Citation Nr: 21069681 Decision Date: 11/19/21 Archive Date: 11/19/21 DOCKET NO. 08-09 496 DATE: November 19, 2021 ORDER An initial rating in excess of 70 percent for posttraumatic stress disorder (PTSD) from May 31, 2007, is denied. Entitlement to a total rating based on individual unemployability (TDIU) from May 31, 2007, to December 3, 2014, is denied. FINDINGS OF FACT 1. From May 31, 2007, the preponderance of the evidence shows that the Veteran's PTSD is productive of no more than occupational and social impairment with deficiencies in most areas at all times. 2. From May 31, 2007, to December 3, 2014, while the Veteran meet the schedular requirements of 38 C.F.R. § 4.16(a), the preponderance of the evidence shows that he was able to secure and follow substantial gainful employment and the 38 C.F.R. § 4.16(b) criteria for referral of his claim to the Under Secretary for Benefits or the Director, Compensation Services for extraschedular consideration were not met because there is no reasonable possibility that he is unemployable by reason of his service-connected disabilities because he was gainfully employed. CONCLUSIONS OF LAW 1. The criteria for an evaluation in excess of 70 percent for PTSD have not been met from May 31, 2007. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 3.102, 4.7, 4.130, Diagnostic Code 9411. 2. The criteria for a TDIU have not been met from May 31, 2007, to December 3, 2014. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1968 to August 1970, including combat service in the Republic of Vietnam and his decorations include the Purple Heart Medal and the Combat Action Ribbon. This matter originally came to the Board of Veterans' Appeals (Board) from an October2007 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) which granted service connection for PTSD and assigned an initial 30 percent rating, effective May 31, 2007. In a May 2012 rating decision, the RO increased the rating for PTSD to 50 percent, effective April 12, 2012. In October 2015 a Veterans' Law Judge not the undersigned, among other things, remanded the claims for a higher evaluation for PTSD and the claim for a TDIU. In a September 2017 decision a Veterans' Law Judge not the undersigned, among other things, issued a Board decision that granted an initial 50 percent rating for PTSD effective May 31, 2007, and remanded the TDIU claim. The Veteran appealed the September 2017 Board decision to the United States Court of Appeals for Veterans Claims (Court). In a May 2018 order, which incorporated the parties Amended Joint Motion for Partial Remand (JMPR-1), the Court vacated and remanded the portion of the Board's September 2017 decision which denied an initial rating in excess of 50 percent for PTSD. In October 2018, the Board remanded the claims for an initial rating in excess of 50 percent for PTSD and for a TDIU. In a December 2018 rating decision, the RO granted the Veteran a TDIU effective December 3, 2014, even though the claim, under Rice v. Shinseki, 22 Vet. App. 447 (2009), was part of the claim for an increased rating for PTSD which had been pending since May 31, 2007. Also see Fenderson v. West, 12 Vet. App. 119, 125-26 (1999); AB v. Brown, 6 Vet. App. 35 (1993). In March 2019 and October 2019, the Board, among other things, remanded the claim for an initial rating in excess of 50 percent for PTSD from May 31, 2007, and the claim for a TDIU from May 31, 2007, to December 3, 2014. In a February 2020 decision a Veterans' Law Judge not the undersigned issued a Board decision that granted an initial 70 percent rating for PTSD effective May 31, 2007, and denied the claim for a TDIU from May 31, 2007, to December 3, 2014. The Veteran appealed the February 2020 Board decision to the Court. In a January 2021 order, which incorporated the parties Joint Motion for Partial Remand (JMPR-2), the Court vacated and remanded the portion of the Board's February 2020 decision to the extent that it denied a rating in excess of 70 percent for PTSD from May 31, 2007, and denied the claim for a TDIU from May 31, 2007, to December 3, 2014. Initially, the Board notes that additional evidence was added to the claims file since the RO issued the April 2019 and August 2020 supplemental statements of the case. Nonetheless, the Board finds that it may adjudicate the appeal without first remanding this evidence for agency of original jurisdiction (AOJ) review because in October 2021 the Veteran's representative waived such review. See 38 C.F.R. § 20.1304(c). More delay in this case, in light of the above, would be unconscionable. In this regard, the Board apologies for the delays in the full adjudication of this case. The concerns raised by the JMPR-1 and JMPR-2 as well as post-Remand compliance As to the concerns raised by JMPR-1 and JMPR-2, the Board finds that the below decision addresses these concerns because when addressing below whether the Veteran meets the criteria for a 100 percent rating for PTSD it specifically considers the significance, if any, of all of his adverse symptomatology to include, as directed by the JMPR-1 and/or JMRP-2 the following evidence: i. the September 2016 statement from the Veteran's spouse regarding his aggression while driving and the confrontations he has with his co-workers and supervisors; ii. September 2016 statement from the Veteran's spouse regarding the appellant "...[not] even keep himself clean" and his wife having to "...to constantly tell him to take a shower;" iii. the January 2017 statement in which it was reported that the Veteran did not "shower or change [his] clothes at least four or five times per week;" and iv. the January 2017 statement in which it was reported that the Veteran was unable to perform daily tasks. Therefore, the Board finds that no further discussion of this concern is needed at this time. As to post-Remand compliance, the Board finds that the VA examinations obtained in August 2016 and November 2018, when taken together, are adequate to rate the Veteran's PTSD and adjudicate the TDIU claim because they included an examination and/or a review of the record on appeal with opinions as to the severity of his PTSD that considered his treatment records, the appellant's, his friends, and his families competent and credible lay claims regarding his observable symptomatology, and the opinions/conclusions are supported by medical reasoning and citation to controlling medical literature. See 38 U.S.C. § 5103A(d); Barr v. Nicholson, 21 Vet. App. 303 (2007); Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97 (2008) (holding that only substantial, and not strict compliance with the terms of a remand request is required); Dyment v. West, 13 Vet. App. 141, 146-47 (holding that there was no Stegall violation when the examiner made the ultimate determination required by the Board's remand, because such determination more than substantially complied with the Board's remand order); Guerrieri v. Brown, 4 Vet. App. 467, 473 (1993) ("the probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion the physician reaches.... As is true with any piece of evidence, the credibility and weight to be attached to these opinions [are] within the province of the [Board as] adjudicators..."). The Board also finds that the post-Remand development substantially complied with the Remand because all identified and available VA and private treatment records were obtained and associated with the claims file. See 38 U.S.C. § 5103A(b); Stegall, supra. Therefore, the Board finds that further delay by remanding the appeal to obtain another opinion or to obtain additional medical records is not required. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran are to be avoided). Further development or analysis does not serve the interests of the appellant or the Veterans' Administration (VA). The Rating Claim The Veteran and his representative claims, in substance, that the adverse symptomatology caused by the appellant's PTSD warrants a 100 percent rating from May 31, 2007. Disability evaluations are determined by the application of a schedule of ratings which is based, as far as can practically be determined, on the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Each service-connected disability is rated on the basis of specific criteria identified by a Diagnostic Code. 38 C.F.R. § 4.27. When rating the Veteran's service-connected disability, the entire medical history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Separate higher or lower compensable evaluations may be assigned for separate periods of time if such distinct periods are shown by the competent evidence of record during the appeal, a practice known as "staged" ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119, 126 (1999). Regulations require that where there is a question as to which of two evaluations is to be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The assignment of a particular diagnostic code is "completely dependent on the facts of a particular case." See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual's relevant medical history, the current diagnosis and demonstrated symptomatology. Any change in a diagnostic code by VA must be specifically explained. Pernorio v. Derwinski, 2 Vet. App. 625 (1992). In evaluating the evidence, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Indeed, the Court has declared that in adjudicating a claim, the Board has the responsibility to do so. Bryan v. West, 13 Vet. App. 482, 488-89 (2000). In doing so, the Board is free to favor one medical opinion over another, provided it offers an adequate basis for doing so. Owens v. Brown, 7 Vet. App. 429, 433 (1995). