “few years ago” but stated he did not go to the hospital for this incident. He denied current suicidal or homicidal ideations. He reported no changes in social, marital, or family history since his last exam. Veteran reported he is divorced and lives alone. He stated he stays to himself and prefers not to be around others. He further reported current issues with anxiety, sleep, depression, hypervigilance, and social isolation. The examiner assessed the following symptoms: depressed mood; anxiety; panic attacks that occur weekly or less often; chronic sleep impairment; flattened affect; disturbances of motivation and mood; difficulty adapting to stressful circumstances; inability to establish and maintain effective relationships; difficulty in adapting to stressful circumstances, including work or a work like setting; and suicidal ideation. Upon mental status examination, the Veteran presented with a flat affect and depressed and anxious mood. He was hypervigilant in the waiting room and the clinician’s office, often watching doorways and being easily startled. He answered the clinician’s questions but his responses were short and clipped. Upon objective psychological testing, the Veteran reported severe depression, anxiety, and PTSD symptoms. In reviewing the Veteran’s VA medical records for the period on appeal, the Veteran’s overall presentation was mostly within normal limits. He repeatedly denied suicidal ideation, obsessional rituals, and his speech was within normal limits. While he reported depression and anxiety, it was not noted to be continuous. His impulses and hygiene were normal and he was oriented. However, he was noted to have difficulty in adapting to stressful circumstances and inability to establish and maintain effective relationships by his treating providers. Using the September 2020 examiner’s testing as a framework for the Veteran’s overall psychiatric functioning, the Board considered the testing measures reported by the Veteran. While his depression (PHQ) scores were always low to mild, his PTSD symptom (PCL) scores were consistently severe to very severe. At the Veteran’s February 2019 hearing, he testified that he started isolating again, he snaps at his children, and he avoids people. He avoids loud sounds and has poor sleep. He recently had been in altercations and purchased a gun. Based on the foregoing, the Board finds the Veteran’s service-connected PTSD was manifested primarily by symptoms that included difficulty in adapting to stressful circumstances and an inability to establish and maintain effective relationships. As a whole, the effect of the severity, frequency, and duration of these signs and symptoms most nearly approximate occupational and social impairment with deficiencies in most areas. While VA treatment providers and examiners found the Veteran’s objective presentation to be within normal limits, his reported PTSD symptoms were consistently severe to very severe. Further, the Veteran attended in-patient treatment for eight months total in 41 months—roughly one-fifth of the time period. Thereafter, his reports of severe PTSD symptomology continued. Unlike a surgery, psychological distress doesn’t become “repaired” after a period of convalescence. Given that the Veteran attended three in-patient stays (one prior to the period on appeal), it is more likely that he had a tenuous relationship with his daily functioning and adapting to changes in his routine if he was not isolating himself. The Veteran’s treating VA doctor provided two DBQs that lend to support to the overall level of the Veteran’s functioning during this period. While the DBQs are not fully supported by the contemporaneous medical record, the VA doctor treated the Veteran for seven years and was familiar with the Veteran’s functioning during that period, even if the medical record does not document the symptomology. Given this, the Board affords the opinions great probative weight. As to whether the Veteran’s rating is total, the Board does not find gross impairment in thought processes or communication; persistent delusions; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of closes relatives, own occupation, or own name, or equivalent symptomology. The presence or absence of specific symptoms that correspond to a particular rating, is not dispositive. Mauerhan v. Principi, 16 Vet. App. 436, 442. The pertinent issue is the level of occupational and social impairment resulting from the Veteran’s symptomatology. In that regard, as explained above, the Board finds the effect of symptoms associated with the Veteran’s psychiatric disability during the period on appeal most nearly approximated occupational and social impairment with deficiencies in most areas. A greater level of impairment is simply not shown. In view of the foregoing, the Board concludes that the evidence with application of the benefit-of-the-doubt rule, demonstrates that a rating of 70 percent is warranted for service-connected PTSD during the period on appeal. Thus, the claim is granted. TDIU 3. Entitlement to a TDIU from December 1, 2010 until October 22, 2012 The Veteran asserts that his service-connected disabilities, to include PTSD, preclude employment. The Veteran was previously granted a TDIU effective October 22, 2012. The Veteran was under a period of convalescence until December 1, 2010. Therefore, the Board will consider the period from December 1, 2010 until October 22, 2012. VA will grant a total rating for compensation purposes based on unemployability when the evidence shows that the Veteran is precluded, by reason of service-connected disabilities, from obtaining and maintaining any form of gainful employment consistent with his education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. Under the applicable regulations, benefits based on individual unemployability are granted only when it is established that the service-connected disabilities are so severe, standing alone, as to prevent the retaining of gainful employment. Substantially gainful employment is defined as work which is more than marginal and which permits the individual to earn a living wage. See Moore v. Derwinski, 1 Vet. App. 356 (1991). Factors to be considered in determining whether unemployability exists are the Veteran’s education, employment history, and loss of work-related functions due to pain. Ferraro v. Derwinski, 1 Vet. App. 326, 330, 332 (1991). Consideration may not be given to the veteran’s age or to any impairment caused by non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. The ultimate question is whether the veteran, because of service-connected disabilities, is incapable 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). Total (100 percent) disability ratings will be assigned “when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation.” 38 C.F.R. § 3.340(a). A total disability rating may be assigned under a Diagnostic Code where the Diagnostic Code associated with a disability prescribes a 100 percent disability rating. Additionally, regulations provide other methods by which TDIU may be awarded. TDIU may be assigned to a veteran who is “unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities,” provided that he has received a disability rating of 60 percent or greater, or if he is service-connected for two or more disabilities, at least one of those disabilities has been assigned a disability rating greater than 40 percent, and the combined disability rating for all disorders is at least 70 percent. 38 C.F.R. § 4.16(a). For the period from December 1, 2010 until October 22, 2012, the Veteran’s service-connected disabilities combine to form a 90 percent rating, as follows: PTSD, rated at 70 percent; bilateral shoulder disabilities, rated at 20 percent each (with a bilateral factor of 3.6 percent); arthritis of the thoracolumbar spine, rated at 20 percent; migraines and tinnitus, rated at 10 percent each; and a non-compensable rating for service-connected GERD. Thus, for the period on appeal, the Veteran meets the schedular criteria for entitlement to a TDIU. The question now turns to whether the Veteran is factually unemployable. The Veteran stopped working in 2009 due to his back disability. Since then, the Veteran’s ability to lift, walk, take direction, attend to tasks and supervision, interact with coworkers and the public, and maintain attention are all impacted by his service-connected disabilities. Given these limitations, even if the Veteran had education and skills from previous work, the Board finds that his impairments would preclude any benefit he may have derived from that experience. Thus, the Board finds that the Veteran is unemployable for the period from December 1, 2010 until October 22, 2012 and his service-connected disabilities have rendered him unable to secure or follow substantially gainful employment. See 38 C.F.R. § 4.16 (a); Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013); Floore v. Shinseki, 26 Vet. App. 376, 381 (2013) (in a claim for TDIU, the ultimate question of whether a Veteran is capable of substantially gainful employment is not a medical one; that determination is for the adjudicator); see also Gilbert, supra. Therefore, the Veteran is entitled to a TDIU for this period. Bethany L. Buck Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board I. M. Hitchcock 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.