Citation Nr: 21004842 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 14-23 273 DATE: January 28, 2021 ORDER Entitlement to an initial rating in excess of 30 percent for posttraumatic stress disorder (PTSD) and a rating in excess of 50 percent for PTSD from October 3, 2019 is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. From September 15, 2010 to October 2, 2019, the severity, frequency, and duration of the Veteran’s PTSD symptoms did not more closely approximate occupational and social impairment with reduced reliability and productivity. 2. From October 3, 2019, the severity, frequency and duration of the Veteran’s PTSD symptoms did not more closely approximate occupational and social impairment with deficiencies in most areas. 3. The preponderance of the evidence is against finding that his service-connected disabilities preclude him from securing or maintaining substantially gainful employment. CONCLUSIONS OF LAW 1. From September 15, 2010 to October 2, 2019, the criteria for an initial rating in excess of 30 percent for PTSD have not 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. 2. From October 3, 2019, the criteria for a rating in excess of 50 percent for PTSD have not 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. The criteria for the assignment of a TDIU on an extraschedular basis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1978 to February 1980. This case is before the Board of Veterans’ Appeals (Board) on appeal from rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded for additional development in December 2018 and August 2020 Board decisions. The Board finds that there has been substantial compliance with those remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that a remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with its remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand); see also D’Aries v. Peake, 22 Vet. App. 97, 105 (2008) (holding that only substantial rather than strict compliance with the Board’s remand directives is required under Stegall). Increased Rating for PTSD Disability ratings are assigned in accordance with VA’s Schedule for Rating Disabilities and are intended to represent the average impairment of earning capacity resulting from a disability. See 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. When a question arises as to which of two ratings shall be applied under a diagnostic code, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Reasonable doubt regarding the degree of disability will be resolved in the veteran’s favor. 38 C.F.R. § 4.3. The Veteran’s PTSD is rated under the General Rating Formula for Mental Disorders. Under 38 C.F.R. § 4.130, DC 9411, a 10 percent rating is warranted for occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication. A 30 percent rating is warranted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). A 50 percent rating is warranted for occupational and social impairment with reduced reliability and productivity due to such symptoms as, for example: 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 warranted for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as, for example: 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 worklike setting); inability to establish and maintain effective relationships. A 100 percent rating is warranted for total occupational and social impairment, due to such symptoms as, for example: 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. The symptoms listed in VA’s general rating formula for mental disorders are not an exhaustive list, but rather serve as examples of the type and degree of symptoms, or their effects, that would justify a rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). 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). “[T]he presence or lack of evidence of a specific sign or symptom listed in the evaluation criteria is not necessarily dispositive of any particular disability level.” Id. at 22. When evaluating a mental disorder, the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran’s capacity for adjustment during periods of remission must be considered. 38 C.F.R. § 4.126(a). 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). This appeal arises from the original assignment of a disability evaluation following an award of service connection, thus the severity of the disability at issue is to be considered during the entire period from the initial assignment of the disability rating to the present time. Separate ratings can be assigned for separate periods of time based on the facts found, a practice known as “staged” ratings. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). In this case, the Veteran’s PTSD is currently evaluated as 30 percent disabling from September 15, 2010 to October 2, 2019, and 50 percent disabling from October 3, 2019. 1. Entitlement to an initial rating in excess of 30 percent for PTSD, from September 15, 2010 to October 2, 2019. Turning to the evidence of record, social security administration (SSA) records reflect that the Veteran was previously a laborer and concrete finisher who last worked in 2010. He is in receipt of SSA benefits due to his physical disabilities. A mental disorder was not reported by the Veteran as contributing to his inability to work, and the SSA also did not find a mental disability to be a factor in the Veteran’s inability to work and function. A psychiatric evaluation was conducted in January 2011 by G.S., M.D. as part of the Veteran’s claim for disability benefits. Dr. S. noted that the Veteran was married from 1983 to 2006, and currently lived with his girlfriend. He described his relationship with her as good and noted that he had two sons in