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Veteran's PTSD is rated as 70 percent disabling under 38 C.F.R. § 4.130, Diagnostic Code 9411 (the General Rating Formula for Mental Disorders (General Formula)) from May 31, 2007. The General Formula provides a 50 percent rating is warranted when the evidence shows occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is warranted when 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 posttraumatic stress disorder (PTSD) affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships. A 100 percent rating is warranted when the evidence shows total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Ratings are assigned according to the manifestation of particular symptoms. However, the use of the term "such as" in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). When determining the appropriate disability evaluation to assign, however, the Board's "primary consideration" is the Veteran's symptoms. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013). The Court has also held that suicidal ideation generally rises to the level contemplated in a 70 percent evaluation. See Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017) (stating the language of 38 C.F.R. § 4.130 "indicates that the presence of suicidal ideation alone, that is, a veteran's thoughts of his or her own death or thoughts of engaging in suicide-related behavior, may cause occupational and social impairment in most areas."). Similarly, the Court has held that, "it is the information in a medical opinion, and not the date the medical opinion was provided that is relevant when assigning an effective date." Tatum v. Shinseki, 24 Vet. App. 139, 145 (2010) (discussing assignment of an effective date for a reduction in disability rating under Diagnostic Code 7528); see also Young v. McDonald, 766 F.3d 1348, 1352-53 (Fed. Cir. 2014). (holding that a medical opinion can diagnose the presence of the condition and identify an earlier onset date based on preexisting symptoms). Initially, the Board notes that because the claim has been pending since 2007, approximately six year before the issuance of the AMERICAN PSYCHIATRIC ASSOCIATION: DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, 5th Edition (2013) (DSM-5) and eleven years before the Court issued its' decision in Golden v. Shulkin, 29 Vet. App. 221 (2018) it is unclear whether the Board's adjudication of the claim can include a discussion of the Global Assessment of Functioning (GAF) scores found in the record. Nonetheless, with giving the Veteran the benefit of doubt in this case, the Board finds that they below adjudication will include such a discussion. As discussed in more detail below, the Board finds that after considering the frequency, severity, and duration of the Veteran's PTSD symptoms the criteria for a higher, 100 percent, rating are not met at any time from May 31, 2007. The Board has reached this conclusion because, and as will also be explained in more detail below, even when considering the totality of the Veteran's adverse psychiatric symptomatology it shows that his PTSD does not cause total occupational and social impairment from May 31, 2007. See Owens, supra; Also see VA examinations dated in October 2007, March 2009, December 2010, April 2012, August 2016, and November 2018; letter from the Veteran's VA treatment provider dated in June 2015; private psychiatric evaluation dated in May 2017; and vocational assessment dated in September 2021. Initially, that Board notes that an October 2007 VA examination report showed that the Veteran reported difficulty with sleep. Intrusive thoughts were reported about Vietnam that made him emotional and tearful. He reported that these incidents occurred once per week. Exaggerated startle responses were only reported if the Veteran witnessed something related to war on TV, which was then followed by avoidance behavior. Hypervigilant behavior was reported in the form of sitting with his back to the wall when in public and being uncomfortable in large groups of people. Anger and irritability with physical outbursts were not reported to have occurred for the last 20 years, but verbal outbursts were reported. The Veteran reported that he had good relationships with his two siblings and had been married divorced five times but had a girlfriend since 2006. The Veteran also had five children but only maintained a relationship with one. The Veteran reported that his current occupation was of a custom furniture builder and stated that he was having some difficulty performing work due to his physical health. The examiner reported that it did not appear that his mental health symptomatology had been significant in the impairment of his work performance. The Veteran was noted to maintain his personal hygiene with a clean and casual appearance. He was noted to be capable of meal preparations and other chores of daily living. He reported socializing with his girlfriend and a couple of friends. The examiner reported that overall, the Veteran related anger and irritability as occasional and brief in duration. Mental status examination showed normal memory; oriented in all spheres; normal speech; tic of the mouth was noted; thought processes was spontaneous, sometimes overabundant in detail; continuity of thought contained considerable rambling and some tangential responses; no suicidal or homicidal ideations; no delusions; abstract ability and concentration were both satisfactory; mood was euthymic; affect broad; judgement adequate; and insight was fair. The Veteran was diagnosed with PTSD. The examiner remarked that the Veteran's symptomatology was in the moderate range. The March 2009 and December 2010 VA examination reports show that the Veteran reported feeling regretful and was very easily angered and quick tempered. He reported that he was not experiencing nightmares although he was still having difficulty with sleep. The Veteran reported that he avoided crowds and was hypervigilant. Startle responses were also reported. The Veteran reported being distant with people and had only one good friend. Intrusive thoughts on a daily basis were reported. He also reported experiencing a difficulty in short term memory and concentration. The Veteran reported working in woodworking but was not working at the time due to his PTSD symptoms. He reported that he had an attitude and did not like being told what to do and liked being left alone at work. The Veteran reported still being in contact with his two sisters. The Veteran reported that he was living with someone he used to have a romantic relationship with but now were just friends and roommates. He reported that he was able to complete all activities of daily living without any assistance. No current hobbies or interests were reported. Mental status examination shows that the Veteran was alert; oriented time three; casually dressed; mood was regretful and/or irritated, angry, and quick tempered; affect was appropriate to content; good eye contact; rate, tone, and volume of speech were within normal limits; no psychomotor agitation or retardation were observed; memory was not formally assessed; thought process was logical and goal oriented; no suicidal or homicidal ideation; no evidence of a psychotic disorder; judgment and insight appeared to be fair to good; and intelligence was estimated to be average. The examiner remarked that the Veteran's PTSD would have a bearing on any type of work environment he would find himself engaged in. The examiner reported that it was possible for the Veteran to be employed in an environment that would have a very minimal level of interaction with customers, supervisor, and co-workers. It was opined that his GAF score was 50 in March 2009 and 53 in December 2010. The December 2019 VA examiner also opined that the Veteran's GAF score in the last year was 55. An April 2012 VA examination report shows that the Veteran was diagnosed with PTSD. The Veteran was assessed with occupational and social impairment with reduced reliability and productivity. The Veteran reported that he had good relationships with his two sisters and continued to be married to this sixth spouse since April 2010. Contact with only two of his five children was reported. He also reported that he had detachment in relations to his social/leisure/recreation activities. The Veteran reported that he had one friend, but contact was noted to be monthly or less. The Veteran reported that he continued to work as a cabinetmaker and struggled at work due