Citation Nr: 21004694 Decision Date: 01/27/21 Archive Date: 01/27/21 DOCKET NO. 15-17 353 DATE: January 27, 2021 ORDER Entitlement to a rating in excess of 50 percent prior to May 10, 2016 for service-connected acquired psychiatric disorder, to include other specified trauma-related disorder, is denied. Entitlement to a rating in excess of 70 percent as of May 10, 2016 for service-connected acquired psychiatric disorder, to include other specified trauma-related disorder, is denied. Entitlement to total disability based on individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. Prior to May 10, 2016, the Veteran’s acquired psychiatric disorder, to include other specified trauma-related disorder, had been manifested by symptoms which most closely equate to occupational and social impairment with reduced reliability and productivity. 2. Since May 10, 2016, the Veteran’s acquired psychiatric disorder, to include other specified trauma-related disorder, has been manifested by symptoms which most closely equate to occupational and social impairment with deficiencies in most areas. 3. The Veteran’s service-connected acquired psychiatric disorder, to include other specified trauma-related disorder, does not prevent him from obtaining and retaining substantially gainful employment. CONCLUSIONS OF LAW 1. Prior to May 10, 2016, the criteria for an increased rating in excess of 50 percent for an acquired psychiatric disorder, to include other specified trauma-related disorder, have not been met. 38 U.S.C. §§ 1155, 1507; 38 C.F.R. §§ 3.102, 4.7, 4.130; Diagnostic Code (DC) 9413-9410. 2. Since May 10, 2016, the criteria for an increased rating in excess of 70 percent for an acquired psychiatric disorder, to include other specified trauma-related disorder, have not been met. 38 U.S.C. §§ 1155, 1507; 38 C.F.R. §§ 3.102, 4.7, 4.130; DC 9413-9410. 3. The criteria for TDIU have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from August 1961 to August 1965. The Veteran testified before a now-retired Veterans Law Judge at a hearing in November 2015. A transcript of the proceeding has been associated with the claims file. The Veteran was notified of this in August 2020 and given the opportunity to request another hearing. In September 2020, the Veteran notified the Board that he did not wish to appear at another Board hearing. As such, another hearing is not required. 38 C.F.R. § 20.700. These matters were previously denied by the Board in April 2018 and the Veteran timely appealed to the Court of Appeals for Veterans Claims (the Court). In a March 2019 Joint Motion for Partial Remand (JMPR), the Court remanded the matter for further adjudication after it was determined that the Board provided inadequate reasons and bases for its denial. It was also determined that the matter of entitlement to TDIU was reasonably raised by the record. In an August 2019 decision, the Board subsequently granted the matter in-part, denied the matter in-part, and remanded the issue of entitlement to TDIU for further development. The Veteran timely appealed the decision to the Court. In a September 2020 JMPR, the Court vacated the portions of the August 2019 Board decision denying entitlement to increased rating for an acquired psychiatric disorder because the Board failed to substantially comply with the 2019 JMPR by addressing specific evidence of record and because the Board provided an inadequate statement of reasons or bases by failing to address this evidence. Concerning the issue of TDIU, the Board made multiple attempts to contact the Veteran to obtain the necessary VA Form 21-8940 for an entitlement to TDIU claim. However, the Veteran never responded to these communications and did not return the necessary forms. Additionally, the Board instructed the regional office (RO) to obtain additional medical records and obtain a TDIU medical opinion. The requested development has been completed, and the appeal has returned to the Board for further appellate consideration. As is discussed below, the Board also addresses the relevant evidence noted in both the March 2019 and September 2020 JMPRs and provides adequate reasons and bases for its decision. The Board is now satisfied there was substantial compliance with the remand. See Stegall v. West, 11 Vet. App. 268 (1998). Increased Rating Disability evaluations are determined by applying a schedule of ratings which is based on average impairment of earning capacity based on the specific diagnostic codes identifying the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two separate evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that particular rating. 38 C.F.R. § 4.7. While the Board typically considers only those factors contained wholly in the rating criteria, it is appropriate to consider factors outside the specific rating criteria when appropriate in order to best determine the level of occupational and social impairment. See Mauerhan v. Principi, 16 Vet. App. 436 (2002); Massey v. Brown, 7 Vet. App. 204, 208 (1994). 