Citation Nr: 21004970 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 17-40 108A DATE: January 28, 2021 ORDER A 70 percent initial disability rating, but no higher, for service-connected chronic adjustment disorder with post-traumatic stress disorder (PTSD) is granted prior to February 18, 2020, subject to the law and regulations governing the payment of monetary benefits. An initial disability rating in excess of 70 percent for chronic adjustment disorder with PTSD from February 18, 2020, is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) is granted. FINDINGS OF FACT 1. Prior to February 18, 2020, the severity, frequency, and duration of the Veteran’s chronic adjustment disorder with PTSD most nearly approximated occupational and social impairment with deficiencies in most areas; the severity, frequency and duration of the Veteran’s symptoms did not more closely approximate total occupational and social impairment at any time prior to February 18, 2020. 2. From February 18, 2020, the severity, frequency, and duration of the Veteran’s chronic adjustment disorder with PTSD did not more closely approximate total occupational and social impairment. 3. The Veteran’s chronic adjustment disorder with PTSD renders her unable to maintain any form of substantially gainful employment consistent with her education, training, and work history. CONCLUSIONS OF LAW 1. Prior to February 18, 2020, the criteria for an initial disability rating of 70 percent, but no higher, for chronic adjustment disorder with 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 9411-9440. 2. From February 18, 2020, the criteria for an initial staged disability rating in excess of 70 percent for chronic adjustment disorder with 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 9411-9440. 3. The criteria for a TDIU have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16, 4.18. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1966 to September 1969. This appeal comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing in December 2020 before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the record. Entitlement to a TDIU due to service-connected disability has been raised by the record and the issue is properly before the Board. See Rice v. Shinseki, 22 Vet. App. 447 (2009). Increased Rating Disability ratings are intended to compensate for impairment in earning capacity due to a service-connected disorder. 38 U.S.C. § 1155. Separate diagnostic codes identify the various disabilities. 38 C.F.R. § 4.27. It is necessary to rate the disability from the point of view of the Veteran working or seeking work and to resolve any reasonable doubt regarding the extent of the disability in the Veteran's favor. 38 C.F.R. §§ 4.1, 4.2, 4.3. Evaluations are based on functional impairments which impact a veteran's ability to pursue gainful employment. 38 C.F.R. § 4.10. If there is a question as to which disability rating to apply to the Veteran's disability, the higher rating will be assigned if the disability picture more nearly approximates the criteria for that rating, otherwise the lower rating will be assigned. 38 C.F.R. § 4.7. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, and the entire history of the Veteran's disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Staged ratings are appropriate for an increase rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). In cases such as this where the Veteran's rating has been staged, the Board is tasked with reviewing the propriety of both the disability ratings assigned as well as the dates of the stage. Evaluations for various psychiatric disabilities are assigned pursuant to 38 C.F.R. § 4.130. Under the General Formula, a 30 percent rating is assigned when symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events), cause 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 normal conversation). A 50 percent evaluation is warranted for PTSD when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more 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. A 70-percent evaluation applies when a veteran's occupational and social impairment reflects deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control; spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances; or an inability to establish and maintain effective relationships. A 100-percent rating is assigned when there is total occupational and social impairment, due to such symptoms as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close 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 Veteran's capacity for adjustment during periods of remission. The rating agency shall assign a rating 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. 38 C.F.R. § 4.126 (a). When evaluating the level of disability from a mental disorder, VA will also consider the extent of social impairment, but shall not assign a rating solely based on social impairment. 38 C.F.R. § 4.126 (b). When determining the appropriate disability evaluation to assign, the Board's primary consideration is the veteran's symptoms, but it must also make findings as to how those symptoms impact the veteran's occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013); Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). Because the use of the term “such as” in the rating criteria demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, the Board need not find the presence of all, most, or even some, of the enumerated symptoms to award a specific rating. Mauerhan, 16 Vet. App. at 442; Sellers v. Principi, 372 F.3d 1318, 1326-27 (Fed. Cir. 2004). Nevertheless, all ratings in the general rating formula are also associated with observable symptomatology and the plain language of the regulation makes it clear that the veteran's impairment must be “due to” those symptoms, a veteran may only qualify for a given disability by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio, 713 F.3d at 118. 1. An initial 70 percent disability rating, but no higher, for chronic adjustment disorder with PTSD is granted prior to February 18, 2020. In a correspondence dated June 17, 2015, the Veteran’s representative argued that both the July 3, 2003 and January 13, 2012 VA examinations reported that the Veteran experienced symptoms of disability compatible with a 70 percent disability rating. Similarly, in his November 2016 briefing he argued that the evidence overall demonstrated the existence of symptoms most consistent with a 70 percent disability rating since receipt of the claim for service connection for PTSD. The Board agrees that a 70 percent initial rating, but no higher is warranted. Disability evaluations are determined by the application of VA’s Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3. The Veteran’s entire history is reviewed when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where the question for consideration is the propriety of the initial evaluation assigned, evaluation of the evidence since the grant of service connection and consideration of the appropriateness of a "staged rating" (assignment of different ratings for distinct periods of time, based on the facts found) is required. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). 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 of adjustment during periods of remission. The rating agency shall assign a rating 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. 38 C.F.R. § 4.126 (a). When evaluating the level of disability from a mental disorder, VA will also consider the extent of social impairment, but shall not assign a rating solely on the basis of social impairment. 38 C.F.R. § 4.126 (b). Under the General Rating Formula, a 50 percent rating is assigned when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more 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; in difficulty establishing effective work and social relationships. Id. A 70 percent rating is warranted 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 the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships. Id. A 100 percent rating is warranted when there is evidence of total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time and place; memory loss for names of close relatives, own occupation or name. Id. When determining the appropriate disability rating to assign, the Board's primary consideration is the veteran's symptoms, but it must also make findings as to how those symptoms impact the veteran's occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013); Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). Because the use of the term “such as” in the rating criteria demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, the Board need not find the presence of all, most, or even some, of the enumerated symptoms to ward a specific rating. Mauerhan, 16 Vet. App. at 442; see also Sellers v. Principi, 372 F.3d 1318, 1326-24 (Fed. Cir. 2004). Nevertheless, all ratings in the general rating formula are also associated with objectively observable symptomatology and the plain language of the regulation makes it clear that the veteran's impairment must be “due to” those symptoms. A veteran may only qualify for a given disability by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio, 713 F.3d at 118. At the December 2020 Board hearing, the Veteran testified that she was unable to sustain long term, full-time employment due to difficulty adapting to work due to her anxiety. She testified that she had to work part-time in temporary positions because she had difficulty having sustained contacts with people and could only work in varied positions with different people for short periods. She testified that while she had the nursing skills, she did not have the interpersonal skills and that she was inpatient and unable to express herself. She further testified that she had problems with being irritable with the management and staff of the temporary agency where she was last employed part-time. She also testified that she was so irritable with people that she could no longer even be in a medical setting. She testified that she was so irritable that she could not be in a medical setting, such that it caused her to lose her last part-time temporary position. She testified that she had difficulty getting the appropriate therapy for her chronic adjustment disorder with PTSD symptoms. She testified that she has difficulty taking care of herself and goes for days without feeling like doing anything. She testified that she thinks that her dental health is so bad because she neglects her dental hygiene. The Veteran also testified that she does not interact much with other people and feels that it is useless to do so. She further testified that she has difficulty attending to her personal finances and has issues with her thinking patterns. The Board finds that the Veteran has offered competent testimony as to a more severe disability picture than that previously assigned, specifically, a disability picture consistent with reduced reliability and productivity in most areas. Layno v. Brown, 6 Vet. App. 465, 470 (1994). Turning to the medical evidence of record, the Veteran had a VA examination for initial PTSD in November 2014. The Veteran reported that she was not working and that she last worked 8 years prior as a nurse and had to stop working because she was too irritable and was finding it too difficult to interact with people. She reported working as a pro re nata (PRN) staff member with various agencies and that her longest period of employment was for 2-3 years. The VA examiner found that the Veteran met the diagnostic criteria for PTSD due, in pertinent part to persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead her to blame herself or others, feelings of detachment or estrangement from others, irritable behavior with angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. The examiner found that for VA rating purposes, the Veteran had symptoms of depressed mood, anxiety, difficulty in establishing and maintaining effective work and social relationships. The Veteran stated that she used to be more involved in community work, but that she now prefers to be alone because she is inpatient and does not want to be irritated by other people. With regard to relevant social history, specifically friendships, the Veteran reported that she had two male friends, both living in other states who she talks to a few times a month and an “associate” with whom she exchanges emails, but nothing else in terms of friendship. Although the VA examiner opined that these symptoms are consistent with occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks, the Board finds that the symptoms are most consistent with reduced reliability and productivity in most areas. The Veteran’s inability to remain employed in one job and interact regularly with the same co-workers, and her inability to form anything other than long distance friendships, is most consistent with an inability to establish and maintain effective relationships and difficulty adapting to stress circumstances (including work or work like setting), both of which are listed in the criteria for a 70 percent