Citation Nr: 21070334 Decision Date: 11/23/21 Archive Date: 11/23/21 DOCKET NO. 17-12 666 DATE: November 23, 2021 ORDER For the entire appeal period, a disability rating of 70 percent, but no higher, for posttraumatic stress disorder (PTSD) with major depressive disorder is granted. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is granted, subject to the laws and regulations governing the payment of monetary benefits. FINDINGS OF FACT 1. Throughout the appeal period, the Veteran's service-connected posttraumatic stress disorder (PTSD) with major depressive disorder has been manifested by symptomatology more nearly approximating occupational and social impairment with deficiencies in most areas, but not total occupational and social impairment. 2. The Veteran meets the schedular percentage requirements for TDIU, and the evidence is at least in equipoise as to whether he is unable to secure or follow a substantially gainful occupation consistent with his educational and occupational background as a result of his service-connected disability. CONCLUSIONS OF LAW 1. For the entire appeal period, the criteria for a 70 percent disability rating, but no higher, for posttraumatic stress disorder (PTSD) with major depressive disorder have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.125, 4.126(a), 4.130, Diagnostic Code 9411. 2. The criteria for a total disability rating based on individual unemployability due to service-connected disabilities are met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS At the outset, the Board acknowledges that VA treatment records and a VA examination were made part of the file after the issuance of the last statement of the case (SOC), dated February 2017. The Veteran did not submit a waiver of review by the Agency of Original Jurisdiction (AOJ). However, given the favorable outcome for the increased rating claim for PTSD with major depressive disorder, the Board will adjudicate the matter as it is not prejudicial to the Veteran. The Board also acknowledges that the claim for TDIU is part and parcel of the increased rating claim. Therefore, the Board has taken jurisdiction, as reflected by the title page. The Veteran testified before the undersigned Veterans Law Judge in an October 2021 virtual hearing. Increased Rating Psychiatric disabilities, such as PTSD, are evaluated under the General Rating Formula for Mental Disorders (pertinent portions listed below). See 38 C.F.R. § 4.130, Diagnostic Code 9411. Under the General Rating Formula for Mental Disorders, a 100 percent disability rating requires total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation, or own name. Id. A 70 percent disability rating requires occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); or inability to establish and maintain effective relationships. Id. A 50 percent disability rating requires 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. Id. When evaluating mental health disorders, the factors listed in the Rating Schedule are simply examples of the type and degree of symptoms, or their effects, that would justify a particular rating; the analysis should not be limited solely to whether a veteran exhibited the symptoms listed in the Rating Schedule. Rather, the determination should be based on all a veteran's symptoms affecting his level of occupational and social impairment. See Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002). The lists of symptoms under the Rating Schedule are meant to be examples of symptoms that would warrant the disability evaluation but are not meant to be exhaustive. Id. Further, the United States Court of Appeals for the Federal Circuit has acknowledged the "symptom-driven nature" of the General Rating Formula and 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." Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116 (Fed. Cir. 2013). The Federal Circuit has explained that "symptomatology should be the fact-finder's primary focus when deciding entitlement to a given disability rating." Id. at 117. The Veteran contends that his PTSD with major depressive disorder is more severe than contemplated by the disability rating assigned. Specifically, he is requesting a 70 percent disability rating. See August 2015 notice of disagreement. The Veteran filed his claim for an increased disability rating in March 2015. Under the governing law and regulations outlined above, the Board generally reviews the evidence dating back to one year prior to the date of the claim to determine whether, within that one-year period, an increase in a disability was factually ascertainable. See 38 C.F.R. § 3.400(o). Therefore, the Board will assess VA medical treatment records dated outside of the appeal period. The Veteran has received mental health treatment at VA throughout the appeal period, as early as 2009. VA treatment records (progress notes) dated between April 2014 and May 2019 show that the Veteran attended individual psychotherapy once a month. Following the filing of his claim for an increased rating he has been provided two VA examinations for his PTSD with major depressive disorder. The pertinent information from treatment and the examinations