Citation Nr: 21071221 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 16-20 719 DATE: November 30, 2021 ORDER 1. Entitlement to an increased rating in excess of 30 percent for posttraumatic stress disorder (PTSD) for the period prior to March 4, 2014, is denied. 2. Entitlement to a 50 percent rating, and no higher, for the period from March 5, 2014, to June 25, 2018, for PTSD is granted. 3. Entitlement to a rating in excess of 70 percent, from June 26, 2018, for PTSD is denied. 4. A total disability rating based on (TDIU) as of June 26, 2018, is granted. Please note that the Veteran's entitlement to a total disability rating based on a TDIU rating, on an extraschedular basis, for the period prior to June 26, 2018, is addressed in the remand section of this decision. REMANDED A total disability rating based on a TDIU rating, on an extraschedular basis, for the period prior to June 26, 2018 is remanded. FINDINGS OF FACT 1. Prior to March 4, 2014, the evidence shows that the Veteran's disability most closely resembled occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. 2. For the period of March 5. 2014 to June 25, 2018, the evidence shows that the Veteran's disability picture most closely resembled occupational and social impairment with reduced reliability and productivity. 3. From June 26, 2018, the Veteran's disability most closely resembles occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. The Veteran's symptoms do not show total occupational and social impairment. 4. From June 26, 2018, the Veteran's PTSD renders him unable to secure or follow a substantially gainful occupation. CONCLUSIONS OF LAW 1. Prior to March 4, 2014, the criteria for a disability rating in excess of 30 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2012); 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.3, 4.10, 4.130, Diagnostic Code 9411 (2015). 2. From the period of March 5. 2014 to June 25, 2018, the criteria for a disability rating of percent 50 percent and no higher, for PTSD have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2012); 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.3, 4.10, 4.130, Diagnostic Code 9411 (2015). 3. From June 26, 2018, the criteria for a disability rating in excess of 70 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2012); 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.3, 4.10, 4.130, Diagnostic Code 9411 (2015). 4. From June 26, 2018, a schedular TDIU rating is warranted. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.1, 4.3, 4.16 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1967 to May 1969. This case comes before the Board of Veterans' Appeals (Board) on appeal of rating decisions dated September 2011 and May 2015. The PTSD increased rating claim was remanded by the Board in January 2018. The Veteran filed an increased rating claim for his PTSD in February 2011. In the September 2011rating decision, the RO denied entitlement to an increased rating of more than 30 percent for PTSD. The Veteran expressed disagreement with the rating decision and timely filed a substantive appeal. While the issue was on appeal, in a March 2019 rating decision, the RO granted an increase to 70 percent effective June 26, 2018. On March 14, 2019, the Board issued a decision denying entitlement to an increased rating in excess of 30 percent prior to June 26, 2018, and in excess of 70 percent thereafter for (PTSD). The Veteran then appealed to the United States Court of Appeals for Veterans Claims (CAVC). In a February 2020 Joint Motion for Remand (JMR), CAVC vacated and remanded the Board's denial of entitlement to an increased rating in excess of 30 percent prior to June 26, 2018, and in excess of 70 percent thereafter, for (PTSD), and remanding the issue for readjudication. The PTSD claim is now before the Board again. The Veteran through his attorney has argued that the Veteran's PTSD claim should date back to January 30, 2007, the date the Veteran was granted a 30 percent rating for his PTSD. As part of his argument the Veteran's attorney stated that the Veteran's PTSD claim should be open as of the January 2007 date, because "service connection was granted for PTSD as of January 30, 2007, in a decision issued in February 2009." The attorney further argued that 38 C.F.R.§ 3.156(b) applies to the facts of this case because new and material evidence (in the form of VA treatment records) was constructively associated with the Veteran's VA file within one year of that decision. See 38 C.F.R.§ 3.156(b). The attorney further argued that "such records were specifically referred to by the Court of Appeals for the Federal Circuit in. Lang v. Wilkie, 971 F.3d 1348, 1355 (Fed. Cir.2020) as meeting the definition of "new and material evidence" for purposes of 38 C.F.R. § 3.156(b)." Moreover, the attorney stated that the medical records generated within a year of the February 2009 VA decision include an August 2009 VA treatment report which documents ongoing PTSD symptoms. See 8/18/09 VA Mental Health Physician Note discussing the Veteran's "chief complaint" of the day: "I think the Trazodone helps but is too weak." The attorney asserted that this treatment report is "new" for the purposes of 38 C.F.R.§ 3.156(b) because it was in VA's constructive possession within a year of the February 2009 VA decision. Finally, the attorney argued that since the above medical record was generated by VA itself, "it is automatically considered 'reasonably related' (and therefore material)." TDIU rating is inherent in any claim for an increased rating, see Rice v. Shinseki, 22 Vet. App. 447 (2009). In the Veteran's case, he also specifically filed for TDIU. The Board will thus consider the Veteran's TDIU claim in addition to his PTSD claim. The Veteran's TDIU claim was remanded in March 2019 to obtain relevant employment information and/or updated records for his TDIU. In June 2020, the RO issued a Supplemental Statement of the Case. TDIU is now before the Board again. 