Citation Nr: 21074066 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 15-31 426A DATE: December 14, 2021 ORDER Entitlement to an initial rating in excess of 50 percent prior to March 19, 2015, for an acquired psychiatric disorder, to include post-traumatic stress disorder (PTSD) with major depressive disorder (MDD), is denied. Entitlement to a rating in excess of 70 percent from March 19, 2015 to August 21, 2018, for an acquired psychiatric disorder is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities prior to August 21, 2018, is denied. FINDINGS OF FACT 1. Prior to March 19, 2015, the preponderance of the evidence shows that the Veteran's acquired psychiatric disorder was not productive of 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 worklike setting); inability to establish and maintain effective relationships. 2. From March 19, 2015 to August 21, 2018, the preponderance of the evidence shows that the Veteran's acquired psychiatric disorder was not productive of 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. 3. Prior to August 21, 2018, the most probative evidence of record indicates that the Veteran's service-connected disabilities did not preclude him from substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for entitlement to a disability rating greater than 50 percent prior to March 19, 2015, for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.130, Diagnostic Code 9411. 2. The criteria for entitlement to a disability rating greater than 70 percent prior to August 21, 2018, for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.130, Diagnostic Code 9411. 3. The criteria for a TDIU have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty with the United States Marines Corps from April 1968 to April 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2014 rating decision by the Regional Office (RO) of the United States Department of Veterans Affairs (VA). The matter was previously before the Board in March 2019 and May 2021, each time being remanded for additional development. In this regard, the Board must apologize to the Veteran for the delays in the full adjudication of his claim. The evaluation of a problem at different times is complex. As a preliminary matter, the Board notes that the Veteran is diagnosed with PTSD, MDD and chronic insomnia. See October 2019 VA PTSD Examination. The Board has therefore re-characterized the issue of entitlement to a higher rating for PTSD to encompass entitlement more broadly to service connection for an acquired psychiatric disorder, to include PTSD, MDD and insomnia, pursuant to Clemons v. Shinseki, 23 Vet. App. 1 (2009). The Board also highlights that the Veteran's PTSD with major depressive disorder is rated as 100 percent disabling, effective August 21, 2018. As this represents the maximum rating for his acquired psychiatric disorder, the period from August 21, 2018 will not be further discussed in this decision. Post-Remand Compliance In the May 2021 Board remand, the RO was instructed to obtain the Veteran's treatment records from a medical facility in San Bernardino for the period prior to August 21, 2018 and readjudicate the claim. However, the medical facility identified in the May 2021 remand is not a federal entity and a signed release was needed to obtain the identified records. VA sent the Veteran a letter on May 12, 2021 requesting that he complete a release of information or submit the records. To date, no response has been received. The Board acknowledges the statements of the Veteran's representative, which suggest the possibility the Veteran may not have received the May 2021 VA development letter. See October 2021 Appellate Brief. However, there is no evidence to suggest, nor does the Veteran allege any reason to rebut the presumption of regularity in the mail in this case. The presumption of regularity presumes that government officials "have properly discharged their official duties." Clarke v. Nicholson, 21 Vet. App. 130, 133 (2007) (quoting United States v. Chem. Found., Inc., 272 U.S. 1, 14-15, 47 S. Ct. 1, 71 L. Ed. 131 (1926)). The presumption is not absolute it may be rebutted by clear evidence to the contrary. E.g., Baxter v. Principi, 17 Vet. App. 407, 410 (2004). Once rebutted, the burden shifts to the Secretary to show that the practices and protocols used were regular. See Baxter, 17 Vet. App. at 410; see also Ashley v. Derwinski, 2 Vet. App. 307, 309 (1992). Importantly, claiming a VA decision was not received is not, by itself, the clear evidence required to rebut the presumption of regularity in mailing. Crain v. Principi, 17 Vet. App. 182, 186 (2003). Therefore, without evidence, such as returned mail or other clear evidence to the contrary, the Board finds the presumption of regularity in the mail has not been rebutted. Accordingly, the Board finds the required development has been completed and the matter is properly before the Board at this time. See Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). INCREASED RATING The Veteran contends that his PTSD is more severe than represented by the rating assigned at all times during the appeal. Ratings for service-connected disabilities are determined by comparing the Veteran's symptoms with criteria listed in VA's Schedule for Rating Disabilities, which is based, as far as practically can be determined, on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 C.F.R. Part 4. When rating a service-connected disability, the entire history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two ratings shall be applied, the higher rating 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 Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2009). The Board notes that 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). 