will be summarized below. During a September 2013 VA mental health appointment, the Veteran reported that he has been struggling with his part time employment at UPS. He once owned his own business, a dollar store, but gave it up as it had been held up so many times. He is married, but he and his wife are separated, and she resides outside of Pennsylvania. He still considers his wife his best friend. He has a son (born in 1971) with his first wife. He has a second son, age 21 that he had with a woman 11 years younger. His 21-year-old son is in his third year in college and undergoes transfusion treatment every three months because he has sickle cell anemia. He drives his son back and forth for the treatments. Upon mental examination, the Veteran was alert and oriented to all three spheres, his mood was depressed, his affect restricted, thought process goal directed, and insight and judgement fair. He was neatly dressed. He did not have suicidal or homicidal ideation, auditory hallucinations, or delusions. An April 2014 VA progress note documents the Veteran's reporting of getting injured at work. He injured himself by engaging in unsafe behavior. He was under pressure of tight deadlines and performance quotas. He injured his knee and shin. A May 2014 VA progress note illustrates the anger and sadness the Veteran experienced over the death of his sister. He had regularly taken her to her dialysis appointments and expected her to pass away of kidney failure. He did not expect her to pass in the manner she did. She fell down her front steps and was pronounced dead on arrival at the hospital. During a June 2014 VA mental health appointment, the Veteran reported that his doctor at the Vet Center (Dr. F.C.) agrees that he needs to stop working due to his PTSD. He described driving his son four hours each way for his sickle cell anemia treatment. He reported that it has been a difficult year as his oldest brother died in January and his sister passed away in May. He clearly denied suicidal ideation, stating that he is dedicated to his son and his religious beliefs are such that he would not commit suicide because it is a "sin," and he would go to "hell." During a September 2014 VA mental health appointment, he reported that his depression has improved, but that his PTSD symptoms are more prevalent. He isolates as he does not want to encounter triggers to his PTSD. On examination, his affect was stated as "chronically appears restricted" and "smiles when he talks about his son who is graduating college this year." He clearly denied suicidal and homicidal ideation. A November 2014 VA progress note illustrates a discussion regarding the Veteran's employment. He stated, "I'm just too tired and too old to be doing this." They discussed the possibility of disability retirement benefits. The examiner assessed that the Veteran's PTSD symptoms are compromising his ability to work, concluding that his coping skills are wearing down. A January 2015 VA progress note illustrates further discussion regarding the Veteran's employment. He related an incident where he got into an argument with his general manager. He wanted to hit him but instead threw his lunch into the waste basket. The examiner assessed that the Veteran has reached the point at which his coping skills are being overwhelmed at work, concluding that his job is increasing his PTSD symptoms to point where he is likely to become unsafe at work. A February 2015 VA mental health telephone note shows that one doctor (Dr. C.C) received a message from the Veteran's therapist (Dr. F.C), where the therapist expressed that she has been encouraging the Veteran to leave his job at UPS as it is too stressful. She plans to write a letter on his behalf. The doctor agreed with this decision and planned on discussing this with the Veteran to include applying for an increase for his psychiatric disorder. A March 2015 VA progress note illustrates further discussion regarding the Veteran's employment. He works in a very high stress job and has been losing ground in accessing his coping skills. The examiner assessed that the Veteran's PTSD has definitely compromised his job performance in the last six years, concluding that he has become increasingly depressed and anxious over his job. A March 2015 VA progress note illustrates further discussion regarding the Veteran's employment. The examiner assessed that the Veteran likens his experience at work to being in the war zone. He now looks forward to retirement. During a March 2015 VA mental health appointment, the Veteran reported that his son was hospitalized. He also reported that his PTSD interferes with his ability to perform his job. He reported being overly irritable. He tends to get more depressed due to his UPS job. He has considered retiring from this job of 15 years as his doctor (Dr. F.C) has strongly encouraged him to do so and has written a letter on his behalf, which this doctor (Dr. C.C.) also agreed. During the July 2015 VA examination, the examiner concluded that the Veteran's level of impairment 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 reported that over the past six years he has maintained a good relationship