1. Entitlement to an increased rating in excess of 30 percent for posttraumatic stress disorder (PTSD) for the period prior to March 4, 2014 Legal Criteria Disability evaluations are determined by the application of a schedule of ratings, which is based on the average impairment of earning capacity caused by the given disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining, including the degree of disability, is to be resolved in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). In any claim for an increased rating, "staged" ratings may be warranted when the factual findings show distinct periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings under the applicable diagnostic code(s).). Hart v. Mansfield, 21 Vet. App. 505, 509 (2007); Fenderson v. West, 12 Vet. App, 119 (1999). The potential for staged ratings "accounts for the possible dynamic nature of a disability while the claim works its way through the adjudication process." Id. PTSD is rated under the General Rating Formula for Mental Disorders (General Formula). A 30 percent rating is warranted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal). This may be due to such symptoms as depressed mood; anxiety; suspiciousness; panic attacks (weekly or less often); chronic sleep impairment; and/or mild memory loss (such as forgetting names, directions, and recent events). 38 C.F.R. § 4.130, Code 9411. Id. A 50 percent evaluation is warranted where there is an occupational and social impairment with reduced reliability and productivity. This may be due to such symptoms as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent evaluation is warranted where there is occupational and social impairment, with deficiencies in most areas (such as work, school, family relations, judgment, thinking, or mood). This may be 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 worklike setting); inability to establish and maintain effective relationships. Id. A 100 percent evaluation is warranted for total occupational and social impairment. This may be 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 (ADLs) (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. The list of symptoms in the General Formula is not intended to constitute an exhaustive list but provides examples of the type and degree of symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). However, 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 (Fed. Cir. 2013). Furthermore, when evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment but shall not assign an evaluation solely based on social impairment. 38 C.F.R. § 4.126 Prior to August 4, 2014, VA's Rating Schedule for mental disorders was based upon the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, of the American Psychiatric Association (also known as "DSM-IV"). 38 C.F.R. § 4.130. Like this case, diagnoses many times included an Axis V diagnosis or a Global Assessment of Functioning (GAF) score. The DSM has been updated with a 5th Edition ("DSM-5"), and VA issued an interim final rule amending certain provisions in the regulations to reflect this update, including the Schedule for Rating Disabilities. 70 Fed. Reg. 45093 (Aug. 4, 2014). This updated medical text recommended that GAF scores be dropped due to their "conceptual lack of clarity." See DSM-5, at 16. Because the Veteran's increased rating claim was in the process of adjudication prior to and during the adoption of the DSM-5, both the DSM-IV and DSM-5 criteria will be utilized in the analysis set forth below. When in effect, GAF scores were considered a scale reflecting the psychological, social, and occupational functioning on a hypothetical continuum of mental health illness. Carpenter v. Brown, 8 Vet. App. 240 (1995). GAF scores ranging from 61-70 denote some mild symptoms (e.g., depressed mood and mild insomnia) or some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships. GAF scores ranging from 51-60 reflect moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers). GAF scores ranging from 41 to 50 reflect serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job). GAF scores ranging from 31-40 reflect some impairment in reality testing or communication (e.g., speech is at time 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; child frequently beats up younger children, is defiant at home, and is failing at school). Factual Background The Veteran's August 2011 VA examination shows that the Veteran should be kept at a 30 percent rating. In August 2011, the Veteran attended a VA examination. His GAF score was scored at 60. In explaining the score the examiner stated that the Veteran's psychiatric symptoms caused "occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress; or symptoms controlled by medication." The examiner explained that his conclusion was based on the record and the Veteran's reports of experiencing symptoms, that included chronic sleep impairment, recurrent distressing dreams of the trauma, efforts to avoid thoughts, feelings, or conversations associated with the trauma, efforts to avoid activities, places or people that arouse recollections of the trauma, and difficulty concentrating. The examiner also noted that the Veteran was neatly groomed and dressed and had good eye contact. At the examination, the Veteran denied hallucinating or thoughts to harm himself or others. His insight and judgment into hypothetical situations were also reportedly intact. VA medical records from Tuscaloosa and dated in May 2011 show that the Veteran was