Citation Nr: 21005931 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 19-33 047 DATE: February 2, 2021 ORDER An effective date prior to May 23, 2018, for the award of service connection for posttraumatic stress disorder (PTSD) is denied. An initial rating in excess of 50 percent for PTSD is denied. As of March 21, 2018, a rating in excess of 30 percent for bilateral hearing loss is denied. Entitlement to a total disability rating based on individual unemployability due to service-connected disability (hereinafter, TDIU) prior to February 25, 2020, is denied. REMANDED Entitlement to service connection for a headache disorder is remanded. FINDINGS OF FACT 1. The Department of Veterans Affairs (VA) received the Veteran’s intent to file an original claim for service connection for PTSD on May 23, 2018, and his formal claim for such was received on June 25, 2018. 2. For the entire appeal period, the Veteran’s PTSD is manifested by symptomatology resulting in occupational and social impairment with reduced reliability and productivity, without more severe manifestations that more nearly approximate occupational and social impairment with deficiencies in most areas, or total occupational and social impairment. 3. As of March 21, 2018, the Veteran has had no worse than Level VI hearing acuity in the right ear and Level III hearing acuity in the left ear. 4. For the appeal period stemming from May 23, 2018, to February 25, 2020, the Veteran’s service-connected disabilities did not render him unable to secure or follow a substantially gainful occupation consistent with his education and work history. CONCLUSIONS OF LAW 1. The criteria for an effective date prior to May 23, 2018, for the award of service connection for PTSD have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 2. For the entire appeal period, the criteria for an initial rating in excess of 50 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9411. 3. As of March 21, 2018, the criteria for a rating in excess of 30 percent for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.85, 4.86, DC 6100. 4. For the appeal period stemming from May 23, 2018, to February 25, 2020, the criteria for a TDIU have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.40, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1969 to January 1971. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2018 rating decision issued by a VA Regional Office (RO). Additional evidence, to include updated VA and private treatment records, was associated with the record subsequent to the issuance of the November 2019 supplemental statement of the case. The Veteran has not waived Agency of Original Jurisdiction (AOJ) consideration of such evidence. However, such is either duplicative or irrelevant to the issues on appeal, or pertinent to the issues of hypertension and headaches, which has been granted and will be remanded, respectively. Therefore, no prejudice results to the Veteran in the Board proceeding with a decision at this time. 38 C.F.R. § 20.1304(c). Furthermore, while an unappealed December 2020 rating decision denied the Veteran’s claim of entitlement to a TDIU, the Veteran has alleged that his PTSD renders him unemployable. Accordingly, such is part and parcel to his increased rating claim for PTSD and the Board has assumed jurisdiction over his claim for a TDIU pursuant to Rice v. Shinseki, 22 Vet. App. 447, 453–54 (2009). Following certification of the claim of entitlement to service connection for hypertension in December 2019, the Agency of Original Jurisdiction granted service connection for diabetes mellitus, type II, with erectile dysfunction and hypertension in a rating decision issued in October 2020. Such award constitutes a full grant of the benefit sought on appeal with respect to the service connection claim for hypertension, and the Veteran has not initiated an appeal with respect to any part of the decision. See Grantham v. Brown, 114 F.3d 1156, 1158-59 (Fed. Cir. 1997); Baughman v. Derwinski, 1 Vet. App. 563, 566 (1991). Consequently, such issue is not before the Board at this time. 1. Entitlement to an effective date prior to May 23, 2018, for the award of service connection for PTSD. The Veteran contends that an effective date prior to May 23, 2018, for the award of service connection for PTSD is warranted. However, as VA received the Veteran’s original intent to file a claim for service connection for such disorder on May 23, 2018, followed by an original claim for such on June 25, 2018, an earlier effective date is not warranted. Except as otherwise provided, the effective date for an award of service connection is the day after separation from service or date entitlement arose, if a claim is received within one year of separation from service; otherwise, the date of receipt of claim, or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(b)(1); 38 C.F.R. § 3.400(b)(2)(i). A claim for VA benefits, whether formal or informal, must be in writing and must identify the benefit sought. 