Citation Nr: 21068983 Decision Date: 11/17/21 Archive Date: 11/17/21 DOCKET NO. 18-44 989 DATE: November 17, 2021 ORDER Entitlement to a 70 percent rating for posttraumatic stress disorder (PTSD) prior to June 2, 2018, is granted. Entitlement to a rating in excess of 70 percent for PTSD from June 2, 2018, is denied. Entitlement to an effective date earlier than November 24, 2015, for the award of increased rating for PTSD is denied. Entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU) prior to June 2, 2018, is granted. Entitlement to special monthly compensation (SMC) is denied. REMANDED Entitlement to a TDIU prior to November 24, 2015, is remanded. FINDINGS OF FACT 1. Throughout the appeal period, the Veteran's PTSD has been productive of occupational and social impairment with deficiencies in most areas, such as work, school, family relationships, judgment, thinking or mood. 2. An informal claim for increased rating for PTSD was received in July 2012. 3. The record does not show that during the one-year period preceding receipt of the Veteran's July 2012 informal claim and prior to November 24, 2015, that an increase in the Veteran's service-connected psychiatric disability was factually ascertainable such that a 50 percent disability rating was warranted. 4. Based on the Board's award of TDIU due to PTSD alone, the Veteran had a single service-connected disability rated at 100 percent; however, he does not have additional service-connected disabilities having a combined rating of 60 percent. CONCLUSIONS OF LAW 1. The criteria for a 70 percent rating for PTSD, prior to June 2, 2018, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.7, 4.130, Diagnostic Code 9411. 2. The criteria for a rating in excess of 70 percent for PTSD, from June 2, 2018, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.7, 4.130, Diagnostic Code 9411. 3. The criteria for an earlier effective date than November 24, 2015, for the grant of an increased disability rating for PTSD have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.400. 4. The criteria for entitlement to a TDIU from November 24, 2015, to June 2, 2018, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.1 (a). 5. The criteria for entitlement to SMC have not been. 38 U.S.C. §§ 1114(s), 5107; 38 C.F.R. §§ 3.102, 3.350. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1965 to August 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO), which assigned a 50 percent rating for PTSD effective November 24, 2015. During the course of the Veteran's appeal, the RO assigned an increased 70 percent rating for PTSD, effective June 2, 2018. As higher ratings for the disability are available prior to and from this date, the appeal continues. See AB v. Brown, 6 Vet. App. 35 (1993) (where a claimant has filed a notice of disagreement as to an RO decision assigning a particular rating, a subsequent RO decision assigning a higher rating, but less than the maximum available benefit, does not abrogate the pending appeal). In August 2015, the Agency of Original Jurisdiction (AOJ) effectuated a Board decision granting entitlement to a TDIU. The AOJ assigned an effective date of June 2, 2018. However, as the Veteran's TDIU claim was raised during the course of the appeal for increased rating for PTSD and is therefore part-and-parcel of that claim. The award of a TDIU does not cover the entire period on appeal pertaining to PTSD, which stems from a November 2015 claim--with informal claim received in July 2012 and discussed in greater detail below. Rice v. Shinseki, 22 Vet. App. 447 (2009); Harper v. Wilkie, 30 Vet. App. 356 (2018); Payne v. Wilkie, 31 Vet. App. 373 (2019). As such, the Board will address the issue of entitlement to a TDIU prior to June 2, 2018. Increased Rating 1. Entitlement to a rating in excess of 50 percent for PTSD prior to June 2, 2018. 2. Entitlement to a rating in excess of 70 percent for PTSD from June 2, 2018. Disability evaluations are determined by application of the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. An evaluation of the level of disability present must also include consideration of the functional impairment of the Veteran's ability to engage in ordinary activities, including employment. 38 C.F.R. § 4.10. When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 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. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). The Court has held that "staged" ratings are appropriate for any rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119 (1999). In this case, the Veteran has already been awarded staged ratings; the Board will consider the propriety of the rating at each stage. The Veteran's PTSD is rated as 50 and 70 percent disabling pursuant to 38 C.F.R. § 4.130, Diagnostic Code 9411. PTSD is rated under the General Rating Formula for evaluating psychiatric disabilities other than eating disorders. Under the General Rating Formula, a 50 percent rating is assigned when a psychiatric disorder causes 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-term and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is assigned 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 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. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of closes relatives, own occupation, or own name. The symptoms listed in the rating schedule are not intended to constitute an exhaustive list, but rather serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436 (2002). In Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013) the Federal Circuit stated that "a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration." It was further noted that "§ 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas." In a statement received in December 2015, the Veteran reported that he stopped working as a truck driver in February 2013. He had attended readjustment counseling service in July 2013 for elevated stress and noted that he could not relax enough to provide a urine sample to his employer to continue working. On VA examination in January 2016, the Veteran reported that he had been working as a regional truck driver for the same company for 15 years when the business folded in 2013. He looked for another truck driver position but gave up after hearing no response to his applications. He indicated that he previously was able to function as a driver because it is solitary, and he could avoid confrontation with petty people. He noted that he could not stand the stress of being a truck driver now because most car drivers were inconsiderate, and he could not tolerate the long hours. He stated that he could not "put up with people who mess with [him]." The Veteran indicated that he avoided most stress now by staying in a controlled environment where his wife helped him stay calm. He still did yell out of the car window at bad drivers. He took melatonin for help with sleep but had never been prescribed medications or received other treatment for mental illness. The Veteran noted that he had been married 3 times, with the first 2 marriages ending in divorce partly because of his anger and detachment issues. He stated that his current wife of 18 years was very patient and helped him avoid stress and live a healthy lifestyle. His relationship with his grown daughter was close. He also reported that he had 2 close friends and attended church once per week with his wife. The examiner indicated that symptoms associated with the Veteran's psychiatric disability included difficulty in establishing and maintaining effective work and social relationships and difficulty in adapting to stressful circumstances, included work or a work-like setting. On mental status examination, the Veteran was alert and oriented, casually dressed, and appropriately groomed. Mood was mostly euthymic. Affect was full in range. Thought process was mostly linear and goal directed. The Veteran denied suicidal or homicidal ideation. No psychotic behavior was indicated or observed. Cognitive function was intact during the interview. Judgment and insight were fair. The examiner diagnosed PTSD and found the disability to be productive of 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. In a statement received in May 2018, the Veteran's spouse reported that the Veteran had difficulty handling stress when working. It got to the point where he refused to drive to Los Angeles because it was too stressful. She noted that she was scared to drive with him on the highway because his road rage was frightening. She indicated that his anger affected everyone around him and caused him to become isolated. If she disagreed with him about anything, he yelled at her and in the past had shoved her in anger. She expressed that she "walked on eggshells" around him. He had no social contacts outside of a friend who he spoke with once per month. She further noted that he had difficulty establishing relationships with others as he did not accept people who had a difference of opinion and could not accept others for who they are. She also expressed that she thought it would be dangerous for him to try to return to work as a truck driver due to his anger issues. He could not work a job where he had to work with other people who had different opinions. The Veteran submitted his own statement in May 2018, in which he described the impact of his Vietnam experiences on his functioning. He noted that he had been through 2 divorces and could not let them close to him. He had to work every day on his current marriage to deal with his anger. He noted that he had fewer attacks of stress and anger because he was no longer working. He indicated that he could not deal with other drivers and could not go back to truck driving. The Veteran further noted that he did not have any close friends that he saw regularly. He found it hard to develop close social relationships as he got irritated with others. On VA examination in June 2018, the Veteran reported that he isolated himself more from others. He denied depressive symptoms such as daily sad mood, loss of pressure, and suicidal ideation. The Veteran noted that he had 1 friend. He avoided crowds but could go to the movies even if it was crowded. He reported that his relationship with his wife was okay, though sometimes lacking in affect. He had 1 daughter and his relationship with her was good, though little things could "tick them off." He retired in 2013 after he was laid off. He was able to work at his last place of employment because his employer was able to accommodate his restrictions on driving certain places. The Veteran did not take any medication and stopped psychotherapeutic treatment in 2011 or 2012. His wife reported that if something "ticked him of, he doesn't go back." Symptoms associated with the Veteran's psychiatric disorder included anxiety, suspiciousness, mild memory loss, impairment of short- and long-term memory, disturbances in motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and difficulty in adapting to stressful circumstances, including work or a work-like setting. On mental status examination, the Veteran's general appearance was appropriate Thought process was rambling and tangential. His affect was congruent and appropriate to the conversation. Speech rate was normal. He was alert and oriented. He asked his wife to help him remember and explain things. The examiner diagnosed PTSD and alcohol use in full sustained remission. The examiner commented that the Veteran's