their twenties whom he sees or hears from regularly. The Veteran reported that he goes to church once a week and noted that his only close friend is his girlfriend. On examination, Dr. S. reported that the Veteran wore a clean shirt and pants. His attitude was cooperative, his speech was of a normal rate and rhythm, thought processes were logical and goal directed, his mood was euthymic and affect full range. Immediate and remote memory were intact, judgment and insight were intact, and concentration was within normal limits. Dr. S. noted that the Veteran gets angry at least once a day but reported that he would be able to get along with people on a purely mental basis. A February 2011 psychiatric review by D.B., M.D. diagnosed the Veteran with an anxiety-related disorder that was not severe. He also noted that the Veteran alleged PTSD and experienced nightmares. Dr. B. reported that the Veteran’s mental impairment did not result in restriction of activities of daily living or difficulties in maintaining social functioning. Dr. B. reported mild difficulties in maintaining concentration, persistence or pace. A March 2011 VA mental health consult noted that the Veteran’s mood was depressed and anxious, his speech was of a normal rate and tone and his affect was constricted at the beginning of the interview but showed full range towards the end. The Veteran denied thought disturbances, and the examiner noted that his thought process was clear and logical and his remote and current memory were intact. The Veteran denied any thoughts of suicidal or homicidal ideation in the present or past, and denied auditory or visual hallucinations. The Veteran reported that he is divorced from his first wife due to many affairs on his part and noted that he still has contact with the children from this relationship. The examiner noted that the Veteran had significant interpersonal stressors along with continuing legal and financial stressors, and reported that the Veteran was having difficulty in his relationship with his girlfriend of three years due to his not working and their living situation, noting that the Veteran currently lives with his brother. At an April 2011 VA Mental Health consult, the Veteran reported experiencing anxiety and depression. He also discussed how things have improved for him in his close personal relationships, noting that he is fighting less with his brother. The Veteran also reported that he was getting out of the house more to do activities he enjoys, including fishing and spending time with friends from church. He stated that he has been going with his wife to her job, noting that this brings him more pleasure than staying at home with his brother. On examination, the Veteran’s speech was of a normal rate and tone. His mood was euthymic, and his affect was more engaged and open with each visit. He denied suicidal or homicidal ideation and denied auditory or visual hallucinations. The examiner noted that the Veteran was more optimistic this visit and had been getting himself involved in activities that take him out of the home which allows him to not feel so isolated in his circumstances. In an April 2011 VA examination, the examiner diagnosed the Veteran with PTSD and reported symptoms of anxiety, chronic sleep impairment and difficulty in establishing and maintaining effective work and social relationships. The examiner opined that the Veteran suffered from occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication. The examiner reported that the Veteran’s PTSD impacted his ability to work, noting that he worked for a laborers union for many years and got along reasonably well on the job but could be irritable. The examiner noted that the Veteran performed best when working relatively independently as a result of PTSD related difficulty with closeness to others. In June 2011, the Veteran reported that he experiences sleep issues and panic attacks. See June 2011 notice of disagreement. In an August 2011 VA mental health treatment note, the Veteran complained of anxiety and noted that he worries over his finances. He reported that he and his girlfriend of ten years are members of a church that they attend regularly and noted that he volunteers a little for the church. The Veteran reported that he suffers from irritability and road rage but denied fighting or homicidal ideation. He reported that he was going camping the coming weekend. On examination, the examiner noted that the Veteran lacked energy and motivation and had a depressed mood and intermittent anxiety. The Veteran’s speech was clear, he had a contracted affect and did not report suicidal ideation. An April 2012 VA treatment note reported a good mood and affect and noted that the Veteran’s depression and PTSD were doing well without medication. A November 2012 VA treatment note reflected that the Veteran was mildly depressed but did not want treatment. The examiner noted that the Veteran had a good mood and affect with no report of suicidal ideation. The examiner assessed the Veteran with minor depression and PTSD and found that his mental health condition did not require further intervention. A June 2014 VA mental health triage note reflected that the Veteran experiences anxiety and panic symptoms when he has medical, dental or social appointments. He also reported that he has difficulty in traffic. The Veteran reported that he is living with his girlfriend and noted that he is not getting along with his current landlord. He stated that these psychosocial stressors are bothersome. On examination, the Veteran was dressed casually with normal grooming and hygiene, he was pleasant, engaging, alert and oriented, his speech was spontaneous and of a normal rate, pattern