Citation Nr: A21019902 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 200717-99442 DATE: December 14, 2021 ORDER Entitlement to a rating of 70 percent for posttraumatic stress disorder (PTSD) with major depressive disorder (MDD) is granted. Entitlement to a total disability rating based on individual unemployability (TDIU) is granted. FINDINGS OF FACT 1. The preponderance of the evidence demonstrates that the Veteran's PTSD with MDD more nearly approximated occupational and social impairment with deficiencies in most areas, but not total occupational and social impairment during the period on appeal. 2. The Veteran's combination of the Veteran's service-connected disabilities, to include ischemic heart disease and PTSD with MDD, preclude him from securing and following a substantially gainful occupation consistent with his education and work experience. CONCLUSIONS OF LAW 1. The criteria for a disability rating of 70 percent for PTSD with MDD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. 2. The criteria for award of a TDIU have been met. 38 U.S.C. §§ 1155, 5103(a), 5107(b); 38 C.F.R. §§ 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1968 to September 1969. The rating decision on appeal was issued in July 2020; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In the July 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) (NOD), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal. 38C.F.R. § 20.301. Although the July 2020 AMA decision did not discuss it, the Board finds there was an implicit finding that new and relevant evidence was received by the AOJ as the claim was readjudicated on the merits. In addition, the AOJ also determined in a July 2019 rating decision that the Veteran was not working and his service-connected disabilities combined to a 70 percent evaluation to meet the schedular requirements for a TDIU. The Board is bound by these favorable findings. 38 C.F.R. § 3.104(c). This appeal has been advanced on the Board's docket pursuant to 38 U.S.C. § 7107 (a)(2) and 38 C.F.R. § 20.800(c). In March 2019, the Veteran filed a claim for an increased rating for his PTSD and ischemic heart disabilities, along with a claim for TDIU. In a December 2019 rating decision, the AOJ continued the Veteran's 50 percent rating for PTSD and denied a TDIU. After the Veteran requested a Higher Level Review, the AOJ confirmed its decision in a May 2020 rating decision. In June 2020, the Veteran filed a Supplemental Claim which was adjudicated in the rating decision on appeal. As the Veteran has continuously pursued his claims for an increased rating for PTSD and a TDIU, the period on appeal begins is from March 22, 2019 (the date of the claim) to July 1, 2020 (the date of the rating decision notification letter), along with the one-year lookback period. 38 C.F.R. § 3.400(o)(2), 3.2500(h). Increased Rating Disability ratings are determined by the application of VA's Schedule for Rating Disabilities. 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during service and the residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321 (a), 4.1. The determination of whether an increased rating is warranted is based on review of the entire evidence of record and the application of all pertinent regulations. 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 whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings," whether it is an rating case or not. Fenderson v. West, 12 Vet. App. 119, 126-27(1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Evaluations for psychiatric disabilities are assigned pursuant to VA's General Rating Formula for Mental Disorders under 38 C.F.R. § 4.130. The Veteran's PTSD with MDD is rated under DC 9411. See 38 C.F.R. § 4.130. Ratings are based on a schedule of reductions in earning capacity from specific injuries or combination of injuries. The ratings shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations. 38 U.S.C. § 1155. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § § 4.1. Under DC 9411 a 50 percent rating is assigned when symptoms such 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; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. A 70 percent rating is warranted where there is occupational and social impairment with deficiencies in most areas, including work, school, family relationships, judgment, thinking or mood, due to such symptoms as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. A 100 percent is warranted where there is 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. The list of symptoms under the rating criteria are meant to be examples of symptoms that would warrant the evaluation, but are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific evaluation. Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). See also Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013) (explaining that the symptoms that could give rise to a given rating are those in like kind, i.e., of similar duration, severity, and frequency, to those provided in the non-exhaustive lists). A claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Thus, separate ratings can be assigned for separate periods of time based on the facts found a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. 