to health problems. He reported that he worked when he could, but his work performance was affected by physical health problems, not mental health issues. PTSD symptoms were noted as anxiety, 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, including work or worklike settings. It was opined that his GAF score was 50. A June 2015 letter from the Veteran's VA treatment provider reported that the Veteran was unable to hold job or perform requirements for a job. Near continuous panic attacks were noted. The VA treatment provider reported that the Veteran would have severe difficulty maintaining effective work relationships. Anxiety issues were noted to truly prevent the Veteran from working a desk job, answering phones, or being a Walmart greeter. The treatment provider remarked that it was more likely than not that the Veteran's service-connected issues rendered him unemployable. An August 2016 VA examination shows that the Veteran was diagnosed with PTSD. The Veteran was assessed with occupational and social impairment with reduced reliability and productivity. The Veteran reported that he was married and reported ongoing problems as not doing things together with his spouse and loss of intimacy. He reported seeing one of his daughters monthly and talking on the phone weekly. He also reported talking to his son once per week. The Veteran had a buddy who was also a Veteran. He reported his only stress reliever was riding his motorcycle and participating in rallies. The Veteran reported that he had not worked since 2014 when he was employed as a cabinetmaker as he noted a history of problems with getting along with supervisors. Symptoms were noted as depressed mood, anxiety, chronic sleep impairment, disturbances of motivation and mood, difficulty in establishing and maintaining work and social relationships; and a difficulty in adapting to stressful circumstances, including work and worklike settings. The examiner noted that the Veteran cried during the examination and showed a spotty memory. Concentration was noted as adequate, insight was good, and orientation was intact. A May 2017 private psychiatric evaluation report shows that after a review of the record and examination of the Veteran that the symptoms of PTSD had caused occupation and social impairment with deficiencies in areas such as work, family relations, judgement, and mood, since May 2007, and social and occupational impairment due to disturbances in mood and temperament affecting the ability to function appropriately and effectivity, difficulty adapting to stressful circumstances, and an inability to establish and maintain effective social relationships. The private psychologist disagreed with the October 2007 VA examiner in that the examiner only considered present symptomology and did not take into account that the Veteran had multiple marriages and only one friend. The private psychologist also noted that the March 2009 VA examination report suggested a very limited realm of work options that was not consistent with the Veteran's work experience. Regarding the December 2010 VA examination, the examiner disagreed with the report's emphasis of the Veteran's physical pain rather than PTSD symptomatology. The private psychologist reported that the evidence of record demonstrated an inability to maintain significant social relationships due to consistent patterns of mood instability and social isolation, to include necessary physical and emotional connections. It was also reported that the Veteran's inability to adequately relate and interact appropriately with supervisors suggests deficiencies in judgement, rational thinking, impaired impulse control, and lack of adequate emotional control. Additionally, the private psychologist reported that the Veteran has social and occupational impairment with deficiencies in most area such as work, family relations, judgement, and mood since May 2007 to the present, due to impairment of disturbances of mood and circumstances; and an inability to establish and maintain effective social relationships. Further it was reported that the Veteran's psychiatric disability precluded his ability to secure and follow substantially gainful employment. In a September 2016 statement, the Veteran's spouse detailed social isolation, outbursts of anger, lack of hygiene, and other symptoms related to the Veteran's PTSD. Specifically, she stated as follows: He would argue with me about little things and would cut me short when I tried to present my side. When we're on the road, he would sometimes raise his voice and say the "F_" word when some unruly drivers got in our way. There were times he wanted to race up to them and fight. I had to pacify him. He used to work making wood furniture and often times came home complaining about people in the shop. He confronted co-workers not agreeing to his opinions and ideas, or apparently showing oppressive attitudes. He even fought with his bosses. He ended up not staying long in one job and transferred from one employer to another. From 2010 to 2014, he worked in 6 companies. Since he retired 2 years ago, his moods became intolerable. He has not been helping in the house that leaves me doing chores when I come home from work. He doesn't even keep himself clean that I have to constantly tell him to take a shower. What scares me though, are the nightmares that he's been having. On a few occasions, I was awakened when his arms were swinging and hitting me. Because of these, I decided to sleep in a separate bedroom. He has not shown me affection for the past years. We have not been going out to have fun or even watch movies. In a January 2017 statement, the Veteran detailed his social isolation, outbursts of anger, lack of hygiene, and other symptoms related to his PTSD, and provided as follows: I also experience symptoms of my PTSD that prevent me from working and completing daily tasks. I suffer from depression, anxiety; paranoia, and irritability on a daily basis. I experience anxiety in the form of excessive worry and irrational thoughts that occur at least two times per day. I worry about everything in my life and I have irrational thoughts in regards to my general safety. For example, while I am riding my motorcycle, I don't care about riding recklessly, and subsequently do not care about the sake of my life or others. I also experience depression at least three to four times per day. My depressive symptoms are characterized by withdrawn affect, lack of motivation, and disinterest. As a result, I do not shower or change my clothes at least four or five times per week. On occasion, my depressive symptoms will also include feeling extremely sad and occasional crying. I also experience anxiety, nervousness, and paranoia whenever I am around people or in large crowds. Therefore, I stay at home as much as possible and do not socialize with anyone. While I was working, I did not like the daily interaction I had with other people because it made me nervous and I did not trust anyone. I was hypervigilant and paranoid; I would always be watching the other people around me the entire time I was at work. Because we were all working with tools, I thought that my coworkers would use them to hurt me. My distrust, irritability, and nervousness made it very easy for me to become angry with my coworkers and supervisors. They were always disrespectful to me and I got into multiple verbal arguments with them. On one occasion, I challenged my supervisor to meet me outside because I wanted to physically harm him. My supervisor did not meet me outside, and I was terminated following this incident. My service-connected conditions have also impacted my personal relationships. I have been married six times because I neglected to address my PTSD symptoms for some time and I was hard to live with as a result of my depressed mood, irritability, and lack of motivation. My current relationship with my wife is strained due to my lack of motivation to do anything for or with her, especially in regards to communicating. I also miss out on many family events because I don't want to be around people; my wife is going to spend Christmas with her family and I am staying at home by myself. I currently take medication and attend routine psychiatric treatment sessions in order to help manage the symptoms I suffer from daily. At the November 2018 VA examination, the Veteran reported that his relationships with his sisters is good, he had been married 6 times, he was last married in 2010, he is still married, his marriage has it's up and down, he currently lives with his wife, and he has 5 children with three different women. He reported that he has a few local friends, but rarely socializes. He also reported that he worries about his marriage. He avoids crowds and shopping. He has to sit with his back to the wall facing the doors in restaurants. As to his occupational history, the Veteran reported that he had "hundreds of jobs" since service that rarely lasted a year, he last worked in 2014, and he reported that at work he typically had trouble getting along with