Citation Nr: 21061394 Decision Date: 10/01/21 Archive Date: 10/01/21 DOCKET NO. 10-34 213 DATE: October 1, 2021 ORDER For the rating period from February 25, 2008 through July 21, 2009, a higher initial disability rating of 70 percent for service-connected posttraumatic stress disorder (PTSD) is granted; for the rating period from February 25, 2008 through March 8, 2021, a higher initial disability rating in excess of 70 percent, excluding the period of receipt of a temporary total rating, is denied. From February 25, 2008 through March 8, 2021, a total disability rating for compensation purposes based on individual unemployability due to service connected disabilities (TDIU) is granted. FINDINGS OF FACT 1. From February 25, 2008 through July 21, 2009, the severity, frequency, and duration of the symptoms of the service-connected PTSD more nearly approximated occupational and social impairment with deficiencies in most areas. 2. From February 25, 2008 through March 8, 2021, excluding the period in which the Veteran was in receipt of a temporary total rating, the severity, frequency, and duration of the symptoms of the service connected PTSD did not manifest as total occupational and social impairment. 3. From February 25, 2008 through March 8, 2021, the Veteran was unable to maintain substantially gainful employment as a result of service connected disabilities. CONCLUSIONS OF LAW 1. Resolving reasonable doubt in the Veteran's favor, from February 25, 2008 through July 21, 2009, the criteria for a higher initial disability rating of 70 percent for the service connected PTSD have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.3, 4.7, 4.130, Diagnostic Code 9411. 2. For the initial rating period on appeal from February 25, 2008 through March 8, 2021, excluding the period in which the Veteran was in receipt of a temporary total rating, the criteria for a higher initial disability rating in excess of 70 percent for service connected PTSD have not been met or more nearly approximated. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.3, 4.7, 4.130, Diagnostic Code 9411. 3. Resolving reasonable doubt in the Veteran's favor, from February 25, 2008 through March 8, 2021, the criteria for a TDIU have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.340, 3.341, 4.15, 4.16, 4.18, 4.19, 4.25. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant, had active service from February 1980 to February 1983, and from August 2005 to February 2008. This matter came before the Board of Veterans' Appeals (Board) on appeal from a February 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida, which granted service connection for PTSD and assigned an initial disability rating of 50 percent, effective February 25, 2008. During the course of this appeal, in various adjudications by the Agency of Original Jurisdiction (AOJ), the Veteran was granted a staged increased disability rating of 70 percent from July 22, 2009 through August 27, 2013, and from November 1, 2013 through March 8, 2021, a temporary total rating from August 28, 2013 through October 31, 2013, and a staged increased disability rating of 100 percent from March 9, 2021. The instant matter has been before the Board on multiple occasions throughout the course of this appeal. Review of the record reflects that all prior remand directives have been adequately fulfilled by the AOJ, and the instant matter is ripe for adjudication. See Stegall v. West, 11 Vet. App. 268, 271 (1998). In March 2012, the Veteran testified at a Board video conference hearing before a Veterans Law Judge (VLJ) who is no longer employed by the Board. A copy of the March 2012 hearing transcript is of record. In October 2016, the Veteran was sent a letter providing 30 days to elect to present testimony at another Board hearing. To date, the Veteran has not requested a new hearing before the Board. The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.159, 3.326(a). As the instant decision grants a TDIU for the entire relevant rating period on appeal, no further discussion of VA's duties to notify and assist is necessary as to that issue. Further, as the PTSD rating issue arises from the Veteran's disagreement with the initial rating assigned following the grant of service connection, no additional notice is required regarding this downstream element of the service connection claim. Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007); Dunlap v. Nicholson, 21 Vet. App. 112 (2007); 38 C.F.R. § 3.159(b)(3). Regarding the duty to assist, the record reflects that VA obtained all relevant documentation and provided the Veteran with adequate VA examinations. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). As such, the Board finds that the duties to notify and assist the Veteran in this case have been fulfilled. Neither the Veteran nor the evidence has raised any specific contentions regarding the duties to notify or assist. 1. Rating PTSD Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) found in 38 C.F.R. Part 4. 38 U.S.C. § 1155. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. Where there is a question as to which of two disability ratings 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. It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the rating of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a veteran's service-connected disabilities. 38 C.F.R. § 4.14. It is possible for a veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes; however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits compensating a veteran twice for the same symptoms or functional impairment). When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. Conjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diagnosis, or for those not fully supported by clinical and laboratory findings. Nor will ratings assigned to organic diseases and injuries be assigned by analogy to conditions of functional origin. 