1. Entitlement to a rating of greater than 50 percent for posttraumatic stress disorder (PTSD) with major depressive disorder (MDD) from March 22, 2019, to July 1, 2020. The Veteran through his representative asserts that his service-connected PTSD is more disabling than what is reflected by the 50 percent rating. He noted that he was last examined in April 2019 and believes that that examination report shows that he has severe symptoms. The Veteran through his representative highlighted the fact that the April 2019 examination shows he has intrusive and recurrent dreams, markedly diminished interests, feelings of detachment from others along with having little social life other than his wife. The Veteran asserts that he has irritable behavior and outbursts and reported that the examiner stated that his symptoms cause significant employment impairment. See Appellate Brief Received June 2021. The Veteran is currently service connected for PTSD with MDD pursuant to Diagnostic Code 9411 and has been assigned a rating of 50 percent from September 2017. The Veteran's post service treatment records capture some of the Veteran's PTSD and MDD symptoms. An August 2017 psychiatry note states that the Veteran experiences depression a lot, noting that when the Veteran gets bored, he experiences passive suicidal ideations. It was further noted that he last had passive suicidal ideations earlier this week with no intent or plan to carry out an act. A November 2017 treatment record indicates that the Veteran was experiencing intrusive thoughts, nightmares, poor sleep, mood disturbances, irritability, feelings of sadness, low energy, and anhedonia. In a January 2017, January 2018 and May 2019 Depression screening, it was noted that the Veteran has a history of depression. Additionally, a January 2018 psychiatry note indicates that the Veteran went into a depression for two to three days stating he hadn't been doing anything lately but would go to the Legion on occasion. In a July 2019 primary care nursing note, the Veteran denied suicidal and homicidal ideation as well as depression. A December 2019 psychiatry note states that the Veteran experienced depression almost constantly and his mood was characterized as depressed and irritable. The Veteran's psychiatrist noted the Veteran experienced suicidal ideations "way back when" and experienced them intermittently since his last ideations three to four years back. The Veteran stated that he has never attempted suicide. It was noted that he experiences feelings of guilt, helplessness, hopelessness, low energy, low motivation, low concentration, decreased appetite, sleep changes, avoidance symptoms, feelings of detachment/estrangement, emotional numbness, anger outburst, exaggerated startle response, panic attacks, and excessive worry. A February 2020 physical medicine rehab consult states that the Veteran did not experience depression or suicidal ideations. A March 2020 mental health telephone encounter note states the Veteran reported that his depression and anxiety are stable, despite COVID-19 fears. See CAPRI treatment records received May 2020. Another March 2020 treatment record indicates that the Veteran had no suicidal or homicidal ideations and his depression and PTSD were noted as stable. Id. The Veteran was afforded a VA examination to evaluate his psychiatric disability in April 2019. The examiner diagnosed the Veteran with PTSD and mild major depressive disorder. The examiner noted that it is not possible to differentiate what symptoms are attributable to each diagnosis, given that the diagnoses have some of the same overlapping symptoms. The examiner described the Veteran's level of occupational and social impairment as 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 examiner noted that the Veteran reported that he is still married to his wife of 22 years (at the time of the exam). Additionally, the examiner stated for leisure the Veteran enjoys reading western novels and watching television. The Veteran stated he prefers to be away from others as he feel uncomfortable around others since his time in Vietnam. It was also noted that the Veteran reported that he has very little social support outside of his wife. Additionally, the Veteran stated that he has experiences in which he becomes irritable with others and will shut down, often not wanting to interact when he is around others. Moreover, the examiner noted that the Veteran actively experienced symptoms of depressed mood, anxiety, chronic sleep impairment, and disturbances of motivation and mood. The examiner noted that the Veteran was alert and oriented to person and place and was dressed appropriately and his hygiene and grooming were adequate. The examiner also noted that the Veteran did not demonstrate problems with his gait or coordination. Furthermore, it was noted that the Veteran was cooperative and fully participated in the exam. His speech was characterized as somewhat impoverished. His mood was described as anxious and dysphoric, with constricted affect. The examiner noted that his thought process was goal directed and organized. It was noted that he did not demonstrate formal thought disordered symptoms, however, memory aspects were noted to be somewhat impaired when assessed. His concentration was stated to be intact and his judgment and insight when briefly assessed was stated to be good. The examiner noted that the Veteran denied current suicidal and homicidal ideation. Additionally, the examiner stated that in relation to severity, the Veteran reported distress and limitations in his social functioning due to symptoms of his PTSD and also stated that he remains socially isolative and often remains at home due to his fear of others, his irritability and his persistent negative cognitive distortions. The examiner stated that the Veteran requires mental health treatment to manage his symptoms. The examiner stated that in general, in relation to the severity of his disorder and its impact upon psychosocial functioning, the Veteran experiences symptoms which cause him social impairment however, the Veteran continues to engage in his activities of daily living, self-care and conversation. An