with his 21-year-old son who is in college. He has limited contact with his 41-year-old son who lives out of state. He speaks with his four grandchildren from his older son occasionally but rarely gets to see them. He has not been in any romantic relationship since his last evaluation. He stays in contact with his estranged wife regarding his oldest son, but they interact very little. On the weekends he attends religious services and occasionally he attends bible study during the week. Overall, he mostly stays to himself. He reported having few interests that he enjoys. He looks forward to retiring and most likely will move to South Carolina to live near his family. He remains fully independent for activities of daily living (ADLs) and instrumental activities of daily living (IADLs). He reported problems dealing with his subordinates have gotten worse since his last exam. He has problems getting his supervisees to comply with his directives and stated, "I talk to them like they are in the military expecting them to get the job done." He described coming off as being abrupt and demanding with his workers. He reported periodic verbal altercations with his supervisor. He described increasing difficulties dealing with the overnight shift of his current position. He plans on retiring this year. He confirmed that he goes to the Vet Center in individual therapy once a month. He reports that he does not tolerate groups well and has mostly been involved with individual sessions since his last evaluation. The symptoms for VA rating purposes were depressed mood, anxiety, suspiciousness, chronic sleep impairment, flattened affect, disturbances of 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. Upon mental examination, the Veteran was oriented times four, he made good eye contact, and his thought processes were clear, and goal directed. His affect was flat, and his mood depressed. He denied any suicidal ideations, plans, or intentions to self-harm at this time. He presented with no evidence of psychosis or paranoid ideations. His memory and cognitive functions were grossly intact. His intellectual abilities appeared to be in the average range based on his work history. He reported mostly keeping to himself with few social supports and he avoids dealing with large crowds of people. He reported that he has distressing recollections daily, which are intensified when he has difficult interpersonal interactions with others. He described problems coping with stress and has little motivation. He reported nightmares about Vietnam on average two to three times per week. He attends religious services on the weekend, but he does not interact with others much. He reported that he mostly keeps people at a distance, has difficulties expressing emotions, and feels sad most of the time. He reported limited motivation and that he isolates from others in his home. He only goes to grocery stores when he knows it will not be crowded. "Based on the Veteran's reported symptoms it's this writer's clinical opinion that the Veteran service-connected PTSD and secondary depressive symptoms have gotten worse with regard to frequency." During a September 2015 VA mental health appointment, he reported still being married and separated. His wife still lives in Georgia (since 1987). He reported things being better at work, but that he is still planning on retiring on the first of January. He attends church regularly and bible study, which makes up his social network. He enjoys listening to sports radio. He admits to depression at times, especially if he is alone. He continues to have intrusive memories. He continues to have chronic insomnia and nightmares. He tends to be extremely avoidant. During a February 2016 VA mental health appointment, he reported continued difficulty coping with stress at work. He gets irritable and nervous. His work exacerbates his PTSD. He has chronic insomnia, nightmares related to Vietnam that are worse with the stress of work. He is very hypervigilant and stated that he has to have his bedroom door locked and he still feels that he can hear "movement" outside the room. He still does not present with any auditory hallucinations or delusions, but he is so hypervigilant that he thinks he can hear "movement" outside the room. During a May 2016 VA mental health appointment, he reported still being close to his wife, despite her living in Georgia. He continued to have stress at work because of his PTSD and he looked forward to retiring. He continued to be depressed but he has not had any fleeting suicidal thoughts for a long while. He was still very hypervigilant and checks locks. He reported sleeping with his bedroom door locked and feeling like he wants to sleep in a foxhole. He still has intrusive memoires and flashbacks at times, when he thinks he sees a familiar face from Vietnam. An October 2016 VA progress note illustrates a discussion where the Veteran expressed his concern over his son and how he had posted entries on Facebook such as "I'm tired of living this way," worrying that his son may be suicidal. During a December 2016 VA mental health appointment, he reported being much less irritable since cutting back