Citation Nr: 21063613 Decision Date: 10/14/21 Archive Date: 10/14/21 DOCKET NO. 17-31 605 DATE: October 14, 2021 ORDER Entitlement to an initial disability rating of 70 percent, but no higher, from September 13, 2012, for posttraumatic stress disorder (PTSD) with panic attacks (formerly unspecified anxiety disorder, other specified trauma and stressor-related disorder with prominent anxiety, claimed as PTSD and attention deficit disorder) (hereinafter PTSD) is granted. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected PTSD from September 13, 2012, is granted. FINDINGS OF FACT 1. Throughout the entire period on appeal from September 13, 2012, the Veteran's PTSD has consistently manifested in symptoms suggesting occupational and social impairment with deficiencies in most areas, but has not resulted in 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, disorientation to time or place, or memory loss, suggesting total occupational and social impairment. 2. From September 13, 2012, the Veteran met the schedular criteria for TDIU, and the Veteran's service-connected PTSD rendered him unable to maintain substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial disability rating of 70 percent, but no higher, from September 13, 2012, for PTSD have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9411. 2. The criteria for entitlement to TDIU due to service-connected PTSD from September 13, 2012, have been met. 38 U.S.C. §§ 1155, 5103, 5107; 38 C.F.R. §§ 3.341, 4.16, 4.25. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 2003 to October 2007. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a May 2014 rating decision issued by the Department of Veterans' Affairs (VA) Regional Office (RO) in Chicago, Illinois. Preliminary matters By way of background, the Veteran initiated this claim on September 13, 2013, prompting a May 2014 rating decision granting service connection for other specified trauma and stressor-related disorder at 50 percent disabling. In November 2014, the Veteran timely appealed filing a Notice of Disagreement (NOD). The Veteran ultimately withdrew said NOD prior to certification to the Board. The RO, however, had already continued development prompting a May 2015 rating decision pursuant to 38 C.F.R. § 3.156(b) which continued the Veteran's 50 percent disability rating and denied entitlement to TDIU. Thereafter, additional evidence continued to be added to the record including treatment records and the Veteran's subsequent increased rating claim in April 2016 prompting a July 2016 rating decision pursuant to 38 C.F.R. § 3.156(b) which again continued the Veteran's 50 percent disability rating. The Veteran perfected his appeal to the Board thereafter. The Board remanded the Veteran's increased rating claim for PTSD and TDIU for additional development in an October 2019 decision. The Board finds substantial compliance with the October 2019 remand directives has been met. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board notes in the October 2019 decision, the July 2016 rating decision was referenced as the decision on appeal; however, upon review, the Board finds the Veteran's claim has been continually pursued since receipt of the initial claim in September 2013. While the Veteran attempted to withdraw his appeal, development continued to occur thereby requiring the RO to issue multiple subsequent rating decisions extending the period on appeal. See 38 C.F.R. § 3.156(b). Thus, the period on appeal in this case begins with the Veteran's claim in September 2013. The Board notes the Veteran was granted benefits from September 13, 2012, under Section 506 of Public Law 112-154, amended 38 U.S.C. § 5110. Thus, the Board will consider the period on appeal beginning September 13, 2012. During the course of the Veteran's appeal, TDIU was granted effective April 13, 2016, as part of an August 2020 rating decision. The grant of TDIU, effective from April 13, 2016, constitutes a full grant of the benefits sought on appeal and, therefore, there remains no further case or controversy from this date regarding TDIU. Prior to April 13, 2016, however, the issue remains on appeal and is for consideration by the Board. See Harper v. Wilkie, 30 Vet. App. 356 (2018) (if a TDIU claim is part of an increased rating claim before the Board, the appeal period is the same as the underlying increased rating claim and the Board has jurisdiction of the TDIU for the rest of the appeal period even if the RO grants TDIU for part of it). Accordingly, the TDIU claim has been appropriately recharacterized above. The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). 1. Entitlement to an initial disability rating of 70 percent, but no higher, from September 13, 2012, for PTSD is granted. The Veteran contends his service-connected PTSD symptoms warrant a higher rating during the period on appeal. The Board finds a 70 percent rating, but no higher, is warranted throughout the entire period on appeal from September 13, 2012. The Veteran's PTSD is currently rated as 50 percent disabling from September 13, 2012, and 70 percent disabling from April 13, 2016, under DC 9411. DC 9411 provides that PTSD should be rated under the General Formula for Mental Disorders (General Formula). The Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). A noncompensable rating is assigned when a mental condition has been formally diagnosed, but symptoms are not severe enough to either require continuous medication, or to interfere with occupational and social functioning. A 10 percent rating is assigned when mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of occasional stress, or symptoms controlled by medication cause occupational and social impairment. 