and volume, and his mood/affect was euthymic, congruent and full. His thought process was linear, his judgment and insight were fair, cognitive deficits and memory impairment was not reported or observed, and psychotic symptoms/thought content was absent. The Veteran denied suicidal or homicidal ideation. In a June 2014 statement, the Veteran reported that he frequently blows up over little things and noted that he cannot go into crowds or stand anyone coming up behind him. He reported that he has trouble completing projects because he loses interest. See VA Form 9. In an April 2015 VA Primary Care consult, the Veteran reported that he had not been feeling down or depressed but has experienced some difficulty with initiating sleep. The Veteran noted that he had mental health appointments at VA in the past but was not interested in returning to see mental health at this point. At this consult, the Veteran was oriented to time, place and person, recent and remote memory were intact, and his mood and affect were appropriate. At a May 2015 VA psychiatric consult, the Veteran presented complaining of anxiety, noting that he cannot get through a dental procedure or an MRI due to PTSD and phobic anxiety. On examination, he was alert, oriented, cooperative, his speech was coherent, his mood anxious, thoughts were reality based, judgment was intact, and he did not have suicidal or homicidal ideation. August 2015 and June 2016 VA primary care notes reflect that the Veteran was oriented to time, place and person, his recent and remote memory was intact, and his mood and affect were appropriate. The Veteran refused a referral to mental health. In a March 2018 VA primary care note, the Veteran denied anxiety or depression, and denied hallucinations or delusions. On examination, the Veteran’s mood was euthymic, his thought content was linear and appropriate, his judgment and insight were good, and his speech was fluent and non-pressured. The Veteran denied suicidal ideation and hallucinations or delusions. At an April 2019 VA primary care visit the Veteran noted that he was having issues with his PTSD and would like a mental health consult as he feels it is getting worse and noted that he is not sleeping well. On examination, the Veteran’s mood was euthymic, his thought content was linear and appropriate, his judgment and insight were good, and his speech was fluent and non-pressured. The Veteran denied suicidal ideation and hallucinations or delusions. The physician assessed the Veteran with PTSD, noting exacerbating symptoms of insomnia and anxiety. The Veteran requested medication management, noting that it was an urgent request as he had flipped out on people and wanted to get help soon. In this case, the preponderance of the evidence is against finding that the Veteran’s PTSD disability picture for the period prior to October 3, 2019 more nearly approximates the criteria for a higher 50 percent evaluation. The preponderance of the evidence does not reflect occupational and social impairment with reduced reliability and productivity due to such symptoms as flattened affect, circumstantial, circumlocutory or stereotyped speech, difficulty in understanding complex commands, impairment of short and long term memory, and impaired judgment and abstract thinking. In fact, the April 2011 VA examiner opined that the Veteran suffered from occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication, which is indicative of a 10 percent evaluation. The Board affords the April 2011 VA examiner’s opinion significant probative weight as it was rendered after taking a thorough history from the Veteran, examining the record and conducting an in-person examination. Further, the evidence of record throughout the appeal period supports the April 2011 VA examiner’s assessment and does not reflect symptoms indicative of a higher 50 percent evaluation for PTSD. Specifically, the Veteran’s speech has been found to have a normal rate, tone and rhythm, and has been described as fluent, coherent, spontaneous and non-pressured. The record does not reflect circumstantial, circumlocutory, or stereotyped speech. See January 2011 psychiatric evaluation by Dr. S., March, April and August 2011 VA mental health consults; and June 2014, May 2015, March 2018 and April 2019 VA treatment notes. Further, the record does not reflect that the Veteran experiences impaired memory, judgment or abstract thinking or difficulty in understanding complex commands. The Veteran’s thought processes have consistently been described as clear, linear, logical and goal directed, and his judgment and immediate and remote memory are intact. Cognitive deficits and memory impairment were not observed by the examiners during the appeal period. See January 2011 psychiatric evaluation, March 2011, June 2014 and May 2015 VA mental health consults; and March 2018 and April 2019 VA primary care treatment notes. Finally, instead of a flattened affect, the Veteran’s affect has been described as full range, euthymic, engaged and appropriate with only one mention of a constricted affect (in August 2011) throughout the nine-year appeal period. See January 2011 psychiatric evaluation and April 2011, April 2012, June 2014, April 2015, June 2016, March 2018 and April 2019 VA treatment notes. The Board acknowledges that the 2011 VA examiner noted that the Veteran had difficulty establishing and maintaining effective work and social relationships; however, the examiner ultimately concluded that the Veteran suffered from occupational and social impairment due to mild or transient PTSD symptoms, which does not reflect the level of severity contemplated by a higher 50 percent evaluation. Regarding the Veteran’s level