PTSD was characteristic of nightmares, flashbacks, recurring thoughts, intense reactions to reminders of past traumas, avoidance symptoms, anger and irritability, hypervigilance, concentration problems insomnia, loss of interest or pleasures, persistent negative amotions states, inability to experience positive emotions, negative beliefs about self, world, and others, tendency to illogically blame himself for trauma, and feelings of detachment from others, trouble sleeping, and trouble concentrating. The Veteran's prior substance abuse was in remission. The substance use was independent and separate from PTSD. The examiner determined that the disability was productive of occupational and social impairment with reduced reliability and productivity. The examiner commented that the Veteran's rating was really in-between "reduced reliability" and "deficiencies in most areas." The examiner noted that the Veteran's PTSD is not what led to his stopping work; however, his PTSD may keep him from working the vast majority of other employers. A September 2018 VA examination report reflects the Veteran's report that his third wife had recently left him without notice and moved with her sister. He reported that she had accused him of unspecified abuse, which he vehemently denied. The Veteran had a daughter from his second marriage with whom he had a good relationship. Symptoms related to the Veteran's disorder included anxiety, suspiciousness, chronic sleep impairment, disturbances in motivation and mood, difficulty in establishing and maintaining effective work and social relationships and difficulty in adapting to stressful circumstances, included work or a worklike setting. On behavioral examination, the Veteran presented as alert and oriented. His mood was euthymic and his affect appropriate with full range. His eye contact was appropriate. Speech was normal in rate, volume, and prosody. Thought process was linear and goal directed. The Veteran denied suicidal or homicidal ideation plans or intentions. The examiner diagnosed PTSD and indicated that the disability was productive of 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. In a January 2019 addendum, the examiner commented that the Veteran's PTSD had resulted in 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 Veteran's PTSD would result in occasional decrease in ability to perform complex tasks and a decrease in ability to maintain an appropriate workload. In a November 2019 statement, the Veteran's spouse reported that she had moved out of their home in July 2019 because she could not live with his outbursts. She indicated that she believed that their separation had increased his PTSD. A March 2020 report from private psychologist E. L. reflects that he reviewed the Veteran's claims file and conducted a clinical interview. He noted that he found the Veteran's statements during the interview to be consistent with the medical records he reviewed. The Veteran reported that he was married but was separated and his wife was living in a different state since 2018. He had one adult daughter with whom he had a good relationship. He reported that he had just a few friends. The Veteran reported that he stopped working in 2013. He indicated that he was very uptight and could not relax on the job. He reported sleep disturbances with nightmares as well as irritability and anger outbursts. The Veteran also noted hypervigilance and suspiciousness. Other symptoms including avoidance, detachment, startle response, and general anxiety were noted. He indicated that he had just a few friendshe kept in touch with a high school friend and had a friend from church but had not made many new friends for a long time. He reported that he could not really function outside of his routine. The psychologist noted that he disagreed with the assignment of occupational and social impairment with occasional decrease in work efficiency noted on the January 2016 examination. In particular, that examiner had indicated difficulty in adapting to stressful circumstances which denoted a much higher degree of occupational and social impairment. The Veteran had reported on exam that his first two marriage ended due to anger and detachment issues, and he was unable to handle the stress of his trucking job. On review of the record, the examiner found it apparent that the Veteran's severe mental health issues were documented as far back as 2013. He found that the Veteran's records and clinical interview demonstrated severe mental health issues and concurrent severe social and occupational impairment going back to at least July 2012. Dr. L. indicated that the Veteran was completely impaired from an employment point of view. He indicated that the Veteran's volatility was of such a degree that it was unlikely that he could work around coworkers and supervisors without the probability of significant verbal and possibly physical confrontations, as demonstrated by his wife's May 2018 statement. Also, he tended to isolate himself, but was compounded by his intrusive memories and periodic dissociative episodes/flashbacks. He believed that the Veteran's ability to concentrate on job-related tasks would be significantly impaired. Due to high levels of anxiety, he was unable to even tolerate a fairly low stress job as a truck driver and had minimal interactions with others. The examiner indicated that the Veteran's PTSD had resulted in deficiencies in most areas, including work, family relations, judgment, and thinking. Diagnosis of PTSD as well as secondary major depressive disorder due to his active-duty related stressors were assigned. In his opinion, the Veteran's disability had rendered him unable to secure or follow a substantially gainful occupation. An April 2020 