Citation Nr: 21064092 Decision Date: 10/19/21 Archive Date: 10/19/21 DOCKET NO. 17-49 945 DATE: October 19, 2021 ORDER Entitlement to a 70 percent disability rating, but no higher, for posttraumatic stress disorder (PTSD) prior to February 28, 2017 is granted. Entitlement to a disability rating in excess of 70 percent for PTSD from February 28, 2017 is denied. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) prior to February 28, 2017 is granted. FINDINGS OF FACT 1. Throughout the appellate period, both prior to and after February 28, 2017, the Veteran's service-connected PTSD resulted in occupational and social impairment, with deficiencies in most areas, such as work, school, family relationships, judgment, thinking, or mood, due to symptoms including suicidal ideation, near-continuous depression, impaired impulse control, neglect of personal hygiene, difficulty adapting to stressful circumstances, (including work or a work-like setting), and the inability to establish and maintain effective relationships, but was not manifested by total social and occupational impairment. 2. Prior to February 28, 2017, the Veteran's service-connected disabilities rendered him unable to secure or follow a substantially gainful occupation. CONCLUSIONS OF LAW 1. The criteria for entitlement to a 70 percent disability rating for PTSD prior to February 28, 2017 have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.130, Diagnostic Code 9411. 2. The criteria for entitlement to a disability rating in excess of 70 percent for PTSD from February 28, 2017 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.130, Diagnostic Code 9411. 3. The criteria for entitlement to a TDIU prior to February 28, 2017 have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Marine Corps from February 2008 to February 2012. In an April 2019 decision, the Board of Veterans' Appeals (Board) denied the Veteran's claim for a disability rating in excess of 30 percent for PTSD prior to February 28, 2017 and in excess of 70 percent thereafter, as well as his claim of entitlement to a TDIU prior to February 28, 2017. The Veteran appealed to the U.S. Court of Appeals for Veterans Claims (Court). In a March 2021 Memorandum Decision, the Court found that the Board failed to provide adequate reasons and bases for the April 2019 decision. The decision was vacated and remanded to the Board for further development and readjudication. 1. Entitlement to a 70 percent disability rating, but no higher, for PTSD prior to February 28, 2017 is granted. 2. Entitlement to a disability rating in excess of 70 percent for PTSD from February 28, 2017 is denied. The Veteran maintains entitlement to higher disability ratings for his service-connected PTSD throughout the appeal period. Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. 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, as well as the entire history of the Veteran's disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. 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. In deciding this appeal, the Board has considered whether separate ratings for different periods of time, based on the facts found, are warranted, a practice of assigning ratings referred to as "staging the ratings." See Fenderson v. West, 12 Vet. App. 119 (1999). The Veteran's PTSD is currently assigned a 30 percent rating prior to February 28, 2017 and 70 percent from that date pursuant to 38 C.F.R. § 4.130, Diagnostic Code 9411. Turning to the rating criteria, the Board first observes that the symptoms listed in VA's general rating formula for mental disorders are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). A 30 percent rating is warranted for occupational and social impairment with occasional decrease in efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). See Id. 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; difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130, Diagnostic Code 9411. A 70 percent evaluation 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. See Id. Finally, a 100 percent evaluation is warranted 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; memory loss for names of close relatives, own occupation, or own name. See Id. When it is not possible to separate the effects of a non-service-connected condition from those of a service-connected disorder, reasonable doubt should be resolved in the claimant's favor with regard to the question of whether certain signs and symptoms can be attributed to the service-connected disability. See Mittleider v. West, 11 Vet. App. 181, 182 (1998); see also 38 C.F.R. § 3.102. The record includes VA examination reports, medical records, and lay statements. These records have been reviewed by the Board, although they will not all be discussed in assessing the rating assigned to the Veteran's PTSD disability. The Veteran attended a VA examination in September 2016. He attended the examination 45 minutes early. He was dressed in clothing that appeared stained and dirty. No abnormalities of gait or posture were noted, and he was cooperative with the interview process although his eye contact was poor. The Veteran was fully oriented. His speech was somewhat difficult to understand due to low volume. His mood was depressed. His affective expression was significantly restricted in range. His thought process was logical and goal-directed, and his thought content was relevant with adequate detail. The Veteran's gross concentration and memory were adequate. His insight and judgment were intact. There was no evidence of perceptual disturbance, thought disorder, or hallucinations. Current homicidal and suicidal ideation were denied, although he reported that he had suicidal ideation in the past. Socially, the Veteran described positive communication with his mother and sisters. He indicated that he had lived with one of his cousins for about a year due to problems with housing and that cousin acted as a good support system, helping him stay focused, take his medication, and maintain hope that things would get better. The