sleeping well at night and denied having any problems with his mood or having any suicidal or homicidal ideation. VA medical records in November 2011, November 2012, March 2012, and August 2012 show that the Veteran denied having any psychosis, mood swings, or depression. VA medical records dated in June 2013 show that the Veteran reported that he was "doing alright" with respect to his PTSD symptoms though he reported having insomnia and nightmares. In August 2011, the Veteran's siblings collectively wrote a buddy statement describing how the Veteran changed after returning from Vietnam. Specifically, the Veteran's siblings wrote that their brother seemed distant, detached, and unhappy. They also stated that their brother avoided gatherings and people. The Veteran's siblings also stated that noises seemed to bother their brother. The Veteran's siblings also stated that the Veteran had little interest or energy, and he did not sleep well. Moreover, they reported that the Veteran would physically lash out when startled. The Veteran's siblings also stated that the Veteran had a good job and went to work but showed little true enjoyment of his work. Analysis Before addressing the time period above, it is necessary to address why the Veteran's disability claim cannot be granted prior to February 2010. The Board acknowledges that the August 18, 2009, medical record was in the VA's constructive possession. All VA records "are always reasonably related to a veteran's claim" and thus are in VA's constructive possession. See Lang v. Wilkie, 971 F.3d 1348, 1355 (Fed.Cir. 2020). It is not enough for the VA medical records to be in VA's constructive possession, however. Specifically, in Young v. Shinseki, 25 Vet. App. 201, 203 (2012), the CAVC noted that 38 C.F.R. § 3.156(b) provides a potential exception to the general rule that a decision will become final unless a NOD is filed within one year of the underlying rating decision if new and material evidence is received within that year. 22 Vet. App. 461, 466 (2009). This provision applies both to claims that are denied by the AOJ and to claims for which a rating decision grants service connection and assigns an initial rating and effective date. See Id. at 474 (Lance, J., concurring). In Young, the CAVC found that, upon receipt of medical evidence relating to the veteran's disability within one year after the rating decision that granted service connection, VA was required to determine whether that evidence constituted new and material evidence under 38 C.F.R. § 3.156 in order to determine the proper scope of the issue on appeal. Id. at 467-68. New evidence is evidence not previously part of the actual record before agency adjudicators. Material evidence means existing evidence that by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). The Board finds that the August 2009 medical report is neither new nor material. While the August 2009 medical report may not have been specifically reviewed, evidence of the Veteran's treatment for insomnia prior to the date had been reviewed. In fact, it was one of the reasons the Veteran was granted 30 percent when granted service connection. The Board further finds that an additional mention of the Veteran's insomnia is cumulative and redundant, and would not substantiate a higher rating. Returning to the period of February 10, 2010, to March 13, 2014, the Board finds that the August 2011 VA examination report, other medical records, and lay statement collectively establish that the Veteran's PTSD symptomatology prior to March 14, 2014 more nearly approximates occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. This warrants a 30 percent rating, but no higher. The Veteran's symptoms of chronic sleep impairment, depressed mood, anxiety, and suspiciousness fit squarely under the 30 percent rating criteria. Additionally, there is no competent and credible evidence of record indicating that between February 10, 2010, to June 14, 2014, the Veteran was experiencing symptoms rising to levels contemplated by or commensurate with the 50 percent, 70 percent, or 100 percent rating criteria. The August 2011 examiner also found no-more-than-once-a-week panic attacks. VA medical records further confirm that the Veteran was not experiencing symptoms such as suicidal ideation, obsessional rituals, illogical speech, spatial disorientation, neglect of personal appearance and hygiene, or other symptoms with such severity, frequency, and duration, rising to the level contemplated by the criteria of a higher 50, 70, or 100 percent rating. Notably, the Veteran has not contended that he was experiencing any such symptoms. In sum, the Board finds that a preponderance of the evidence is against the Veteran's claim for a higher rating in excess of 30 for his service-connected PTSD for the period prior to June 5, 2014. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 2. Entitlement to a 50 percent rating, and no higher, for the period from March 5, 2014 to June 25, 2018 Factual Background In a March 2014, the Veteran filed a VA Form 9, where he reported short and long-term memory loss, homicidal thoughts, irritability, and panic attacks at least twice a week. Most recently, the Veteran saw a private doctor in September 2021. The doctor reviewed the Veteran's VA and private medical records, service records, compensation and pension examination reports, lay attestations, and ancillary information regarding the veteran. The doctor proceeded to provide a "medical chronology," followed by an interview with the Veteran. (page 2) The doctor then documented his "findings and conclusions" in a separate part of his examination report. Notably, the doctor commented on the August 2011 VA examination stating "It was apparent in