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 rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. A 70 percent rating is assigned when 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 worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions 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; or memory loss for names of close relatives, own occupation or own name. As discussed above, the Board will consider the period on appeal beginning September 13, 2012. Turning to the relevant evidence of record, the Veteran endorsed experiencing anxiety attacks, anxiety, suspiciousness, hypervigilance, an exaggerated startle response, flashbacks, isolation, impaired sleep, memory problems, concentration problems, irritability, and impaired impulse control. The Veteran reported experiencing anxiety attacks once or twice a day including episodes where he has a "rush of adrenaline and feels invisible." See November 2013 VA treatment records. He stated that he does not feel like himself during these episodes and goes into "fight or flight mode." He is afraid of what he might do and does not feel safe. He reported feeling detached during these episodes, has been unable to control his emotions, and feels the most impulsive. See September 2013 VA treatment records. He prefers to be alone because of these episodes and does not feel the need to report them because he has lived with them for so long. He endorsed worsening panic attack episodes since discharge from service. See September 2013 VA treatment records. He reported pulling a fire alarm once to get attention and help during an episode. He also called the National Suicide Prevention Hotline during panic attacks. For instance, in 2014, the Veteran walked into the emergency room after calling the VA National Suicide Prevention Hotline stating that he "is feeling out of sorts" and experiencing "a major panic attack." See September 2014 VA treatment records. Treatment records also reflect an incident where the Veteran was admitted for observation prompted by attending a family funeral when he deteriorated and began screaming on the hotel lawn to "let out his frustration / feelings." See May 2015 VA treatment records. During the admission, he reported being found "making a public scene" and endorsed mood lability, inability to cope with recent stressor, helplessness and hopelessness, issues with energy, self-isolation, and irritability. Regarding isolation, the Veteran lives alone and declined having contact with family. He stated that his mother contacts him occasionally and he communicates with and sees a friend. The Veteran reported that he tries to limit contact with his family because it is "dysfunctional." See May 2016 VA examination. He reported that he liked being a "recluse" and does not "feel like the rest of the world." In 2015, he endorsed feeling isolated because he works hard to hide his mental health and has no one to confide in when he is having a difficult time. See August 2015 VA treatment records. In 2016, he reported isolating from others but also expressed a desire to have close friends. In 2019, the Veteran continued to self-isolate describing significant trust issues and feelings of detachment. See September 2019 VA treatment records. In 2020, the Veteran reported being isolated and lonely with minimal social contacts other than a friend and his sister, with whom he endorsed not talking to as often. See July 2020 VA records. The Veteran reported experiencing strong impulses and problems controlling his impulses. In 2014, treatment records reference the Veteran reported experiencing strong impulses to enter construction sites even though he is not allowed and reported "almost being arrested" surrounding a restaurant incident. See July 2014 VA treatment records. In 2016, the Veteran reported that he "just lost it" during an altercation with the police describing an incident where he presented to the police department to file a complaint but instead got into a verbal altercation where he was able to leave without arrest but was very upset about the situation. See July 2016 VA treatment records. He reported being "very concerned" that he is unable to control his issues with anger. Again in 2016, the Veteran reported "losing it" on a few teenagers noting that he verbally "snapped" at them prompting the police to be called. See August 2016 VA treatment records. In 2017, the Veteran reported struggling with impulse control noting that he "lost it" on a child at the park prompting the police to be called. See June 2017 VA treatment records. Treatment records reflect providers have consistently found the Veteran to be alert and oriented with intact memory and appropriately groomed. In 2013, during a neuropsychology evaluation, the Veteran was found to experience "significant and longstanding deficits related to attention, sequencing action particularly with multi-step