Veteran stated that he was divorced with two children who lived with their mother. He reported that he did not see them often as he had "not been doing too well," explaining that he was unable to work and function like an adult. He indicated that he was unable to watch them because he slept a lot and did not remember things. His ex-wife was hesitant to let him see the children due to his unstable mood. The Veteran denied having friends because he no longer had the energy or interest in participating in activities with them and was also moody, often becoming irritated and agitated over little things. The Veteran indicated that when irritable, he lashed out and became loud and verbally aggressive. He reported that he did not like to go out in public much due to his annoyance with crowds and difficulty with even small noises, such as music or car horns. Occupationally, the Veteran reported that he was unable to keep jobs very long. At a security position, he was late often and slept on the job. At a restaurant position, he was unable to handle the stress of the customers and the environment. He stated that he had last worked in 2014. Concerning relevant legal and behavioral history, the Veteran reported that he received tickets or reckless driving and was arrested for driving without a license, spending four days in jail. The examiner performed a clinical evaluation and noted that he used medication in order to try and manage symptoms including depressed mood, anxiety, chronic sleep impairment, and difficulty adapting to stressful circumstances, including work or a worklike setting. She deemed him competent to handle his financial affairs. The examiner ultimately determined that the Veteran met the DSM-5 criteria for PTSD and that this disability caused occupational and social impairment due to mild or transient symptoms which decreased work efficiency and the ability to perform occupational tasks only during periods of significant stress or symptoms were controlled by medication. In December 2016, the Veteran filed his notice of disagreement indicating that he experienced delusions and that people were often scared to be around him, feeling that he was a danger and "borderline crazy." That same month he submitted statements from his former spouse and his mother. His former spouse described him as depressed, moody, and aggressive. She indicated that he could not function in a normal setting and often made "horrible" decisions. She noted that he was heavily medicated, staying in his room almost half of the day. She further stated that she would not let him stay with their children alone because of her fear he will snap and harm them or himself. His mother reported that the Veteran was significantly impaired in his speech and communication, was totally irresponsible, and struggled to live a routine life as an adult. She indicated that he exhibited inappropriate and sometimes malicious behavior and that she did not trust him to be alone with his children as he might hurt himself or them. She observed that he was unable to keep a job due to his inability to get out of bed, care for his hygiene consistently, or handle any type of stress. In February 2017, the Veteran sought to reestablish mental health care at a different VA facility. There, he was cooperative, appropriately dressed, and fairly groomed. He sat calmly and made little to no eye contact. The Veteran did not make abnormal movements. His gait and station were within normal limits. His speech was normal and spontaneous. His affect was neutral. His thought process was goal-directed, and his thought content was unremarkable, devoid of suicidal or homicidal ideation. His insight was adequate. The Veteran stated that he had moved with his current girlfriend due to her new job opportunity. He reported the use of psychotropic medication to assist with his mental health symptoms. The Veteran endorsed a 5-month period of progressively worsening irritability, anger outbursts, self-imposed social isolation, poor motivation, chronic fatigue, impaired ability to acquire and maintain sleep, excessive worrying, preservative thoughts regarding negative outcomes, mood swings, and intermittent panic attacks. He also reported intermittent periods with difficulty performing activities of daily living (ADLs) and getting out of bed on a regular basis. He also described intermittent periods of helplessness and lack of motivation. He indicated that he had not been able to work since his return home from the military. The Veteran denied a history of suicidal ideations, gestures, plans, and/or attempts. He denied a family history of suicidality and denied access to firearms and/or other weapons. April 2017 VA treatment records document an increase in one of the Veteran's medications and the recommendation of mental health therapy to help with symptoms of self-isolation, anxiety and nervousness, mood swings, depression, and nightmares. He stated that he lived with a female friend but was unable to interact productively with others outside of their home. He denied the desire to harm himself or others. June 2017 VA treatment records document the Veteran's complaints of nightmares, anxiety, and isolation, and August 2017 records show complaints of hypervigilance, nightmares, anger, mood swings, and difficulty with memory. The Veteran again denied the desire to harm himself or others. In an August 2017 letter from the Vet Center, the Veteran's clinical psychologist and therapist documented his symptomatology, including avoidance symptoms, mild memory problems, avoidance, emotional trauma, hyperarousal, anger, irritability, problems sleeping, and problems with concentration. Nightmares, intrusive thoughts, hallucinations, and flashbacks were also noted. The Veteran also had persistent suicidal thoughts, lacked personal hygiene, and was prone to isolation. In a September 2017 statement in support of claim, the Veteran reported that he could not work and had sleep problems due to his condition. In response to the Veteran's contentions that his condition