of social functioning, the Veteran was married for 23 years and although he divorced, it was not due to his mental health symptoms. See March 2011 VA mental health consult. The Veteran currently lives with his girlfriend and described his relationship with her as good. He noted that he had two sons in their twenties whom he sees or hears from regularly. He reported that he goes to church once a week but noted that his only close friend is his girlfriend. See January 2011 psychiatric evaluation by G.S., M.D. The Veteran also reported that he was getting out of the house to do activities he enjoys, including fishing and noted that he was reading more often. He stated that he was accompanying his girlfriend to her job, which gets him out of the house and brings him more pleasure than staying at home with his brother. See April 2011 VA mental health consult. Further, the Veteran reported that he is a member of a church which he attends regularly and noted that he volunteers for the church and spends time with friends from church. See April and August 2011 VA mental health treatment notes. The Board finds that this level of social functioning is contemplated by the currently assigned 30 percent evaluation, as noted by the April 2011 VA examiner and Dr. B. in his February 2011 psychiatric review where he reported that the Veteran’s mental impairment did not result in difficulties in maintaining social functioning. Additionally, in terms of the Veteran’s level of occupational impairment due to his PTSD symptoms, the April 2011 VA examiner noted that the Veteran worked for a laborers union for many years and got along reasonably well with others on the job but could be irritable. The examiner noted that the Veteran performed best when working relatively independently because his PTSD made it difficult for him to be near others. Dr. S. in her January 2011 psychiatric evaluation also opined that although the Veteran gets angry, he would be able to get along with people on the job. Although these clinicians determined that the Veteran’s irritability and difficulty being close to others would impact him on the job when he was required to work with others, the Board finds that this degree of occupational impairment is contemplated by the currently assigned 30 percent evaluation which notes occupational impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. Significantly, SSA records reflect that the Veteran reported that he was unable to work due to his physical disabilities, not as a result of mental health concerns. He was ultimately awarded disability benefits due to his physical disabilities. A psychiatric disability was not a factor in the SSA’s determination that the Veteran was unable to work. In sum, the preponderance of the evidence is against finding that the Veteran’s PTSD symptoms are severe enough to result in the level of occupational and social impairment contemplated by a higher 50 percent evaluation. While the Veteran did experience panic attacks (weekly or less often), a depressed mood, anxiety and chronic sleep impairment, these symptoms are contemplated by the currently assigned 30 percent evaluation. In addition, the Board finds the severity, frequency, and duration of the Veteran’s depression and anxiety symptoms more closely approximate the 30 percent rating, which are less severe, less frequent, and shorter in duration than those contemplated by a 50 percent rating. For example, the Veteran’s anxiety has been described as intermittent, (see August 2011 VA mental health consult), an April 2012 treatment note reported the Veteran’s mood as “good” not depressed, and in March 2018, the Veteran reported that he was not currently experiencing anxiety and depression. See March 2018 primary care note. Notably, the Veteran reported that he primarily experiences anxiety and panic symptoms when he has medical, dental or social appointments, suggesting that his anxiety symptoms arise in certain situations and are intermittent and less frequent in nature rather than constant. See June 2014 mental health triage note. In conclusion, the preponderance of the evidence weighs against finding that the Veteran experiences PTSD symptoms more closely approximated by the higher 50 percent evaluation that result in occupational and social impairment with reduced reliability and productivity. Although the Veteran does experience panic attacks and disturbances of motivation and mood due to anxiety and depression, the severity, frequency, and duration of these symptoms do not result in the level of impairment required for a 50 percent rating. As such, the criteria for a 50 percent or higher rating are not met and the appeal must be denied. 2. Entitlement to a rating in excess of 50 percent for PTSD from October 3, 2019. The Veteran contends that his PTSD symptoms are more severe than what is contemplated by the currently assigned 50 percent evaluation for the period since October 3, 2019. At an October 2019 VA PTSD examination, the examiner reported that the Veteran’s PTSD caused occupational and social impairment with reduced reliability and productivity. The VA examiner reported that the Veteran’s PTSD symptoms included a depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships and difficulty in adapting to stressful circumstances, including work or a worklike setting. Regarding social functioning, the VA examiner noted that the Veteran was socially isolated. At this examination, the Veteran reported that he remains single with no plans to date and reported that he gets anxious even thinking about dating again. He noted that he has not been in a relationship since his last examination. The Veteran reported that he does not have friends and is