work hours with UPS. He reported that his sleep was adequate, but he continues to have occasional nightmares. His son with sick cell anemia had to drop out of college in his senior year. During a June 2017 VA mental health appointment, he reported that he enjoys being somewhat isolative, but he has a supportive family. He recently spent time with his wife, his brother, and first son. He went to his first son's wedding in Georgia and went fishing with his brother, catching a 10-pound bass. He planned on returning to Georgia for 4th of July, because there were not a lot of fireworks in the county where he stays in Georgia. During an October 2017 VA mental health appointment, he reported continuing to feel depressed at times, but it has improved as he becomes more active and gets back into the things he enjoys. He reported recently going fishing, stating "that brought back so much joy for me to be fishing again." He enjoyed gardening and did this with his best friend. His best friend was a good cook and cooked the vegetables they grow. During a September 2018 VA mental health appointment, he discussed the passing of his 24-year-old son who suffered from sickle cell anemia. He passed away in March after being septic at the end of February. He reported decreased sleep and weight loss of 20 pounds. He did not endorse suicidal ideation but stated that he "just did not care" about himself and stopped taking his medications. He shared photos and video of his son playing the piano. His son attended college and was a self-taught musician. His ex-wife (mother of his oldest son) remained close to him and she has been supportive of him through his grief. He still planned to retire in January and had recently been thinking about relocation to South Carolina where he has family. During a November 2018 VA mental health appointment, he reported that he continued to be depressed. He admitted to anhedonia, although he was able to state that he had been watching the Eagles until their recent loss. He declined an invitation to spend Thanksgiving in Georgia with his friend as he feels the drive is too long. He continued to be active in individual therapy at the Vet Center with Dr. F.C. During a January 2019 VA mental health appointment, he reported that he continued to struggle with the grief of losing his son. He declined any invitation for the holidays, but still attends church regularly and went to services on New Year's Eve. His wife, who lives in Georgia, called him every day to check on him since his son died. He continued to struggle with sadness daily with a decrease in appetite, but he was caring for himself adequately. During a March 2019 VA mental health appointment, he discussed the fact that it was the one-year anniversary of the death of his son. He was going to church every Sunday. He was still planning on retiring at the end of the year and hoped to volunteer more at his church after retirement. During a July 2019 VA mental health appointment, he discussed how his good friend also lost a son, a few months ago. He was supporting his friend through his grief. His depression had significantly improved, and he was smiling today as he talked about retirement. He planned to retire in August and planned a trip to New Orleans with his church in September. During the October 2019 VA examination, the examiner concluded that the Veteran's level of impairment resulted in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. He was still married and still separated. He has been married since 1971 but his wife has been living apart from him in Georgia since 1987. He described their relationship as still "the best of buddies" and he helps her financially. He reported not dating or having other relationships. He described being close with his younger son who passed in 2018, stating they were close "like two peas in a pod." He described his relationship with his older son as "not good." The older son has returned to the area after residing out of state and has invited the Veteran over for dinner. He has not yet made plans to see his son. He reported that his grandchildren "are away" and he does not have contact with them. He has four surviving brothers who live out of state. He talks to three of them and has made plans to get together for Thanksgiving. The youngest of the four brothers is out of touch with the family. He has one close friend who knows how to be supportive "without asking too many questions." He has set limits on other church members by relaying any messages to them via this friend. He worked as a supervisor since August 2000 and retired from UPS in August 2019. He felt he could not handle dealing with the number of people and handling the amount of responsibility that would have come with working full time. He retired when he did because "PTSD was getting worse and (verbally) losing control." A few months prior to his retirement he got into a "shouting match" with a female supervisor whom he felt "came at" him "the wrong way." He would frequently speak unprofessionally to his subordinates, calling them "dumb ass" or "lazy." His subordinates complained about him so much so that a union representative warned him that he