1. Entitlement to increased rating for an acquired psychiatric disorder, to include other specified trauma-related disorder Prior to May 10, 2016, the Veteran had been in receipt of a 50 percent rating for an acquired psychiatric disorder, to include other specified trauma-related disorder, under 38 C.F.R. § 4.130, DC 9413-9410. From May 10, 2016, the Veteran has been in receipt of a 70 percent rating for his psychological disability under 38 C.F.R. § 4.130, DC 9413-9410. He contends that his symptoms of acquired psychiatric disorder merit increased ratings, and that he experiences a wide range of symptoms, which includes irritability, nightmares, night sweats, severe sleep disturbance, a tendency to isolate, difficulty creating or maintaining relationships, depression, intrusive memories, social anxiety, difficulty finishing anything he starts, panic-like “spells,” and suicidal ideation. A 50 percent rating is warranted where there is occupational and social impairment with reduced reliability and productivity due to such 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 (e.g. retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Id. In order to warrant a 70 percent rating, the evidence must show occupational and social impairment with deficiencies in most areas, such as work, school, family, relationships, judgment, thinking, or mood, due to symptoms such as, but not limited to, suicidal ideation; obsessional rituals which interfere with routine activities; impaired impulse control (such as unprovoked irritability with periods of violence); near-continuous panic or depression affecting ability to function independently, appropriately, and effectively; spatial disorientation; speech intermittently illogical, obscure, or irrelevant; 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. Id. In order to warrant a 100 percent rating, the evidence must show total occupational and social impairment, due to such symptoms as, but not limited to, 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 personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name. Id. Prior to May 10, 2016 After a review of the evidence of record, the Board determines that an increased rating in excess of 50 percent prior to May 10, 2016 is not warranted. Indeed, while the Veteran had occasional symptoms that could support a higher rating, they did not, on balance, cause social and occupational impairment with deficiencies in most areas of his daily living. Specifically, during a February 2013 VA examination, the Veteran reported that he has trouble sleeping and “would be fine if he could just sleep.” He was noted to have diagnoses of depression and posttraumatic stress disorder (PTSD), as well as seizures. However, the examiner indicated that he is not a psychologist and indicated that the VA should defer to one. Furthermore, the Veteran reported that he is still able to drive his tractor and take care of his 6-acre property. In September 2014, the Veteran underwent a VA examination for PTSD and he reported experiencing depression, anxiety, chronic sleep impairment, recurrent, involuntary, and intrusive distressing memories of a traumatic in-service event, recurrent distressing dreams, marked physiological reactions to internal or external cues that symbolize the event, avoidance of or efforts to avoid distressing memories, thoughts, and feelings associated with the event, and hypervigilance. Despite these reports, the Veteran was observed as mildly anxious and distressed when discussing the traumatic event, but otherwise pleasant, cooperative, fully oriented, adequately groomed, having normal memory and attention, having normal speech and thought processes, and without evidence of psychosis, suicidal ideation, or homicidal ideation. He was also able to joke and laugh with the examiner throughout the interview. Furthermore, he reported during the examination that he had been married for over 40 years and enjoys visiting with high school friends, seeing family, and spending time with his wife. The examiner indicated that the Veteran does not meet the DSM-5 criteria for a PTSD diagnosis and opined that the Veteran had 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. Next, the Veteran underwent a VA examination for mental disorders in September 2015 and reported symptoms that included significant re-experiencing of the traumatic event, hypervigilance in crowds, feelings of numbness, “terrible” self-esteem, avoidance, depressed mood, anxiety, chronic sleep impairment with recurrent waking nightmares, mild memory loss, difficulty concentrating, irritability without prominent anger, difficulty in adapting to stressful circumstances, and feelings of guilt, hopelessness, and worthlessness. While he reported that he has no friends and he needs instructions in front of him or he cannot complete a task, he also reported that he had a “good, average” relationship with his wife, had “okay” relationships with his adult sons, maintained phone contact with his brothers, and entertained himself by cutting wood. Despite the reported symptoms, the September 2015 examiner observed that the Veteran was adequately groomed in casual dress, cooperative, alert, well-oriented, had a stable affect with logical and coherent thought and speech processes, was able to interpret a common proverb and could spell “world” forward and backward. The examiner indicated a diagnosis of other specified trauma-related disorder and, consistent with the September 2014 examiner, opined that the Veteran had 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. Although the Veteran reported numerous and severe symptoms during the February 2013, September 2014, and September 2015 VA examinations, the evidence beyond the VA examinations does not show the level of impairment contemplated by a 70 percent rating. Medical records between September 2011 and May 2016 indicate that the Veteran was receiving treatment for mental health symptoms