had worsened, he was afforded another VA examination in January 2018. The Veteran's hygiene was fair, and he was dressed casually. No unusual movements or gestures were observed. His speech was within normal limits in articulation, rate, tone, volume, and production. He made minimal eye contact. The Veteran was alert, attentive, and oriented to person, place, time, and situation. His attention and concentration were intact. His memory abilities (e.g., immediate, recent, and remote) were intact, as indicated by his performance throughout the interview. However, his memory functioning was not formally assessed and he self-reported severe memory problems. He presented with abstract reasoning abilities. His thought processes were logical and organized and there was no evidence of delusional thought content or perceptual disturbances. He described his mood as depressed and exhibited constricted affect. Socially, the Veteran reported that he rarely spoke to or visited his mother, sisters, and children due to his mood swings and state of mind (depression and "zoning out" due to medication). He stated that he occasionally spoke to a buddy he was in Iraq with but that was all. He denied having any other friends or involvement in other social activities, other than occasionally going to church with his aunt whom he had lived with for the past 1.5 years. He stated that he primarily watched television during the day. He indicated that he got along with his aunt but mostly stayed in his room. Occupationally, the Veteran again reported that he was unable to keep jobs very long due to his symptoms, having last worked in 2014. The Veteran endorsed problems sleeping, panic attacks, and stress due to his ability to work. Based on clinical tests, the examiner stated that the Veteran endorsed unusual severe mental health symptoms and idiosyncratic responses causing validity concerns. The Veteran frequently repeated mental health symptoms and his belief that he was unable to work when asked questions not related to current symptoms or ability to work. His responses were inconsistent with other evidence of record. Specifically, on examination, the Veteran reported that he has been living with his aunt for the past 1.5 years. However, at the September 2016 examination he reported living with a cousin for the past year. Further, February 2017 VA medical records document his report that he relocated with a girlfriend, and in April 2017 he reported that he lived with a female friend. The examiner concluded that the Veteran's profile could not be interpreted with confidence and did not provide an opinion on the level of occupational and social impairment. The examiner explained, "[I]ndividuals who present with inaccurate self-report of symptoms may very well have mental health symptoms that are clinically significant and distressing, and it does not necessarily preclude the presence of a psychiatric diagnosis. However, a mental disorder diagnosis or accurate assessment of functional impairment cannot be determined based on the interview and testing conducted today without resorting to mere speculation." The Veteran attended another VA examination in February 2018. There, he was cooperative and arrived in appropriate clothing. His speech prosody, rate, and rhythm were within normal limits. He had averted eye contact. He at times portrayed an exaggeration of deficits; he reported "seeing things." Upon further questioning, the examiner found that he was recalling a memory or experience, not a visual hallucination. He was oriented on all spheres. He described his moods as "bad." His affect was worn out. There was no evidence of psychotic thinking noted. His thought content and thought processing were intact. His insight and judgment were fair. Socially, the Veteran reported that his family noticed his poor sleep patterns, irritability, agitation reactions, and desire to isolate. He indicated that he was socially isolative and had minimal social contacts. Occupationally, the Veteran again reported that he was unable to keep jobs very long due to his symptoms, having last worked in 2014. The examiner performed a clinical evaluation and noted that he used medication in order to try and manage symptoms including depressed mood, anxiety, suspiciousness, chronic sleep impairment, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. She deemed him competent to handle his financial affairs. The examiner ultimately determined that the Veteran met the DSM-5 criteria for PTSD and that this disability caused occupational and social impairment with reduced reliability and productivity. The Veteran was afforded another VA examination in April 2018. There, he was well-groomed, cooperative, and fully oriented. His maintained good eye contact throughout the interview. The Veteran appeared to be a reliable historian. His mood was euthymic, and his affect was stable. There was no evidence of significant social discomfort or anxiety during the interview. His speech was spontaneous, articulate, and easily understood. Abnormal gait, movement, or mannerisms were not observed. There was no objective evidence of hallucinations, delusions, or psychoses. The Veteran did not report psychoses and he was not observed to be attending to internal stimuli. The Veteran's attention and concentration were normal, and his memory recall of service, symptoms, and related interview data appeared to be easily accessed. Socially, the Veteran reported that his current relationships with his extended family members was close. He reported that he had been in a dating relationship for the past 18 months that was loving and supportive. The examiner found no evidence of significant social impairment. Occupationally, he continued to report the inability to maintain employment. Concerning relevant legal and behavioral history, the Veteran reported being arrested twice, once in 2015 for domestic violence, and again in 2016 for failure to appear in court for a traffic violation. The examiner performed a clinical evaluation and noted that he used