Citation Nr: 21066445 Decision Date: 11/01/21 Archive Date: 11/01/21 DOCKET NO. 13-21 871A DATE: November 1, 2021 ORDER Effective July 30, 2010, an increased, 70 percent disability rating for post-traumatic stress disorder (PTSD) is granted. Entitlement to a total disability rating based on an individual unemployability (TDIU) is granted. FINDINGS OF FACT 1. By resolving all reasonable doubt in the Veteran's favor, the severity of his PTSD symptoms more closely approximate an occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgement, thinking and/or mood. 2. The Veteran is unable to maintain and/or secure substantially gainful employment as a result of his service-connected PTSD and right wrist disability; and more specifically, as a result of his service-connected PTSD alone. CONCLUSIONS OF LAW 1. For the entire appellate period, the criteria for an increased, 70 percent rating, for post-traumatic stress disorder (PTSD) have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9411. 2. The criteria for an entitlement to a TDIU have been met. 38 U.S.C. §§ 1114, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.15, 4.16, 4.19, 4.25. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from September 1964 to September 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal from July 2013 and July 2014 rating decisions of the Department of Veterans Affairs (VA) Regional Office in Winston-Salem, North Carolina. In March 2018, the Board remanded the case to the Regional Office for further evidentiary developments. Subsequently, in an August 2019 rating decision, the Regional Office increased the rating disability for PTSD, from 30 percent to 50 percent disabling, effective October 11, 2018. In a February 2020 rating decision, however, the Regional Office adjusted the effective date for the increased, 50 percent PTSD disability rating to July 30, 2010. In a February 2020 decision, the Board denied the claims for an increased rating for PTSD and for a TDIU. Thereafter, the Veteran filed an appeal of this February 2020 Board decision with the United States Court of Appeals for Veterans Claims (Court). However, the Veteran's appeal of this decision was only limited to the issues of an increased rating for PTSD and entitlement to a TDIU. Thus, as he did not appeal the issue of service connection for a bilateral knee disability, this issue is no longer before the Board, on appeal. In an April 2021 memorandum decision, the Court found that the Board provided inadequate reasons and bases for finding that the Veteran was not entitled to a rating evaluation that is higher than 50 percent, as well as improperly discounting medical opinions from a private treatment provider. Related to this finding, the Court also found that a remand was warranted for the TDIU claim, as it inextricably intertwined with the increased rating claim for PTSD, and thus, both issues must be remanded together. In this regard, the Court set aside and remanded the part of the February 2020 Board decision that denied the claims for an increased rating for PTSD and TDIU. Increased Rating Disability ratings are determined by application of the criteria set forth in VA's Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating applies. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran's entire history is to be considered when making disability evaluations. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran asserts entitlement to an increased, rating for his service-connected post-traumatic stress disorder (PTSD). He is currently assigned a 50 percent disability rating for the mental disorder. The criteria for evaluating PTSD are found in the General Rating Formula for Mental Disorders, under 38 C.F.R. § 4.130, DC 9411. Under this rating criteria, a 50 percent rating is warranted where 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; impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and, difficultly in establishing and maintaining effective work and social relationships. Id. A 70 percent rating is warranted where there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (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 inability to establish and maintain effective relationships. Id. A 100 percent rating requires total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name. Id. The symptoms listed above serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating, and are not intended to constitute an exhaustive list. See Mauerhan v. Principi, 16 Vet. App. 436, 442 44 (2002). According to the applicable rating criteria, when evaluating a mental disorder, the frequency, severity, duration of psychiatric symptoms, length of remissions, and the Veteran's capacity for adjustment during periods of remission must be considered. See 38 C.F.R. § 4.126(a). Medical treatment records indicate that the Veteran denied having slurred speech or mental confusion. See e.g. March 2018 Primary Care Nurse Note; see also December 2018 Primary Care Nursing Note. Otherwise, medical treatment records do not provide any pertinent details about the severity of the