38 U.S.C. § 5101; 38 C.F.R. §§ 3.1(p), 3.151, 3.155 (2014); Rodriguez v. West, 189 F.3d 1351 (Fed. Cir. 1999); Lalonde v. West, 12 Vet. App. 377 (1999). Prior to March 24, 2015, any communication or action indicating intent to apply for one or more benefits under the laws administered by VA, was considered an informal claim. As of March 24, 2015, a claimant, or certain other individuals as specified in section 3.155(b), may indicate a claimant’s intent to file a claim for benefits by submitting an intent to file a claim to VA. 38 C.F.R. § 3.155(b). An intent to file a claim must provide sufficient identifiable or biographical information to identify the claimant. Upon receipt of the intent to file a claim, VA will furnish the claimant with the appropriate application form prescribed by the Secretary. If VA receives a complete application form prescribed by the Secretary, as defined in 38 C.F.R. § 3.160(a), appropriate to the benefit sought within one year of receipt of the intent to file a claim, VA will consider the complete claim filed as of the date of the intent to file a claim was received. 38 C.F.R. § 3.155(b). While the VA should broadly interpret submissions from a veteran, it is not required to conjure up claims not specifically raised. Brannon v. West, 12 Vet. App. 32 (1998); Talbert v. Brown, 7 Vet. App. 352, 356-57 (1995). In the instant case, the Veteran submitted a VA Form 21-0966, Intent to File a Claim for Compensation and/or Pension or Survivors Pension and/or DIC, on May 23, 2018. Thereafter, VA received the Veteran’s VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits on June 25, 2018. In the November 2018 rating decision, the AOJ awarded an effective date for PTSD based on the date of VA’s receipt of the intent to file. In this regard, the AOJ explained that the date of rating for the Veteran’s PTSD could not predate the date of the Veteran’s intent to file a claim. Here, the Board finds it cannot construe any document as a formal or informal claim for service connection for PTSD or an acquired psychiatric disorder prior to the receipt of the Veteran’s informal claim on May 23, 2018. Despite a voluminous record, to include extensive correspondence, and informal and formal claims received prior to such date, such does not include a reference to PTSD or an acquired psychiatric disorder, or contain a communication indicating an intent to apply for service connection for such a disability. Furthermore, the evidence does not show, and the Veteran does not contend, that he submitted an application for benefits prior to such date or within one year of separation from service. The Board finds that there is likewise no general statement of intent to seek benefits coupled with a reasonably identifiable in-service medical diagnosis in the Veteran’s service treatment records that may constitute an earlier claim for benefits. Sellers v. Wilkie, 30 Vet. App. 157 (2018). In this regard, a review of the Veteran’s submissions reflects that he has consistently been specific in his applications for benefits. Furthermore, upon review of his earlier filings, the Board finds that such did not identify specific medical records that contained a reasonably ascertainable diagnosis of an acquired psychiatric disability so that such submission may constitute an informal claim for benefits. Shea v. Wilkie, 926 F.3d 1362 (Fed. Cir. 2019). Furthermore, even assuming a prior submission may be considered an earlier claim for service connection for PTSD, entitlement did not arise until an October 10, 2018, VA examination when the examiner opined that the Veteran’s current PTSD was related to his military service. Consequently, an effective date prior to May 23, 2018, the date of receipt of the Veteran’s informal claim for the award of service connection for PTSD is not warranted. There is no doubt to be resolved, and the appeal for an earlier effective date for the award of service connection must be denied. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. § 3.400. 2. Entitlement to an initial rating in excess of 50 percent for PTSD. Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant’s favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods 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). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. The Veteran is currently in receipt of an initial 50 percent rating for his PTSD effective May 23, 2018, pursuant to DC 9411, which provides that such disability is evaluated pursuant to the General Rating Formula for Mental Disorders. See 38 C.F.R. § 4.130. In this regard, a 50 percent rating contemplates 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; impairments of short-and long-term memory; impaired judgment; impaired abstract thinking; disturbance 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, 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 the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships. Id. A 100 percent evaluation 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. Id. As the United States Court of Appeals for the Federal Circuit 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. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 11617 (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, supra, 713 F.3d at 117–18 ; 38 C.F.R. § 4.130, DC 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). The Board notes that the revised DSM-5, which, among other things, eliminates Global Assessment of Functioning (GAF) scores, applies to appeals certified to the Board after August 4, 2014, as is the case here. See 79 Fed. Reg. 45, 093 (Aug, 4, 2014). Consequently, the Board will not consider any previously assigned GAF scores in determining the outcome of this case. See Golden v. Shulkin, 29 Vet. App. 221 (2018). The Veteran was afforded a VA psychological examination in October 2018. At such time, he reported that his PTSD symptoms began after his deployment to Vietnam. He stated that he could not stop thinking about the war and experienced symptoms of stress, depression, anxiety, and sleep impairment. He reported not seeking treatment at any point, though he did state that he suffered from symptoms of PTSD for many years. He stated that he experienced memory impairment, often forgetting names, appointments, and important information. He stated that symptoms of his PTSD have affected his relationships due to a short temper and agitation in social settings. In the October 2018 VA psychological examination, the Veteran further reported recurrent, involuntary, and intrusive memories; recurrent distressing dreams; intense or prolonged psychological distress at exposure to reminders of his reported stressor; avoidance behavior; markedly diminished interest or participation in significant activities; feelings of detachment or estrangement from others; hypervigilance; problems with concentration; and sleep disturbance. The Veteran also stated that he still struggles with depressed mood, anxiety, suspiciousness, mild memory loss, flattened affect, disturbance in motivation and mood, difficulty establishing and maintaining effective work and/or social relationships, and difficulty adapting to stressful circumstances. Upon consideration of the foregoing, the VA examiner found that the Veteran’s PTSD resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. While such finding corresponds with the criteria for a 30 percent rating under DC 9411, the RO assigned a 50 percent rating for the Veteran’s PTSD based on his reported symptoms such as difficulty in establishing and maintaining effective work and social relationships, memory impairment, and disturbance in mood. Upon review, the Board finds that, for the entire appeal period, the criteria for an initial rating in excess of 50 percent for the Veteran’s PTSD is not warranted. In this regard, the record reflects that such disability was consistently manifested by symptoms of depression, anxiety, sleep impairment, difficulty with concentration, mild memory loss, disturbances of motivation and mood, difficulty with irritability and controlling his temper, and difficulty in establishing and maintaining effective work and social relationships. In this regard, while the Veteran consistently reported experiencing depression and anxiety, such are not shown to be of a frequency, severity, or duration so as to more nearly approximate near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively, as will be discussed below. Specifically, upon a holistic analysis in assessing the nature, frequency, severity, and duration of the signs and symptoms of the Veteran’s service-connected psychiatric disability, and their resulting social and occupational/industrial impairment, the Board finds that such do not more nearly approximate serious impairment in the ability to establish and maintain effective or favorable relationships with people or obtain or maintain employment, or occupational and social impairment with deficiencies in most areas. Specifically, while the Veteran reported agitation in social settings, the record reflects that he consistently maintained close relationships with his wife, his children, and a few friends, who he considers to be his support system. Therefore, while the Veteran’s psychiatric disability results in some discomfort in leaving home, and a resulting difficulty in establishing and maintaining effective work and social relationships, it is not shown that such disability results in serious impairment in the ability to establish and maintain effective or favorable relationships with people, which is indicative of a 70 percent rating. With respect to occupational impairment, the VA examiner noted the Veteran had worked as a machine operator for approximately ten years until he retired in 2011. He reported being able to maintain positive working relationships with his peers and colleagues. In addition, the Board finds the Veteran has not reported symptoms commensurate with a 100 percent rating, nor do treatment records or examination