that included nightmares that caused him to thrash in his sleep, wake up screaming, sweat, tremble, and have heart palpitations,; tearfulness; difficulty sleeping more than a few hours per night; depressed mood; intrusive thoughts of the traumatic event that caused him to “space out;” “spells” that caused sweating, dizziness, chest pain, zoning out, palpitations, and full body tremors; difficulty concentrating; feelings of lethargy; feelings of helplessness and hopelessness; flashbacks to the event; avoidant behavior; anxiety; social anxiety around big crowds; difficulty with short-term memory; mood swings; loss of interest and motivation; decreased self-esteem; somatic preoccupation; irritability; avoidance of thoughts and feelings about the event; hypervigilance; exaggerated startle response; feelings of shame and guilt; and, in March 2012, he indicated that he experienced some passive thoughts of death but denied ever having suicidal ideation, plan, or intent. Additionally, he reported in March 2014 that he has thoughts that he would be better off dead or hurting himself several days. Lastly, during a medical appointment in November 2014, the Veteran’s wife informed his physician that the Veteran had been having a “bad year” since January as both of his parents passed away, and that he spent a lot of time lying on the couch, which led to a 21-pound weight loss. He was treated with periods of psychotherapy and various medications. During some of his appointments, physicians observed moments of tearfulness, depressed mood, anxious mood, a period of dissociation that required redirection in March 2012, an appointment in April 2012 where the Veteran appeared to have possibly “doz[ed] off” multiple time during the examination, and one instance in October 2012 where the Veteran appeared mildly unkempt. Additionally, his physicians opined that his “spells,” where he appears to have staring spells, rapid heart rate, dizziness, and tremors, were psychogenic in nature because cardiac and neurological workup was normal, and his physician noted that it could be caused by anxiety or his trauma-related disorder. Despite this, physicians generally observed the Veteran as alert, oriented, polite, cooperative, having adequate hygiene, having logical and linear thinking, having fair-to-good insight and judgment, reporting no periods of mania, psychosis, or audio or visual hallucinations, and predominantly reporting no suicidal ideation. The Veteran also reported to his physicians that he is able to grocery shop independently and independently perform his activities of daily living, he has relationships with his children and grandchildren, and he spends his free time working on projects and maintaining his property. Additionally, the Veteran never required hospitalization for psychological symptoms. Furthermore, the Veteran and his wife testified in November 2015 that the Veteran had almost weekly “meltdowns” that lasted for 48 hours where the Veteran could not function, would not eat, and did nothing but sleep. The Veteran reported that he would start many projects in his garage but would not finish many of them out of fear that if he finishes them incorrectly, someone close to him could be harmed. His wife noted that his garage where he works was in extreme disarray. Both testified that the Veteran did not have friends other than one couple. The Veteran also reported that he had “really bad” nightmares at least once per week and that he only slept for 2 or 3 hours per night as a result. He noted that he was unable to nap during the day despite being tired. The Veteran reported that he would isolate and not spend time with anyone other than his family. Finally, he reported that he did not trust anyone except his wife and that medication and therapy did not effectively treat his symptoms. Although the Veteran and his wife reported severe symptoms, the Veteran also indicated that he was able to grocery shop weekly, he kept busy with projects, he could drive, he visited with his family, he performed chores around the property such as chopping wood and cleaning the tractor, and each of his seven grandchildren would spend a week with him and his wife. Finally, in May 2016, the Veteran reported to a psychological examiner that he did not report suicidal ideations during earlier examinations because his wife was present, and he did not want to discuss that in front of her. In specific response to the previous JMRs, the Board separately addresses the Veteran’s suicidal ideation. Specifically, such symptoms were noted in March 2012, March 2014, and May 2016. Moreover, difficulty adapting to stressful circumstances, and difficulty establishing and maintaining effective relationships reported throughout the record. However, the Board notes that, contrary to what the JMR implies, a single symptom in the meeting the 70 percent criteria is not a “tripwire” for a higher rating, but is merely one aspect of his overall disability picture. Here, despite the fact that he mentioned suicidal ideation in 2012, 2014, and 2016, he has otherwise denied suicidal ideation throughout the period on appeal, and there are other medical appointments in the record, such as in October 2012, where the Veteran’s wife was not present but he still denied such symptoms. 38 C.F.R. § 4.126 (“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”). Cf. Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017). Here, despite the presence of sporadic suicidal ideation, his overall impairment does not rise to the 70 percent level. Similarly, the Veteran argues that his alleged weekly meltdowns lasting 48 hours caused neglect of personal appearance and hygiene; that his irritability and isolation (he reported in the medical record in April 2013 that he “[flew] off the handle” at times) demonstrated impaired impulse control (such as unprovoked irritability and periods of violence); his nightmares related to the traumatic event and distressing intrusive memories the day following a nightmare equated to hallucinations and delusions; and his difficulty finishing projects due to a fear that he will complete it wrong and harm someone represents obsessional rituals which interfere with his routine activities. Despite these contentions, the totality of the evidence demonstrates that the Veteran’s symptoms are more adequately characterized by the 50 percent rating he receives. Overall, while the Veteran reported and displayed some symptoms of a higher rating, including suicidal ideation, inability to establish and maintain effective relationships, and difficulty in adapting to stressful circumstances, a holistic review of the Veteran’s symptoms were better characterized by the 50 percent rating he perceived prior to May 10, 2016. Of particular note, the symptoms associated with a 70 percent rating are quite severe, as represented by symptoms such as suicidal ideation, obsessional rituals, severe difficulty communicating, and near continuous panic. It is reasonable to believe that such symptoms would be so severe, that even a layperson would readily be able to identify the impairment. Here, such impairment was not shown. Specifically, despite alleging an inability to maintain personal hygiene and appearance, the Veteran was described throughout the record as adequately groomed and appropriately dressed. Although he contends that distressing intrusive memories and difficulty finishing projects equated to hallucinations and delusions, physicians throughout the record specifically noted that the Veteran had no signs or symptoms of audio or visual hallucinations, psychosis, or a thought disorder. Additionally, physicians described the Veteran as having normal speech and logical goal-oriented thought processes. While the Veteran reported an inability to complete projects, he reported to physicians that he performed chores around his 6-acre property such as chopping wood and cleaning his tractor, and he noted that he independently grocery shopped and performed activities of daily living. Furthermore, there is no evidence in the record that the Veteran’s physicians categorized his symptoms as obsessional rituals that interfere with routine activities. While the Veteran once reported “fl[ying] off the handle,” he specifically reported that he did not experience prominent anger, which does not rise to the level of impaired impulse control (such as unprovoked irritability with periods of violence). While the Veteran reported isolating and not making many friends, he reported good relationships with his wife, brothers, adult children, and grandchildren, who he would keep in contact with either over the phone or through visits. Lastly, the Veteran indicated that his “spells” he experienced “for 40 years” that caused sweating and intense anxiety would last between 5 minutes and several hours, but that he had never lost consciousness and he would feel normal again after lying down to get away from people. This does not support that the Veteran suffered from near-continuous panic or depression that affected his ability to function independently, as he was able to reduce the symptoms within a few hours without seeking medical attention, and as already stated, he performed his activities of daily living independently. Next, although the general rating formula provides specific examples of symptoms that may result from various acquired psychiatric disorders, the Board emphasizes that its analysis should also consider other relevant criteria outside of the rating code in order to determine the level of occupational and social impairment. Mauerhan v. Principi, 16 Vet. App. 436, 444 (2002). As such, the Board has also considered the extent to which there are other indications of occupational and social impairment, such as difficulty in adapting to stressful circumstances or the inability to establish and maintain effective relationships that may have caused deficiencies in most areas, to include social and occupational inadaptability. In this regard, the Board would point out that the level of impairment sufficient to justify a 70 percent rating is particularly significant, and such impairment has not been shown here. As discussed, the Veteran has been married for more than 40 years, reported good relationships with his brothers and sons who he stayed in contact with, stayed in touch with his grandchildren and had them stay with him for a week each, and reported being able to grocery shop independently, which would have required him to be around others in public. He was also described as adequately groomed, cooperative, alert, and having normal speech and thought processes. Additionally, he was able to perform tasks like chopping wood and cleaning his tractor to maintain a 6-acre property. Therefore, the evidence demonstrates that his level of social and occupational impairment was not deficient in most areas, even when factoring in other relevant criteria outside of the rating core. See Mauerhan at 444. The