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). The Merits of the Claim Initially, the Board notes that the Veteran filed a VA 21-526EZ, Fully Developed Claim (Compensation) for PTSD in March 2014. During the pendency of the claim, a September 2014 rating decision granted service connection for PTSD and assigned an initial rating of 50 percent disabling, effective March 24, 2014, the date the claim for PTSD was received. Over the next several years, the Veteran continuously pursued a claim for increased rating and in an April 2017 rating decision the Veteran's rating for PTSD was increased to 70 percent disabling, effective March 19, 2015. A June 2020 rating decision found the Veteran's PTSD was 100 percent disabling, effective August 21, 2018. The Veteran contends that he is entitled to an initial rating in excess of 50 percent for his service-connected PTSD prior to March 19, 2015, and a rating in excess of 70 percent from March 19, 2015 to August 21, 2018. The Veteran's service-connected PTSD is rated under Diagnostic Codes 9411 which utilize General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130. Under the General Formula, a 50 percent rating is assigned when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks (more than once a week); difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is warranted for 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); and the inability to establish and maintain effective relationships. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of closest relatives, own occupation, or own name. As the United States Court of Appeals for the Federal Circuit (Federal Circuit) recently explained, evaluation under 38 C.F.R. § 4.130 is "symptom-driven," meaning that "symptomatology should be the fact-finder's primary focus when deciding entitlement to a given disability rating" under that regulation. VazquezClaudio v. Shinseki, 713 F.3d 112, 116-17 (Fed.Cir.2013). The symptoms listed are not exhaustive, but rather "serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating." Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). In the context of determining whether a higher disability evaluation is warranted, the analysis requires considering "not only the presence of certain symptoms[,] but also that those symptoms have caused occupational and social impairment in most of the referenced areas" - i.e., "the regulation... requires an ultimate factual conclusion as to the Veteran's level of impairment in 'most areas.'" Vazquez-Claudio, 713 F.3d at 117-18; 38 C.F.R. § 4.130, Diagnostic Code 9411. Further, when evaluating a mental disorder, the Board must consider the "frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission," and must also "assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination." 38 C.F.R. § 4.126(a). Lastly, the Board notes that this claim for a higher rating was pending before the agency of original jurisdiction on or after August 4, 2014. Therefore, the Board finds that the AMERICAN PSYCHIATRIC ASSOCIATION: DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, 5th Edition (2013) (DSM-5) applies to the current appeal. See 53 Fed. Reg. 14308 (March 19, 2015); 38 C.F.R. §§ 3.384, 4.125, 4.126, 4.127, and 4.130 (2017). Accordingly, the Board's adjudication of this claim cannot include any discussion of the Global Assessment of Functioning (GAF) scores found in the record. See Golden v. Shulkin, No. 16-1208, Slip opinion at 5 (Vet. App. Feb. 23, 2018). 1. Entitlement to an initial rating in excess of 50 percent prior to March 19, 2015, for an acquired psychiatric disorder Turning to the evidence, in August 2014, the Veteran underwent a VA examination for PTSD and the examiner opined the Veteran's PTSD caused occupational and social impairment with reduced reliability and productivity. The examiner found symptoms as depressed mood, anxiety, suspiciousness, depression affecting the ability to function independently, appropriately and effectively, chronic sleep impairment, mild memory loss, flattened affect, disturbance of motivation and mood, difficulty establishing and maintaining effective work and social relationships. To the extent the Veteran claims he is entitled to a rating in excess of 50 percent prior to March 19, 2015, considering not only the presence of certain symptoms, but also whether those symptoms have caused occupational and social impairment in most of the referenced areas under the rating criteria (see Vazquez-Claudio, supra), as well as the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission (see 38 C.F.R. § 4.126(a)), and when considering the appellant's competent reports