commands, and memory." See September 2013 VA treatment records. He stated that his mind is always racing, and he has specific periods, lasting hours, where he reports excessive racing thoughts and anxiety. Later in 2013, the Veteran was noted to have an intact memory but had issues with sustained attention. In 2014, the Veteran endorsed experiencing a lack of focus and decreased memory. See July 2014 VA treatment records. As an example, he stated that he has conversations with people but does not remember what he said. See November 2014 VA treatment records. He continued to endorse memory and concentration problems in 2015. See April 2015 VA examination. Beginning in 2015 and continuing in the years after, providers noted the Veteran's thought process was "somewhat tangential" but mostly logical / organized. See December 2015 VA treatment records; see also April and June 2016 VA treatment records; see also January, March, and July 2020 VA treatment records. Treatment records reflect the Veteran denied experiencing delusions, hallucinations, suicidal ideation, or homicidal ideation during the period on appeal. He declined previous suicide attempts. In 2013, the Veteran did note having recurring thoughts about death / dying and what it would mean if he was no longer here. See November 2013 VA treatment records. Treatment records reflect the Veteran has called the National Suicide Prevention Hotline but consistently denied experiencing suicidal or homicidal ideation during said calls. For example, in 2014, the Veteran called the National Suicide Prevention Hotline while experiencing a panic attack. In 2015, the Veteran explaining, "I use the hotline faithfully, because I'm afraid of my thoughts and I know that I must call them." See February 2015 VA treatment records. Again in 2015, the Veteran called the VA National Suicide Prevention Hotline expressing anxiety about going to work but denied suicidal or homicidal ideation. See August 2015 VA treatment records. During the period on appeal, the Veteran underwent an evaluation with the Bureau of Disability Determination Service wherein the provider noted that the Veteran was experiencing recurrent and distressing intrusive memories and nightmares, heightened reactivity to stimuli that reminded him of service, persistent hypervigilance, prolonged hyperarousal that manifests in agitation and restlessness, irritability, feelings of guilt and grief, and pervasive avoidant behavior that severely limits his ability to function in society, in a job, and in forming lasting relationships. See April 2015 correspondence. The evaluator found that the Veteran's jobs caused increased anxiety which affected his ability to concentrate and complete tasks. The evaluator opined that the Veteran is "severely and persistently disabled, with PTSD which has had a profound and pervasive impact on both social and vocation functioning." The Veteran has also been afforded multiple VA examinations to determine the severity of his PTSD. In April 2014, the examiner opined that the Veteran experienced occupational and social impairment with reduced reliability and productivity based on symptoms of prominent anxiety in the context of trauma history as well as anxiety, chronic sleep impairment, and difficulty in establishing and maintaining effective work and social relationships. See April 2014 VA examination. During the examination, the Veteran reported having contact with his mother and that he has friends he does not wish to see. He reported sometimes being able to tolerate one friend at a time but cannot tolerate a group. The Veteran did not report any hobbies or interests stating that he sits by the VA. The Veteran denied significant depression. He declined experiencing suicidal ideation or homicidal ideation or a history of suicide attempts. The Veteran conveyed experiencing nightly sleep disturbance. He endorsed irritability and anger but denied physical altercations. He endorsed anxiety that "releases so much energy he goes into a seizure like state." He endorsed experiencing panic attacks describing them in the context of anger rather than anxiety. Another VA examination occurred in April 2015 during which the examiner opined the Veteran has occupational and social impairment with reduced reliability and productivity based on symptoms of anxiety, panic attacks that occur weekly or less often, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. See April 2015 VA examination. The Veteran presented with good grooming / hygiene and speech within normal limits. At times, the examiner found the Veteran's thoughts were difficult to follow. Memory and attention were fair for evaluation purposes but were not formally assessed. He was noted to be working part-time since November 2014 without formal disciplinary action against him. He reported experiencing anxiety while working but stated that he does his job and goes home. The Veteran declined experiencing suicidal or homicidal ideation, intent, or plan and had no history of suicidal ideation. His sleep was reported as "good." The Veteran conveyed experiencing verbal angry outbursts on a weekly basis without physical altercations. He reported difficulty controlling thoughts about his past at times. The Veteran stated that he has panic attacks approximately weekly but has