Veteran's PTSD. Nonetheless, the Veteran underwent an assessment of the severity of his PTSD with private and VA medical examiners. For example, an August 2010 psychological evaluation from a private psychological advocate, L.G., which was co-signed by Dr. A.F. (private examiner), noted that the Veteran began experiencing numerous PTSD symptoms after his military service, including hypervigilance, problems with memory and concentration, and exaggerated startled response. The Veteran reported that he had a hard time fitting back into the civilian world, post service, he avoids crowds, positions himself with his back to the wall when in a public space, he cannot tolerate having anyone behind him, does not socialize and prefers to spend time alone. He has a hard time trusting people, and he get nervous when riding as a passenger in traffic when another car pulls out in front of him. He also reported that he has problems going to sleep and staying asleep, and experiences nightmares and night sweats; he often gets up during the night to check the locks on his doors and windows; often sees shadows in his peripheral vision; and he looks out of the window at night to make sure no one is out there. Further, he additionally reported having problems with memory and concentration; having a difficult time remembering what he reads; having a hard time focusing long enough to finish tasks; and being startled easily. On mental status examination, the private examiner observed that the Veteran was cooperative; he was dressed was normally; his mood was agitated; and that his affect was restricted. The private examiner also noted that there was no current suicidal or homicidal ideation, and the Veteran was oriented to person, place, and time (oriented x3). The private examiner remarked that the Veteran's PTSD symptoms have caused significant disturbances in all areas of his life; and that he is severely compromised in his ability to initiate or sustain work or social relationships, due to his hypervigilance and isolating behaviors. The private examiner further found that he is unable to learn new tasks due to his memory and concentration problems; due to the severity and chronicity of his PTSD symptoms, his prognosis for recovery is poor. On these bases, the private examiner opined that she considers him to be totally and permanently disabled. Subsequently, in a follow-up March 2013 psychological evaluation, the same private examiner remarked that the Veteran continues to suffer from significant disturbances in all areas of his life due to PTSD symptoms. Pertinently, the private examiner additionally remarked that over the years, the Veteran and his wife have separated multiple times because of his anger. Additionally, in this March 2013 psychological evaluation, the private examiner reiterated that she considers the Veteran to be totally and permanently disabled. The Veteran underwent a VA examination for mental disorders in March 2011. At this VA examination, the Veteran reported that he lost interest in activities, such as fishing, ball games, and working on cars; he feels detached from others; and he feels that he cannot trust people. He also reported that he feels irritable, and that he has difficulty sleeping and gets approximately three to four hours of total sleep throughout the night; and difficulty concentrating, whereas he cannot recall what he reads approximately one hour after he reads it. He also reported having symptoms of hypervigilance, in which he checks the doors and windows at night, and constantly walks his yard to make sure things are safe. Further, he complained of having panic attacks three to four times a week, and that all these above-mentioned symptoms have been ongoing since he was deployed. In terms of social history, the Veteran reported that he has two brothers and sisters, and he is close to one of his brothers; he had been married for 42 years (at the time of this March 2011 VA examination); he has one adult son and a granddaughter; and that he is close with his wife, children, son, and granddaughter. On mental status examination, the VA examiner observed that the Veteran was appropriately dressed and groomed; pleasant; showed no signs of psychomotor agitation or retardation; his speech was normal in tone, rate, and content; his thoughts appeared organized and logical; he was a reliable historian; suspiciousness was absent; concentration was normal; and he denied suicidal or homicidal ideation. However, the VA examiner observed that the Veteran's mood was depressed; his affect was restricted; and that he had panic attacks. The VA examiner assessed the level of occupational and social impairment, with respect to his PTSD, as an 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. The VA examiner found that that the Veteran's PTSD symptoms, include depressed mood; panic attacks three to four times per week; and chronic sleep impairment. In the most recent VA examination for PTSD, in October 2018, a VA examiner assessed the level of occupational and social impairment, with respect to his PTSD, as an 