of his observable adverse symptomatology (see Davidson, supra), based on all the evidence of record that bears on occupational and social impairment related to his PTSD, he does not meet the criteria for at least a 70 percent, or higher, rating, because prior to March 19, 2015 his symptoms are not productive of occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. Moreover, the best medical and lay evidence show that his associated symptoms of PTSD prior to March 19, 2015 do not have the frequency, severity, and duration sufficient to warrant a 70 percent, or higher rating in this claim. The Board has reached this conclusion because prior to March 19, 2015 the adverse symptomatology of the Veteran's PTSD, considering the above criteria, did not manifest 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), or an inability to establish and maintain effective relationships. In fact, the August 2014 VA examination shows that the Veteran's PTSD symptoms were productive of occupational and social impairment with reduced reliability and productivity indicative of a 50 percent disability rating. The Board also notes that while treatment records and lay statements periodically document the Veteran's complaints and treatment related to his PTSD during this period, nothing in the record demonstrates that his adverse symptomatology was worse than what has been reported at the August 2014 VA examination prior to March 19, 2015. Accordingly, the criteria for a rating in excess of 50 percent is not shown to have been met at any time prior to March 19, 2015 because the Veteran's symptoms do not rise to the level required for a 70 percent, or higher, disability rating under 38 C.F.R. § 4.130, Diagnostic Code 9411. 2. Entitlement to a rating in excess of 70 percent from March 19, 2015 to August 21, 2018, for an acquired psychiatric disorder In March 2015, the Veteran underwent a VA examination for PTSD and the examiner opined the Veteran's PTSD caused occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgement, thinking and/or mood. The examiner found symptoms as anxiety, suspiciousness, chronic sleep impairment, mild memory loss, impaired judgement, disturbances of motivation and mood, inability to establish and maintain effective relationships, impaired impulse control, such as unprovoked irritability with periods of violence. On the basis of the March 2015 VA examination the Veteran was granted a 70 percent disability rating for his PTSD, effective March 19, 2015. See April 2017 rating decision. In May 2016, the Veteran submitted a memorandum for record from a readjustment counselor at High Desert Vet Center, who opined the Veteran's PSTSD has had a significant impact on his life and reported the Veteran's PTSD symptoms were productive of impaired impulse control, unproved irritability with periods of violence, disturbances of motivation and mood, flattened affect, difficulty in establishing and maintaining effective work and social relationships, panic attacks more than once a week, occupational and social impairment with reduced reliability and productivity, chronic sleep impairment, anxiety, suspiciousness, and depressed mood. In June 2017 the Veteran underwent a VA examination for PTSD. The examiner opined that the Veteran's PTSD caused occupational and social impairment with reduced reliability and productivity. Symptoms were reported as depressed mood, anxiety, chronic sleep impairment, disturbances of motivation and mood. In August 2018, the Veteran underwent a private psychological examination for his service-connected PTSD. See Psychological Examination by Dr. R.G.H., report dated August 30, 2018. The examiner, Dr. R.G.H., articulated in great detail that the Veteran's symptoms of PTSD have been present since service and have progressively worsened to his present condition. He opined that the Veteran is 100 percent disabled due to his PTSD. Dr. R.G.H. also opined that the Veteran is unable to maintain a quality of competent functioning in any substantially gainful occupation as a result of his service-connected mental health condition. To the extent the Veteran claims he is entitled to a 100 percent rating at any time prior to the private psychological examination in August 2018, the evidence does not show that the symptoms of his PTSD were productive of total occupational and social impairment prior to August 21, 2018. Moreover, the associated symptoms of his PTSD do not have the frequency, severity, and duration sufficient to warrant a 100 percent disability rating in this claim at any time prior to August 21, 2018. Prior to August 21, 2018, even when considering not only the presence of the Veteran's reported symptoms, but also whether those symptoms have caused occupational and social impairment in most of the referenced areas under the rating criteria (see Vazquez-Claudio, supra), as well as the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission (see 38 C.F.R. § 4.126(a)), and when considering the Veteran's competent reports of his observable adverse symptomatology (see Davidson, supra), based on all the evidence of record that bears on occupational and social impairment related to his PTSD, he does not meet the criteria