rating. In December 2014, VA treatment records reflect that the Veteran completed a World Health Organization Disability Assessment and indicated that she had mild difficulties with washing her whole body, which indicates a neglect of personal appearance and hygiene, which is a symptom associated with reduced reliability and productivity in most areas. Also, in December 2014, the Veteran underwent VA psychological testing which indicated a “moderately severe” level of depression. The Veteran had a VA examination for mental disorders in July 2017. With regard to her employment history, she reiterated that she had had difficulty adapting to work due to problems interacting with people, and thus, retired. She reported that she is currently angry and irritable. She reported that her current anxiety symptoms began after her service in Vietnam. The examiner found that the Veteran had symptoms of depressed mood, anxiety, chronic sleep impairment, mild memory loss, such as forgetting names, directions or recent events, and disturbances of motivation and mood. The examiner noted that regarding the Veteran’s current psychosocial functioning, she was socially isolated. Although the VA examiner opined that these symptoms are consistent with occupational and social impairment with reduced reliability and productivity, the Board finds that these symptoms are most consistent with those contemplated by a 70 percent rating. mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks, the Board finds that the symptoms are most consistent with those contemplated by a 70 percent rating. The Veteran’s difficulty maintaining a full-time job as a nurse, then her difficulty maintaining part-time temporary employment as a nurse is most consistent with difficulty to adapting to stress circumstances (including work or work like setting) which is listed in the criteria for a 70 percent rating. The Veteran’s report of choosing to retire due to poor concentration, crying spells and difficulties with interacting with people, including wanting to be left alone, are consistent with difficulty adapting to stress circumstances (including work or work like setting) and an inability to establish and maintain effective relationships, which are both listed in the criteria for a 70 percent rating. An October 2017 VA therapy note states that the Veteran reported having issues with patience and anger management, and that she is currently managing them with medication and acupuncture. VA treatment records during the entire period show that the Veteran participated in integrative health and wellness, which included yoga, meditation and acupuncture, as well as group behavioral support counseling. The Board acknowledges the Veteran’s written statement dated and received in October 2014, stating that she has the following PTSD symptoms: survivor’s guilt, anxiety, deep sadness, nightmares, flashbacks, startle reaction, trouble getting close to people, irritable, trouble sleeping, trouble concentrating, short term memory problems and anger with avoidance. The Board has considered these symptoms in the determination of the appropriate rating for her chronic adjustment disorder with PTSD. Based on the Veteran’s testimony, her VA treatment examinations and treatment records, the Veteran’s overall disability picture for the entire period on appeal more closely approximated occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgement, thinking, or mood. As such, the assignment of a 70 percent disability rating, and no higher, is warranted for the period on appeal for the Veteran’s chronic adjustment disorder with PTSD. Staged ratings are not warranted as the overall disability picture has been relatively consistent since the effective date of service connection. The frequency, severity, and duration of the Veteran’s chronic adjustment disorder and PTSD are not consistent with 100 percent “total” impairment consistent with a 100 percent rating. The evidence does not show that the Veteran has ever had gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, disorientation to time or place, and memory loss for names of closest relatives, own occupation, or own name. The Veteran does have one symptom of total occupational and social impairment, which she testified to at the December 2020 Board hearing, namely an intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene, (specifically problems maintaining her dental health and an indication that the symptom was present throughout the appeal period). However, considering the totality of the evidence, as instructed by Mauerhan v. Principi, 16 Vet. App. 436, 440-41 (2002) and Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013) the Veteran’s overall symptoms have not resulted in, or more closely approximated, total social and occupational impairment, warranting a 100 percent disability rating. In sum, although the Veteran has shown a severe impairment in occupational and social functioning and a single symptom consistent with a 100 percent “total” categorization, the impairment, overall, has not been shown to be total. The Board additionally notes that the Veteran maintains some friendships and familial relationships to include with her mother, for whom she is caretaker. Thus, a 100 percent rating is not warranted for the Veteran’s chronic adjustment disorder with PTSD during the appeal period prior to February 18, 2020. 2. A disability rating in excess of 70 percent for chronic adjustment disorder with PTSD from February 18, 2020 is denied. The Veteran was granted a 70 percent evaluation for chronic adjustment disorder with PTSD in the September 2020 rating decision. The Veteran seeks a higher initial rating throughout the appeal period, thus she seeks a higher rating than the 70 percent currently assigned for chronic adjustment disorder with PTSD from February 18, 2020. The Veteran had a VA examination for PTSD in February 2020. The Veteran presented in casual attire, was appropriately groomed, alert and oriented. Her mood was dysthymic, and affect was tearful. Her thoughts were logical, linear and goal directed. There was no evidence of hallucinations, delusions or thought disorder. Speech was normal in volume, rate and articulation. She displayed mild difficulties with concentration. Judgement and insight appeared normal. She denied suicidal ideation and homicidal ideation. The Veteran stated that she is struggling with being her mother’s caretaker due to her lack of motivation and poor mood. The Veteran stated that her relationships with her adult children and ten grandchildren are “good.” She reported that