could not say certain things. He would come in early and stay late in order to complete work that he was slow in completing due to impaired concentration. The symptoms for VA rating purposes were depressed mood, anxiety, chronic sleep impairment, disturbances of 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. Upon mental examination, the Veteran was open and cooperative, affect was depressed, and he made little eye contact. There was no evidence of psychosis, mania, or disorientation observed. He reported having safe stable housing, attending to his hygiene, washing daily, and showering four to five times a week. He denied suicidal and homicidal ideation. He has a gun, and it is stored unloaded and with a lock, at the suggestion of his psychologist Dr. F.C. He stated that he did not know where the ammunition was kept. The examiner noted that the Veteran had other symptoms attributable to his mental disorder that was not listed above. The symptoms were described as impaired concentration and irritability. During an October 2019 VA mental health appointment, the Veteran smiled as he discussed his retirement. He retired at the end of August. He has been focused on taking better care of himself, walking daily, and trying to eat healthy. He took a vacation to New Orleans for a week. He enjoyed himself, reading, and sightseeing. He has already planned another trip to South Carolina and Georgia for Thanksgiving to see family. The examiner noted that the Veteran smiled when he stated that he is "going to carve the turkey at my brother's home." During a January 2020 VA mental health appointment he stated, "I am maintaining." He reported keeping in touch with his good friend who also lost a son. They support each other in grief and tend to do enjoyable things together like traveling. The Veteran is currently rated at 50 percent. Affording all reasonable doubt in favor of the Veteran, his PTSD warrants a 70 percent rating for the entire period on appeal, but no higher. His PTSD with major depressive disorder was uniformly manifested by symptoms of anxiety, depression, avoidance, chronic sleep impairment, irritability, isolation, difficulty in adapting to stressful circumstances including work or worklike setting, all resulting in deficiencies in most areas, but less than total social and occupational impairment. Throughout the appeal period the Veteran's PTSD manifested in symptoms consistent with a 70 percent disability rating such as experiencing chronic insomnia, having nightmares and intrusive memoires regularly about his time in Vietnam, being so hypervigilant that he has to have his bedroom door locked and at times would feel that he could hear "movement" outside the room. The preponderance of the evidence does not support a rating higher than 70 percent at any time on appeal. Specifically, the Veteran's PTSD with depressive disorder has not been manifested by symptomatology more nearly approximating total occupational and total social impairment due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation, or own name. At no time during the appeal period did the Veteran's PTSD manifest in total occupational and social impairment. The Board has fully considered the frequency, severity, and duration of all the Veteran's psychiatric symptoms with respect to their effect on his overall occupational and social functioning, and finds they support a 70 percent rating. The record shows that the Veteran's hygiene was consistently stated as appropriate; thought process goal directed, and insight and judgement fair. Throughout the appeal period, the Veteran's impairment was significant and impacted his work and family life. He consistently exhibited symptoms of difficulty sleeping, intrusive memories, anxiety, depression, hypervigilance, irritability, and isolation, all consistent with a 70 percent rating. Of note, at no time did the Veteran exhibit some of the most severe symptoms consistent with a 70 percent rating, such as suicidal ideation. During a May 2016 VA mental health appointment, he reported that he had not had any fleeting suicidal thoughts for a long while. Not only was that the only mention of him having any suicidal ideation, but it was described as "fleeting," and throughout the entire period on appeal he has consistently and clearly denied any suicidal ideation. That notwithstanding, the Board finds that throughout the appeal period the Veteran's PTSD with depressive disorder have manifested in symptoms more consistent with a 70 percent disability rating. Also, the October 2019 VA examiner's conclusion of the severity of the occupational and social impairment of the Veteran's PTSD is consistent with a 70 percent rating. The Veteran did not show symptoms consistent with total occupational or social impairment at any time during the appeal period. The record shows that he does not have gross impairment of 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, or disorientation to time or place. Not one of the VA examiners opined that the Veteran's psychiatric disorder symptoms resulted in total occupational and social impairment. In fact, the July 2015 VA examiner's assessment was more in line with