reports reflect any such symptoms throughout the pendency of the appeal. Furthermore, while he has reported difficulty in maintaining effective relationships, which is contemplated by a 70 percent rating, such are not shown to be of a nature, frequency, duration, and severity as to result in social and occupational impairment with deficiencies in most areas. Specifically, the Veteran reporting maintaining good relationships with colleagues, family members, and a few close friends over the years. He has maintained impulse control, has not reported any suicidal or homicidal ideations or plan, and is considered a low risk for violence. Therefore, based on the foregoing, the Board finds that the Veteran's PTSD was manifested by psychiatric symptomatology resulting in occupational and social impairment with reduced reliability and productivity, without more severe manifestations that more nearly approximate occupational and social impairment with deficiencies in most areas, or total occupational and social impairment. Thus, an initial rating in excess of 50 percent for such disability is not warranted. The Board has also considered whether staged ratings under Fenderson, supra, are appropriate for the Veteran’s service-connected PTSD; however, the Board finds that such symptomatology has been stable throughout the appeal period. Therefore, assigning staged ratings is not warranted. Further, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record in connection with the initial rating claim adjudicated herein, other than the effective date of such rating, which has been addressed above. Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). In sum, the Board finds that the preponderance of the evidence is against an initial rating in excess of 50 percent for the Veteran’s PTSD. Therefore, the benefit of the doubt doctrine is not applicable to the instant claim and his claim for a higher initial rating for his PTSD must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 3. Entitlement to a rating in excess of 30 percent for bilateral hearing loss as of March 21, 2018. By way of background, the instant appeal arises from the Veteran’s disagreement following the RO’s denial for his claim for an increased rating for his bilateral hearing loss in a November 2018 rating decision. Specifically, in his subsequent notice of disagreement, received by VA on September 18, 2019, the Veteran disagreed with the 30 percent rating assigned, as well as the date of such assignment. In this regard, however, the Board notes that the Veteran’s claim of entitlement to a compensable rating for bilateral hearing loss prior to March 11, 2016, was already adjudicated in a January 2019 Board decision. The appeal period currently before the Board stems from the Veteran’s intent to file a claim for an increased rating for his bilateral hearing loss received on March 21, 2018, plus the one-year look-back period. Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). Ratings of hearing loss range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of speech discrimination tests combined with the average hearing threshold levels as measured by pure tone audiometry tests in the frequencies 1000, 2000, 3000, and 4000 cycles per second. To rate the degree of disability for service-connected hearing loss, the Rating Schedule has established eleven auditory acuity levels, designated from level I, for essentially normal acuity, through level XI, for profound deafness. 38 C.F.R. § 4.85(h), Table VI. In order to establish entitlement to a compensable rating for hearing loss, it must be shown that certain minimum levels of the combination of the percentage of speech discrimination loss and average pure tone decibel loss are met. The assignment of disability ratings for hearing impairment is derived by a mechanical application of the Rating Schedule to the numeric designations assigned after audiometric evaluations are rendered. Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). The criteria for rating hearing impairment use controlled speech discrimination tests (Maryland CNC) together with the results of pure tone audiometry tests. These results are then charted on Table VI, or Table VIA in exceptional cases as described in 38 C.F.R. § 4.86, and Table VII, as set out in the Rating Schedule. 