addendum/clarification DBQ opinion was provided in December 2019 for the examiner to indicate whether or not the MDD was secondary to, a progression of or otherwise related to the Veteran's service-connected PTSD. The examiner noted that the Veteran endorsed a lack of energy and interest with low motivation, irritability and occasional hopelessness and worthlessness. The examiner noted that although there are a variety of contributing factors to the Veteran's depression including but not limited to the Veteran's wife's infidelity, the Veteran's medical problems, Vietnam trauma experiences are associated with feelings of sadness. The examiner ultimately concluded that the Veteran's major depressive disorder, recurrent, mild is at least partially secondary to his PTSD condition. Based on the foregoing, the Board finds that the Veteran's overall disability picture for the period on appeal is representative of a 70 percent disability rating. The Board has considered and affords the assessments detailed above probative value and finds that when considering the examination reports and the Veteran's treatment records, a 70 percent rating is most appropriate. Although the Veteran's symptoms varied at times, the record supports that during the appeal period the Veteran had numerous symptoms that comport with those described in the 70 percent rating and that demonstrate that the Veteran's symptoms are manifested by occupational and social impairment with deficiencies in most areas. Specifically, during the period on appeal the Veteran experienced near-constant feelings of sadness and depression, chronic sleep issues, nightmares, isolation, irritability, anxiety, lack of motivation, memory issues, avoidance symptoms, feelings of detachment/estrangement, emotional numbness, anger outburst, exaggerated startle response, panic attacks, and excessive worry, guilt, persistent negative cognitive distortions, feelings of hopelessness and helplessness; all of which collectively reflect deficiencies in most areas. Moreover, the Board notes that the evidence is in relative equipoise about whether the Veteran experiences suicidal ideation. Although many treatment records indicate that the Veteran denied suicidal and homicidal ideations, other records reflects that the Veteran had more than occasional thoughts of harming himself. The Board recognizes that the 70 percent rating criteria do not distinguish between active and passive suicidal ideation and that, in some cases, the mere presence of suicidal ideation (ranging from passive thoughts of one's own death to active thoughts of engaging in suicide-related behavior), may cause occupational and social impairment with deficiencies in most areas. See Bankhead v. Shulkin, 29 Vet. App. 10 (2017). However, "VA must engage in a holistic analysis in which it assesses the severity, frequency, and duration of the signs and symptoms of the veteran's service-connected mental disorder; quantifies the level of occupational and social impairment caused by those signs and symptoms; and assigns an evaluation that most nearly approximates that level of occupational and social impairment." Bankhead, 29 Vet. App. at 22 (internal citations omitted). In this case, the report of experiencing suicidal ideations as referenced in the August 2017 treatment note (passive or otherwise) as well as the December 2019 treatment note that stated that the Veteran experienced intermittent suicidal ideations since three to four years ago, when considered with other symptoms, caused the level of occupational and social impairment associated with a 70 percent disability rating, when all doubt is resolved in the Veteran's favor. The Board is aware that the examinations of record do not specifically indicate that the Veteran experienced occupational and social impairment in most areas; however, given the frequency and severity of the Veteran's combined PTSD and MDD symptoms including constant feelings of sadness and depression, chronic sleep issues, nightmares, isolation, irritability, anxiety, lack of motivation, memory issues, avoidance symptoms, feelings of detachment/estrangement, emotional numbness, anger outburst, exaggerated startle response, panic attacks, and excessive worry, guilt, persistent negative cognitive distortions, feelings of hopelessness and helplessness, a wholistic view of the record indicates that his symptoms reveal deficiencies in most areas from September 26, 2017 and throughout the entire appeal period. However, the preponderance of the evidence is against the assignment of a schedular rating in excess of 70 percent for any portion of the appeal period. The evidence does not reflect a consistent history of delusions and hallucinations. The Veteran has not been noted to have disorientation to time or place. He has had a period of suicidal ideation as indicated; however, the overall record does not indicate that he poses a persistent danger to himself or others. He has not been shown to suffer from an inability to remember his own name, occupation, or the names of close family members. The Veteran maintains a close relationship with his wife and while the record indicates that he has challenges forming close relationships with others due to issues that he experiences with isolation, it cannot be said that he has suffered total social impairment as the Veteran stated that he attends events at the Legion. There is no indication that he is unable to maintain minimal personal hygiene, and he has not demonstrated grossly inappropriate behavior. In fact, the examiner noted that the Veteran continues to engage in his activities of daily living, self-care and conversation. The Board notes that the Veteran is competent and credible to