co-workers, supervisors, and the public, and this led to him being fired. On examination, it was opined that the Veteran's adverse PTSD symptomatology consisted of the following: a depressed mood; anxiety; suspiciousness; panic attacks that occur weekly or less often; chronic sleep impairment; 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; circumstantial, circumlocutory or stereotyped speech; impaired judgment; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty adapting to stressful circumstances, including work or a work like setting; inability to establish and maintain effective relationships; and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. His memory was mildly impaired. His mood was dysthymic. Otherwise, it was reported that he was appropriately dressed, he was casually groomed, his hands were clean, and his fingernails were trimmed and clean. He drove himself to this appointment. His speech was of normal tone, volume, and speed. His receptive and expressive language appeared to be intact. He was alert and oriented in all spheres. He was able to maintain attention and concentration during the interview. His eye contact was good and intermittent. His motor behavior was within normal limits and he displayed no unusual mannerisms. His affect was congruent. His thought processes were logical and goal oriented. He did not display any signs of paranoia or delusions. He denied any hallucinations. He did not appear to be responding to internal stimuli. He does not endorse symptoms consistent with mania, hypomania, OCD, self-injurious behaviors, eating disorders, or psychosis. There was no evidence of disorganized speech or bizarre behaviors. There was no evidence of elevated mood, decreased need for sleep, expansiveness, intensification of goal-directed activity, grandiosity, flight of ideas, or risky hedonistic pursuits. He denies suicidal thoughts and denies homicidal ideation and does not have a suicide plan or intent. He has made no suicide attempts. Next, it was noted that the Veteran reported having symptoms of depression with episodes of low motivation and energy. He is anhedonic. His appetite is good. He reports his libido is fair. He reported having thoughts of helplessness and hopelessness. He rarely has crying episodes. He admits to having irritability and verbal anger outbursts without recent throwing and breaking objects. He has road rage at times. He admits to having anxiety and nervousness. He admits to being jumpy and easily startled. He is hypervigilant. He is suspicious of others. He admits to having onset insomnia, taking an hour to fall asleep. He takes medication to help his sleep. He reports having repeated awakenings. He checks his locks and the perimeter when he awakens. He reports still having nightmares several times per month. He reports having night sweats when he has a nightmare. He is averaging 5 hours of interrupted sleep in a day. His wife has to remind him to take showers. It was opined that the Veteran's PTSD caused occupational and social impairment with reduced reliability and productivity. It was also opined that the Veteran could manage his own financial affairs. Lastly, as to the Veteran's ability to function in an occupational environment, it was opined as follows: The Veteran is 68 years old. He has not worked since 2014 when he was employed as a cabinet maker. He reports not getting along with his boss and the veteran was fired after working with the company for a year. The veteran reports a history of problems getting along with supervisors, indicating frequent verbal altercations. He is able to communicate. He has difficulty remembering and following instructions. He has some poor judgment, shows some insight, and can think abstractly. He has poor concentration. He is not able to interact with coworkers and/or customers due to his PTSD symptoms. He is unable to adapt to changes, stress, or demands at work. He is not able to work in public or in an enclosed space/cubicle. He may be able to work in a loosely supervised situation, requiring little interaction with the public. The claimant does not appear to pose any threat of danger or injury to self or others. Thereafter, in the September 2021 vocational assessment, the examiner noted that the Veteran lives with his sixth wife who he also isolates himself from and thereafter reported the Veteran's claims that his PTSD caused him to have problems with the following: hypervigilance; suspiciousness; the tendency to isolate and avoid the general public; anxiety; depression; anger and irritability; feelings of hopelessness; being distracted and unable to concentrate; low motivation; sleep disturbance with nightmares causing daytime fatigue which interferes with concentration and recalling information; and infrequently tending to his hygiene. It was also noted that the Veteran reported that he tries to control his anger. The examiner thereafter opined, in substance, that the Veteran could not work since February 2009 solely because of his service-connected PTSD. Initially, the Board finds that nothing in the Veteran's treatment records shows his adverse PTSD symptomatology is materially worse than what was reported by the above examiners nor documents complaints of adverse symptomatology not recoded in the above lay statements. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991) (VA may only consider independent medical evidence to support its findings and is not permitted to base decisions on its own unsubstantiated medical conclusions). Additionally, the Board notes that the Veteran's treatment record are uniform in reporting that his GAF score was, at its worst, a 45. See, e.g., VA treatment records dated in September 2015, December 2015, June 2016, September 2016, November 2016, February 2017, July 2017, March 2018, June 2018, September 2018, December 2018, March 2019, August 2019, December 2019, and June 2020. With the above evidence in mind, the Board first notes that while the criteria for a 100 percent rating specifically identifies problems with being a "persistent" danger of hurting self, and while this is not exclusive symptomatology, the Board finds the fact that the record, including the October 2007, March 2009, December 2010, April 2012, August 2016, and November 2018 VA examinations, May 2017 private psychiatric evaluation, and September 2021 vocational assessment and the VA treatment records, is negative for suicidal ideation, a suicide plane, or suicide attempt, and this fact weighs heavily against finding that the appellant's PTSD causes a "persistent" danger of hurting self. See Owens, supra. In this regard, the Board finds the Veteran's own words to the October 2007, March 2009, December 2010, April 2012, August 2016, and November 2018 VA examiners when he denied, in substance, current thoughts of suicide or a plan weights against the claim. See Owens, supra. Simply stated, on this very limited issue, the Veteran himself provides some evidence against this claim that is of high probative value. In fact, not all evidence in this case supports the current evaluation. Likewise, the Board notes that the criteria for a 100 percent rating specifically identifies problems with "memory loss for names of close relatives, own occupation, or own name" and the examinations and treatment records noted a problem with memory loss. See, e.g., VA examinations dated in August 2016 and November 2018; vocational assessment dated in September 2021. However, the Board finds the fact that the examiners that noted memory loss also opined that it was mild/had symptoms that were mild as well as because vocational assessment examiner reported that it was due to a lack of sleep and not an independent symptom as well as because the VA treatment records are negative for more severe memory loss than was reported by the examiners weighs against finding that the memory loss reported by some of the above examiners is the type of memory loss contemplated by the criteria for a 100 percent rating. See Owens, supra. Simply stated, based on a detailed review of the Veteran's overall statements over time, the Veteran himself is describing a 70% disability with his PTSD. Next, while not exclusive symptomatology the criteria for a 100 percent rating also specifically identifies problems with "persistent danger of hurting ... others," and, and, as noted in the JMPR-1, the Veteran's spouse in September 2016 reported that the Veteran was aggressive while driving as well as had confrontations with his co-workers and supervisors. Moreover, the Veteran told multiple examiners that he had problems with arguing with co-workers and employers as well as with "road rage." However, the Board notes that the record, including the October 2007, March 2009, December 2010, April 2012, August 2016, and November 2018 VA examinations, May 2017 private psychiatric evaluation, September 2021 vocational assessment, and the VA treatment records are negative for homicidal ideation. In fact, at the October 2007, March 2009, and November 2018 VA examinations the Veteran either specifically denied and/or the examiner found that the appellant did not have homicidal ideation. Therefore, the Board finds that the periodic problem the Veteran has with road rage as well as confrontations with his co-workers and supervisors is not the type of problem contemplated by the criteria for a 100 percent rating. See Owens, supra. Additionally, while not exclusive symptomatology the criteria for a 100 percent rating also specifically identifies problems with an "intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene)." Moreover, and as noted in the JMPR-1 and the JMPR-2, the Veteran's spouse in September 2016 reported that the Veteran "...