38 C.F.R. § 4.85. An exceptional pattern of hearing loss occurs when the pure tone threshold at 1000, 2000, 3000, and 4000 Hertz is 55 decibels or more, or when the pure tone threshold is 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz. 38 C.F.R. § 4.86. In this regard, the Veteran underwent a private audiological examination on March 15, 2018. While the exact pure tone thresholds in decibels at the tested frequencies of 1000, 2000, 3000, and 4000 are not discernible from the examination report, the examiner noted that the pure tone threshold average was 85 decibels in both ears, with word recognition testing revealing speech recognition ability of 96 percent in both ears. No exceptional pattern of hearing loss was reported. The audiometric test results, therefore, equate to Level III hearing in both ears, which equates to a noncompensable rating for bilateral hearing loss. The Veteran underwent another private audiological examination on May 1, 2018. At such time, he reported difficulty hearing. Pure tone thresholds in decibels at the tested frequencies of 1000, 2000, 3000, and 4000 Hertz were 60, 70, 70, and 80, respectively, in the right ear and 55, 70, 75, and 80, respectively, in the left ear. The examiner noted that the pure tone threshold average was 70 decibels in both ears. Word recognition testing revealed speech recognition ability of 98 percent in the right ear and 94 percent in the left ear. No exceptional pattern of hearing loss was shown. These audiometric test results equate to Level II hearing in the right ear and Level II hearing in the left ear, which equates to a noncompensable rating for bilateral hearing loss. Next, the Veteran underwent an additional private audiological examination on October 11, 2018. At such time, he again reported difficulty hearing, explaining that he has difficulty understanding people when they speak to him. Pure tone thresholds in decibels at the tested frequencies of 1000, 2000, 3000, and 4000 Hertz were 55, 70, 85, and 85, in the right ear and 60, 70, 80, and 85, in the left ear. The examiner noted that the pure tone threshold average was 73.75 decibels in both ears. Word recognition testing revealed speech recognition ability of 88 percent in the right ear and 84 percent in the left ear. No exceptional pattern of hearing loss was shown. These audiometric test results equate to Level III hearing in the right ear and Level III hearing in the left ear, which equates to a noncompensable rating for bilateral hearing loss. Finally, the Veteran underwent a private audiological examination on August 27, 2019. Pure tone thresholds in decibels at the tested frequencies of 1000, 2000, 3000, and 4000 Hertz were 55, 65, 75, and 75, in the right ear and 55, 70, 70, 75, in the left ear. The examiner noted that the pure tone threshold average was 67.50 decibels in both ears. Word recognition testing revealed speech recognition ability of 72 percent in the right ear and 100 percent in the left ear. No exceptional pattern of hearing loss was shown. These audiometric test results equate to Level VI hearing in the right ear and Level II hearing in the left ear, which equates to a 10 percent rating for bilateral hearing loss. Further, while the Veteran’s VA treatment records reflect that he has been prescribed hearing aids, such do not include audiometric findings. Thus, based on the foregoing, the Board finds that a rating in excess of 30 percent for bilateral hearing loss is not warranted on or after March 21, 2018. In this regard, the aforementioned VA audiometric results reveal that the Veteran's bilateral hearing loss resulted in, at most, Level VI hearing acuity in the right ear as shown by the August 2019 examination, and Level III hearing acuity in the left ear, shown as of March 2018. Accordingly, no evidence of record warrants a rating in excess of 30 percent as of such date. To the extent that the Veteran contends that his bilateral hearing loss is more severe than currently evaluated, the Board observes that the Veteran, while competent to report symptoms capable of lay observation, to include difficulty hearing and understanding speech, especially with background noise, and requesting others to repeat themselves, is not competent to report that his hearing acuity is of sufficient severity to warrant higher ratings under VA’s tables for rating hearing loss disabilities because such an opinion requires medical expertise (training in evaluating hearing impairment), which he has not been shown to possess. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Charles v. Principi, 16 Vet. App. 370 (2002); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Despite the foregoing, the Board acknowledges the Veteran’s aforementioned reports of the difficulties associated with his bilateral hearing loss. However, even after considering such contentions as to the effects of the disability on his daily life, the Board finds that the criteria for higher ratings are not met. See Lendenmann, supra. In this regard, in Doucette v. Shulkin, 28 Vet. App. 366 (2017), the Court held that the rating criteria for hearing loss contemplate the functional effects of decreased hearing and difficulty understanding speech in an everyday work environment as these are the effects that VA's audiometric tests are designed to measure. The Veteran has not otherwise described functional effects that are considered exceptional or that are not otherwise contemplated by the assigned evaluation. Id. Thus, his complete disability picture is compensated under the rating schedule. The Board has also considered whether additional staged ratings under Hart, supra, are appropriate for the Veteran’s service-connected bilateral hearing loss; however, the Board finds that his symptomatology has been stable throughout each period on appeal. Therefore, assigning additional staged ratings for such disability is not warranted. Further, neither he nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record, in regard to the increased rating claim adjudicated herein. Doucette, supra. Therefore, the Board finds that a rating in excess of 10 percent prior to March 21, 2018, and in excess of 30 percent thereafter for bilateral hearing loss is not warranted. In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran’s claim. Therefore, the benefit of the doubt doctrine is not applicable in the instant appeal and his increased rating claim must be denied. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 4. Entitlement to a TDIU prior to February 25, 2020. Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when a veteran 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, such disability shall be ratable as 60 percent or more, and 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. 38 C.F.R. § 4.16(a). Rating boards should submit to the Director of Compensation Service for extra-schedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities but who fail to meet the percentage standards set forth in 38 C.F.R. § 4.16(a). 38 C.F.R. § 4.16(b). Unlike the regular disability rating schedule, which is based on the average work-related impairment caused by a disability, “entitlement to a TDIU is based on an individual's particular circumstances.” Rice, supra, at 452 (2009). Therefore, when adjudicating a TDIU claim, VA must take into account the individual veteran’s education, training, and work history. Hatlestad v. Derwinski, 1 Vet. App. 164 (1991) (level of education is a factor in deciding employability); Friscia v. Brown, 7 Vet. App. 294 (1994) (considering Veteran’s experience as a pilot, his training in business administration and computer programming, and his history of obtaining and losing 19 jobs in the previous 18 years); Beaty v. Brown, 6 Vet. App. 532 (1994) (considering Veteran’s 8th grade education and sole occupation as a farmer); Moore v. Derwinski, 1 Vet. App. 356 (1991) (considering Veteran’s master’s degree in education and his part-time work as a tutor). Age may not be considered as a factor when evaluating unemployability or intercurrent disability, and it may not be used as a basis for a total disability rating. 38 C.F.R. § 4.19. There must be a determination that the service-connected disabilities are sufficient to produce unemployability without regard to advancing age or a non-service-connected disability. 38 C.F.R. §§ 3.340, 3.341, 4.16. The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. A high rating in itself is recognition that the impairment makes it difficult to obtain or keep employment. The ultimate question, however, is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether he or she can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). As noted above, the instant appeal stems from the Veteran’s initial intent to file a service connection claim for PTSD received on May 23, 2018. In a rating decision issued in October 2020, the AOJ awarded service connection for chronic ischemic vessel disease (transient ischemic attack) with a 100 percent rating and special monthly compensation at the housebound rate from February 25, 2020, to September 1, 2020. Thus, a TDIU for such period is moot. See Buie v. Shinseki, 24 Vet. App. 242 (2011); Bradley v. Peake, 22 Vet. App. 280 (2008). The Board has characterized the issue on appeal accordingly. During the period on appeal, the Veteran is service-connected for PTSD, evaluated as 50 percent disabling; bilateral hearing loss, evaluated as 30 percent disabling; diabetes mellitus with erectile dysfunction and hypertension, evaluated as 20 percent disabling; peripheral neuropathy of the upper and lower extremities, each respectively evaluated as 20 percent disabling as of June 25, 2018; tinnitus, evaluated as 10 percent disabling; peripheral neuropathy of the right lower extremity with sciatic nerve involvement, evaluated as 10 percent disabling as of June 25, 2018; and peripheral neuropathy of the right lower extremity with femoral nerve involvement, evaluated as 10 percent disabling as of June 25, 2018. Given such ratings, the Veteran meets the schedular threshold for consideration of a TDIU for the relevant appeal period prior to February 25, 2020. Pertinent to his work history, the Veteran reported in his November 2020 Veteran’s Application for Increased Compensation Based on Unemployability (VA Form 21-8940) that he last worked in 2011 when he retired from Abbott Laboratory. Prior to such, he transitioned to the Navy Reserves upon leaving active duty and worked as a structural mechanic until 1976. He said that he continued to work in a civilian capacity as a structural mechanic until his retirement from such position in 1996. Finally, he reported working as a machine operator in Abbott Laboratory for an additional ten years, until his retirement in 2011. See October 2018 Initial PTSD Disability Benefits Questionnaire. With respect to education, the Veteran reported completing high school and two years of college. He stated that he had no other education and training before becoming unable to work. Notably, the Veteran declined to fill out most of the employment information in his VA Form 21-8940, stating that such was inapplicable due to his retirement. The Board also notes that in the VA Form 21-4192, Request for Employment Information in Connection with Claim for Disability Benefits, returned to VA on November 9, 2020, the Veteran stated that such form was not applicable due to his being a retired person. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) (“The duty to assist is not always a one-way street. If a veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence.”). Nevertheless, the Board has attempted to piece together his work history and education through various statements made throughout the appeal period. In this regard, the record reflects that the Veteran was employed in a full-time capacity with a shipyard for 20 years following his retirement from the Navy and for an additional 10 years in a laboratory following his retirement from the shipyard. Only one statement in an application for social security disability compensation mentions physical limitations contributing to his decision to retire. In this regard, the Veteran stated that his gout prevented him from standing all day. At such time, he did not attribute an inability to work to symptoms of PTSD or any other service-connected disability. Furthermore, in his October 2018 VA psychological examination, the Veteran stated that he struggled some with work relationships due to a language barrier when he was young; however, he also reported that once his English language skills improved, he maintained positive working relationships with his peers and colleagues for many years. He did not report that symptoms of his PTSD prevented him from working at any time prior to retirement or prevented him from again seeking employment following retirement. Moreover, the VA examiner did not find the Veteran’s PTSD resulted in significant occupational impairment. In conclusion, the evidence in the instant case shows the Veteran maintained full-time employment for three decades following his retirement from the Navy, and the record does not reflect clinically significant occupational impairment resulting from his service-connected PTSD during the appeal period. Moreover, the Veteran has not alleged functional impairment associated with any other service-connected disabilities, per his VA Form 21-8940. Therefore, the Board finds the record does not demonstrate that the Veteran’s service-connected disabilities, alone or in combination, rendered him unable to secure or follow a substantially gainful occupation consistent with his education and work history for the appeal period prior to February 25, 2020. In sum, the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable, and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. REASONS FOR REMAND 1. Entitlement to service connection for a headache disorder. The Veteran contends that he experiences headaches as a result of his military service. The relevant evidence of record includes the Veteran’s report of experiencing chronic headaches, a February 2020 medical treatment record cited “headache visual disturbance” as the reason for a CT scan, and service treatment records from June 1974 document that the Veteran may have experienced headaches during service. As a result, the Board finds VA’s duty to provide a VA examination and medical opinion exploring this potential correlation is triggered, and a remand for such is warranted. See McLendon v. Nicholson, 20 Vet. App. 79 (2006) (holding that an examination is necessary if, inter alia, evidence indicates that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or service-connected disability). The matter is REMANDED for the following action: Afford the Veteran an appropriate VA examination to determine the nature and etiology of his claimed headache disorder. The record, to include a copy of this Remand, should be provided to the examiner and any indicated tests should be conducted. Thereafter, the examiner should address the following inquiries: (A) Identify all current headache disorders. (B) For each diagnosed headache disorder, offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that such had its onset in, or is otherwise related to, the Veteran’s military service. The examiner must address the February 25, 2020, report noting “headache visual disturbance” as the reason for a CT scan, as well as the June 9, 1974, report of frequent or severe headaches on an annual examination. A complete rationale should be provided for any opinion offered. M. M. Celli Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Breckenridge, 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.