private vocational assessment reflects past work history of working at his family's dry-cleaning business, working in real estate buying and fixing up properties, and then working as a truck driver. The Veteran related that his anxiety caused him to go through a lot of trucking companies before he found his last employer who only had 2 trucks and tolerated his problems. He related that his last employer gave him special treatment and let him pick his routes to drive due to his psychiatric limitations causing him high stress. After review of the medical evaluations and records the vocational assessor concluded that the Veteran was not employable due to his service-connected PTSD, and that he has been unable to work since at least February 2013, when he last worked. In a September 2021 statement, the Veteran's representative asserted that the Veteran had been severely socially and occupationally impaired by his PTSD since November 2015. In sum, the aforementioned evidence reflects that the Veteran's psychiatric disorder has been manifested by anger, anxiety, depression, sleep impairment, some mood and concentration issues, and difficulties with maintaining relationships. In the opinion of the Board, the frequency, severity, and duration of these symptoms have been productive of occupational and social impairment with deficiencies in most areas. Such symptomatology is consistent with a higher 70 percent rating. Accordingly, the Board finds that a 70 percent rating throughout the appeal period is warranted. These symptoms have been relatively consistent throughout the appeal period, and therefore a uniform 70 percent rating is assigned prior to and from June 2, 2018. The Board acknowledges that the evidence has varied, particular with regard to the 2016 examination report; however, the Veteran's and his spouse's statements suggest that more severe symptomatology was present prior to June 2018, and the private psychologist report also challenged the 2016 examiner's conclusion and provided support for finding that more significant symptoms present prior to 2018. Accordingly, the Board resolves reasonable doubt in the Veteran's favor and finds that a 70 percent rating is warranted throughout the appeal period. However, at no point during the period of the appeal is the service-connected PTSD shown to have met the criteria for a rating in excess of 70 percent. As noted, a 100 percent rating requires total occupational and social impairment due to symptoms such as gross impairment in thought processes or communication; persistent delusions; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of closes relatives, own occupation, or own name. Although no particular symptom is required, the probative evidence does not show such symptoms as delusions, hallucinations, disorientation to time or place severe memory loss, gross impairment in thought process, persistent danger to himself or others, or grossly inappropriate behavior. While the Veteran has documented problem of irritability and anger, and his spouse indicated that he had shoved her on occasion, persistent danger to others has not been demonstrated. The Veteran has also consistently denied suicidal ideation. Therefore, persistent danger to self or others is not demonstrated. Nor had the Veteran presented with symptoms of similar severity. Notably, with respect to social functioning, the record reflects that although the Veteran is socially withdrawn and is now separated from his current spouse, he reports good relationships with his child and some acquaintances and participates in some social activities. Thus, it cannot be said that he has "total" social impairment, and such is consistent with the findings on examination. Without evidence of more serious social impairment, a higher rating is not warranted. Overall, the Veteran has not demonstrated symptoms consistent with or approximating the general level of impairment warranting a 100 percent evaluation or akin to the symptoms as found in the rating criteria. Mauerhan, supra. Accordingly, the Board finds that a uniform 70 percent rating for PTSD, but no higher, is warranted. In reaching this decision, the Board has considered the benefit-of-the-doubt doctrine. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). Effective Date 3. Entitlement to an effective date earlier than November for the award of an increased rating for PTSD The effective date of an award of increased compensation to a Veteran shall be the earliest date as of which it is ascertainable that an increase in disability has occurred if application is received within one year of such date. 38 U.S.C. § 5110 (b)(2); 38 C.F.R. § 3.400(o)(2); Harper v. Brown, 10 Vet. App. 125 (1997). Otherwise, the effective date is the date of receipt of claim. 38 U.S.C. § 5110 (b)(2); 3.400(o)(2). Under 38 U.S.C. § 5101(a), a specific claim must be filed in order for benefits to be paid or furnished to any individual under the laws administered by VA. See also 38 C.F.R. § 3.151(a). Effective March 24, 2015, VA amended its regulations to require that all claims governed by VA's adjudication regulations be filed on a standard form. Prior to March 24, 2015, VA recognized both formal and informal claims. The amendments also, inter alia, eliminated the constructive receipt of VA reports of hospitalization or examination and other medical records as informal claims to reopen. See 79 Fed. Reg. 57,660 (Sept. 25, 2014), codified as amended at 38 C.F.R. §§ 3.151, 3.155. The amended regulations, however, apply only to claims filed on or after March 24, 2015. Prior to March 2015, any communication or action indicating an intent to apply for one or more benefits under laws administered by the VA from a claimant may be considered an informal claim. Such an informal claim must identify the benefits sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. 