our interview that the Veteran struggled to articulate the breadth and intensity of his psychiatric symptoms. It took careful probing before we were able to establish an effective rapport, and only then was he willing to open up about how his PTSD has affected his life over the years." The examiner further stated that "this resistance has prevented the Veteran from receiving efficacious treatment and likely contributed to the August 2011 VA examiner underestimating the true severity of his disease process. The doctor then expressly stated that even when the Veteran did attend examinations, psychiatric assessments, or psychotherapy, he struggled to fully express himself, and he has indicated that he is more comfortable expressing himself in writing than in in-person interviews. (Page 10.) Analysis The Board acknowledges that it is raising the Veteran's rating based on his lay statements. Here, the Veteran is competent to discuss the worsening of his PTSD symptoms because as a layperson, he is qualified to report observable symptoms and medical events. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (2007) See also Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) holding that the Veteran is competent to report experiencing the above psychiatric symptoms. Moreover, given the fact that the Veteran's private doctors stated he was best able to express his psychological symptoms in writing, the fact that the Veteran indicated a worsening of his symptoms in writing in his March 5, 2014 VA Form 9including short-term and long-term memory loss, homicidal thoughts, irritability, and twice-a-week panic attacksfurther supports a 50 percent rating as of that date. Affording the Veteran the benefit of the doubt, the Board finds his competent and credible statements about the worsening of his psychiatric impairment to be highly probative evidence that his disability picture more closely approximates a 50 percent rating for the period of March 5, 2014, to June 26, 2018. 3. Entitlement to a rating in excess of 70 percent, from June 26, 2018, for PTSD Factual Background In accordance with the January 2018 Board remand, the Veteran underwent a VA examination in June 2018. During the examination, the examiner opined that the Veteran's PTSD symptoms were causing him occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood, as opposed to total occupational and social impairment. The examiner explained that his conclusion was based on the record, including the Veteran's reports of experiencing persistent and frequent PTSD symptoms, including depressed mood, anxiety, panic attacks more than once a week, near-continuous panic or depression affecting the ability to function independently, appropriately and effectively, chronic sleep impairment, mild memory loss, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, including work or a worklike setting, inability to establish and maintain effective relationships, and impaired impulse control, such as unprovoked irritability with periods of violence. The September 2021 private examination also included two buddy statements from June 2021, further documenting the Veteran's struggle with PTSD. The first statement from the Veteran's wife discussed the following "observations" 1. The Veteran used to go to church before Vietnam, but after returning home he no longer goes to church. Moreover, the Veteran avoids large gatherings. Loud noises make the Veteran anxious. Moreover, the Veteran no longer "initiates interactions with friends," rather he spends most of his time alone. 2. The Veteran's wife also stated that the Veteran has lost interest in hobbies at home and the community at large. 3. Moreover, the Veteran's wife stated that the Veteran has "mood swings." Specifically, the Veteran often appears preoccupied and becomes angry. He seems annoyed when spoken to, ignores questions, and does not respond. If responding, he is abrupt and short-spoken. At times, the Veteran is happy and agreeable. This can change for no known reason. If it does, the Veteran becomes sullen/negative and nothing is right. Finally, the Veteran's wife also detailed her husband's issues with sleep. (Page 13.) Next, the Veteran's younger sister wrote a buddy statement that described the Veteran's issues with sleeping and loss of interest in hobbies and being with family. The sister said, "He now reluctantly attends family gatherings - we spend most of our time together with Larry outside, alone." The sister also stated that while the Veteran no longer does so, he used to physically "lash out" and "swing his fists" when he was awakened. Finally, the sister described the Veteran's mode as sullen and angry for no known reason. The Veteran was also described as quiet and not talkative. (Page 14.) Analysis The Board finds that the Veteran's symptoms fit into the 70 percent rating criteria. For instance, the examiner noted that the Veteran exhibited near-continuous panic or depression affecting the ability to function independently, and impaired impulse control, such as unprovoked irritability with periods of violence, which are squarely contemplated by the 70 percent rating criteria. The evidence does not support a100 percent rating. This is because the evidence does not show that the Veteran was experiencing symptoms analogous to those that are contemplated under the 100 percent rating such 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. In sum, the June 26, 2018, VA examination report and lay statements collectively establish that the Veteran's PTSD symptomatology from June 26, 2018 more nearly approximates occupational and social impairment with deficiencies in most areas, as opposed to total occupational and social impairment due to PTSD. The preponderance of the evidence is against a finding of total occupational and social impairment due to PTSD. The claim is, therefore, denied. 