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. At this VA examination, the Veteran reported having the same symptoms and manifestations as those noted in his March 2011 VA examination, as noted above. The VA examiner found that the symptoms that are applicable to the Veteran's PTSD diagnosis include, depressed mood; anxiety; suspiciousness; chronic sleep impairment; mild memory loss, such as forgetting names, directions, or recent events; impairment of short and long term, for example, retention of only highly learned material, while forgetting to complete tasks; difficulty in understanding complex commands; and disturbances of motivation and mood. On behavioral observation, the VA examiner observed that the Veteran was alert, fully oriented, well groomed, pleasant, and cooperative throughout his interview. The VA examiner further remarked, among other findings, that the Veteran has had a sleep problem for more than 20 years; he continues to worry a great deal; he does not trust many people, as he is suspicious of people taking advantage of him; and that he goes through periods of crying and feeling tearful. In summary, the probative evidence reflects that the Veteran consistently reported and manifested PTSD symptoms to include, chronic sleep impairment; anxiety; depressed mood; suspiciousness; hypervigilance, impairment of short- and long-term memory; mild memory loss, such as forgetting names, directions, or recent events; disturbances of motivation and mood; panic attacks three to four times per week; and an inability to establish and maintain effective relationships. Additionally, the evidence reflects that the Veteran complained of feeling irritable, and that over the years, the Veteran and his wife have separated multiple times because of his anger. Further, as noted above, the August 2010 and March 2011 private examiner found that there have been significant disturbances in all areas of his life due to PTSD symptoms. Thus, by resolving all reasonable doubt in the Veteran's favor, the Board finds that the frequency, duration, and severity of the Veteran's PTSD symptoms more closely approximate an occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgement, thinking and/or mood. Thus, the criteria for a 70 percent disability rating have been met. Although the most recent, October 2018 VA examination report suggests the Veteran's PTSD has worsened, as it indicates that the Veteran now manifests additional PTSD symptoms, to include retention of only highly learned material, while forgetting to complete tasks, as well as difficulty with understanding complex commands, an even higher rating is not warranted. Particularly, an increased, maximum, 100 percent disability rating is not warranted because, overall, the probative medical evidence does not show that the Veteran has the frequency, severity, and duration of PTSD symptoms typically associated with a 100 percent disability rating, such as, for example, gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; disorientation to place or time; or a persistent danger of hurting self or others. Despite the August 2010 and March 2013 private examiner's opinion that the Veteran is considered to be totally and permanently disabled, which is within the scope of her professional competency to render this medical opinion, the evidence does not show, and neither the private examiner nor the Veteran has asserted that he has, for example, gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, a persistent danger of hurting self or others, disorientation to time or place, and/or any other PTSD symptoms that are tantamount to a complete, total occupational and social impairment. To the contrary, and as noted above, all private and VA evaluative reports indicated that the Veteran was oriented x3 at his examinations. Also, the evidence does not show, and neither the private examiner nor the Veteran has asserted that his PTSD results in an intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. Although the Veteran reported that that he lost interest in his activities, all private and VA evaluations consistently noted that the Veteran was well groomed or appropriately dressed, and no examiner indicates that the Veteran is unable to undertake activities of daily living, such as, for example, undertaking house chore, as a result of his PTSD. To the contrary, for example, the March 2011 VA examination report specifically noted that the Veteran is able to undertake basic activities of daily living, despite a decreased interest in socializing and a lost interest in many of his activities, and that in terms of family duties, he seems to do well and is able to take care of his wife at home. Further, and more specifically, total social impairment is not shown. As noted above, the Veteran has been married for over forty years. Even though the Veteran reported that he has separated from his wife multiple times as a result of his anger, at the same time, the Veteran also reported that he has a good relationship with his wife, son, and granddaughter. Thus, this shows that the Veteran is still able to maintain some type