learned how to reduce panic symptoms. The Veteran endorsed memory / concentration problems. Auditory and visual hallucinations were not found. Another VA examination occurred in May 2016, where the examiner opined the Veteran experiences occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and / or mood based on symptoms of anxiety, suspiciousness, panic attacks more than once a week, chronic sleep impairment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, including work or a work-like setting, and an inability to establish and maintain effective relationships. See May 2016 VA examination. The examiner noted good grooming and hygiene with a cooperative, but odd, manner / attitude. The Veteran reported worsened sleep due to homelessness and a lack of a vehicle. Suspiciousness and paranoia were indicated. The Veteran also noted periods of anxiety, which he thinks might be manic symptoms. The examiner, however, found that the overall medical evidence does not show strong support for a bipolar disorder and said symptoms were more consistent with anxiety disorder and strong maladaptive personality traits. He reported having problems maintaining employment since discharge from service. The Veteran said that he last worked from November 2014 through September 2015 and became increasingly aggressive on the job and had to leave. The examiner indicated that it was unclear if the Veteran left or was fired. The Veteran reported periods of aggression but is not sure if he had any physical altercations. Hallucinations were denied. The Veteran's most recent VA examination occurred in July 2020 during which the examiner opined that the Veteran's symptoms were productive of occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and / or mood. See July 2020 VA examination. The examiner explained that the Veteran's symptoms from each diagnosis have a combined impact on his functioning noting that it was impossible to differentiate the level of impact each diagnosis has without resorting to speculation. Symptoms were noted to include depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, speech intermittently illogical, obscure, or irrelevant, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, including work or a work-like setting, inability to establish and maintain effective relationships, and impaired impulse control, such as unprovoked irritability with periods of violence. The examiner opined that the Veteran's PTSD symptoms would produce functional impairment negatively impacting his ability to hold a job. The examiner noted that it was "extremely difficult" to keep the Veteran on track and get an answer to "straightforward" questions. He had mildly tangential speech. The Veteran denied hallucinations, suicidal ideation, and homicidal ideation. The examiner noted the Veteran reported believing others were watching him and said descriptions bordered on persecutory delusions but may be accounted for by the suspiciousness that often times accompanies PTSD. The examiner found the Veteran was appropriately groomed and oriented. Upon review of the totality of the record, and resolving any doubt in favor of the Veteran, the Board finds an initial disability rating of 70 percent, but no higher, is warranted throughout the entire period on appeal from September 13, 2012. The Veteran's representative has contended that the Veteran should be assigned a rating in excess of 50 percent prior to April 13, 2016, and the Board agrees. See July 2021 Appellate Brief. The evidence shows that the Veteran's PTSD symptoms included depressed mood; anxiety; panic attacks; chronic sleep impairment; speech intermittently illogical, obscure, or irrelevant; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances; and impaired impulse control. During this period, the Board finds that the Veteran's disability is fully capable of evaluation under the rating schedule. While the 2014 and 2015 VA examiners only opined the Veteran experienced anxiety, chronic sleep impairment, and difficulty in establishing and maintaining effective work and social relationships productive of occupational social impairment with reduced reliability and productivity, when reviewing the totality of the Veteran's treatment records during the entire period on appeal, his symptom severity is more appropriately rated as 70 percent disabling based on impaired impulse control, difficulty in adapting to stressful circumstances, and illogical speech. Regarding impulse control, the Veteran reported instinctively grabbing a person on the bus when the bus stopped, having multiple "breakdowns" during a treatment program, and passing out after being overwhelmed by ordering food. These records were not discussed by the 2014 or 2015 VA examiners. The Veteran's reports of struggling with impulse control were corroborated by the evidence of record during this time including later reports of feeling impulses to enter restricted construction sites and almost being arrested during a restaurant incident. He also reported confronting strangers and conveying personal information that he later forgot discussing, an outburst at the police department, and multiple verbal interactions with other people that required police contact. Additionally, the 2015 VA examiner noted the Veteran endorsed verbal angry outbursts on a