38 C.F.R. § 4.20. The Veteran had appealed from the initial rating assigned for the service connected PTSD. In Fenderson v. West, 12 Vet. App. 119, 125 26 (1999), the United States Court of Appeals for Veterans' Claims (Court) addressed a similar appeal and directed that such appeal of the initial rating assigned following a grant of service connection was specifically not a claim for an increased disability rating. The Court also directed that separate ratings may be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. Under Diagnostic Code 9411, a 50 percent rating will be assigned for a mental disability which is productive of occupational and social impairment with reduced reliability and productivity due to symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks occurring 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 or 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 rating will be assigned for occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking, or mood due to symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; 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); and an inability to establish and maintain effective relationships. A 100 percent rating will be assigned for total occupational and social impairment due to symptoms such as gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, a persistent danger of hurting herself or others, an 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. 38 C.F.R. § 4.130. The Secretary of VA, acting within the authority to adopt and apply a schedule of ratings, chose to create one general rating formula for mental disorders. 38 U.S.C. § 1155; see 38 U.S.C. § 501; 38 C.F.R. § 4.130. By establishing one general formula to be used in rating more than 30 psychiatric disorders, there can be no doubt that the Secretary of VA anticipated that any list of symptoms justifying a particular rating would in many situations be either under- or over inclusive. The Secretary's use of the phrase "such symptoms as," followed by a list of examples, provides guidance as to the severity of symptoms contemplated for each rating, in addition to permitting consideration of other symptoms, particular to each veteran and disorder, and the effect of those symptoms on the claimant's social and work situation. This construction is not inconsistent with Cohen v. Brown, 10 Vet. App. 128 (1997). See Mauerhan v. Principi, 16 Vet. App. 436, 442 (1992). The evidence considered in determining the level of impairment under 38 C.F.R. § 4.130 is not restricted to the symptoms provided in the diagnostic code. Instead, the rating specialist is to consider all symptoms of a claimant's condition that affect the level of occupational and social impairment, including, if applicable, those identified in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). See 38 C.F.R. § 4.126. If the evidence demonstrates that a claimant suffers symptoms or effects that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the diagnostic code, the appropriate, equivalent rating will be assigned. The schedular rating criteria rate by analogy psychiatric symptoms that are "like or similar to" those explicitly listed in the schedular rating criteria. Mauerhan, 16 Vet. App. at 443. The Federal Circuit has embraced the Mauerhan interpretation of the criteria for rating psychiatric disabilities. Sellers v. Principi, 372 F.3d 1318, 1326 (Fed. Cir. 2004). In Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (2013), the Federal Circuit held that VA "intended the General Rating Formula to provide a regulatory framework for placing veterans on a disability spectrum based upon their objectively observable symptoms." The Federal Circuit stated that "a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration." It was further noted that "§ 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas." See also Bankhead v. Shulkin, 29 Vet. App. 10 (2017) (indicating that the Board should consider the severity, frequency, and duration of the signs and symptoms of a mental disorder when determining the appropriate rating). In Bankhead v. Shulkin, the Court held that evidence of more than thought or thoughts of ending one's life to establish the symptom of suicidal ideation is not required. "Suicidal ideation appears only in the 70 percent rating criteria. There are no analogues at the lower evaluation levels." Also, both "passive and active suicidal ideation are comprised of thoughts: passive suicidal ideation entails thoughts such as wishing that you were dead, while active suicidal ideation entails thoughts of self-directed violence and death." Bankhead v. Shulkin, 29 Vet. App. 10. In other words, a Veteran need not be at a risk, whether a high or low risk, of self-harm in order to establish the criteria of suicidal ideation. "[T]he presence of suicidal ideation alone may cause occupational and social impairment with deficiencies in most areas." Bankhead at 11. 