report the subjective symptoms and functional limitations he experiences regarding his service-connected disabilities. See Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Board finds that when the Veteran's reports and assertions regarding his PTSD and MDD symptoms are considered in conjunction with the clinical evidence of record, as well as the pertinent rating criteria, there is further support for why a rating of 70 percent is appropriate for the period on appeal. The Board has considered and affords the April 2019 examiner's assessment high probative value, as it was based on a thorough review of the evidence and interview of the Veteran. Moreover, it is consistent with the other evidence of record, including the treatment notes concerning the Veteran's PTSD and MDD. However, these records do not support a finding that the Veteran's psychiatric disability results in total social and occupational impairment. Pursuant to Fenderson v. West, 12 Vet. App. 119, 126 (1999), the Board has considered the applicability of staged ratings. However, in this case, the evidence does not support the assignment of a 100 percent schedular rating for any portion of the period on appeal. Resolving reasonable doubt in the Veteran's favor, the preponderance of the evidence shows the Veteran's PTSD and MDD symptoms were productive of occupational and social impairment, with deficiencies in most areas. Thus, a rating of 70 percent and no higher is granted during the entire period on appeal. TDIU A claim for TDIU, either expressly raised by the Veteran or reasonably raised by the record, involves an attempt to obtain an appropriate rating for a disability and is part of the claim for an increased rating. Rice v. Shinseki, 22 Vet. App. 447 (2009). VA will grant a total rating for compensation purposes based on unemployability when the evidence shows that a veteran is precluded, by reason of service-connected disability, from obtaining and maintaining any form of gainful employment consistent with his education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. Substantially gainful employment is employment that is ordinarily followed by the nondisabled to earn a livelihood, with earnings common to the particular occupation in the community where the employee resides. The term suggests a living wage. Ferraro v. Derwinski, 1 Vet. App. 326 (1991). The ability to work sporadically or to obtain marginal employment is not substantially gainful employment. 38 C.F.R. § 4.16(a); Moore v. Derwinski, 1 Vet. App. 356 (1991). Employment may be marginal even when the veteran's earned income exceeds the poverty threshold if the veteran is employed in a protected environment such as a family business or sheltered workshop. 38 C.F.R. § 4.16(a). VA may consider the level of education, special training, and previous work experience in making this determination, but may not consider the Veteran's age or the impairment caused by any nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19; see also Ferraro v. Derwinski, 1 Vet. App. (1991). In 2019, the U.S. Court of Appeals for Veterans Claims (CAVC) held that substantially gainful employment, in the TDIU context, contains economic and noneconomic components; the economic component means an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person, while the noneconomic component requires consideration of a veteran's ability to secure or follow that type of employment. Ray v. Wilkie, 31 Vet. App. 58 (2019). The CAVC also provided guidance as to the meaning of a veteran's ability to secure and follow such employment, noting that attention must be given to: the veteran's occupational history, education, skill and training; whether the veteran has the physical ability to perform occupational activities; and whether the veteran has the mental ability to perform occupational activities. Medical evidence describing the effect of each disorder on the Veteran's occupational functioning is crucial to permit the Board to arrive at an assessment of employability. 38 C.F.R. § 4.1. However, the question of whether the Veteran's service-connected disabilities are of sufficient severity to produce unemployability is ultimately the Board's determination to make. See Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013) (citing 38 C.F.R. § 4.16(a) as support for the conclusion that the applicable statutory and regulatory provisions "place responsibility for the ultimate TDIU determination on the VA, not a medical examiner"). Benefits based on individual unemployability are granted only when it is established that the service-connected disability or disabilities are so severe, standing alone, as to prevent the retaining of gainful employment. If there is only one such disability, it must be rated at 60 percent or more. If there are two or more service-connected disabilities, one disability must be rated at 40 percent or more, and there must be sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). Where a veteran meets the schedular criteria for consideration of unemployability under 38 C.F.R. § 4.16(a), the remaining question is whether the veteran is unable to secure or follow a substantially gainful occupation as a result of his service-connected disability. 