of functioning relationship with his family, rather than an inability to maintain any kind of relationship with anyone. This is not suggestive of a total social impairment, however. Finally, the medical evidence consistently reflects that the Veteran denied having suicidal or homicidal ideation; no history of assault is noted; there is no evidence that his memory loss is to the extent where he cannot recall the names of close relatives, his occupation, or his name; and there is no evidence, nor does the Veteran indicate, that he has a history of psychiatric hospitalizations due to his PTSD. Therefore, the severity of the Veteran's PTSD are not tantamount to a total occupational and social impairment. Nonetheless, for the reasons and bases articulated above, the Board finds that by resolving all reasonable doubt in the Veteran's favor, an increased rating, but no higher than 70 percent disabling, is warranted for the period beginning July 30, 2010. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. TDIU The Veteran asserts that he is unemployable because of his PTSD, right wrist, and left knee disabilities. See September 2013 Application for Increased Compensation Based on Unemployability (TDIU Application). A total disability rating may be warranted where the schedular rating is less than total, and a disabled person is unable to secure or follow a substantially gainful occupation as a result of a single 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. §§ 3.340, 3.34l, 4.16(a). While consideration may be attributed to a veteran's level of education, special training, and previous work experience, consideration must not be given to the veteran's age or an impairment that is due to a nonservice-connected disability. See 38 C.F.R. §§ 3.341, 4.16, 4.19. Additionally, marginal employment will not be considered as substantially gainful employment. 38 C.F.R. § 4.16 (a). "Substantially gainful employment" essentially means that the work provides income above the poverty level established by the United States Department of Commerce, without benefit of protected family employment or a sheltered workshop. 38 C.F.R. § 4.16(a). There is no requirement that employment be in a certain field or provide a certain standard of living or income level beyond the poverty level. When the minimum percentage criteria, under 38 C.F.R. § 4.16(a) are not met, TDIU may still be granted on an extraschedular basis under circumstances where the Veteran is unable to secure and/or follow a substantially gainful occupation by reason of a service-connected disability. 38 C.F.R. § 4.16(b). To establish TDIU on an extraschedular basis, however, the record must reflect some factor that takes the case outside of normal circumstances. The sole fact that a Veteran is unemployed or has difficulty obtaining employment is not sufficient. While a disability rating is recognition that the impairment makes it difficult to obtain or keep employment, the ultimate question is whether a Veteran is capable of performing the physical and mental acts required by employment, and not whether one can find employment. See Van Hoose v. Brown, 4 Vet. App. 361 (1993). A determination as to whether a veteran can secure or follow a substantially gainful occupation includes an economic component and a noneconomic component. The economic component means that a veteran must not receive income from employment that exceeds the poverty threshold for one person. The non-economic component requires consideration of a number of factors, including the frequency and duration of periods of incapacity or time lost from work due to a service-connected disability, the veteran's employment history and current employment status, and the veteran's annual income from employment, if any. See Ray v. Wilkie, 31 Vet. App. 58 (2019). The Veteran is service-connected for PTSD, at 70 percent disabling; and for right wrist injury residuals, status-post tenosynovitis (right wrist disability), at 10 percent disabling. Thus, as the combined disability rating, given the increased rating from this decision, the minimum percentage criteria for a TDIU is established. 38 C.F.R. §§ 4.16(a), 4.25. Nonetheless, the central inquiry is whether the Veteran's service-connected disabilities alone are of enough severity to produce unemployability. Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). The sole fact that a veteran is unemployed or has difficulty obtaining employment is not sufficient. As a matter of fact, a high rating in itself is recognition that the impairment makes it difficult to obtain or keep employment. However, the ultimate question is whether a veteran is capable of performing the physical and mental acts required by employment, and not whether he or she can find employment. Hoose v. Brown, 4 Vet. App. 361 (1993). The United State Court of Appeals for Veterans Claims (Court) held that "[i]n determining whether a veteran can secure and follow a substantially gainful occupation, attention must be given to": (1) The veteran's history, education, skill, and training; (2) Whether the veteran has the physical