70 Percent Rating for Period from February 25, 2008 through July 21, 2009 is Granted Having reviewed the evidence of record, lay and medical, the Board finds that, from February 25, 2008 through July 21, 2009, the severity, frequency, and duration of the symptoms of the service connected PTSD more nearly approximated occupational and social impairment with deficiencies in most areas, to warrant the grant of an increased 70 percent disability rating for this period on appeal. As discussed in the introduction, during the course of this appeal the Veteran was granted a staged increased 70 percent disability rating from July 22, 2009, the date of a VA examination showing that an increase was warranted. As such, the question before the Board is whether the symptoms noted at the time of the July 22, 2009 VA examination were present since the date of service connection, and prior to the July 22, 2009 VA examination. Per the report from the July 2009 VA mental health examination, at that time the Veteran was not involved in any serious personal relationships and had very little tolerance for spending time with others. The Veteran was experiencing suicidal ideation, and impulse control was only noted to be fair. The Veteran was unemployed at the time of the examination, and the VA examiner found that the Veteran's symptoms, specifically impatience, irritability, and impaired concentration, would limit the ability to seek and retain jobs. Further, the VA examiner assessed that the Veteran had notable impairments in psychosocial and occupational functioning during the previous two years, and was limited in the ability to form meaningful interpersonal contacts and/or to complete productive work. At the conclusion of the examination the VA examiner assessed that the Veteran had occupational and social impairment with deficiencies in most areas. The Veteran received a VA mental health examination in December 2008. Per the examination report the Veteran had limited social interaction and a low frustration tolerance. It was noted that the Veteran was irritable, with only fair impulse control. Significantly, the Veteran was noted to have suicidal ideation at that time. Upon examination the VA examiner found that the Veteran's symptoms ranged from moderate to severe, and noted that the Veteran had a poor quality of life and social isolation. At the conclusion of the examination the VA examiner opined that, while the Veteran did not have total occupational and social impairment, the overall occupational and social impairment was "fairly marked." Considering the evidence of record, the Board finds that the VA examiner's opinion that the Veteran's symptoms resulted in "fairly marked" occupational and social impairment is effectively an opinion that the symptoms were of such severity, frequency, and duration to result in deficiencies in most areas. After a review of all the evidence, lay and medical, the Board finds that, from February 25, 2008 through July 21, 2009, the severity, frequency, and duration of the symptoms of the service connected PTSD more nearly approximated occupational and social impairment with deficiencies in most areas, as required for a disability rating of 70 percent under Diagnostic Code 9411. As discussed above, during the rating period from February 25, 2008 through July 21, 2009, two VA examiners in December 2008 and July 2009 effectively opined that the severity, frequency, and duration of the PTSD symptoms resulted in deficiencies in most areas. Significantly, the evidence of record, to include the above discussed VA examination reports and the available VA treatment records, reflects that during the initial rating period from February 25, 2008 through July 21, 2009, the Veteran experienced suicidal ideation, which can support the grant of a 70 percent disability rating on its own. See Bankhead at 11. For these reasons, resolving all reasonable doubt in favor of the Veteran, the Board finds that the lay and medical evidence shows that a higher initial disability rating of 70 percent is warranted for the service connected PTSD for the rating period from February 25, 2008 through July 21, 2009. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7, 4.130, Diagnostic Code 9411. Initial Disability Rating in Excess of 70 Percent from February 25, 2008 through March 8, 2021 is Denied Having reviewed the evidence of record, lay and medical, the Board finds that, for the initial rating period on appeal from February 25, 2008 through March 8, 2021, the severity, frequency, and duration of the symptoms of the service connected PTSD did not manifest as total occupational and social impairment. Per the report from the December 2008 VA mental health examination, the Veteran had limited social interactions and fair family relations at that time. At the time of the July 2009 VA mental health examination, the Veteran was reported to be maintaining direct contact with four out of five sisters, and the Veteran had been attending daily AA meetings. As noted in the introduction, the Veteran testified at a March 2012 Board videoconference hearing. At that time, the Veteran testified to going on fishing trips with his brother in law. Further, the brother in law accompanied the Veteran and testified on his behalf at the March 2012 Board videoconference hearing. Such evidence supports that the Veteran was maintaining some social contacts at the time of the Board hearing. Per an October 2013 VA treatment record, the Veteran noted as having "supportive family and/or friends". In a January 2014 VA treatment note, it was reported that the Veteran had spent the holidays with a few close family members, and an August 2015 VA treatment note reported that the Veteran had a supportive family. A July 2015 VA treatment record specifically recorded that the Veteran was in regular contact with his brother and sisters. Following the death of one of the sisters, a September 2018 VA treatment record reflects that the Veteran was planning to move closer to his brother. Subsequently, a December 2019 VA treatment record reported that the Veteran was living with one of the sisters, and the records reflect that he was still living with her as of March 2020. Review of the evidence of record reflects that, for the initial rating period from February 25, 2008 through March 8, 2021, the Veteran was able to maintain a relationship with various family members. As such, it cannot be said that, during the initial rating period from February 25, 2008 through March 8, 2021, the Veteran's social impairment was total, as required for a 100 percent disability rating under Diagnostic Code 9411. For these reasons, the Board finds that a total 100 percent disability rating is not warranted at any point during the initial rating period from February 25, 2008 through March 8, 2021. 