Board concludes that the weight of the evidence is against the claim for increased rating in excess of 50 percent prior to May 10, 2016, and there is no doubt to be otherwise resolved. See Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). The appeal is denied. Since May 10, 2016 Based on the evidence of record, the Board determines that an increased rating in excess of 70 percent since May 10, 2016 is not warranted. Indeed, while the Veteran has occasional symptoms that could support a higher rating, they do not on balance cause total social and occupational impairment. Specifically, the Veteran reported during a September 2019 VA examination that he has been distressed and more depressed since the death of one of his grandchildren and the divorces of his sons. He noted that he experiences nightmares once or twice per week, intrusive memories, thought avoidance, irritability, hypervigilance, and chronic sleep problems. The Veteran and his wife also noted during the examination that the Veteran will have difficulty with his thoughts after nightmares, he will disappear for long stretches of time on his property, and he continues to be “haunted” by imagery associated with his military trauma. It was also noted that the Veteran experiences anxiety, difficulty in establishing and maintaining effective work and social relationships, and difficulty in adapting to stressful circumstances. The Veteran’s wife also noted during the examination that the Veteran screams in his sleep and she is unable to find him when she wakes up in the morning because he is out on the property. The examiner noted that the Veteran had difficulty understanding and hearing the questions, as he has bilateral hearing loss, and that his responses were vague, negativistic, and inarticulate. The examiner also noted that the Veteran appeared irritable with a congruent affect. However, they also noted that the Veteran had adequate hygiene and grooming and appropriate eye contact. The Veteran also reported that he attends church and he tries to keep his mind busy by performing tasks, playing on the computer, or “putz[ing]” in the garage. They were unable to assess the Veteran’s psychogenic episodes due to insufficient medical records and the medication the Veteran was taking, but noted that if he is taking Depakote as a mood stabilizer rather than an anticonvulsant, then that is typically given for relatively severe mental health conditions. As such, the examiner opined that the Veteran has occupational and social impairment with reduced reliability and productivity. Next, the Veteran underwent a VA examination with his wife once again present in November 2020. He and his wife reported that he has a good relationship with his wife but finds it difficult to “manage if anything is going on with his wife and then feels overwhelmed.” He reported good relationships with his sons and grandchildren despite still having difficulty managing the death of one of his grandchildren. He notes that he is close with his brother and one “handyman” who helps him with many projects and who he considers a close friend. Despite being a member of the American Legion and volunteering a few times, he found it difficult to “break into the group” and is not active in it. He reported that he has not attended church since his grandson’s death, and he spends most of his time at home in his workshop, on the computer, and with his cat, who he finds supportive. The Veteran reported feeling anxious and uncomfortable when he is not at home and avoids going out in public if possible or meeting new people. However, he denied having significant irritability issues. He also noted that he reads but cannot remember what he reads, and he tries to write things down on the computer but it does not always help. Finally, he reported that he and his wife are doing well financially, but he worries about money, and it would be difficult for him to manage bills due to attention and concentration issues. The examiner noted that the Veteran’s symptoms include frequent nightmares, night sweats, intrusive memories, decreased energy, fatigue, decreased appetite, rumination, restlessness, difficulty relaxing, attention and concentration difficulties, hopelessness, helplessness, increased tearfulness. depression, anxiety, suspiciousness, panic attacks that occur weekly or less often, chronic sleep impairment, mild memory loss, disturbances of motivation or mood, difficulty in establishing and maintaining effective relationships, difficulty in adapting to stressful situations, including in a work-like setting, and fleeting suicidal ideation. The examiner observed that the Veteran needed questions repeated due to his hearing impediment, was a poor historian, and deferred to his wife often to answer questions. Finally, they noted that the Veteran’s mood was down with an irritated affect. Despite the noted symptoms and observations, the examiner described the Veteran as cooperative with adequate eye contact, casually dressed, with adequate hygiene and grooming, and having logical and goal-directed thought processes. Like the September 2019 VA examiner, this examiner opined that the Veteran has occupational and social impairment with reduced reliability and productivity. Although the Veteran reported numerous and severe symptoms during the September 2019 and November 2020 VA examinations, the evidence beyond the VA examinations does not show the level of impairment contemplated by a 100 percent rating. Medical