ability (both exertional and non-exertional) to perform the type of activities (e.g., sedentary, light, medium, heavy, or very heavy) required by the occupation at issue, in which factors that may be relevant include, but are not limited to, the veteran's limitations, if any, concerning lifting, bending, sitting, standing, walking, climbing, grasping, typing, and reaching, as well as auditory and visual limitations; and (3) Whether the veteran has the mental ability to perform the activities required by the occupation at issue, in which factors that may be relevant include, but are not limited to, the veteran's limitations, if any, concerning memory, concentration, ability to adapt to change, handle work place stress, get along with coworkers, and demonstrate reliability and productivity. Ray v. Wilkie, 31 Vet. App. 58 (2019). However, consideration cannot be given to the Veteran's age or to the impairment caused by non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19 (2018); Van Hoose v. Brown, 4 Vet. App. 361 (1993). Additionally, "[by] discussing [the] potentially relevant factors, we don't create a checklist that must be run completely through in every case. Instead, discussion of any factor is only necessary if the evidence raises it." Ray, 31 Vet. App. at 58. The Veteran reported that he became too disabled to work in March 2007. See September 2013 TDIU Application. In assessing the Veteran's employability, the Court defines "substantially gainful employment" as encompassing both an economic and a noneconomic component. Ray, 31 Vet. App. at 58. The economic component means "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," whereas the noneconomic component requires consideration of a veteran's ability to secure or follow that type of employment. In this case, the Veteran has not met the criterion for the economic component at any time during the entire appeal period, as the evidence suggests that the Veteran stopped working full-time in March 2007. See September 2013 TDIU Application. With respect to the noneconomic component, factors to consider, as noted above, include the veteran's history, education, skill, and training; his or her physical abilities, including any audio or visual limitations, as well as limitations in lifting, bending, sitting, standing, walking, climbing, grasping, typing, reaching; and his or her mental ability, including limitations in memory, concentration, ability to adapt to change, handle workplace stress, get along with coworkers, and demonstrate reliability and productivity. Id. The Veteran initially reported, in his September 2013 TDIU application, that the highest level of education he completed is four years of high school, with no further, additional education or training. However, he clarified that he obtained his general education development (GED) certificate during his time in service, as he dropped out of high school in the 10th grade. More so, he has not worked in thirteen years; and at his last employment, he worked as a mechanic for thirty years. See September 2013 TDIU Application; see also March 2011 VA Examination Report; see too, October 2018 VA Examination Report. Although he reported that he worked for Good Year Tire and Rubber Company (from 1977 to 2007) in his September 2013 TDIU application, the Veteran subsequently reported that he worked for Kelly Springfield for thirty years at his March 2011 and October 2018 VA examinations. Although Kelly Springfield is not precisely listed as a former employer in his September 2013 TDIU application, the Board shall liberally construe this discrepancy with the name of the Veteran's former employer as the same employment, given that the Veteran consistently reported that he worked for his last employer for thirty years in the September 2013 TDIU application, the March 2011 VA examination report, and the October 2018 VA examination report; and additionally, his October 2018 VA examination report concomitantly notes that he worked for Goodyear Tire Company for thirty years, and retired in 2007. Although he asserts that he is unable to secure or follow substantially gainful employment as a result of his PTSD, right knee, and left knee, the Veteran is not service-connected for his left knee disability at this time. Thus, the Board has only considered whether he unemployable as a result his service-connected PTSD and/or right wrist disabilities. At the time the Veteran underwent a VA examination for wrist conditions in March 2011, a VA examiner reported that the Veteran experienced flare-ups in his right wrist, and that the Veteran described the overall functional impairment of his wrist as an inability to work and do usual activities, and more specifically, the Veteran reported that this impairment resulted in his ability to work on cars. Although the VA examiner noted that the Veteran has a history of right wrist surgery, with residuals of swelling, numbness, and decreased strength pain, he noted that the right wrist condition does not result in any incapacitation. At the same time, however, the VA examiner also found that the effect