Citation Nr: 21068577 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 17-12 175 DATE: November 10, 2021 ORDER For the entire period on appeal, beginning April 23, 2009, an initial rating of 70 percent, but no higher, for posttraumatic stress disorder (PTSD) is granted, subject to the laws and regulations governing payment of monetary benefits. From April 23, 2009 to September 15, 2019, a total disability rating based on individual unemployability (TDIU) is granted, subject to the laws and regulations governing payment of monetary benefits. FINDINGS OF FACT 1. For the entire initial rating period on appeal, beginning April 23, 2009 the Veteran's PTSD symptoms most nearly approximated occupational and social impairment with deficiencies in most areas, but not total social and occupational impairment. 2. From April 23, 2009 to September 15, 2019, the Veteran's service-connected PTSD rendered him unable to obtain and maintain substantially gainful employment consistent with his educational and occupational background. CONCLUSIONS OF LAW 1. For the entire period on appeal, beginning April 23, 2009, the criteria for an initial rating of 70 percent, but no higher, for PTSD have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.130, Diagnostic Code (DC) 9411 (2020). 2. From April 23, 2009 to September 15, 2019, the criteria for a TDIU have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant in this case, served on active duty from December 1966 to September 1969. His awards and decorations include the Purple Heart Ribbon and the Combat Action Ribbon. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2012 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In a May 2020 decision, the Board, in pertinent part, denied entitlement to both a rating in excess of 50 percent for PTSD and a TDIU for the period on appeal prior to September 16, 2019 and a TDIU. The Veteran appealed this decision. In May 2021, the United States Court of Appeals for Veterans Claims (Court) granted the April 2021 Joint Motion for Partial Remand (JMPR) submitted by counsel for the Veteran and VA, vacated the Board's May 2020 decision as to the issues addressed herein, and remanded this matter to the Boar for action consistent with the JMPR. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion 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); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). Increased Ratings Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. The percentage ratings are based on the average impairment of earning capacity and individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The Veteran's entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Staged ratings are appropriate for any initial rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119, 126 (1999). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3. In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to her through her senses. See Layno, 6 Vet. App. 465, 469. Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau, 492 F.3d 1372, 1377. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 1. Entitlement to an initial rating in excess of 50 percent for PTSD for the period on appeal prior to September 16, 2019. The Veteran is in receipt of a 50 percent initial disability rating for PTSD under 38 C.F.R. § 4.130, DC 9411, for the period on appeal prior to September 16, 2019. He seeks a higher rating. The Veteran's PTSD is rated under the general rating formula for rating mental disorders pursuant to 38 C.F.R. § 4.130, DC 9411. Under such formula, a 50 percent rating is warranted for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short-and long-term memory (e.g. retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing effective work and social relationships. A 70 percent rating is warranted when the psychiatric disorder results in occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, 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 an 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. A total schedular rating of 100 percent is warranted when the disorder results in 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 mental and personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name. In applying the above criteria, the Board notes that, when it is not possible to separate the effects of the service-connected disability from a nonservice-connected disability, such signs and symptoms shall be attributed to the service-connected disability. See 38 C.F.R. § 3.102; Mittleider v. West, 11 Vet. App. 181 (1998), citing Mitchem v. Brown, 9 Vet. App. 136, 140 (1996). Effective August 4, 2014, VA amended the portion of the Rating Schedule dealing with mental disorders and its adjudication regulations that define the term "psychosis" to remove outdated references to the DSM-IV and replace them with references to the updated Fifth Edition (DSM-5). See 79 Fed. Reg. 149, 45094. The provisions of the interim final rule apply to all applications for benefits that are received by VA or that were pending before the Agency of Original Jurisdiction on or after August 4, 2014. Id. VA adopted as final, without change, the interim final rule and clarified that the provisions of this interim final rule do not apply to claims that have been certified for appeal to the Board or are pending before the Board as of August 4, 2014. See 80 Fed. Reg. 53, 14308 (March 19, 2015). Here, the RO certified the Veteran's appeal