38 C.F.R. §§ 4.3, 4.7. Extraschedular Claim Not Raised The Board finds that neither the Veteran nor the record has raised a claim for extraschedular rating under 38 C.F.R. § 3.321(b) for any period for the rating issue on appeal. See Thun v. Peake, 22 Vet. App. 111 (2008); Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record); Yancy v. McDonald, 27 Vet. App. 484, 494 (2016), citing Dingess v. Nicholson, 19 Vet. App. 473, 499 (2006), aff'd, 226 Fed. Appx. 1004 (Fed. Cir. 2007) (holding that when 38 C.F.R. § 3.321(b)(1) is not "specifically sought by the claimant nor reasonably raised by the facts found by the Board, the Board is not required to discuss whether referral is warranted"). 2. TDIU Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities (Rating Schedule), which is based on the average impairment of earning capacity. 38 U.S.C. § 1155. Total disability is considered to exist when there is any impairment which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. Total disability may or may not be permanent. 38 C.F.R. § 3.340(a)(1). Total ratings are authorized for any disability or combination of disabilities for which the Rating Schedule prescribes a 100 percent rating. 38 C.F.R. § 3.340(a)(2). TDIU may be assigned when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. The service-connected disabilities, employment history, educational and vocational attainment, and all other factors having a bearing on the issue will be addressed in both instances. 38 C.F.R. § 4.16(a),(b). If there is only one such disability, it must be rated at 60 percent or more; if there are two or more disabilities, at least one disability must be rated at 40 percent or more, with sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). For the above purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable, (2) disabilities resulting from common etiology or a single accident, (3) disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric, (4) multiple injuries incurred in action, or (5) multiple disabilities incurred as a prisoner of war. 38 C.F.R. § 4.16(a). If a veteran's disabilities do not meet the objective combined rating percentage criteria of 38 C.F.R. § 4.16(a), it then becomes necessary to consider whether the criteria for referral for extraschedular consideration are met under § 4.16(b) criteria. It is the established policy of VA 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. Submission to the Director, Compensation and Pension Service, for extraschedular consideration is warranted in all cases of veterans who are unemployable by reason of service-connected disabilities, but who fail to meet the percentage standards set forth in § 4.16(a). 38 C.F.R. § 4.16(b). Individual unemployability must be determined without regard to any non service connected disabilities or a veteran's advancing age. 38 C.F.R. §§ 3.341(a), 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). The sole fact that a veteran is unemployed or has difficulty obtaining employment is not enough. A high rating in itself is recognition that the impairment makes it difficult to obtain or keep employment, but the ultimate question is whether a veteran is capable of performing the physical and mental acts required by employment, not whether a veteran can find employment. Id. at 361. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in a veteran's favor. 38 C.F.R. § 4.3. In Faust v. West, 13 Vet. App. 342 (2000), the United States Court of Appeals for Veterans Claims (Court) defined "substantially gainful employment" as an occupation that provides an annual income that exceeds the poverty threshold for one person, irrespective of the number of hours or days that a veteran actually works and without regard to a veteran's earned annual income. In Hatlestad v. Derwinski, 5 Vet. App. 524, 529 (1993), the Court held that the central inquiry in determining whether a veteran is entitled to a TDIU is whether a veteran's service connected disabilities alone are of sufficient severity to produce unemployability. The determination as to whether a total disability is appropriate should not be based solely upon demonstrated difficulty in obtaining employment in one particular field, which could also potentially be due to external bases such as economic factors, but rather to all reasonably available sources of employment under the circumstances. See Ferraro v. Derwinski, 1 Vet. App. 326, 331-332 (1991). In evaluating a veteran's employability, consideration may be given to the level of education, special training, and previous work experience in arriving at a conclusion, but not to age or impairment caused by non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. Marginal employment is not considered substantially gainful employment and generally is deemed to exist when a veteran's earned income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. Marginal employment may also be held to exist in certain cases when earned annual income exceeds the poverty threshold on a facts-found basis. Consideration shall be given in all claims to the nature of the employment and the reason for termination. 