of the right wrist disability on the Veteran's usual occupation is limitations in lifting and carrying heavy items. See also July 2014 VA Examination Report for Wrist Conditions (describing the impact of the Veteran's wrist condition on his ability to work as an inability to lift objects, and being unable to work as a mechanic or welder). The evidence also suggests that the functional impairment of the Veteran's PTSD also impacts his ability to work. Although March 2011 and October 2018 VA examination reports summarized the level of occupational and social impairment on the Veteran's PTSD as an occasional decrease in work efficiency and an intermittent inability to perform occupational tasks, in pertinent part, the medical evidence suggests that the impact of the functional impairment of the Veteran's PTSD on his occupation is more significant. In August 2010 and March 2013 psychological evaluations, a private examiner found that the Veteran's PTSD symptoms cause significant disturbances in all areas of his life. More specifically, the VA examiner indicated that the Veteran is severely compromised in his ability to initiate or sustain work or social relationships as a result of his hypervigilance and isolating behaviors; and that due to memory and concentration problems, he is unable to learn new tasks. See August 2010 Psychological Evaluation. More so, the private examiner additionally noted that the Veteran does not feel safe anywhere out in public; and in addition to an Axis I, PTSD diagnosis, the private examiner also listed an "[inability] to use grip in right hand", as an Axis IV diagnosis. Despite noting, in pertinent part, that the level of occupational and social impairment on the Veteran's PTSD is an occasional decrease in work efficiency and an intermittent inability to perform occupational tasks, the October 2018 VA examiner, noted, at the same time, that the Veteran reported having difficulty with concentrating and cannot recall what he reads approximately one hour after he reads it; and that he suffers from panic attacks, which occur three to four times a week. Pertinently, the VA examiner also found that the symptoms that are applicable to the Veteran's PTSD, include, among other symptoms, mild memory loss, such as forgetting names, directions, or recent events; impairment of short- and long-term memory, for example, retention of only highly learned material, while forgetting to complete tasks; difficulty in understanding complex commands; and disturbances of motivation and mood. In considering the functional limitations of the Veteran's PTSD and right wrist disabilities, the Board acknowledges that his work experience is solely limited to the capacity of a mechanic. The Veteran has a 10th grade education, with a GED, and he has not worked in any other capacity since 1977. Furthermore, he has not worked in more than thirteen years. Thus, given his work experience, skill, and limited education and training, the Board finds that the pursuit of other jobs, such as, for example, a sedentary position or any other type of work that enables him to work, without any impact on the functional limitations from his service-connected PTSD and right wrist disabilities, is not practical. The work of a mechanic requires the use of both hands, and a mechanic must be able to undertake his duties with full concentration, and occasionally, interact with other individuals or customers, for purposes of understanding and resolving the pertinent issue related to the job at hand. Additionally, occasional heavy lifting and carrying is required for a mechanic to utilize or place tools and equipment. However, the Veteran's right wrist disability has symptoms of swelling, numbness, and decreased strength pain; and the functional impairment of his right wrist disability places limitations on lifting and carrying, which makes it impractical for him to execute his duties as a mechanic. Further, as noted above, the Veteran has severe PTSD symptoms, including, among others, short- and long-term memory loss, to include the retention of only highly learned material, while forgetting to complete tasks; difficulty with understanding complex commands; and disturbances of motivation and mood. Thus, the Board also finds that the Veteran does not have the physical abilities to maintain or secure any type of work as a mechanic; and he is incapable of securing an alternative or new position, which requires him to learn how to undertake new tasks, develop new skills, or follow instructions. Therefore, the Board finds that the PTSD and right wrist disabilities, collectively, render the Veteran unable to maintain and secure substantially gainful employment. Further, and more specifically, the Board additionally finds that the Veteran's service-connected PTSD alone sufficiently renders him unable to maintain and/or secure substantially gainful employment. Thus, for these foregoing reasons and bases, entitlement to a TDIU is granted. M. Tenner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board V-N. Pratt 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.