to the Board after August 4, 2014; therefore, the PTSD claim is governed by DSM 5 and the GAF scores are not relevant for consideration. See Golden v. Shulkin, 29 Vet. App. 221, 225-26 (2018) (holding that the Board errs when it uses GAF scores to assign a psychiatric rating in cases where DSM-5 applies). When evaluating mental health disorders, the factors listed in the Rating Schedule are simply examples of the type and degree of symptoms, or their effects, that would justify a particular rating; the analysis should not be limited solely to whether a veteran exhibited the symptoms listed in the Rating Schedule. Rather, the determination should be based on all of a veteran's symptoms affecting his level of occupational and social impairment. See Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002). The lists of symptoms under the Rating Schedule are meant to be examples of symptoms that would warrant the disability evaluation but are not meant to be exhaustive. Id. Turning to the evidence, the January 2011 VA examination report indicated that the Veteran had been divorce three times and had few friends, and that anger limited his relationships and friends. The VA examiner observed that the Veteran seemed somewhat agitated, as his speech was somewhat rapid and he was restless with hands and a rubber band in constant motion. Sleep impairment was noted. He had no hallucinations. The VA examiner noted that Veteran had personal space issues and needed to have special seating arrangement, door placement, and had boundary issues needed to a much great extent than the average veteran. He did not have obsessive/ritualistic behavior, panic attacks, homicidal thoughts, or suicidal thoughts. His impulse control was good, but he had episodes of violence. He was able to maintain minimum personal hygiene and had no problem with activities of daily living. His memory was normal. The VA examiner indicated that the Veteran retired in 2008 due to a back injury. The VA examiner opined that the Veteran is limited by PTSD features, sleep disorder, impulsivity, and personal tendencies which limit social interaction. He was reportedly easily frustrated and found it difficult to appropriately interact with others, apparently alienating potential friends. In a November 2011 addendum opinion, the VA examiner reported that the Veteran's functional impairments due to PTSD have an impact on his ability to obtain and maintain both physical and sedentary employment. The Veteran reported that he experiences anger issues and many interactive problems and with respect to his own probability of employment, "I'm lost. I can't keep a job." The VA examiner opined that the Veteran is significantly limited with respect to employability. However, the examiner explained that he was unable to determine if the Veteran was precluded from all possible employment because the examiner is limited to his specialty. An October 2012 VA mental health treatment note indicated that the Veteran came in extremely angry, hostile, and screaming, apparently due to confusion regarding a prescription. The VA psychiatrist described the Veteran as angry all the time. The Veteran had difficulty with relationships, such that he could not sustain a relationship, and irritability. The Veteran stated that due to his rages he was like "a walking time bomb." He was angry that his daughter did not want to be with him, and he had no friends. A March 2013 VA mental health treatment record indicated that the Veteran presented as hyperactive, hypervigilant, and hyperverbal. The Veteran admitted to himself that he was constantly angry, constantly agitated, and unable to keep friends or relationships due to his anger issues. The Veteran stated that he was not close to his siblings, and his daughter and two grandchildren could not "stand to be around because of his anger." March 2015 VA treatment records indicate that the Veteran reported having a hard time getting along with people. He reported that he became short with people and did not get along with his family. He reported that he had trouble sleeping and his days and nights were mixed up. The Veteran stated that he was seeking help in managing his anxiety and anger. He reported that he had lost multiple jobs secondary to being too hyper and too argumentative. The Veteran was appropriately groomed and dressed. He was cooperative and his mood was irritable. The examiner noted that the Veteran's affect was congruent with the content of his speech. The Veteran was alert and oriented in all spatial spheres. There were no observed or reported perceptual distortions. His thought processes were logical, and the content was relevant within normal limits. The examiner determined that the Veteran's insight and judgment were fair. The December 2016 VA examination report indicated that the Veteran struggled to make and maintain social relationships. The Veteran reported having been divorce three times, being estranged from his siblings, having few friends, and having a hard time getting along with people. He reported being angry and short with people, and that he did not have patience for anything. He was fired from his last job due to an altercation with employee, and reported having been fired about 15 times for altercations, having a bad temper, and not getting along with fellow employees. He had been stopped for arguments on the road. He sometimes forgot his keys or people's names. He spent most of his leisure time