a 30 percent rating and the most recent VA examination illustrates an assessment more consistent with a 70 percent disability rating. Additionally, a review of the VA mental health treatment records and the examination reports indicates that the Veteran's PTSD with depressive disorder symptomatology most closely approximates occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and or mood consistent with a 70 percent disability rating. Therefore, looking at the totality of the circumstances, and resolving all doubt in the Veteran's favor, the Veteran's symptoms are best represented by a 70 percent rating. As referenced above, the Veteran specifically requested a 70 percent disability rating in his notice of disagreement. As the Board has granted a 70 percent disability rating for the entire period on appeal, it appears that this is a full grant of the benefits sought on appeal. See AB v. Brown, 6 Vet. App. 35 (1993). The most probative evidence shows significant occupational and social impairment as evidenced by his 70 percent rating, but it does not show that he has total occupational and social impairment due to his PTSD with major depressive disorder symptoms. Total disability rating based on individual unemployability (TDIU) A Veteran will be entitled to a TDIU upon establishing that he is unable to secure or follow a substantially gainful occupation due solely to impairment resulting from his service-connected disabilities. See 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16. The Veteran's service-connected PTSD with major depressive disorder is now rated as 70 percent disabling. Therefore, he meets the minimum scheduler criteria for TDIU under 38 C.F.R. § 4.16(a). As such, the question before the Board is whether the Veteran's is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. In VA Form 21-8940, the Veteran indicated that the last time he worked full-time was in 2019 and that he became too disabled to work in 2019. He indicated that he worked for UPS, engaged in package delivery. According to this TDIU application, the Veteran completed four years of high school. As described in detail above, VA mental health treatment records dated between September 2013 and July 2019 clearly illustrate how the Veteran's PTSD severely impacted his ability to perform his job duties as a supervisor at UPS. VA treatment records dated October 2019, January 2020, as well as the October 2019 VA examination all reflect consistent reporting by the Veteran that he retired from his job at UPS in August 2019. A letter dated June 2015 was authored by a VA psychiatrist and VA clinical psychologist. Both VA doctors have been treating the Veteran for the last eight years (as the date of the letter) and both agreed that the Veteran's work environment has contributed the most to exacerbating his PTSD. They both opined that the Veteran "has put himself physically and psychologically at risk for far too long and it is our wish that he stop working not only at UPS but in any gainful employment." The most probative evidence of record shows that the Veteran's former full-time, and later part time employment required interaction with others and how his PTSD symptoms impacted his ability to perform his work duties. He described having to come in early and stay late in order to complete work that he was slow in completing due to his impaired concentration. He consistently reported and described the various stressors his work induced and how his PTSD symptoms would further exacerbate things and often cause altercations between himself and his subordinates and his supervisors. Both of his treating doctors concluded that because of his PTSD he is unable to sustain gainful employment. The Veteran meets schedular requirements for a TDIU, is service connected for one disability, PTSD with major depressive disorder. The medical and lay evidence of record show that his service-connected PTSD causes a significant impact on his ability to work especially in work settings where he has to interact with people. The Board finds that the realistic chances of the Veteran obtaining and retaining employment must also be considered in light of his physical and educational capabilities. Although it is conceivable that there may be some occupations that the Veteran could perform, the totality of the evidence supports a finding that during the appeal period his service-connected disability renders him unable to obtain and maintain substantially gainful employment when his educational and work background are taken into consideration. Thus, the Board will resolve reasonable doubt in the Veteran's favor and find that during the appeal period he was unable to secure or follow a substantially gainful occupation as a result of his service-connected disability. As such, a TDIU is granted. As TDIU has been granted, the Board will allow the RO to assign, in the first instance, the appropriate effective date of this award when it implements the Board's decision. See Urban v. Principi, 18 Vet. App. 143, 145 (2004) (per curiam order). H.M. WALKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Talamantes, 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.