weekly basis. Further, throughout the entire appeal period, the Veteran consistently and credibly reported experiencing panic attacks that varied in severity but could occur more than once per day. Treatment records during this period also consistently convey the Veteran's thought process was "somewhat tangential" with providers noting he was difficult to follow or understand at times. The Board finds the 2013 provider's opinion that the Veteran was minimizing his symptoms to be highly probative because when reviewing the totality of treatment records and VA examinations during this period, the Veteran's symptoms reflect severity contemplated by the 70 percent disability rating criteria. Whereas standing alone, the 2014 and 2015 VA examinations support only a 50 percent rating. The Board notes the May 2016 and July 2020 VA examinations found the Veteran's symptoms were productive of occupational and social impairment, with deficiencies in most areas. Thus, notwithstanding the 2014 and 2015 VA examiners opinions of severity, the Board finds the Veteran's treatment records and lay statements reflect symptom severity more nearly approximating occupational and social impairment, with deficiencies in most areas, as the Veteran experienced impaired impulse control during this time, difficulty in adapting to stressful circumstances, and had somewhat tangential speech that was difficult to follow. Resolving any doubt in favor of the Veteran, the totality of his symptoms during this period, especially his credible reports of frequent panic attacks and impaired impulse control, reflects a disability picture more nearly approximating a 70 percent disability rating from September 13, 2012. In so finding, the Board also finds a higher 100 percent rating is not warranted at any point during the appellate time period as the Veteran has never demonstrated total occupational and social impairment or symptoms of similar severity, frequency, or duration as to those contemplated by the 100 percent criteria. Indeed, treatment records lack any reference to gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene), disorientation to time or place, or memory loss for names of close relatives, own occupation or own name. While the Veteran reported periods of homelessness, he was found to be adequately groomed and treatment records lack any mention of an intermittent inability to perform activities of daily living due to PTSD symptoms. Further, the Veteran has not complained of or been found to be disoriented. Rather, treatment records consistently note the Veteran has been oriented to time and place with an intact memory. While the Veteran subjectively conveyed memory problems, providers have consistently found his memory to be intact. Thus, the Board finds even if the Veteran experienced memory loss during this period, it did not amount to memory loss for names of close relatives, own occupation, or own name as contemplated by the 100 percent rating criteria. While the October 2013 private provider opined that the Veteran's PTSD has a profound and pervasive impact on his social functioning, the Veteran's symptoms as discussed above more nearly approximate a 70 percent disability rating. The Veteran has also consistently denied experiencing auditory or visual hallucinations. While the July 2020 VA examiner noted the Veteran reported believing others were watching him and said descriptions bordered on persecutory delusions, the examiner found the Veteran does not experience delusions and said symptom may be accounted for by the suspiciousness that often times accompanies PTSD. Further, the remaining VA examinations and significant treatment records lack any mention of delusions or hallucinations. The Veteran has also consistently denied experiencing suicidal or homicidal ideation. The Board acknowledges the Veteran noted thoughts of death, but suicidal ideation is contemplated by the 70 percent rating criteria and said thoughts do not amount to persistent danger of hurting self or others. While the Veteran has had outbursts, the records do not indicate physical outbursts towards other people or himself. The Veteran's speech has been evaluated as "somewhat tangential" and at times providers have noted it was difficult to follow the Veteran's thoughts, but he was still found to have logical and goal-oriented thought process that did not amount to gross impairment in thought process or communication. The Veteran's representative has contended that an increased rating is warranted based on disorientation to time or place, grossly inappropriate behavior, and social withdrawals. See July 2021 Appellate Brief. As discussed above, the evidence of record fails to establish the Veteran experiences disorientation to time or place. Additionally, the Veteran's behavior has been considered in association with impaired impulse control (such as unprovoked irritability with periods of violence) as contemplated by the 70 percent rating criteria. Finally, while the Veteran has consistently reported experiencing social withdrawals and preferring isolation, he has been maintaining contact with his friend and sister. The Veteran credibly and competently conveyed going for walks, feeding the ducks, exercising, meditating, and attending care at the VA. While the Board has no doubt the