38 C.F.R. § 3.155(a). To determine when a claim was received, the Board must review all communications in the claims file that may be construed as an application or claim. See Quarles v. Derwinski, 3 Vet. App. 129, 134 (1992). In November 2015, the Veteran submitted a VA Form 21-526b, Supplemental Claim, seeking an increased rating for his service-connected PTSD. In the January 2016 rating decision on appeal, the RO assigned an increased, 50 percent rating effective the November 24, 2015, date of receipt of claim. By way of background, in June 1998 rating decision, the RO granted service connection or PTSD and assigned a 30 percent rating, effective September 6, 1996. The Veteran filed a claim or increased rating in March 2005; a February 2006 rating decision continued the 30 percent rating assigned. The Veteran did not perfect an appeal as to these matters, and no additional evidence was received within one year. Therefore, the June 1998 and February 2006 rating decisions became final. See 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 20.302, 20.1103. Following the February 2006 rating decision, the Veteran filed an informal claim in July 2012 seeking an increased rating for PTSD. It does not appear in the record that the Veteran was provided a formal claim for benefits following the June 2012 informal claim. He subsequently submitted a formal claim for benefits in November 2015. As discussed above, the former 38 C.F.R. § 3.155 states that an application form should be forwarded to a claimant for execution of a formal claim upon receipt of an informal claim, and if a formal claim is received within one year from the date it was sent to the claimant, it will be considered filed as of the date of receipt of the informal claim. Here, the Veteran's formal application was not received until November 2015, more than a year after his informal claim was received. However, because the Veteran was not provided a formal application by VA for completion concerning this informal claim, the Board finds that he preserved the effective date of the informal claim that was received by VA on July 22, 2012. Accordingly, July 22, 2012, is the date of claim. See Quarles, 3 Vet. App. 129. The question remains as to whether to the earliest date as of which it is ascertainable that an increase in disability had occurred. In determining when an increase is "factually ascertainable," VA should look to the record as a whole, including testimonial evidence and expert medical opinions, to determine when the increase took place. VAOPGCPREC 12-98 at 5. In this case, there is no record of treatment or examination dated within one year of the July 2012 claim through November 2015. The Board has considered the record as a whole, to include the assessments and evaluations dated after November 2015, and concludes that the record does not show that it was factually ascertainable that the Veteran's increase in severity occurred during the one-year period prior to receipt of his increased rating claim and prior to November 2015. There are no evaluations contemporaneously documenting the frequency, severity, and duration of the Veteran's psychiatric symptoms dated during this period. Although the Veteran reports that he lost his job in 2013, there is no evidence, including any statements from the Veteran, to determine with any degree of certainty a specific date on which it was factually ascertainable that an increase in disability had occurred prior to November 2015. As such, the evidence does not demonstrate that it is factually ascertainable that an increase in disability occurred within the one-year period preceding receipt of the Veteran's increased rating claim in July 2012, and prior to November 2015. Accordingly, the preponderance of the evidence is against the assignment of an effective date prior to November 24, 2015, for the award of a 50 percent disability rating for PTSD (now rated as 70 percent). As the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule is not for application, and the claim must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49, 54-56 (1990). 4. Entitlement to a TDIU prior to June 2, 2018. The Veteran contends that he is unemployable as a result of his service-connected disabilities and has indicated that he is unemployability as a result of his service-connected PTSD. VA will grant a total rating for compensation purposes based on unemployability when the evidence shows that the Veteran is precluded, by reason of his service- connected disabilities, from obtaining and maintaining substantially gainful employment consistent with his education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. Total disability ratings for compensation based on individual unemployability may be assigned where the schedular rating is less than total, when it is found that the 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, 3.341, 4.16(a). For the above purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable; (2) disabilities resulting from common etiology or a single accident, (3) disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric, (4) multiple injuries incurred in action, or (5) multiple disabilities incurred as a prisoner of war. Id. The central inquiry is, "whether the veteran's service-connected disabilities alone are of sufficient severity to produce unemployability." Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Consideration may be given to the Veteran's education, special training, and previous work experience, but not to his age or to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19; see also Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). In order for a veteran to prevail in a claim for TDIU, the record must reflect circumstances, apart from non-service-connected conditions, that place him or her in a different position than other veterans who meet the basic schedular criteria. The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. A high rating in itself is recognition that the impairment makes it difficult to obtain or keep employment. The ultimate question is whether the veteran, in light of his or her service-connected disorders, is capable of performing the physical and mental acts required by employment, not whether he or she can find employment. See Van Hoose, 4 Vet. App. at 361. In Geib v. Shinseki, 733 F.3d 1350 (2013), the Federal Circuit held that VA's duty to assist did not require obtaining a single medical opinion regarding the combined impact of all service-connected disabilities. "Indeed, applicable regulations place responsibility for the ultimate TDIU determination on the VA, not a medical examiner." Id. at 1354. At the outset, the Board notes that the Veteran previously met the schedular criteria for a TDIU from June 2, 2018, and a TDIU has been awarded for this period. In the Board's instant decision, an increased, 70 percent rating for PTSD has been assigned from November 24, 2015. Accordingly, the Veteran also meets the schedular criteria for a TDIU as of this date. As noted above, the records reflects that the Veteran has not worked since February 2013. The Veteran has reported that, although he stopped working due to his employer closing, he could not maintain employment as a truck driver regardless. As for the period from November 2015 to June 2018, the Board finds the evidence of record to be in relative equipoise as to whether the Veteran was unemployable as a result of his service-connected PTSD. In this regard, the 2020 private psychiatric evaluation and vocational rehabilitation expert concluded that the Veteran was unable to maintain employment during this period as a result of his psychiatric disorder. The Veteran's and his spouse's statements indicate that the Veteran had significant anger, irritability, and concentration issues prior to June 2018 that made his past employment as a truck driver no longer feasible. In addition, his statements regarding his past employer indicate that he received significant accommodations that might not be possible through another employer. Therefore, although the record reflects that the Veteran stopped working due to being laid off after the employer closed, and that he tried to obtain other employment afterwards, and the 2016 VA examiner concluded that the Veteran was not unemployable due to his service-connected psychiatric disorder, the evidence also showed significant issues with anger and irritability, difficulty getting along with others, impaired concentration, and other symptoms which appear incompatible with his prior work history. Accordingly, and resolving reasonable doubt in favor of the Veteran, the Board finds that the Veteran's service-connected psychiatric disorder rendered him unable to secure or follow substantially gainful employment from November 24, 2015, to June 2, 2018. Therefore, entitlement to a TDIU for this period is granted. SMC 5. Entitlement to SMC VA has a duty to maximize benefits in increased rating claims, to include consideration of SMC when raised by the record. Buie v. Shinseki, 24 Vet. App. 242 (2011); see also Bradley v. Peake, 22 Vet. App. 280, 294 (2008). Consistent with the Veteran's notice of disagreement, the Board has also considered whether SMC is warranted in this case. In order to qualify for SMC at the housebound rate, the Veteran must have a single service-connected disability rated 100 percent and either: (1) has an additional service-connected disability or disabilities ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems; or (2) is permanently housebound by reason of a service-connected disability or disabilities. As a result of this decision, a TDIU due to the Veteran's service-connected PTSD has been granted; thus, for SMC purposes, this disability satisfies the requirement of a service-connected disability rated at 100 percent. However, the Veteran is not service connected for any other disorder. Thus, the criteria for SMC at the housebound rate have not been met, and this claim must be denied. REASONS FOR REMAND As indicated above, the Veteran's TDIU claim is part-and-parcel of his increased rating claim for PTSD, which the Board notes stems from a July 2012, pending, informal claim. See Rice, 22. Vet. App. at 447. However, as indicated above, the Veteran does not meet the schedular criteria for entitlement to a TDIU prior to November 24, 2015. See 38 C.F.R. § 4.16. The record does reflect the Veteran stopped working in February 2013, and that his prior employer made significant accommodations for him at work, indicating that he may have been working in a protected work environment. Although the Board may not assign an extraschedular rating in the first instance, it must specifically adjudicate whether to refer a case for extraschedular evaluation when the issue either is raised by the claimant or is reasonably raised by the evidence of record. Barringer v. Peake, 22 Vet. App. 242 (2008). As this is such a case, extraschedular consideration is remanded for referral to the Director of Compensation Service. The matters are REMANDED for the following action: 1. Refer the Veteran's claim for a TDIU for the period prior to November 24, 2015, to VA's Director of Compensation Service for adjudication in accordance with 38 C.F.R. § 4.16(b). D. SMART Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. E. Wilkerson, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.