records between May 2016 and November 2020 do not contain records of mental health treatment other than prescribed medications, which is consistent with the Veteran’s reports that he stopped going to therapy sessions due to feeling like they were not working. The Veteran did, however, obtain a private psychiatric evaluation and submitted a disability questionnaire in May 2016. The Veteran reported to the physician that he does not like other people and spends most of his time in his workshop to get away from people, but he also reads and plays solitaire in his spare time. He reported that he gets moody and anxious around others. He also noted that he experiences nightmares and tremors and his wife calms him down when he begins shaking. The Veteran described his sleep as quite poor with frequent waking, causing him to sometimes nap during the day. He reported avoidant behavior, difficulty expressing emotions, hypervigilance, markedly diminished interest or participation in activities he used to enjoy, exaggerated startle response, “okay” concentration, improved anger, feelings of depression and hopelessness seven days per week, feelings of restlessness, poor appetite, low self-esteem, difficulty relaxing, irritability, and thoughts that he would be better off dead or hurting himself in some way. During the examination, the Veteran was observed having some confusion and memory problems with difficulty hearing the questions during the examination, and he expressed emotionality when discussing the traumatic events. However, the Veteran was also observed as being alert, oriented, casually but neatly dressed, fully cooperative, able to communicate effectively, and having adequate hygiene. Although the Veteran reported that he gets too nervous to drive in heavy traffic, he was able to drive to the examination. Additionally, the Veteran could not recall the Vice President, he could not demonstrate abstract thinking abilities, and he reported frequent panic attacks, but he was able to name the President, he spelled “world” backward, and he denied symptoms of a thought disorder. As a result, the examiner opined that the Veteran has total occupational and social impairment. However, the examiner did not indicate that they reviewed the entire evidence of record in forming their opinion. Conversely, the September 2019 and November 2020 VA examiners examined the Veteran, reviewed the evidence of record, and considered his contentions when forming their opinions, which are more consistent with the medical records that show at least some social and occupational functioning such as interacting with family, maintaining a friendship, driving, attending church, working on projects on his property, taking care of a cat, and hosting his grandchildren for a week. As such, the opinions of the VA examiners are of great probative value, while the May 2016 physician’s opinion is afforded less weight. While the Veteran reported some significant symptoms, the Board determines that they were most accurately contemplated by the 70 percent rating he is currently assigned. Of particular note, the symptoms associated with a 100 percent rating are quite severe, requiring total social and occupational impairment, as represented by symptoms such as gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting oneself or others, inability to perform daily activities of living, and memory loss for names of close relatives or one’s own name. Like with a 70 percent rating, it is reasonable to believe that symptoms would be so severe for a 100 percent rating, that even a layperson would be readily able to identify the impairment. Here, such impairment was not shown. Indeed, at the September 2019 and November 2020 VA examinations, the Veteran was cooperative and engaged with the examiner despite having some hearing difficulties and occasional confusion with questions, which his wife helped to answer. He expressed emotionality when discussing the traumatic event and some irritability, but otherwise had an appropriate mood for the content of the discussions. Throughout the medical records, his memory loss has been described as “mild” due to forgetting some names, directions, or recent events, but he was able to name the President, and he can drive, play on the computer, and take care of a cat. While he reported suicidal ideation, the record does not demonstrate evidence that he is a persistent danger of hurting himself or others. There is also no evidence of obsessive-compulsive behaviors, below average intelligence, or delusions or hallucinations. While the Veteran argues that his intrusive thoughts and fear of completing projects are evidence of delusions and hallucinations, there is no evidence in the record that these symptoms have been categorized as such by medical professionals. The Veteran has also never been hospitalized for his symptoms. Overall, while the Veteran may exhibit some symptoms of a higher rating, including intermittent inability to perform daily activities of living during the alleged “meltdowns” reported by the Veteran’s wife, intrusive thoughts, and some short-term memory loss, a holistic view of the Veteran’s symptoms, especially in light of the Veteran’s logical and goal-oriented thought processes without any sign of delusions, hallucinations, grossly inappropriate behavior, or memory loss of his own name or the names of close relatives, are better characterized by the 70 percent rating he has received since May 2016. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 115-117 (Fed. Cir. 2013). Next, the Board considered other relevant criteria outside of the rating code in order to determine the level of social and occupational impairment. See Mauerhan at 444. The Veteran reported that he does not engage in social activities because he gets anxious around others and does not like meeting new people but instead spends most of his time isolated on his property. His wife reported that he has “meltdowns” once per week that can last for 48 hours, and when those occur, he does not eat or take care of himself and only sleeps. He also reported that he has difficulty completing projects because he fears if he finishes them incorrectly, someone might be harmed. He reported that he had to stop working in the year 2000 because he would get “spells” that were described as sweating, shaking, rapid heart rate, and staring, but did not cause loss of consciousness. Despite reporting these difficulties interacting with others and continuing working, the Veteran reported that he has a close friend he works on projects with, he maintains close relationships with his brother, sons, and grandchildren, he has been married for more than 40 years and reports a good relationship with his wife, and he is able to drive. He also reported that he went to church until the passing of his grandson, and he spends his time caring for a cat, working on projects, doing puzzles, and playing on the computer. His ability to regularly interact with others, engage in hobbies, drive, and perform chores such as household projects are not consistent with total occupational and social impairment as contemplated by a 100 percent disability rating. In considering the appropriate disability ratings, the Board has also considered the statements from the Veteran and his wife that his service-connected psychiatric disorder is worse than it has been rated throughout the period on appeal, including that his disabilities cause impairments in his ability to engage in or maintain relationships with others and prevent him from functioning independently. However, the Board finds these statements of limited probative value. While the Veteran and his wife, as lay persons, are competent to report observed symptomatology as it comes to them through their senses, they are not competent to identify the specific level of the Veteran’s service-connected disability according to the appropriate diagnostic codes. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartwright v. Derwinski, 2. Vet. App. 24, 25 (1991) (“although interest may affect the credibility of testimony, it does not affect competency to testify”). On the other hand, such competent evidence concerning the nature and extent of the Veteran’s psychiatric disorders has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports) directly address the criteria under which these disabilities are evaluated and are highly probative. The Board concludes that the weight of the evidence is against the claim for increased rating in excess of 70 percent since May 10, 2016, and there is no doubt to be otherwise resolved. See Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). The appeal is denied. 2. Entitlement to TDIU The Veteran seeks a total disability rating based on individual unemployability (TDIU) A Veteran will be entitled to TDIU upon establishing that he is in fact unable to secure or follow a substantially gainful occupation due solely to impairment resulting from his service-connected disabilities. See 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16. Consideration may be given to his level of education, any special training, and previous work experience in making this determination, but not to his age or impairment from disabilities that are not service connected (i.e. unrelated to his military service). See 38 C.F.R. §§ 3.341, 4.15, 4.16, 4.19. To qualify for a total rating for compensation purposes on a schedular basis, the evidence mush show that the Veteran is unable to secure or follow a substantially gainful occupation as a result of his service-connected disabilities, provided there is one disability ratable at 60 percent or more, or, if more than one disability, at least one disability ratable at 40 percent or more and a combined disability rating of 70 percent. 38 C.F.R. § 4.16(a). 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 38 C.F.R. § 4.16(a); see also Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013) (noting that “applicable regulations place responsibility for the ultimate TDIU determination on the [adjudicator], not a medical examiner”); Floore v. Shinseki, 26 Vet. App. 376, 381 (2013 (observing that “medical examiners are responsible for providing a “full description of the effects of disability upon the person’s ordinary activity,’ 38 C.F.R. § 4.10, but it is the rating official who is responsible for ‘interpret[ing] reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present’ 38 C.F.R. § 4.2”). After considering the evidence of record, the Board finds that the claim should be denied. As an initial matter, the Veteran is rated as a combined 90 percent disabled, with a single 70 percent disability rating for an acquired psychiatric disorder, to include other specified trauma-related disorder, but that he has been rated a combined 80 percent disabled, with a single 50 percent disability rating for an acquired psychiatric disorder with an effective date of November 7, 2014. Therefore, the Veteran meets