medication in order to try and manage symptoms including anxiety, panic attacks occurring more than once a week, mild memory loss, such as forgetting names, directions, or recent events, and disturbances of motivation and mood. The Veteran continued to meet the DSM-5 criteria for PTSD and the examiner found that this disability caused occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. August 2018 VA treatment records document the Veteran's report of living in stable housing. That same month, during a primary care visit, he reported that he was feeling well overall. In March 2019, the Veteran was provided a depression screen and scored 23, indicative of severe depression. In a treatment record from later that month, the provider observed that the Veteran made poor eye contact that improved with time. His gait was stable. His interaction with the provider was spontaneous, calm, and cooperative. He made no involuntary movements. His mood was dysphoric, and his affect was restricted. His speech was of normal rate, rhythm, and volume. His thought process was logical and goal-oriented. His thought content was depressed. He did not exhibit delusions, suicidal ideation or plan, homicidal ideation or plan, and was not preoccupied with or responding to internal stimuli. His insight and judgment were fair. His memory and reality testing were intact. The examiner observed non-compliance with medications. The Veteran indicated that his energy and concentration were low. He described nightmares and "hallucinations" about the violence of the war. He and his wife indicated that his mental health symptoms kept him from working. A final VA treatment record from February 2020 recounts the Veteran's complaints of depression, anxiety, and anhedonia. He indicated that his energy and concentration were still "off." He also reported poor sleep, nightmares, and flashbacks. He denied any other psychiatric symptoms, including suicidal/homicidal ideas, ideations, and plans. Based on the foregoing, the Board finds that prior to February 28, 2017, a higher, 70 percent disability rating is warranted. The Veteran's PTSD symptoms are of the severity, frequency, and duration to cause the level of occupational and social impairment associated with a higher, 70 percent disability rating. He reported a history of suicidal ideation at his September 2016 VA examination. Further, the record is reflective of near-continuous depression affecting the ability to function independently, appropriately, and effectively, as the Veteran, his former spouse, and mother, and VA treatment records described his battle with a constant depressed mood. The Veteran's traffic citations for reckless driving are indicative of impaired impulse control. Further, in their statements, his former spouse and mother described his moodiness and aggression, and their concerns about his ability to control himself. VA providers and the Veteran's former spouse and mother all observed that the Veteran presented unkempt and dirty at times, revealing neglect of his personal appearance and hygiene. The Veteran's difficulty adapting to stressful circumstances (including work or a worklike setting) is evident in his inability to maintain employment since 2014 due to inappropriate behavior, such as coming in late and sleeping on the job, and the stress of the handling of customers. The Board finds that the Veteran's disability prior to February 28, 2017 resulted in occupational and social impairment, with deficiencies in most areas, including work (he was unable to hold a job), family relationships (former spouse and mother are afraid of him and concerned about his interactions with his children), and judgment, as contemplated by a 70 percent disability rating. As such, a 70 percent disability rating prior to February 28, 2017 is warranted. However, the Board finds that there is insufficient evidence that the Veteran's PTSD symptoms are of the severity, frequency, and duration to cause the level of total occupational and social impairment associated with a higher, 100 percent disability rating. Regarding gross impairment in thought processes or communication, the Board acknowledges the Veteran's mother's statement describing his speech and communication as significantly impaired and finds her competent and credible to report such. However, throughout the appeal period the Veteran's thought processes have been routinely described as logical, organized, and goal-directed or goal-oriented by medical providers. While he often made little to no eye contact when speaking and at one examination spoke at a notably low volume, overall, he was able to communicate effectively with VA mental health professionals and examiners. There is no evidence that the VA medical providers and examiners were not competent or credible, and the reports were based on accurate facts and objective examinations. Therefore, the Board finds that the examinations are given significant probative weight as to the frequency and severity of the Veteran's symptoms, including whether he exhibited impairment in his thought processes and communication. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Concerning persistent delusions and hallucinations, the Veteran has described experiencing both. However, on further inquiry and investigation, VA examiners have determined that he does not experience delusions or hallucinations as medically defined; in those moments, he is in fact recalling a memory or experience. Further, even were these experiences to be characterized as delusions and hallucinations, the Board finds that they are not persistent, as at several VA appointments documented in the record the Veteran denied their existence and showed no objective evidence of them. No evidence of psychosis or grossly inappropriate behavior has been documented by any mental health provider during the appeal period. The Board acknowledges the Veteran's reports of suicidal ideation. The Board notes that self-harm is contemplated by the 100 percent criteria. Bankhead v. Shulkin, 29 Vet. App. 10 (2017). However, its frequency, severity, and duration are not such that they cause him to be a persistent danger to himself. Further, this symptom is contemplated under the 70 percent rating criteria awarded herein. Further, while the Veteran's former spouse and mother voiced their fears that the Veteran might harm himself or someone else, he has routinely denied any suicidal or homicidal plan, denied access to firearms or other weapons, and has at no time during the appeal period been assessed as a danger to himself or others by medical providers. The Board acknowledges the Veteran's prior arrests for domestic violence and reckless driving and finds that they are also contemplated by the currently assigned 70 percent rating, as they are indicative of impaired impulse control (such as unprovoked irritability with periods of violence). The Board also acknowledges the Veteran's intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. VA providers and the Veteran's former spouse and mother all observed that the Veteran presented unkempt and dirty at times. However, the Board observes that neglect of personal appearance and hygiene is also appropriately contemplated by the currently awarded 70 percent rating criteria. At no time has the Veteran been disoriented to time or place. Further, while he has described memory and concentration difficulties, such difficulties have not risen to the level contemplated under a 100 percent disability rating; there is no evidence that the Veteran has difficulty remembering extremely significant things such as the names of close relatives, his own occupation, or his own name. Ultimately, the preponderance of the evidence weighs against a finding that the Veteran's disability is characterized by total social and occupational impairment. The Board observes that the Veteran is totally occupationally impaired, as will be discussed further below. However, he has not exhibited total social impairment. The Board notes that the Veteran has experienced some degree of social isolation due to his PTSD but throughout the appeal period, he has described relationships with extended family members, including his mother, sisters, aunt, and cousin. He related that he had lived harmoniously with his cousin and aunt respectively at various times during the appeal period. He also described being in a loving and supportive romantic relationship and living with his partner. These facts preponderate against a finding that the Veteran's disability causes total social impairment as is necessary for a higher, 100 percent disability rating. In summary, a higher, 70 percent disability rating, but no higher, is awarded prior to February 28, 2017 for the Veteran's service-connected PTSD. A disability rating in excess of 70 percent from February 28, 2017 for the Veteran's service-connected PTSD is denied. 3. Entitlement to a TDIU prior to February 28, 2017 is granted. The regional office awarded the Veteran a TDIU from February 28, 2017; however, as this grant does not cover the entire appeal period, entitlement to a TDIU prior to February 28, 2017 remains before the Board. For VA purposes, total disability exists when there is any impairment of mind or body sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. Total disability ratings for compensation may be assigned, where the schedular rating is less than total, if a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16 (a). A "schedular" TDIU may be assigned where the schedular rating is less than total if it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of 1) a single service-connected disability ratable at 60 percent or more, or 2) 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. See 38 C.F.R. §§ 3.340, 3.34l, 4.16 (a). Prior to February 28, 2017, the Veteran had three service-connected disabilities, PTSD, rated as 70 percent disabling (granted herein); and residual hernia repair scar and acne both rated noncompensable (0 percent disabling), for a combined evaluation of 70 percent. Thus, the schedular criteria have been met. Entitlement to a total rating must be based solely on the impact of a Veteran's service-connected disabilities on his ability to keep and maintain substantially gainful work. See 38 C.F.R. §§ 3.340, 3.341, 4.16. The question in a claim of entitlement to a total disability evaluation based on individual unemployability due to service-connected disabilities is whether a Veteran is capable of performing the physical and mental acts required by employment and not whether a Veteran is, in fact, employed. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). The Board notes that the RO's grant of a TDIU from February 28, 2017 was based on findings of avoidance symptoms, mild memory problems, avoidance, emotional trauma, hyperarousal, anger, irritability, problems sleeping, and problems with concentration in VA treatment records from August 2017 and February 2018. It was also based on findings at an April 2018 VA examination which indicated that the Veteran's poor sleep due to anxiety and regular nightmares could result in mental and physical fatigue impacting the Veteran's motivation to go to work and perform work tasks, as well as his ability to concentrate on such tasks. That examiner also observed that the Veteran's symptoms of persistent irritability and related social anxiety could also impair work relationships with co-workers and supervisors. A review of the lay and medical evidence of record prior to February 28, 2017 reflects the same symptomatology described in the aforementioned treatment records and at the April 2018 VA examination. Thus, the Board finds that the same occupational limitations existed prior to February 28, 2017, resulting in the Veteran's inability to obtain or maintain substantially gainful employment. Resolving all reasonable doubt in the Veteran's favor, the Board finds that the evidence supports an award of TDIU prior to February 28, 2017. JENNIFER HWA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Bush 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.