Veteran experiences social withdrawal, the Veteran's overall symptoms during this period are appropriately rated as 70 percent disabling. The Board notes in 2017, the Veteran conveyed that his symptoms had worsened or are different than those reflected in the May 2016 VA examination. While the most recent VA examination reflects some symptoms have changed or other new symptoms have presented, this change does not warrant a rating in excess of 70 percent. Indeed, both the May 2016 and July 2020 VA examiners found the Veteran's symptoms produce occupational and social impairment with deficiencies in most areas. The Board finds the Veteran's symptoms are contemplated by and are more consistent with a 70 percent disability rating under DC 9411 throughout the entirety of the appeal period. Based on the aforementioned, the Board finds a 70 percent disability rating, but no higher, is warranted for the entire period on appeal from September 13, 2012. 2. Entitlement to TDIU due to service-connected PTSD from September 13, 2012, is granted. Here, the Board inferred a TDIU claim based on the Veteran's assertions of unemployability associated with his increased rating claim for PTSD. See Rice v. Shinseki, 22 Vet. App. 447, 453-55 (2009) (holding where a claimant, or the record, raises the question of unemployability due to the disability for which an increased rating is sought, then part of the increased rating claim is an implied claim for TDIU). While the Veteran has since submitted an application for TDIU, the Board will consider the period on appeal for TDIU purposes to begin September 13, 2012, based on the Veteran's increased rating claim. Again, the Board notes the Veteran has been granted TDIU from April 13, 2016. Thus, the Board will only address the remaining period on appeal. Grantham, 114 F.3d at 1158-59. The Veteran contends his service-connected PTSD prevents him from maintaining substantially gainful employment thereby entitling him to TDIU prior to April 13, 2016. The Board finds TDIU is warranted from September 13, 2012. A total disability rating for compensation purposes may be assigned where the schedular rating is less than total and where it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a service-connected disability ratable at 60 percent or more or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16. 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 or her age or to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 4.16, 4.19; see also Van Hoose v. Brown, 4 Vet. App. 361 (1993). In light of the increased rating granted herein, the Veteran now meets the TDIU schedular criteria from September 13, 2012. The Board notes this is the Veteran's only service-connected condition. The phrase "unable to secure and follow a substantially gainful occupation" contains both economic and noneconomic components. See Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). The economic component refers to an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. Id. The noneconomic component requires a determination as to a veteran's ability to secure and follow such employment. Id. Attention should be given to the veteran's history, education, skills, and training; whether the veteran has the physical ability (both exertional and nonexertional) to perform the types of activities required by the occupation at issue (e.g., lifting, bending, sitting, standing, walking, climbing, as well as auditory and visual limitations); and whether the veteran has the mental ability to perform the activities required by the occupation at issue (e.g., memory, concentration, ability to adapt to change, handle work place stress, get along with coworkers, and demonstrate reliability and productivity). Id. An award of TDIU is an individualized determination, specific to a veteran's particular circumstances, e.g., their history, education, skills, and training. See Todd v. McDonald, 27 Vet. App. 79, 85 (2014). It does not require a showing of 100 percent unemployability. Roberson v. Principi, 251 F.3d 1378, 1385 (Fed. Cir. 2001). The ultimate question is whether the veteran is capable of performing the physical and mental acts required by employment, not whether they can find employment. Van Hoose, 4 Vet. App. at 363. Turning to the relevant evidence of record, while in service, the Veteran's DD214 reflects a military occupation specialty of motor transport. See DD 214. The Veteran reported his highest level of education as "college" and reported certifications and training in law enforcement, commercial driving, and criminal justice. See November 2013 VA treatment records. Other treatment records note the Veteran attended college but did not complete a degree. See April 2014 VA examination. He endorsed completing training in law enforcement from February 2010 to August 2010 and training as a Class A truck driver from January 2013 to March 2013. Regarding employment history, the Veteran reported a work history as an assistant, oil change technician, and a driver. See November 2014 VA 21-8940. He stated that he was employed in various positions from December 2008 through September 2014. Contrarily in the Veteran's SSA disability application, he stated that he worked from December 2007 through September 2013. See SSA application. The Veteran reported being fired