[not] even [able to] keep himself clean" and she had to "...to constantly tell him to take a shower" as well as the January 2017 statement in which it was reported that the Veteran did not "shower or change [his] clothes at least four or five times per week" and the January 2017 statement in which it was reported that the Veteran was unable to perform daily tasks. Additionally, multiple examiners reported that the Veteran had an intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. See, e.g., VA examination dated in November 2018 and vocational assessment dated in September 2021. However, the October 2007, March 2009, December 2010, April 2012, and August 2016 VA examinations and May 2017 private psychiatric evaluation are negative for such adverse symptomatology. In fact, at the October 2007 VA examination it was reported that the Veteran was able maintain his personal hygiene with a clean and casual appearance and was capable of meal preparations and other chores of daily living. Similarly, the March 2009 and December 2010 VA examiners opined that the Veteran was casually dressed and was able to complete all activities of daily living without any assistance. Likewise, at the November 2018 VA examination the Veteran was appropriately dressed, was casually groomed, his hands were clean, and his fingernails were trimmed and clean. It was also noted that e drove himself to the appointment and could manage his own financial affairs. Likewise, the Board finds that most of the Veteran's treatment records are negative for more sever adverse symptomatology. Therefore, the Board finds that the periodic problem the Veteran has with maintenance of minimal personal hygiene is not the type of problem contemplated by the criteria for a 100 percent rating. See Owens, supra. Similarly, multiple examiners noted that the Veteran's PTSD caused problems with panic attacks, sleep impairment, nightmares, and/or flashbacks. See, e.g., VA examinations dated in October 2007, March 2009, April 2012, August 2016, and November 2018; private psychiatric evaluation dated in May 2017; and vocational assessment dated in September 2021. Moreover, while not exclusive symptomatology, the criteria for a 100 percent rating also specifically identifies problems with "gross impairment in thought processes or communication," "persistent delusions or hallucinations," and "grossly inappropriate behavior" "disorientation to time or place." However, the Board notes that the record, including October 2007, March 2009, December 2010, April 2012, August 2016, and November 2018 VA examinations, May 2017 private psychiatric evaluation, and September 2021 vocational assessment are negative for "gross impairment in thought processes or communication," "persistent delusions or hallucinations," and "grossly inappropriate behavior" "disorientation to time or place." In fact, at the October 2007, March 2009, December 2010, April 2012, August 2016, and November 2018 VA examinations, May 2017 private psychiatric evaluation, and September 2021 vocational assessment, the Veteran either specifically denied and/or the examiner found that the appellant did not have problems with most or all of the above types of adverse symptomatology. See Colvin, supra. Therefore, the Board finds that the periodic problem the Veteran has with panic attacks, sleep impairment, nightmares, and/or flashbacks is not the type of problem contemplated by the criteria for a 100 percent rating. See Owens, supra. Again, the Board finds the Veteran's own words and the examiners opinions weigh heavily against finding that his PTSD causes the type of adverse symptomatology required for a 100 percent rating at all times from May 31, 2007. See Owens, supra. Simply stated, as noted above, it is important for the Veteran to understand that not all the evidence in this case supports the 70 percent finding, let alone a higher rating. The Board also finds that the GAF scores of 45 to 55 found in the record weights against the Veteran's claim that his PTSD meets the criteria for a 100 percent rating because it causes total social and occupational impairment. See Owens, supra. The Board has reached this conclusion because under the AMERICAN PSYCHIATRIC ASSOCIATION: DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, 4th Edition (1994) (DSM IV) GAF scores of between 41 and 50 means the examiners believe that the Veteran's PTSD caused only "serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in social, occupational, or school functioning (e.g., no friend, unable to keep a job)" and/or "some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) or major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed man avoids friends, neglects family, and is unable to work . . .)." In this regard, the Board finds that all of the foregoing symptoms are contemplated and compensated for by the criteria for 50 percent and/or the 70 percent rating already in place for his PTSD. See Owens, supra. Again, it is important for the Veteran to understand that not all the evidence in this case supports the 70 percent finding, let alone a higher rating. Next, the Board finds that the preponderance of the evidence shows that the Veteran's PTSD does not cause total social and occupational impairment at all times from May 31, 2007. Id. In this regard, the Board notes that while the above examiners noted that the Veteran had been married six times, is socially isolated including from even his current wife with whom he has his ups and downs, as well as avoids crowds and shopping, it was also reported that that he remains married to and lives with his sixth wife since April 2010 (i.e., for over 11 years), keeps in touch with one or two of his five children, has a good relationship with his two sisters, and has one or two friends. See, e.g., VA examinations dated in October 2007, March 2009, December 2010, April 2012, August 2016, and November 2018; private psychiatric evaluation dated in May 2017; and vocational assessment dated in September 2021. The Veteran is simply dealing with a 70% disability for this PTSD, which will, by definition, cause the Veteran many problems. The Board finds that the Veteran's reports of being able to maintain the long term marriage and live with and maintain a relationship with his wife for a decade even though they have their ups and downs as well as maintain a relationship with some of his children, his sisters, and one or two friends weighs against finding his PTSD causes total social impairment at all times from May 31, 2007, despite his many social problems. See Owens, supra. Similarly, and as discussed in more detail below, the Board finds that the preponderance of the evidence shows that the Veteran's PTSD did not cause total occupational impairment at all times from May 31, 2007, to December 3, 2014, despite the many problems he had with his many employers as a cabinet maker or cabinet maker supervisor (i.e., the problems arguing with his co-workers and employers noted in the JMPR-1 as well as at many of the examinations) and the opinions provided by some of the above examiners regarding his PTSD being a bar to employment. See Owens, supra. The Board has reached this conclusion despite the above because, despite his many problems, the record shows that he had, in fact, obtained and maintained substantial gainful employment from May 31, 2007, to December 3, 2014. Id. Moreover, as to the December 3, 2014, to the present time-period the has not overlooked the fact that VA has already granted the Veteran a TDIU. Next, the record shows that the Veteran's VA treatment provider in June 2015, the private psychiatric evaluation in May 2017, the VA examiner in November 2018, and the vocational examiner in September 2021 all opined, in substance, that the Veteran could not work and/or would have a very difficult time working because of his PSD and/or because in part of his PTSD. However, the record is no way clear that the TDIU was granted solely because of the adverse symptomatology caused by his service-connected PTSD. Moreover, the Board finds that these opinions are not enough for the Veteran to meet the criteria of a 100 percent rating for a TDIU because the criteria requires' total social and occupational impairment and, as explained above, the preponderance of the evidence shows that the appellant did not also have total social impairment from December 3, 2014, to the present. Id. While the Veteran clearly has many problems due to his PTSD (this is not in dispute) which cause significant social and occupational impairment, the only question is the degree of the problem. Without taking into consideration his statements the 70 percent finding could not be justified based on this medical evidence. See Davidson, supra. Accordingly, the Board finds that the preponderance of the evidence shows that the Veteran's PTSD is not manifested by symptomatology that causes total social and occupational impairment at any time from May 31, 2007. See Owens, supra. Therefore, the Board finds that the criteria for a 100 percent rating are not met for the Veteran's PTSD at any time from May 31, 2007. See 38 C.F.R. § 4.130; Fenderson, supra; Hart, supra. The TDIU Claim from May 31, 2007, to December 3, 2014 While the Veteran already received a TDIU December 3, 2014, he claims' that his service-connected PTSD prevented him from working at all times during the pendency of the appeal which runs from May 31, 2007, because it is part of his claim for an increased rating for PTSD. See Rice, supra. In the alternative, in the Veteran's representative's October 2021 pleading it was argued that the Veteran met the criteria for a TDIU since January 2009, even though he worked until December 2014, because his episodic employment from January 2009 to December 2014 does not constitute substantial gainful employment because none of the jobs lasted more than a year. Total disability will be considered to exist 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. If the total rating is based on a disability or combination of disabilities for which the Schedule for Rating Disabilities provides an evaluation of less than 100 percent, it must be determined that the service-connected disabilities are sufficient to produce unemployability without regard to advancing age. 38 C.F.R. § 3.341. If the schedular rating is less than total, a total disability evaluation can be assigned based on individual unemployability if the Veteran is unable to secure or follow a substantially gainful occupation because of a service-connected disability, provided that the Veteran has one service-connected disability rated at 60 percent or higher; or two or more service-connected disabilities, with one disability rated at 40 percent or higher and the combined rating is 70 percent or higher. In calculating if the Veteran met the above schedular criteria VA combines the Veteran's service-connected orthopedic disorders. The existence or degree of non-service-connected disabilities will be disregarded if the above-stated percentage requirements are met and the evaluator determines that the Veteran's service-connected disabilities render his incapable of substantial gainful employment. 38 C.F.R. § 4.16(a). A TDIU may be assigned where the schedular rating is less than total if a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16(a). Generally, total disability will be considered to exist when there is present any impairment of mind or body that is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. Further, marginal employment, defined as an amount of earned annual income that does not exceed the poverty threshold determined by the United States Department of Commerce, Bureau of the Census, shall not be considered substantially gainful employment. 38 C.F.R. § 4.16(a). In this regard, 38 C.F.R. § 4.16(a) provides that when earned annual income exceeds the poverty threshold, marginal employment may also be held to exist, on a fact found basis (includes but is not limited to employment in a protected environment such as a family business or sheltered workshop). However, to date, neither the Court nor the Secretary has provided a definition as to what constitutes a "protected work environment." Nonetheless, the Board observes that the examples of "protected environment" used in the text of 38 C.F.R. § 4.16(a) are the family business and sheltered workshop. In the case of a family business, it is common for an employer to hire a relative to fill a position, not because the relative is necessarily the most capable or efficient prospective employee, but for reasons of affection or obligation. 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). It is imperative for the Veteran to understand that neither nonservice-connected disabilities nor advancing age may be considered in the determination. 38 C.F.R. §§ 3.341, 4.19; Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Furthermore, all Veterans who are shown to be unable to secure and follow a substantially gainful occupation by reason of service-connected disability shall be rated totally disabled. 38 C.F.R. § 4.16(b). In cases where the schedular criteria are not met, an extraschedular rating is for consideration. Id. As to a TDIU under 38 C.F.R. § 4.16(b) the Board notes that in Bowling v. Principi, 15 Vet. App. 1, 10 (2001), the Court, citing its decision in Floyd v. Brown, 9 Vet. App. 88, 94-97 (1995), held that the Board cannot award a TDIU under 38 C.F.R. § 4.16(b) in the first instance because that regulation requires that the RO first submit the claim to the Director, Compensation Service, for extraschedular consideration. In this regard, the Board notes that the appropriate standard in considering whether a remand for referral of consideration of extraschedular TDIU under 38 C.F.R. § 4.16(b) is found in Ray v. Wilkie, 31 Vet. App. 58, 65-66 (2019). In this regard, the Court in Ray held that "the decision... to refer [a case for extraschedular consideration under § 4.16(b)] and to award a [TDIU] rating are fundamentally different." 31 Vet. App. 58, 65 (2019). The Court held in Ray that "the initial extraschedular referral decision under § 4.16(b) addresses whether there's sufficient evidence to substantiate a reasonable possibility that a veteran is unemployable by reason of his or her service-connected disabilities." Ray, 31 Vet. App. at 66; id. at 66 n. 38 (explaining that this standard (for initial extraschedular TDIU referral decision) was similar to and merely elaborates on the well-grounded claim standard used in Stanton v. Brown, 5 Vet. App. 563,570 (1993)). 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). In this regard, it is imperative for the Veteran to understand that neither nonservice-connected disabilities nor advancing age may be considered in the determination. 38 C.F.R. §§ 3.341, 4.19; Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Lastly, and as noted in the JMPR-2, the ultimate issue of whether a TDIU should be awarded is not a medical issue, but rather is a determination for the adjudicator. Geib v. Shinseki,733 F.3d 1350 (Fed. Cir. 2013) ("applicable regulations place responsibility for the ultimate TDIU determination on the VA, not a medical examiner"). With the above criteria in mind, the record shows that the Veteran was service-connected for the following disability at all times from May 31, 2007, to December 3, 2014: PTSD rated as 70 percent disabling from May 31, 2007. The record also shows that for at least part of the May 31, 2007, to December 3, 2014, time-period the Veteran was also service-connected for the following disabilities: Right upper extremity radiculopathy rated as 20 percent disabling from February 12, 2009, to August 12, 2020; Left upper extremity radiculopathy rated as 20 percent disabling from February 12, 2009, to August 12, 2020; a neck disability rated as 10 percent disabling from February 12, 2009, to December 5, 2017; and a right knee disorder rated as 0 percent disabling from February 12, 2009, to June 28, 2012, and 10 percent disabling from June 28, 2012, to March 16, 2015. In his VA Form 21-8940, Veterans Application for Increased Compensation Based on Unemployability (TDIU Claim Form), dated or received in February 2009, March 2009, and December 2016, the Veteran reported, in substance, that he had not worked full-time and became too disabled to work full time in January 2009 or December 2014 because of his service-connected disabilities. The Veteran's statements on this key issue are not always clear. As to his work history the Veteran reported, in substance, that from 1987 to 1990 as a gas transport driver and, following a period of incarceration from 1991 to 2006, he worked from 2006 to 2014 as a cabinet maker or a cabinet maker supervisor at numerous places of employment. Specifically, the TDIU Claims Forms note the following full-time employment history a cabinet maker or a cabinet maker supervisor from the May 31, 2007, to December 3, 2014, time-period: December 2006 to August 2007 with a highest monthly gross income of $2,800; July 2007 to August 2007 with a highest monthly gross income of $2,800 (sic?); August 2007 to November 2007 with a highest monthly gross income of $2,800; November 2007 to January 2008 with a highest monthly gross income of $3,200; January 2008 to December 2008 with a highest monthly gross income of $4,000; December 2008 to January 2009 with a highest monthly gross income of $2,800; January 2013 to June 2013 with a highest monthly gross income of $1,838; January 2013 to December 2013 with a highest monthly gross