doing things by himself, stating that he "does not want anyone around." The Veteran indicated that different things triggered him, such as people taking their time or clerks not doing their jobs. The VA examiner noted the Veteran had symptoms of depressed mood, weekly panic attacks, and chronic sleep impairment. The examiner also noted that the Veteran did not appear to pose any threat of danger or injury to self or others. The September 2019 VA examination report noted that the Veteran lives alone and was not in a relationship. The Veteran reported that he broke up with his fiancée due to his symptoms, but noted that they were trying to work things out. He had been married and divorced twice. The Veteran has a strained relationship with his adult daughter. The Veteran reported having a hard time "coping with people." He had a history of verbal and physical outbursts, leading to difficulty getting along with others. He denied regular social contacts or relationships, and preferred being alone. The Veteran reported having lost multiple jobs secondary to being too hyper and argumentative, that he last worked in 2007 in sales, and that he was fired from his last job for punching someone. The Veteran stated that he was asked to leave a restaurant when he started to yell at another patron. He stated that he feels "overwhelmed by people." The Veteran reported having flashbacks all the time and getting into a car accident due to flashbacks. He was able to drive and maintain a driver's license, and complete activities of daily living (ADLs) independently. The VA examiner noted that the Veteran was paranoid and suspicious. The VA examiner opined that the Veteran's PTSD manifested in symptoms of depressed mood, anxiety, suspiciousness, chronic sleep impairment, circumstantial, circumlocutory, or stereotyped speech, disturbances of motivation or mood, inability to establish and maintain effective work and social relationships, difficulty in adapting to stressful circumstances, including work or a worklike setting, and impaired impulse control, such as unprovoked irritability with periods of violence. The Veteran denied having suicidal thoughts or ideations. After a review of all the evidence, lay and medical, the Board finds that the Veteran's PTSD symptoms most nearly approximated occupational and social impairment with deficiencies in most areas for the entire initial rating period on appeal. The evidence reflects that the Veteran's PTSD was consistently characterized by symptoms of inability to establish and maintain effective relationships, difficulty in adapting to stressful circumstances, impaired impulse control with unprovoked irritability. The Veteran reported numerous difficulties with relationships, both socially and professionally, due to his PTSD symptoms. He was socially isolated and repeatedly demonstrated impaired impulse control manifested by irritability with periods of violence. Therefore, a disability rating of 70 percent is warranted for PTSD for the entire period on appeal. However, the criteria for a disability rating in excess of 70 percent for PTSD have not been met. While the Board finds that the Veteran had total occupational impairment due to PTSD throughout the appeal period (see TDIU section below), the evidence does not show total social impairment. Specifically, he reported having and living with a fiancée during the majority of the period on appeal, and having a relationship with his daughter during part of the period on appeal. He is shown to be significantly socially isolated, but a high degree of social isolation and deficiency is adequately contemplated by a 70 percent rating. Both total occupational and social impairment generally requires symptoms severe enough to severely distort the individual's perception of reality, which is not shown by the record. He has not displayed gross impairment in thought processes or communication; persistent delusions or hallucinations; disorientation to time or place; grossly inappropriate behavior; or memory loss for names of close relatives, own occupation, or own name. There is also no evidence of persistent danger of hurting self or others or intermittent inability to perform activities of daily living. To the contrary, the record reflects that the Veteran has consistently performed self-care and activities of daily living independently and the incidents of him harming others (hitting or punching) have not been of such frequency to constitute a persistent danger of hurting others. Therefore, for the entire period on appeal, the criteria for a rating in excess of 70 percent for PTSD have not been met. Finally, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). 2. Entitlement to a TDIU for the period on appeal prior to September 16, 2019. It is the established policy of VA that all veterans who are unable to secure and maintain substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. 38 C.F.R. § 4.16. A finding of total disability is appropriate "when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation." 38 C.F.R. §§ 3.340(a)(1), 4.15. Controlling laws provide that a TDIU may be assigned when a veteran has one service-connected disability rated at 60 percent or more, or two or more service-connected disabilities where at least one disability is rated at 40 percent or more and the combined rating is at least 70 percent. 