from previous jobs because he did not fit in and could not "keep up" and because he violated policies related to driving. See April 2014 VA examination. The Veteran reported working as a cashier for 30 hours a week from 2014 to 2015 but left due to major anxiety attacks and verbal outburst toward customers. See December 2019 VA 21-8940. In an October 2013 Disability Determination, the Veteran was noted to experience PTSD symptoms that "severely limited his ability to function...in a job." See April 2015 non-government treatment records. The provider noted that the Veteran's functioning declined rapidly to the point that he was unable to successfully hold employment following service. The provider opined that from 2007-2013 the Veteran was unsuccessfully able to hold a position for longer than a few months, some only lasting for one month. The Veteran was noted to have been terminated from his position as a printer's assistant and oil change technician because the circumstances of the jobs increased his anxiety and intrusive thoughts thereby impacting his ability to successfully complete his work. The Veteran was noted to have been fired from his truck driving position for unsafe driving and tardiness. Driving logs revealed that the Veteran was unsafe. The Veteran reported being late to deliveries because he avoided bridges while driving. Ultimately, the provider opined that despite the Veteran's ability to barely hold down a job, it was not reflective of his overall functional ability and he is "severely and persistently disabled" with PTSD having a profound and pervasive impact on vocational functioning. Of note, the provider also noted the Veteran has numerous other non-service-connected medical problems that "clearly impact his overall functioning" including an unspecified seizure disorder. The April 2015 VA examiner opined the Veteran's symptoms are considered likely moderately / severely impairing regarding occupational functioning as the Veteran has difficulty in positions with high emotional, social, or cognitive demands. See April 2015 VA examination. During the May 2016 VA examination, the Veteran reported having problems maintaining employment since discharge from service. See May 2016 VA examination. He stated that he last worked as a cashier from November 2014 to September 2015 but became increasingly aggressive while working and had to leave. The examiner opined the Veteran's symptoms included difficulty in establishing and maintaining effective work and social relationships and difficulty in adapting to stressful circumstances, including work. During the July 2020 VA examination, the examiner opined that the Veteran's condition likely negatively impacts his ability to hold a job. See July 2020 VA examination. Impairments associated with his diagnosis may include difficulty with job duties as a function of sleep disturbance, marked daytime tiredness, lethargy, lack of motivation, social withdrawal, cognitive complaints, and somatic complaints. While the examiner noted the degree to which the symptoms are associated with occupational impairments can be variable, at the most severe extreme, individuals may be unable to attend to even basic self-care needs. Based on the above, the Board finds TDIU is warranted from September 13, 2012. Regarding the economic component of Ray, the Veteran has training and education in law enforcement, commercial driving, and criminal justice. He has experience as an assistant, oil change technician, driver, and cashier. The Veteran endorsed working in various capacities and multiple jobs between 2008 to 2015 but has been unemployed since 2015. Regarding the non-economic component of Ray, the Veteran is not service-connected for any physical-limiting disabilities. The Veteran does experience mental ability factors including concentration problems, difficulty handling workplace stress, decreased reliability and productivity, panic attacks, and difficulty controlling emotional mood swings and outbursts. While the Veteran endorsed working through 2015, the Board finds he has been unable to maintain substantially gainful employment throughout the period on appeal. To this point, the Board finds highly probative the October 2013 Disability Determination, during which the provider opined that despite the Veteran's ability to barely hold down a job, it was not reflective of his overall functional ability and he is "severely and persistently disabled" with PTSD having a profound and pervasive impact on vocational functioning. This is corroborated by the April 2015 and July 2020 VA examinations finding that the Veteran's symptoms are considered likely moderately / severely impairing regarding occupational functioning; the Veteran has difficulty in positions with high emotional, social, or cognitive demands; and the Veteran's condition likely negatively impacts his ability to hold a job. Indeed, the Veteran's PTSD symptoms have led to his termination / departure from various jobs during the period on appeal. Accordingly, the Board finds the Veteran's PTSD symptoms render him unable to maintain substantially gainful employment. Thus, TDIU is warranted from September 13, 2012. SHEREEN M. MARCUS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.C. Allen, 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.