4. A total disability rating based on (TDIU) as of June 26, 2018, is granted Legal Criteria To establish entitlement to TDIU, there must be impairment so severe that it is impossible for the Veteran to follow a substantially gainful occupation. See 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. 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 (1993). Consideration may be given to the Veteran's level of education, special training, and previous work experience in arriving at a conclusion, but not to age or to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). A schedular TDIU rating may be assigned where the schedular rating is less than total, when it is found that the disabled Veteran is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more; or if there are two or more service-connected disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16(a). Factual Background As of June 26, 2018, the Veteran's service-connected PTSD is rated 70 percent disabling. See 38 C.F.R. § 4.16(a). In the Veteran's June 2018 VA examination, the examiner stated that "the Veteran's PTSD has a detrimental impact on the Veteran in terms of mood, interpersonal /social, quality of life. and thus, the Veteran can't work on account of PTSD." In September 2021, the Veteran underwent a private medical examination. During the examination the examiner stated that "since leaving the workforce, the veteran has retreated into a largely isolative lifestyle, rarely leaving his property or interacting with anyone outside his immediate family." The doctor explained that this minimizes his exposure to potential triggers and has allowed him to maintain a veneer of functionality. The doctor then emphasized that "these circumstances could not be replicated in an employment setting." The examiner continued by explaining that "In any workforce, there is an expectation that employees are capable of consistent and reasonable interpersonal interactions and managing the daily stresses inherent in an employment setting." Given the veteran's irritability, anger, and social withdrawal, the doctor opined that the Veteran has been unable to handle the stresses of gainful employment since at least 2007 and would quickly decompensate if he returned to work. (Pages 10 and 11.) The examiner went on to state "since he left the workforce, the Veteran has become progressively socially isolated and irritable." The doctor also stated that "the Veteran's employment options were limited by his high school education, along with his impaired memory and concentration would make any job requiring focus or attention to detail extremely difficult." Moreover, the doctor stated, the Veteran's low frustration tolerance and outbursts of anger when confronted with minor inconveniences would cause significant disruptions in the workplace and prevent him from engaging in consistent and appropriate interpersonal interactions. The doctor concluded his medical opinion by stating that the Veteran's situation was "especially disabling, as virtually any job requires sustained attention and the ability to interact appropriately with others." The September 2021 examiner concluded that the Veteran's PTSD rendered him unemployable. Analysis Based on the 2018 VA and September 2021 private medical examinations, the Board finds that the Veteran has been unable to obtain or maintain employment of any sort. This is consistent with both doctors' opinions which stated that the Veteran's PTSD made it impossible for him to work. Given the above, the Board finds that the Veteran's service-connected disabilities render him unable to obtain or sustain substantially gainful employment. Thus, a TDIU rating is granted as of June 25, 2018. REMANDED REASONS FOR REMAND A total disability rating based on a TDIU rating, on an extraschedular basis, for the period prior to June 26, 2018 is remanded. Until January 26, 2018, the Veteran did not have a service-connected disability that was rated at least 60 percent disabling, nor did he have multiple service-connected disabilities, combining to a 70 percent or greater level of impairment with at least one disability rated 40 percent and thus he did not meet the schedular criteria for TDIU eligibility. 38 C.F.R. § 4.16(a). However, the Veteran indicated that he retired on March 15, 2007, due to many health conditions including PTSD. Because of this, the issue of a TDIU rating on an extraschedular basis must be addressed. See 38 C.F.R. § 4.16(b). Even where a veteran does not meet the schedular criteria of 38 C.F.R. § 4.16(a), VA must consider whether TDIU is warranted on an extraschedular basis under 38 C.F.R. § 4.16(b). However, the Board cannot consider entitlement to TDIU under 38 C.F.R. § 4.16(b) in the first instance but must first remand the claim for referral to VA's Director of Compensation Service if such consideration is warranted. Based on the above, the Board finds that there is some evidence suggesting that the Veteran's service-connected disabilities may have rendered him unable to obtain and follow substantially gainful employment prior to June 26, 2018. Thus, the issue of entitlement to a TDIU prior to the date in question is remanded for referral to the Under Secretary for Benefits or the Director of the Compensation Service in accordance with 38 C.F.R. § 4.16(b). The matters are REMANDED for the following action: This matter should be referred to the Director, Compensation Service, for extraschedular consideration pursuant to 38 C.F.R. § 4.16(b). David Gratz Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mintz, Allison 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.