income of $1,838; and January 2014 to December 2014 with a highest monthly gross income of $2,904. As to his education, the Veteran reported that he had 2-years of college. Additionally, while the Veteran did not include in either of his TDIU Claims Forms any information about his employment from February 2009 to December 2012, he nonetheless reported in a January 2017 statement that accompanied the December 2016 TDIU Claims Form the following information: In December 2014 I stopped working... I had worked several jobs between the span of 2011-2012 however I am unable to remember the names or locations of the employment as they were sporadic throughout the year and did not last more than a month or so each... Therefore, I had six jobs over six months that I was either terminated from or left upon my own accord due to difficulty interacting and fighting with coworkers and supervisors. Also, as to his employment history, in May 2009 the RO received a VA Form 21-4192, from one of the Veteran's employers in which it was reported that he worked for them from December 19, 2008, to January 29, 2009, before being laid off and during that time he earned $4,840. Similarly, in August 2018 the RO received a VA Form 21-4192, from another one of the Veteran's employers in which it was reported that he worked for them from January 2, 2014, to December 2, 2014, and during that time he earned $34,848. Next, the Board notes that the March 2009 VA examiner remarked that the Veteran's PTSD would have a bearing on any type of work environment he would find himself engaged in. The examiner reported that it was possible for the Veteran to be employed in an environment that would have a very minimal level of interaction with customers, supervisor, and co-workers. The Board also notes that in a June 2015 letter from the Veteran's VA treatment provider it was reported that the appellant was unable to hold job or perform requirements for a job. Near continuous panic attacks were noted. The VA treatment provider reported that the Veteran would have severe difficulty maintaining effective work relationships. Anxiety issues were noted to truly prevent the Veteran from working a desk job, answering phones, or being a Walmart greeter. The treatment provider remarked that it was more likely than not that the Veteran's service-connected issues rendered him unemployable. In a May 2017 private psychiatric evaluation report it was also opined that the March 2009 VA examination report suggested a very limited realm of work options that was not consistent with the Veteran's work experience. It was thereafter opined that the Veteran's psychiatric disability precluded his ability to secure and follow substantially gainful employment. Likewise, at the November 2018 VA examination it was opined that the Veteran "...is unable to adapt to changes, stress, or demands at work. He is not able to work in public or in an enclosed space/cubicle. He may be able to work in a loosely supervised situation, requiring little interaction with the public..." Similarly, in the September 2021 vocational assessment the examiner, in substance, reported the same employment history as noted in the above TDIU Claims Forms. The examiner thereafter stated as follows: In my professional opinion, as Mr. "J." was unable to sustain any of the above positions for 12 consecutive months, his past sporadic employment from January 2011 until December 2012 for multiple furniture and cabinetry companies, from January 2013 to June 2013 for Wolf's Woodwork, from June 2013 to December 2013 for Different by Design, and from January 2014 to December 2014 for National Mall front Design should be considered unmaintained employment and therefore inconsistent with substantially gainful employment. In my vocational opinion, Mr. "J." was limited to working in only these unmaintained capacities since at least February 2009 due to the limitations from his service-connected PTSD. Also, and as noted above, in the September 2021 vocational assessment the examiner stated, in substance, that the Veteran could not work since February 2009 solely because of his service-connected PTSD. As indicated above, the Board has undergone a highly detailed review of this record. The Board finds the statement above (that the Veteran could not work since February 2009) undermines the credibility of this expert: The Veteran's own statements and evidence that the Veteran himself has provided to the Board does not support this finding. The statement places into question the objectivity and accuracy of the September 2021 vocational assessment overall, nearly totally undermining the probative value of the report. The Board, in this case, is dealing with a intricate issue and requires probative and accurate information from the Veteran's counsel in order to make a just decision in this case. I. 38 C.F.R. § 4.16(a) As to a TDIU from May 31, 2007, to December 3, 2014, under 38 C.F.R. § 4.16(a), this record shows that the Veteran met the schedular requirements of 38 C.F.R. § 4.16(a) at all times during this time period because he either had one disability rated as 60 percent or higher or he had two or more disabilities with one rated as 40 percent or higher and a combined rating of 70 percent or higher. Therefore, the next question for the Board to consider is when, if ever, from May 31, 2007, to December 3, 2014, did the Veteran's service-connected disabilities caused him to be unable to secure or follow substantial gainful employment. Initially, the Board notes that the Veteran has never denied he was not employed or explained why he would meet the criteria for TDIU from May 2007, to January 2009; it was only claimed that under Rice, supra, the claim for a TDIU was pending since his May 31, 2007, claim for an increased rating for PTSD. Instead, the Veteran's representative in his October 2021 pleading argued that the appellant met the criteria for a TDIU since January 2009, even though he worked until December 2014, because his episodic employment from January 2009 to December 2014 does not constitute substantial gainful employment because none of the jobs lasted more than a year. In this regard, the Board has studied the Veteran's work history carefully. A cabinet maker will have many jobs that begin and end. It is not unusual for such an occupation to have jobs that last limited periods of time. Moreover, and as noted above, in support of this argument the Veteran's representative filed with the Board the September 2021 vocational assessment in which the examiner stated, in substance, that the Veteran's episodic employment since February 2009 was not substantial gainful employment as well as opined that the appellant could not work since February 2009 solely because of his service-connected PTSD. However, the Board does not find the opinions provided by the September 2021 vocational examiner that the Veteran's 2009 to 2014 employment was not substantially gainful employment probative because, and as noted in the JMPR-2, the ultimate issue of whether a TDIU should be awarded is not a medical issue, but rather is a determination for the adjudicator. See Geib, supra. Initially, the Board also does not find the vocational examiner opinion that the Veteran's employment from 2009 to 2014 was not substantial gainful employment probative because it finds that examiner's foundation for the opinion (i.e., "unmaintained employment") is not found in 38 C.F.R. § 4.16(a) or in case law. See Owens, supra. In fact, given the nature of the Veteran's employment, cabinet maker or a cabinet maker supervisor, the Board finds nothing unusual in his employment being transient in nature; moving on to a new job every time he finished an old job (it would be unusual if the job in one house never ended or lasted years). In this regard, and as noted in the JMPR-2, the ultimate issue of whether a TDIU should be awarded is not a medical issue, but rather is a determination for the adjudicator. See Geib, supra. Similarly, the Board does not find the opinions provided by the September 2021 vocational examiner that the appellant could not work since February 2009 solely because of his service-connected PTSD probative because the facts of the case show, in fact, that the Veteran was working as cabinet maker or a cabinet maker supervisor at all times during that time period, albeit for many employers (which would not be unusual (the vocational expert should know this), and neither the Veteran nor his representative claim otherwise. See Owens, supra. Next, and as noted above, under 38 C.F.R. § 4.16(a) a Veteran does not have substantial gainful employment when his income is less than the poverty threshold because it is marginal employment. Therefore, the Board will next address this question. In this regard, the Board notes that neither the Veteran's TDIU Claims Forms nor any other writing received from the Veteran or his representative include the appellant's income for the 2007 to 2014 tax years despite the fact that this information could have probably been found in the appellant's income tax returns for all the years in question. Instead, all they provided VA were the Veteran's highest monthly gross income for 2007, 2008, 2013, and 2014. Moreover, the RO in May 2009 and August 2018 obtained VA Forms 21-4192 from two of his old employers. Also, and as noted above, the Veteran and his representative did not provide any detailed information about the appellant's employment from February 2007 to December 2012 except to report that he had multiple jobs but could not remember the months he worked or the amount he earned. Therefore, because the claimant has the responsibility to present and support a claim for benefits under the laws administered by VA, because the appeal has been pending since 2007 and he has had 16 years to provide VA with this information, and because neither the Veteran nor his representative has provided this information in the last 16 years despite the February 2018 request for a TDIU Claim Forms as well as the TDIU Claims Forms placing them on notice of the need to provide this information, the Board finds that it may adjudicate the appeal without this financial information. See Wood v. Derwinski, 1 Vet. App. 190. 