2. Entitlement to TDIU from March 22, 2019, to July 1, 2020. The Veteran asserts that he is unemployable due to his service-connected disabilities. He reports that he last worked in April 2011 and stated that he completed high school. Additionally, the Veteran asserts that he has disabilities involving his heart with a 60 percent rating and he believes that this disability along with his PTSD causes problems with employment. The Veteran contends that due to his service-connected disabilities, he is permanently prevented from maintaining or obtaining any substantially gainful employment. See Appellate Brief Received June 2021. The Veteran's lay statements indicate that he suffered a heart attack around September 2018 and was admitted to the hospital and was given a cardiac cath where the cardiologist discovered a 90 percent blockage and it required a new stent placement. See VA Form 21-4138 Statement in Support of Claim Received September 2018. Total disability ratings are authorized for any disability or combination of disabilities for which the Schedule for Rating Disabilities prescribes a 100 percent disability evaluation, or, with less disability, if certain criteria are met. Id. Where the schedular rating is less than total, a total disability rating for compensation purposes may be assigned 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 ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). As noted in the introduction, the Veteran's service-connected disabilities include ischemic heart disease (60 percent), PTSD and MDD (70 percent), tinnitus (10 percent) and erectile dysfunction (noncompensable), with a combined 70 percent evaluation. As such, the Veteran meets the criteria for schedular consideration of TDIU under 38 C.F.R. § 4.16(a) for the appeal period. See Rating Decision Codesheet dated June 2020. As the Veteran has satisfied the schedular requirements for TDIU, the question that remains is whether his service-connected disabilities preclude him from obtaining or engaging in substantially gainful employment. 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). For the reasons that follow, the Board finds that entitlement to a TDIU is warranted for the period on appeal. The Veteran's treatment records provide insight on his work history. An October 2016 treatment record states that the Veteran retired from building maintenance work six years ago. A treatment record dated November 2017 states that the Veteran worked in maintenance in the military, and then subsequently for an ambulance company, building ambulances. See CAPRI treatment records received January 2018. A treatment record dated March 2020 also states that the Veteran worked in maintenance in the military and then subsequently for an ambulance company, building ambulances. See CAPRI treatment records received May 2020. A November 2011 VA examination noted the Veteran dropped out of high school, but then earned his GED and worked at an auto body shop setting up painting equipment until he was drafted into the Army. It was also noted that after his discharge from the Army, the Veteran returned to his previous job and worked there for about 12 years and then left that job to work for another company where he painted ambulances and did cosmetic trimming of vehicles for about another 12 to 13 years. Additionally, it was noted that the Veteran was unemployed for about one year and then worked in building maintenance for about 13 years and retired in August of 2009. In the April 2019 VA examination for PTSD, the Veteran reported that he has been retired since 2011 and has not worked since retiring. The examiner noted that because the Veteran has been retired since 2011, his occupational functioning is unable to be assessed at this time. An April 2019 VA examination noted the Veteran's heart condition results in dyspnea, fatigue, and an interview-based METs level of greater than 3 but not greater than 5 METs which is found to be consistent with activities such as light yard work (weeding), moving the lawn (power mower), and brisk walking (4 mph). The examiner the Veteran's METs level is due to multiple medical conditions but that it was not possible to accurately estimate the contribution of each medical condition. The examiner concluded that the Veteran's heart condition did not impact his ability to work. When considering the Veteran's employment and educational background, as well as the medical evidence of record, in addition to affording the Veteran the benefit of the doubt, the Board finds entitlement to a TDIU is warranted. The Veteran has no formal education beyond high school and his work experience is limited to physically demanding occupations prior to his retirement in 2011. The Board affords no probative value to the April 2019 examiner's opinion regarding the impact of the Veteran's PTSD and MDD on his ability to work as she failed to fully answer the question based solely on the fact the Veteran is retired. Moreover, the Board finds that the Veteran's heart condition results in impairments that restrict his physical activity to light activities that would not be consistent with the physical demands of work consistent with his education and prior work history. (Continued on the next page) The Board has acknowledged and considered the Veteran's lay statements addressing his employability. The Board notes that the Veteran is competent and credible to report the subjective symptoms and functional limitations he experiences regarding his service-connected disabilities. See Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Board finds the Veteran's statements to be consistent with the evidence of record concerning the impact of his service-connected heart and PTSD with MDD disabilities on his ability to obtain and maintain substantially gainful employment. Accordingly, the Board finds that the Veteran's service-connected disabilities prevent him from obtaining and maintaining substantially gainful employment that is consistent with his experience and education. As such, appeal is granted. Tiffany Dawson Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Dorsey-Kwansa, Associate 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.