not active socially. He indicated that his only social contacts are when he goes to medical appointments and stated that he shops at night when fewer people are around. He reported minimal contact with siblings and occasional contact with sons and grandchildren. The Veteran noted that he lives by himself and his main hobby was fishing. On examination, the examiner found that the Veteran was dressed appropriately in casual but neat clothing and his grooming and hygiene were adequate. The examiner found no obvious deficits in the Veteran’s speed of cognitive processing or mental efficiency. He was alert, oriented, cooperative, and could attend to and concentrate on the questions being asked without difficulty. The Veteran’s speech was coherent and of normal rate and volume. He showed no evidence of a formal thought disorder, psychotic process or delusions and hallucinations. His thinking was logical, linear and goal directed. The Veteran’s mood was dysthymic, and his affect was appropriate and stable. There was no evidence of affective dysregulation and insight and judgment were within normal limits. The examiner described the Veteran as experiencing a persistent negative emotional state, decreased interest in activities, feelings of detachment/estrangement, excessive irritability and problems with sleep and decreased concentration. Considering the pertinent evidence in light of the applicable rating criteria, the Board finds that the preponderance of the evidence weighs against finding that the Veteran’s PTSD symptoms have caused occupational and social impairment with deficiencies in most of the areas of functioning needed for a 70 percent rating, including work, family relations, judgment, thinking and mood. The 2019 VA examiner opined that the Veteran’s PTSD symptoms resulted in reduced reliability and productivity, indicative of a 50 percent evaluation. The Board affords significant probative weight to the VA examiner’s opinion on the level of occupational and social impairment caused by the Veteran’s PTSD because of the examiner’s training and in-person evaluation of the severity of the Veteran’s PTSD. Although the 2019 VA examiner determined that the Veteran was socially isolated, he ultimately found that his level of social and occupational impairment resulted in reduced reliability and productivity, corresponding to a 50 percent rating, instead of deficiencies in most areas which is indicative of a higher, 70 percent evaluation. Further, the PTSD symptoms noted by the Veteran and examiner during the 2019 VA examination more closely correspond to symptoms described in the 30 and 50 percent rating criteria, including, depressed mood (30 percent); anxiety (30 percent); suspiciousness (30 percent); panic attacks that occur weekly or less often (30 percent); chronic sleep impairment (30 percent); mild memory loss (30 percent); disturbances of motivation and mood (50 percent); and difficulty in establishing and maintaining effective work and social relationships (50 percent). Although one symptom mentioned by the 2019 VA examiner is indicative of a higher, 70 percent evaluation—the Veteran’s difficulty in adapting to stressful circumstances, the Veteran does not experience other symptoms indicative of a higher, 70 percent evaluation. For example, his PTSD symptoms do not cause suicidal ideation, obsessional rituals, speech intermittently illogical obscure or irrelevant, unprovoked irritability with periods of violence, spatial disorientation or neglect of personal appearance or hygiene. Further, despite the 2019 VA examiner noting that the Veteran had difficulty establishing and maintaining effective relationships, he was not found to be unable to establish and maintain effective relationships as noted in the rating criteria for a 70 percent evaluation. In conclusion, the Board finds that the preponderance of the evidence indicates that the Veteran experienced occupational and social impairment with reduced reliability and productivity due to his PTSD symptoms which is indicative of a 50 percent evaluation. The severity, frequency and duration of the Veteran’s PTSD symptoms did not more closely approximate occupational and social impairment with deficiencies in most areas. As such, a higher, 70 percent rating is not warranted. 3. Entitlement to TDIU At his January 2019 VA PTSD examination, the Veteran reported that he had not worked since his last VA examination in 2011. This raises the issue of whether the Veteran is entitled to a TDIU pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009). In accordance with Rice, entitlement to a TDIU is considered part and parcel to the increased rating claim already on appeal. Thus, the Board has jurisdiction to consider this issue. Total 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). TDIU may be assigned to a veteran who meets certain disability percentage thresholds and is “unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities.” 38 C.F.R. § 4.16(a). The central inquiry is “whether [a] veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability.” Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Unlike the regular disability Rating Schedule, which is based on the average work-related impairment caused by a disability, “entitlement to TDIU is based on an individual’s particular circumstances.” Rice v. Shinseki, 22 Vet. App. 447, 452 (2009). In determining whether unemployability exists, consideration may be given to a veteran’s level of education, special training, and previous work experience, but not to age or to any impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19; see also Hatlestad v. Derwinski, 1 Vet. App. 164, 168 (1991). A total disability rating may be assigned when the schedular rating is less than total, where, if there is only one disability, the disability is rated at 60 percent or more, or where, if there are two or more disabilities, at least one disability is rated 40 percent or more and there is sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). In this case, the Veteran does not meet the schedular criteria for TDIU at any point during the appeal period. He is currently service connected for tinnitus and rated at 10 percent disabling from September 15, 2010; and service-connected for PTSD at 30 percent disabling from September 15, 2019 to October 3, 2019, and 50 percent disabling since that time. Therefore, during the appeal period, the Veteran’s combined rating was only 60 percent from October 3, 2019 forward, and 40 percent prior to that date. Further, the Veteran does not have a single service-connected disability rated at 60 percent disabling during the appeal period. It is also the policy of the VA, however, that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. 38 C.F.R. § 4.16(b). Therefore, where, as here, the veteran fails to meet the applicable percentage standards enunciated in 38 C.F.R. § 4.16(a), an extraschedular rating is for consideration where the veteran is unemployable due to service-connected disability and the case may be submitted to the Director of the Compensation Service for consideration. 38 C.F.R. § 4.16(b). The Board is precluded from granting a total rating under section 4.16(b) unless the issue is initially reviewed by the Director of the Compensation Service. Floyd v. Brown, 9 Vet. App. 88 (1996); Bagwell v. Brown, 9 Vet. App. 337 (1996). In this case, the Board finds that a referral of the TDIU claim to the Director of VA Compensation Service for extraschedular consideration is not warranted because the preponderance of the evidence is against finding that the Veteran is unable to secure or follow a substantially gainful occupation due to his service-connected PTSD and tinnitus. Although the record indicates that the Veteran has remained unemployed since 2011, the Veteran’s service-connected PTSD and tinnitus are not the basis for his inability to work. SSA records reveal that the Veteran worked as a laborer in the construction industry, pouring concrete, using a jack hammer and shoveling asphalt. He is certified as a heavy equipment operator and has completed high school. The Veteran has been found to be disabled for SSA purposes since 2010 due to his physical disabilities including unspecified arthropathies and osteoarthrosis. When filing his claim with the SSA, the Veteran alleged an inability to work as of October 2010 due to a history of hip, knee and shoulder surgery, bone spurs in his hips and chronic pain. The Veteran did not mention his mental health as a disability that precluded him from working. Throughout the appeal period, the severity of the Veteran’s PTSD was evaluated by several clinicians, none of whom determined that his PTSD symptoms were severe enough to render him unemployable. Although it was found that the Veteran’s PTSD would impact his employment due to his difficulty getting along with others and maintaining work relationships, the Veteran was not found to be unable to work due to his PTSD symptoms. Specifically, in a January 2011 psychiatric evaluation, Dr. S. opined that the Veteran gets angry once a day but does not stay angry long and would be able to get along with people. The April 2011 VA examiner noted that the Veteran could be irritable at times and worked best independently, but found that he got along reasonably well on the job, and opined that the Veteran’s PTSD symptoms decreased his work efficiency and ability to perform occupational tasks only during periods of significant stress. The January 2019 VA examiner stated that the Veteran would have difficulty in adapting to stressful circumstances including work, and difficulty establishing and maintaining effective work relationships, but ultimately concluded that the Veteran’s PTSD symptoms resulted in reduced reliability and productivity while working, rather than rendering him unable to work. The Board accords great weight to the April 2011 and January 2019 VA examiners’ opinions regarding the level of occupational impairment caused by the Veteran’s PTSD. The VA examiners are experienced with assessing disability impairments and their findings are consistent with the other evidence of record. Moreover, the Board finds that difficulty interacting with and being around people does not in itself render the Veteran unemployable. The Veteran would still be able to obtain and maintain a form of employment where he was not required to frequently interact with others. In summary, the salient point to make is that despite the Veteran’s difficulty maintaining work relationships and adapting to stressful circumstances, his PTSD and tinnitus alone are not severe enough to produce unemployability. Although the Veteran is currently not working and has been found to be unemployable by the SSA; his unemployability is the result of impairments caused by nonservice connected physical disabilities. After considering the Veteran’s employment and educational background, as well as the severity of his PTSD, the Board finds that the Veteran is not unable to secure or follow a substantially gainful occupation as a result of his service-connected disabilities. Accordingly, the Board declines to remand the claim for referral to the Director for consideration of TDIU on an extraschedular basis. The claim of entitlement to a TDIU is denied. Jennifer White Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Alison M. Mecone, 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.