the schedular criteria for TDIU from that date forward. The Veteran is presently service connected for an acquired psychiatric disorder, to include other specified trauma-related disorder (70 percent), bilateral sensorineural hearing loss (50 percent), and tinnitus (10 percent). Following a Board remand in August 2019, VA sent multiple letters requesting that the Veteran provide employment, education, and training information, and included a copy of VA Form 21-8940 (Application for Increased Compensation Based on Unemployability). The Veteran did not response to those requests, and to date, VA has not been able to secure his employment history. However, his medical records indicate that he has been unemployed for the duration of the period for which he is eligible for TDIU. The records indicate that he receives Social Security disability for PTSD and depression. Unfortunately, the Board is presented with a less-than-complete evidentiary picture, as the Veteran’s did not provide the evidence requested by the RO to appropriately evaluate his claim. In such circumstances, proper adjudication on the merits is not possible. As stated by the Court, the “duty to assist is not always a one-way street” and the Veteran is obliged to respond with the necessary information that only he can provide. Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). The governing regulation in this situation, 38 C.F.R. § 3.158(a), is clear and unambiguous, and mandates that the claim will be considered abandoned. See Hurd v. West, 13 Vet. App. 449, 452 (2000) (when the regional office requests additional evidence and the appellant does not respond within one year, the claim is considered abandoned). Notably, the Court has held that even if an appellant is ignorant of the abandonment provisions of 38 C.F.R. § 3.158(a), VA regulations are “binding on all who seek to come within their sphere,” regardless of whether an appellant has actual knowledge of what is in the regulations. See Jernigan v. Shinseki, 25 Vet. App. 220, 229-30 (2012). In this case, as discussed above, the Veteran has specifically been asked multiple times to submit a completed VA Form 21-8940 and has been advised that his claim cannot be granted without that form or comparable information. Hence, the Board has no recourse but to conclude that, because of the Veteran’s failure to cooperate, the Veteran has abandoned his claim for TDIU, and the appeal must be denied. Nonetheless, even if the Veteran had submitted the proper forms for a TDIU claim, the Board, based on a review of the evidence, still finds that entitlement to TDIU is not warranted because the Veteran was not incapable of substantially gainful employment due to his service-connected disabilities. See 38 C.F.R. § 4.16(b). Indeed, the medical and lay evidence, including VA examinations from February and March 2015 (hearing loss and tinnitus), September 2015 (psychiatric disorder), September 2019 (hearing loss, tinnitus, and acquired psychiatric disorder), August 2020 (hearing loss, tinnitus, and TDIU), and November 2020 (acquired psychiatric disorder), indicates that the Veteran’s service-connected disabilities would cause some difficulty with concentration and focus at work due to disrupted sleep, he would experience some intrusive thoughts which interfere with his ability to stay focused on the task at hand, and he would be required to wear his assistive hearing devices and work in an environment that is not noisy due to bilateral hearing loss, but that he would not be precluded from performing sedentary or light unskilled work in a work environment that is not noisy. Specifically, the September 2015, September 2019, and November 2020 VA examinations found the Veteran to have logical and goal-directed thought processes, he is able to drive, and he reported that he stays busy by working on projects, playing on the computer, reading, and taking care of his cat. The Board acknowledges the medical and lay evidence asserting an inability to work due to an acquired psychiatric disorder, hearing loss, and tinnitus, and specifically notes a May 2016 private opinion indicating that the Veteran is unemployable due to his symptoms. However, the fact that even a medical professional finds a Veteran unemployable due to a service-connected disability is not dispositive, as the Board has ultimate responsibility for determining whether a Veteran is unemployable. See Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013). Here, the private physician’s opinion is outweighed by the consistent opinions throughout the record that, while the Veteran may have some limitations that limit him to only unskilled light or sedentary work with low noise exposure, he is not completely unable to obtain and sustain employment. This is consistent with the medical records above that indicate the Veteran is capable of creating and maintaining relationships to some extent, he has adequate hygiene, he drives and performs projects around his property, and he engages in various hobbies that require at least some concentration, memory, and cognition. Accordingly, the weight of the evidence is against the Veteran’s TDIU claim. In sum, the Board determines that the Veteran has not been unable to secure and maintain substantially gainful employment during the period on appeal. As such, his TDIU claim is denied.   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. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Kimber Veltri, Associate Counsel