38 C.F.R. § 4.16(a). The record must also show that the service-connected disabilities alone result in such impairment of mind or body that the average person would be precluded from securing or maintaining a substantially gainful occupation. Id. The Veteran in this case has met the schedular percentage requirements for TDIU under 38 C.F.R. § 4.16(a) since April 23, 2009, the date of the claim that gave rise to the present appeal. During the period on appeal, he has been in receipt of service connection for PTSD (rated 70 percent disabling from April 23, 2009); shrapnel wound, muscles, right side of face (rated 10 percent from March 26, 2009); shrapnel wound, nerve right side of face ( rated 10 percent from March 26, 2009), tinnitus associated with bilateral hearing loss (rated 10 percent from September 29, 2009); shrapnel wound scar, right side of face (rated 0 percent from March 26, 2009), and bilateral hearing loss (rated 0 percent from September 17, 2009). His combined disability rating is 80 percent from April 23, 2009. The remaining question is whether these service-connected disabilities preclude the Veteran from securing and following a substantially gainful occupation. See 38 C.F.R. § 4.16(a). The fact that a veteran is unemployed or has difficulty finding employment does not alone warrant assignment of a TDIU, as a high rating itself establishes that his or her disability makes it difficult for him or her to obtain and maintain employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Rather, the evidence must show that he or she is incapable "of performing the physical and mental acts required" to be employed. Id. at 363. Thus, the central question is whether a veteran's service-connected disabilities alone are of sufficient severity to produce unemployability, and not whether a veteran could find employment. Id. Consideration may be given to a veteran's education, training, and special work experience, but not to his or her age or to impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. In Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013), the Federal Circuit held that, when a veteran is claiming TDIU based upon the combined effects of multiple service-connected disabilities, VA's duty to assist "does not require obtaining a single medical opinion regarding the combined impact of all service-connected disabilities." See also Smith v. Shinseki, 647 F.3d 1380, 1385-86 (Fed. Cir. 2011) (VA is not required to obtain an industrial survey from a vocational expert before making a TDIU determination but may choose to do so in an appropriate case). Although VA must give full consideration, per 38 C.F.R. § 4.15, to "the effect of combinations of disability," VA regulations place responsibility for the ultimate TDIU determination on VA adjudicators, not a medical examiner's opinion. Geib, 733 F.3d at 1354; see also 38 C.F.R. § 4.16(a). The ultimate issue of whether TDIU should be awarded is not a medical issue, but rather is a determination for the VA adjudicator. See Moore v. Nicholson, 21 Vet. App. 211, 218 (2007) (ultimate question of whether a veteran is capable of substantial gainful employment is not a medical one; that determination is for the adjudicator), rev'd on other grounds sub nom, Moore v. Shinseki, 555 F.3d 1369 (Fed. Cir. 2009). There is no regulatory definition of "substantially gainful employment." 38 C.F.R. § 4.16(a) provides guidance in that it states: "Marginal employment shall not be considered gainful employment." It also says definitively that marginal employment exists when a veteran's earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. 38 C.F.R. § 4.16(a). Even if the income exceeds the poverty threshold, marginal employment may still exist on a facts-found basis. One example given is employment in a protected environment like a family business or a sheltered workshop. 38 C.F.R. § 4.16(a). VA must consider the nature of employment. Id. Notably, in Ray v. Wilkie, the Court of Appeals for Veterans Claims defined the term "unable to secure and follow a substantially gainful occupation" in § 4.16(b) to have two components: one economic and one noneconomic. 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. The non-economic component includes consideration of the veteran's history, education, skill, and training; whether the veteran has the physical ability to perform the type of activities required by the occupation at issue; and whether the veteran has the mental ability to perform the activities required by the occupation at issue. See Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). Here, the Veteran's DD-214 indicates that he served on active duty for nearly 3 years. His military occupational specialty (MOS) was cook. Turning to the record, in an October 2008 Disability Report to the Social Security Administration (SSA), the Veteran reported that his longest job held was in auto sales from January 2003 to December 2008. In a November 2010 medical opinion, Dr. T.S., the Veteran's treating psychologist since July 2009, stated that the Veteran had been receiving therapy for his PTSD through the VA since March 2009. Dr. T.S. stated that the Veteran had described increasing severity in his PTSD symptoms over the last 12 months, especially relating to his anger and irritability. The impact of PTSD on the Veteran's performance in any type of job was overwhelming. Dr. T.S. opined that the Veteran's irritability and vulnerability to expressing anger inappropriately were a result of his PTSD, and made it impossible for him to function in any