192 (1991) (holding that "the duty to assist is not always a one-way street. If a veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the purgative evidence"); Olson v. Principi, 3 Vet. App. 480, 483 (1992); Also see Sabonis, supra. Overall, based a review of the evidence, it appears (though this is not clear) that this information is being deliberately withheld. We cannot delay this case further. Notwithstanding the above, if the Board were to assume the amount that the Veteran reported as his highest monthly gross income for 2007, 2008, and 2013 was also what he earned for each of the 12 months in that year as well as when applying the income reported on the August 2018 VA Forms 21-4192, his annual income would have been as follows: $34,000 in 2007 ($2,800 a month times 11 months plus 1 month at $3,200); $48,000 in 2008 ($4,000 a month times 12 months); $22,056 for 2013 ($1,838 month times 12 months); and $34,848 for 2014. Given the above, the Board finds that the Veteran has not shown that his income was less than the poverty threshold for the 2007 to 2014 tax years. See https://www.census.gov/data/tables/time-series/demo/income-poverty/historical-poverty-thresholds.html. In fact, given the income the Veteran reported for the 2007, 2008, 2013, and 2014 tax years and the August 2018 VA Form 21-4192, it appears that his income was more than the poverty threshold for those years. See https://www.census.gov/data/tables/time-series/demo/income-poverty/historical-poverty-thresholds.html. Therefore, the Board finds that the preponderance of the evidence shows that the work the Veteran performed from May 31, 2007, to December 3, 2014, cannot be considered marginal employment even though he changed jobs frequently and his PTSD caused him problems during his employment. See Owens, supra. Similarly, neither the Veteran nor his representative claim, and the record does not show, that the appellant worked in a protected or sheltered environment at any time from May 31, 2007, to December 3, 2014. See 38 C.F.R. § 4.16(a). Therefore, the Board finds that this exception also does not apply to the current appeal. Given the above, the Board finds that the most probative evidence of record shows that the Veteran was gainfully employed at all times from May 31, 2007, to December 3, 2014. See Owens, supra. In reaching the above conclusions, the Board has not overlooked the fact the October 2007, March 2009, December 2010, April 2012, August 2016, and November 2018 VA examinations as well as the June 2015 letter from the Veteran's VA treatment provider, May 2017 private psychiatric evaluation, and September 2021 vocational assessment and the VA treatment records show the Veteran's service-connected PTSD, neck disability, and/or bilateral upper extremity radiculopathy caused problems with employment. The Board has also not overlooked the fact that some of the above medical professionals opined that the service-connected PTSD, sometimes in connection with a yet to be service-connected disabilities, caused him to be unemployable including from May 31, 2007, to December 3, 2014. Likewise, and as noted in the JMPR-1 and/or JMPR-2, the Board has not overlooked the September 2016 statement from the Veteran's spouse regarding his aggression while driving and the confrontations he has with his co-workers and supervisors; the September 2016 statement from the Veteran's spouse regarding the appellant "...[not] even keep himself clean" and his wife having to "...to constantly tell him to take a shower;" the January 2017 statement in which it was reported that the Veteran did not "shower or change [his] clothes at least four or five times per week;" and the January 2017 statement in which it was reported that the Veteran was unable to perform daily tasks. However, the Board does not find the opinions regarding the Veteran not being able to work because of his PTSD provided by the VA treatment provider in June 2015, the private psychiatric evaluation in May 2017, and the VA examiner in November 2018 probative because nothing in these opinions specifically relate to the May 31, 2007, to December 3, 2014, time-period. See Owens, supra. The Board also find the other opinions found in the record regarding the Veteran not being able to obtain and maintain substantial gainful employment from May 31, 2007, to December 3, 2014, as well as the appellant's problem with his hygiene, anger in the workplace and while driving, and being able to perform daily tasks lack probative value when it comes to whether the Veteran met the criteria for a TDIU under 38 C.F.R. § 4.16(a) from May 31, 2007, to December 3, 2014. See Owens, supra. The Board has reached this conclusion because, as discussed in detail above, the preponderance of the evidence in this appeal shows that from May 31, 2007, to December 3, 2014, the Veteran had employment even though the appellant frequently changed jobs during this time-period and this employment was substantial gainful employment because he has not shown he earned less than the poverty threshold as well as because this employment was not in a protected or sheltered environment. Id. Accordingly, the Board finds that the preponderance of the evidence shows the Veteran's service-connected disabilities did not cause him to be unable to obtain and maintain substantial gainful employment at all times from May 31, 2007, to December 3, 2014, and the claim for a TDIU for this period under 38 C.F.R. § 4.16(a) is denied. Id. I. 38 C.F.R. § 4.16(b) As to a TDIU from May 31, 2007, to December 3, 2014, under 38 C.F.R. § 4.16(b), as discussed above, the Board finds that the Veteran was gainfully employed during this time period as a cabinet maker or a cabinet maker supervisor. Therefore, the Board finds that the preponderance of the evidence shows that the Veteran's service-connected disabilities did not render him unable to secure and follow a substantially gainful occupation from May 31, 2007, to December 3, 2014. See Ray, supra; Owens, supra. Accordingly, the Board finds that the criteria for a referral of his claim to the Under Secretary for Benefits or the Director, Compensation Services for extraschedular consideration under 38 C.F.R. § 4.16(b) have not been met at all times from May 31, 2007, to December 3, 2014. Therefore, the claim is also denied under 38 C.F.R. § 4.16(b). Conclusion (Continued on the next page) In reaching the above conclusions, the Board has considered the lay claims from the Veteran as well as his friends and family regarding his observable adverse symptomatology. However, while they are competent and credible to report on what comes to them via their own senses, the Board finds that they are not competent to provide medical opinions, including as to whether the Veteran could not work because of a service-connected disability, because this is a medical finding and they do not have the required training. See Davidson, supra. Moreover, the Board finds the medical opinions provided the healthcare professionals discussed above more probative than these lay claims because healthcare professionals have greater medical training. See Black v. Brown, 10 Vet. App. 297, 284 (1997) (in evaluating the probative value of medical statements, the Board looks at factors such as the individual knowledge and skill in analyzing the medical data). The fact that the Veteran has PTSD is clear. The fact that the Veteran has problems with PTSD is also clear. The only question in this case is the degree based on evidence that, in some cases, does not support the current findings. In reaching the above conclusions, the Board has also considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the probative evidence is against the claims, the Board finds that this doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert, 1 Vet. App. at 55-56. John J. Crowley Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N.T. Werner, 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.