she only feels happy when she is around them. For social support, she only spends time with family, although she does not discuss her experiences with them. She reported that she does not interact with other people because she has no interest in it, and would rather rest at home. She reported avoiding crowds and public places due to her anxiety. The Veteran denied symptoms of suicidal ideation, homicidal ideation, psychosis and mania. The examiner found that with regard to her PTSD diagnosis, the Veteran had, in pertinent part, feelings of detachment or estrangement from others, markedly diminished interest or participation in significant activities, persistent negative emotional state and irritable behavior and angry outbursts (with little or not provocation) typically expressed as verbal or physical aggression toward people or objects. The examiner determined that the Veteran had the following symptoms associated with her chronic adjustment disorder with PTSD: depressed mood, anxiety, suspiciousness, near-continuous panic or depression affecting the ability to function independently, appropriately and effectively, chronic sleep impairment, mild memory loss, such as forgetting names, directions or recent events, 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 work-like setting. A January 2020 VA treatment record shows that the Veteran is scheduled to participate in Cognitive Processing Therapy (CPT) for her chronic adjustment disorder with PTSD. The Board acknowledges the Veteran’s written statement dated and received in October 2020, discussing her experiences in Vietnam and post-discharge from service. As discussed above, the Veteran exhibits an intermittent inability to perform activities of daily living, which she testified to at the December 2020 Board hearing, including maintenance of minimum personal hygiene, which is listed in the examples of symptoms consistent with a 100 percent total evaluation. However, when considering the totality of all the evidence since February 18, 2020, as instructed by Mauerhan v. Principi, 16 Vet. App. 436, 440-41 (2002) and Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013) the Veteran’s overall symptoms have not resulted in, or more closely approximated, total social and occupational impairment, warranting a 100 percent disability rating. In this regard, for the same reasons as discussed above for the period prior to February 18, 2020, the preponderance of the evidence is against finding that the Veteran’s chronic adjustment disorder with PTSD warrants a 100 percent schedular rating at any time from February 18, 2020 to the present. The evidence does not show that the Veteran has ever had gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, disorientation to time or place, and memory loss for names of closest relatives, own occupation, or own name during the appeal period. The Board additionally notes that the Veteran maintains some friendships and familial relationships to include with her mother, for whom she is caretaker. Thus, the frequency, duration and severity of her chronic adjustment disorder with PTSD symptoms are most consistent with reduced reliability and productivity, and thus, a disability rating in excess of 70 percent for chronic adjustment disorder with PTSD from February 18, 2020 is denied. 3. A total disability rating based on individual unemployability (TDIU) due to service-connected disability, is granted During the Veteran’s hearing for her increased rating appeal, the Veteran testified that her service-connected chronic adjustment disorder with PTSD rendered her unable to maintain substantially gainful employment. Herein, the Board determined that the issue of entitlement to a TDIU had been raised pursuant to Rice. raised the issue of entitlement issue of TDIU. As such, the applicable rating period for consideration on appeal is from October 8, 2014, the effective date of service connection for chronic adjustment disorder with PTSD. Entitlement to a TDIU requires the presence of impairment so severe that it is impossible for the average person to follow a substantially gainful occupation. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. In reaching such a determination, the central inquiry is “whether the Veteran's service-connected disabilities alone are of sufficient severity to produce unemployability.” Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Consideration may be given to the Veteran's level of education, special training and previous work experience in arriving at a conclusion, but not to his age or to the impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. Where the schedular rating is less than total, a total disability rating for compensation purposes may be assigned when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that, if there is only one such disability, this disability shall be ratable at 60 percent or more, or if there are two or more disabilities, there shall be at least one ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). As a result of this decision, the Veteran is in receipt of a 70 percent rating throughout the appeal period from October 8, 2014. Thus, she meets the schedular requirements for entitlement to a TDIU from October 8, 2014. At the December 2020 Board hearing, the Veteran testified that she applied for early retirement 13 years prior, and that her service-connected chronic adjustment disorder with PTSD rendered her unable to maintain substantially gainful employment. The Veteran’s testimony is supported by the previously discussed medical evidence of record, as she has consistently reported this information throughout the appeal period. Based on the Veteran’s hearing testimony and VA examination reports, the Board concludes that a TDIU due to service-connected disability is warranted. The evidence shows that the Veteran has not been employed throughout the duration of the appeal period. The evidence regarding the impact of her service-connected acquired psychiatric disorder with PTSD on her ability to work has been discussed in detail above and shows that her chronic adjustment disorder with PTSD has unfortunately rendered her completely unable to work. Given the Veteran’s testimony and the medical evidence of record, the Board finds that her service-connected chronic adjustment disorder with PTSD render her incapable of maintaining gainful employment. As such, entitlement to TDIU due to service-connected disability is granted. Jennifer White Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Susan Leary, 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.