type of job that requires interacting with other people. Dr. T.S. opined that the Veteran was unemployable due to his medical condition of PTSD. The January 2011 VA examiner, a psychologist, opined that the Veteran was limited by PTSD features, sleep disorder, impulsivity, and personal tendencies which limit social interaction. The Veteran was easily frustrated and found it difficult to appropriately interact with others. During the examination, the examiner noted that the Veteran displayed inappropriate behavior, including having personal space issues and needed to have a special seating arrangement and door placement, as well as having boundary issues to a much greater extent than the average veteran. In a November 2011 addendum opinion, the January 2011 VA examiner opined that the Veteran was significantly limited with respect to employability due to his service-connected disabilities. However, the examiner stated that he was unable to determine if the Veteran was precluded from all possible employment due solely to his PTSD. A January 2014 VA primary care treatment note indicated that the Veteran was involved in a motor vehicle collision in 2006 and has been unemployed since that time. A March 2015 VA mental health treatment record indicated that the Veteran reported having lost multiple jobs secondary to being too hyper and too argumentative. In an August 2016 VA Form 21-8940, Veteran's Application for Increased Compensation Based on Unemployability, the Veteran reported last working in 2008. He reported a history of working in sales and marketing, and completing one year of college. The December 2016 VA PTSD examination report indicated that the Veteran was last employed as a salesman in 2007 or 2008, but was fired due to an altercation with employee. The Veteran reported that he had been fired about 15 times, due to altercations and a bad temper. He indicated that he does not get along with fellow employees. The examiner opined that the Veteran's PTSD caused clinically significant distress or impairment in social, occupational, or other important areas of functioning. In a September 2019 VA examination report, the VA examiner opined that the Veteran has occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. The Veteran stated that he last worked in 2007 in sales and was fired for "punching someone." The Veteran was noted to be highly irritable with angry moods. He had verbal and physical outbursts leading to difficulty getting along with others. He reported feeling "overwhelmed by people." The VA examiner noted that the Veteran had difficulty falling and staying asleep, and that he was paranoid and suspicious. On examination, the VA examiner noted that the Veteran's thought process was tangential and circumstantial, and his insight, judgment and impulse control were all intact. The VA examiner opined that the Veteran had significant mood disturbance, including anger, irritability, mood lability, and anxiety which affect his ability to interact with others in occupational settings. In addition, symptoms of hypervigilance and hyperarousal affect the Veteran's ability to interact with others. The VA examiner noted that the Veteran PTSD results in difficulty in establishing and maintaining effective personal and work relationships. After a review of the evidence of record, both lay and medical, the Board finds that the Veteran has been unable to secure or maintain substantially gainful employment due to his service-connected PTSD for the entire initial rating period on appeal, beginning April 23, 2009. The evidence reflects that the Veteran experiences severe isolating tendencies, difficulty in adapting to stressful circumstances, chronic sleep impairment, inability to establish and maintain effective relationships, anxiety, depression, hypervigilance, disturbances of motivation and mood, and impaired impulse control due to his service-connected PTSD. In particular, the Veteran's severe isolating tendencies, hypervigilance, anxiety, and impaired impulse control render him incapable of obtaining and maintaining substantially gainful employment. This finding is supported by the November 2010 medical opinion from the Veteran's treating psychologist, Dr. T.S., and the September 2019 VA examiner's opinions regarding the Veteran's functional impairments. For these reasons, the functional impact of the Veteran's service-connected PTSD rendered him unable to obtain and maintain substantially gainful employment consistent with his educational and occupational background for the entire initial rating period on appeal. Indeed, given the significant impact of his service-connected PTSD on the Veteran's ability to work and perform routine tasks that would likely be required for employment, particularly his difficulty with effectively interacting with other people due to his impaired impulse control and history of hitting a co-worker, the weight of the evidence supports a finding that his service-connected PTSD precluded him from obtaining and maintaining substantially gainful employment for the entire period on appeal. Therefore, as the competent and credible evidence is in favor of a finding of unemployability due to the service-connected PTSD, entitlement to a TDIU is warranted for the entire initial rating period on appeal, from April 23, 2009 to September 15, 2019. Megan R. Thomas Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Le, Tai D. 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.