38 C.F.R. § 4.16(a). Marginal employment, odd-job employment, and employment at half the usual remuneration is not incompatible with a determination of unemployability if the restriction to securing or retaining better employment is due to disability. 38 C.F.R. § 4.17(a). The ultimate issue of whether a TDIU should be awarded is not a medical issue, but rather is a determination for the adjudicator. See Moore v. Nicholson, 21 Vet. App. 211, 218 (2007) (ultimate question of whether a veteran is capable of substantial gainful employment is not a medical one; that determination is for the adjudicator), rev'd on other grounds sub nom, Moore v. Shinseki, 555 F.3d 1369 (Fed. Cir. 2009). Although VA must give full consideration, per 38 C.F.R. § 4.15, to "the effect of combinations of disability," VA regulations place responsibility for the ultimate TDIU determination on VA, not a medical examiner's opinion. Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013); 38 C.F.R. § 4.16(a); see also Smith v. Shinseki, 647 F.3d 1380, 1385-86 (Fed. Cir. 2011) (VA is not required to obtain an industrial survey from a vocational expert before making a TDIU determination but may choose to do so in an appropriate case). At the outset, the Board will address the TDIU rating period on appeal. The Veteran is solely service connected for the mental health disability of PTSD. As discussed in the introduction, the Veteran was granted a staged higher initial disability rating of 100 percent from March 9, 2021. As there are no other service connected disabilities that could result in the grant of special monthly compensation benefits, the Board only needs to consider whether a TDIU is warranted for the rating period from February 25, 2008 through March 8, 2021. For the period from February 25, 2008 through March 8, 2021, the service connected PTSD, which is the only service-connected disability, met the disability rating eligibility criteria for a TDIU under 38 C.F.R. § 4.16(a), as the PTSD was rated in excess of 60 percent for the entire relevant rating period on appeal. As noted in the March 2021 supplemental statement of the case (SSOC), the evidence of record reflects that the Veteran has been unemployed during the entire TDIU rating period on appeal. Further, the evidence supports that the Veteran only has a GED, after having dropped out of school in the eighth grade. The evidence also shows that the Veteran has primarily worked in unskilled labor, such as cooking and field work. Per the report from the December 2008 VA mental health examination, the Veteran generally worked menial employment throughout the course of his life. The Veteran was noted to have problems with social interactions and a low frustration tolerance. At that time, the Veteran expressed a belief that the PTSD symptoms were of such severity that returning to work would not be possible. Upon examination the VA examiner found that the Veteran's mental health symptoms, in particular avoidant behaviors and social isolation, resulted in occupational problems and a decreased quality of life. At the conclusion of the examination the VA examiner found that the symptoms resulted in marked impairment in occupational functioning. The Veteran received a new VA mental health examination in July 2009. At that time, the VA examiner explicitly stated that the Veteran's impatience, irritability, and impaired concentration limited the ability to seek and/or retain employment. Further, the VA examiner found that the Veteran remained limited in the capacity for meaningful interpersonal contacts and productive work. Finally, at the conclusion of the examination, the VA examiner assessed that the mental health symptoms resulted in occupational impairment with deficiencies in most areas. It was noted that the Veteran has limited skills and tolerances for interpersonal interactions in the work environment. Review of the records reflect that the Veteran is in receipt of Social Security Administration (SSA) disability benefits due, at least in part, to the service connected PTSD symptomatology. Further, a review of the available VA treatment records support that the PTSD symptomatology has a significant negative impact on the Veteran's ability to work. Having reviewed all the evidence of record, lay and medical, the Board finds that, from February 25, 2008 through March 8, 2021, the Veteran was unable to maintain substantially gainful employment as a result of the service connected PTSD symptoms. As discussed above, the Veteran has a seventh-grade education and a GED. During his life the Veteran primarily worked menial, unskilled jobs. VA examiners in December 2008 and July 2009 both opined that the Veteran would be significantly limited in the ability to obtain and/or maintain employment due to PTSD symptoms including impatience, irritability, social deficiencies, and impaired concentration. The other evidence of record supports the findings of the VA examiners in December 2008 and July 2009. Under these circumstances, the Board finds that the Veteran was unemployable during the rating period on appeal from February 25, 2008 through March 8, 2021. For the above reasons, and resolving reasonable doubt in favor of the Veteran, the Board finds that service-connected PTSD prevented the Veteran from obtaining or maintaining substantially gainful employment during the period from February 25, 2008 through March 8, 2021; therefore, the Board finds that a TDIU is warranted for the entire rating period on appeal from February 25, 2008 through March 8, 2021. 38 C.F.R. §§ 3.340, 3.341, 4.16. J. PARKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Blowers, 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.