for the next higher, 100 percent, total rating at any time prior to August 21, 2018 because his symptoms are not shown to be productive of total occupational and social impairment. The Board has reached this conclusion because, prior to August 21, 2018, the adverse symptomatology of the Veteran's PTSD, considering the above criteria, were not shown to have manifestations of 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 fact, while the March 2015 VA examiner opined the Veteran's PTSD caused occupational and social impairment with deficiencies in most areas, the June 2017 VA examiner actually opined the Veteran's PTSD caused occupational and social impairment with reduced reliability and productivity, which is more demonstrative of a 50 percent disability rating, rather than a total (or, 100 percent) rating. See 38 C.F.R. § 4.130, Diagnostic Code 9411. Simply stated, it is important for the Veteran to understand that not all the evidence in the record support the current ratings, let alone higher ratings. The Board notes that while treatment records and the Veteran's lay statements from this period periodically document the Veteran's complaints and treatment related to his PTSD, nothing in these records demonstrate that his adverse symptomatology was any worse than what was reported at the March 2015 and June 2017 VA medical examinations, prior to August 21, 2018. Accordingly, the Board finds that the criteria for a rating in excess of 70 percent prior to August 21, 2018 is not shown to have been met because the associated symptoms of the Veteran's PTSD are not shown to have been productive of a total occupational and social impairment prior to August 2018, under the criteria set forth in 38 C.F.R. § 4.130, Diagnostic Code 9411. 3. Entitlement to a TDIU prior to August 21, 2018, The Veteran asserts, in substance, that his service-connected disabilities prevent him from securing or following substantially gainful employment prior to August 21, 2018, the date he was awarded a 100 percent disability rating for his service-connected PTSD. Entitlement to a TDIU requires the presence of impairment so severe that it is impossible for the average person to follow a substantially gainful occupation. 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 his or her age or to the impairment caused by nonservice-connected disabilities. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.19. In reaching such a determination, 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). The fact that a Veteran is unemployed or has difficulty obtaining employment is not enough to warrant a TDIU. See Van Hoose v. Brown, 4 Vet. App. 361 (1993). In determining whether a veteran can secure and follow a substantially gainful occupation, attention must be given to: (1) the veteran's history, education, skill, and training; (2) whether the veteran has the physical ability (both exertional and non-exertional) to perform the type of activities (e.g., sedentary, light, medium, heavy, or very heavy) required by the occupation at issue. The law provides that a total disability rating may be assigned where the schedular rating is less than total when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that, if there is only one such disability, this disability shall be ratable at 60 percent or more, or if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. See 38 C.F.R. § 4.16(a). The Veteran is currently service connected for the following: Posttraumatic stress disorder with major depressive disorder, rated as 50 percent disabling from March 24, 2014, as 70 percent disabling from March 19, 2015, and as 100 percent disabling from August 21, 2018. Tinnitus, rated as 10 percent disabling from February 16, 2018. The Veteran's total combined disability rating is 50 percent from March 24, 2014; 70 percent from March 19, 2015; and 100 percent from August 21, 2018. Accordingly, the Board finds that the schedular requirements for a TDIU are met from March 19, 2015. See 38 C.F.R. § 4.16(a). With the above laws and regulations in mind, the Board notes that in his June 2017 VA Form 21-8940, Veterans Application for Increased Compensation Based on Unemployability (TDIU Claim Form), the Veteran reported that he has not worked full-time and became too disabled to work because of his service-connected disabilities in January 2012. As to his work history, the Veteran reported that he worked as an owner and operator of a truck driving business from 1999 until June 2012. The Board notes the Veteran was awarded Social Security Administration (SSA) benefits in January 2009 for non-service connected discogenic and degenerative disorder of the back with osteoarthritis. It is important for the Veteran to understand that this finding undermines his statement that it was his service-connected disabilities that stopped him from working to a copious degree. SSA records further show that the Veteran reported he was self-employed as a transportation supervisor and truck driver from 1965 to his application for SSA benefits in 2009. The Board notes a long work history prior to retirement due to age is clearly indicated in this record. As to his education, the Veteran reported that he completed two years of college as his highest level of education. In any TDIU claim, the Board must consider whether the adverse symptomatology caused by the Veteran's service-connected disabilities are not adequately compensated for by the rating criteria. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. In this regard, the Board has reviewed the record in detail, as outlined above, to include the Veteran's VA and private treatment records, his lay statements, and finds the Veteran's service-connected disabilities, PTSD and tinnitus, did not render him unemployable at any time prior to August 21, 2018. The March 2015 VA examiner found the Veteran's PTSD was productive of occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. Notably, however, the examiner did not opine that the Veteran's occupational impairment was a total impairment after examining the Veteran and reviewing the medical and lay evidence of record. Moreover, on examination, the examiner reported that the Veteran's dress was appropriate, he exhibited good personal hygiene, his thought process was logical and goal directed, his speech pattern was within normal limits, he was able to make and maintain good eye contact, he was able to track the conversation during the interview and provide a coherent history of perceived mistreatment by white military service members, law enforcement, coworkers, and family members, and also noting that the Veteran was guarded and agitated during the appointment, his mood was anxious, and there was no evidence of suicidal or homicidal ideations or thought disorder during the interview. In June 2017, a VA examiner opined that the Veteran's PTSD caused occupational and social impairment with reduced reliability and productivity. Notably, the examiner did not opine that the Veteran's occupational and social impairment was total. Moreover, on examination, the examiner reported the Veteran was alert and oriented, mood and affect were depressed, grooming and dress casual and appropriate, speech very low almost inaudible, eye contact poor, thought process linear, no indication of psychotic thought process, and there was no evidence of suicidal or homicidal ideations during the interview. The Board finds that these opinions are not contradicted by any other medical evidence of record for the time period in question. 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). Therefore, the Board finds the March 2015 and June 2017 VA examinations are the most probative evidence of record. Moreover, while treatment records and the Veteran's lay statements periodically document the Veteran's complaints and treatment related to his PTSD and tinnitus, nothing in these records demonstrate that his adverse symptomatology was any worse than what was reported at the March 2015 and June 2017 VA medical examinations, at any time prior to August 21, 2018. Therefore, based on the best medical and lay evidence of record discussed throughout this decision, the Board finds the Veteran's adverse symptomatology, as shown at the March 2015 and June 2017 VA examinations, as well as VA and private treatment records, do not show an impairment so severe that it would have been impossible for the Veteran to follow a substantially gainful occupation due to his PTSD and tinnitus, prior to August 21, 2018. Based on the above, the medical and lay evidence collectively provide highly probative evidence against this claim. It is important for the Veteran to understand that not all evidence in this case supports the rating evaluation given for his PTSD prior to August 21, 2018. Accordingly, the criteria for a TDIU due to service-connected disabilities is not shown to have been met at any time prior to August 21, 2018 because the Veteran's PTSD did not manifest as an impairment so severe that it would have been impossible for him to follow a substantially gainful occupation considering the veteran's level of education (i.e., 2 years of college), special training (i.e., truck operator and business owner), and previous work experience (i.e., driver and business owner). Conclusion Nothing above suggests that the Veteran is not having problems with this disability. The only question is the degree of the problem based on the evidence and the law. It is important for the Veteran to understand that the medical findings provide highly probative evidence against the claim that the Board cannot, unfortunately, ignore. In addition, the Board has not overlooked the claims from the Veteran regarding his adverse symptomatology. See Davidson, supra. However, the Board finds the VA examiner's opinions as to the Veteran's adverse symptomatology more probative than the lay claims from the appellant to the contrary even though his symptomatology is observable by a lay person because the examiner has 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). 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 claim to the extent outlined above, the Board finds that this doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz, supra; Gilbert, 1 Vet. App. at 55-56. John J. Crowley Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Christopher M. Davidson 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.