Citation Nr: 21006611 Decision Date: 02/04/21 Archive Date: 02/04/21 DOCKET NO. 14-34 210 DATE: February 4, 2021 ORDER Entitlement to an initial rating in excess of 20 percent prior to July 26, 2019, and in excess of 40 percent thereafter, for degenerative arthritis of the lumbar spine is dismissed. Entitlement to an initial rating of 70 percent, but not higher, prior to November 11, 2014 for posttraumatic stress disorder (PTSD) with parasomnia is granted. Entitlement to a rating in excess of 70 percent for PTSD with parasomnia is denied. Entitlement to a total rating based on individual unemployability due to service connected disability (TDIU) is denied. FINDINGS OF FACT 1. In a November 19, 2020 submission, the Veteran’s attorney indicated that the Veteran was withdrawing the issue of entitlement to a higher initial rating for degenerative arthritis of the lumbar spine. 2. Throughout the period on appeal, the Veteran’s PTSD with parasomnia manifested in occupational and social impairment with deficiencies in most area and without total occupational and social impairment. 3. The Veteran’s service-connected disabilities do not render him unable to secure and follow substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for withdrawal of the issue of entitlement to a higher initial rating for degenerative arthritis of the lumbar spine, rated as 20 percent disabling prior to July 26, 2019 and 40 percent thereafter have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 2. The criteria for an initial rating of 70 percent, but not higher, prior to November 11, 2014, for PTSD with parasomnia have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.125, 4.126, 4.130, Diagnostic Code 9423-9411. 3. The criteria for a rating in excess of 70 percent for PTSD with parasomnia have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.125, 4.126, 4.130, Diagnostic Code 9423-9411. 4. The criteria for a TDIU have been not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 2007 to December 2011, to include service in Southwest Asia. The Veteran’s awards and decorations for his service include a Combat Infantryman Badge, among others. These matters come to the Board of Veterans’ Appeals (Board) on appeal from a September 2012 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. In October 2018, the Board issued a decision denying entitlement to increased ratings for degenerative arthritis of the lumbar spine and for PTSD with parasomnia. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (Court). In a July 2019 Order, the Court granted a Joint Motion for Partial Remand of the parties and remanded the case to the Board for action consistent with the Joint Motion. Additionally, in October 2018, the Board remanded the claim for entitlement to a TDIU to the agency of original jurisdiction (AOJ) for further development. That claim has now been returned to the Board for appellate action. The Veteran’s attorney requested an additional 90 days to submit evidence and argument in an August 2020 statement. The Board granted this Motion for Extension of Time in September 2020. This requested time period has expired, and the Veteran’s attorney submitted additional evidence and argument in support of this appeal in November 2020. Increased Rating Disability ratings are determined by application of the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating applies. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). However, the Board must also consider staged ratings. Hart v. Mansfield, 21 Vet. App. 505, 509–10 (2007). The Veteran’s entire history is considered when assigning disability ratings. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). A review of the recorded history of a disability is necessary to make an accurate rating. 38 C.F.R. §§ 4.2, 4.41. The regulations do not give past medical reports precedence over current findings where such current findings are adequate and relevant to the rating issue. Francisco v. Brown, 7 Vet. App. 55 (1994); Powell v. West, 13 Vet. App. 31 (1999). 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 (2007). The assignment of a particular diagnostic code is dependent on the facts of a particular case. See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual’s relevant medical history, the current diagnosis, and demonstrated symptomatology. In reviewing the claim for a higher rating, the Board must consider which diagnostic code or codes are most appropriate for application in the veteran’s case and provide an explanation for the conclusion. See Tedeschi v. Brown, 7 Vet. App. 411, 414 (1995). Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. Therefore, the Board has considered the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran’s disability in reaching its decision. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a Veteran’s service-connected disability. 38 C.F.R. § 4.14. It is possible for a Veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes, however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. The Veteran is competent to report symptoms and experiences observable by his senses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a). The Veteran’s PTSD with parasomnia is rated by analogy under Diagnostic Code 9411-9434. Diagnostic Codes 9411 and 9423 use the General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130, Diagnostic Codes 9411, 9423. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires the use of an additional diagnostic code to identify the basis for the rating assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. A single acquired psychiatric disorder is rated under the same criteria, whether diagnosed as PTSD, anxiety disorder, depression, or another acquired psychiatric disorder. The focus is on impact on functioning (social and occupational impairment). It also prevents pyramiding, or the impermissible rating of the same disability under different diagnostic codes, as all psychiatric disabilities are rated under a General Rating Formula for Mental Disorders. See 38 C.F.R. § 4.14. Psychiatric disabilities are rated based on the General Rating Formula for Mental Disorders codified in 38 C.F.R. § 4.130, which provides disability ratings are based on a spectrum of symptoms. “A veteran may qualify for a given disability rating by demonstrating the particular symptoms associated with that percentage, or others of a similar severity, frequency, and duration.” Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013). VA must consider all symptoms of a claimant’s condition that affect the level of occupational and social impairment, including, if applicable, those identified in the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (4th ed. 1994) (DSM-IV) and (5th ed. 2013) (DSM-5). See Mauerhan v. Principi, 16 Vet. App. 436, 442–43 (2002). VA is to 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 v. Shulkin, 29 Vet. App. 10, 22 (2017). Under the General Rating Formula for Mental Disorders per 38 C.F.R. § 4.130, a 30 percent rating is warranted if the disability is productive of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). A 50 percent rating is warranted if the disability is productive of occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material; forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130, Diagnostic Code 9423. 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); inability to establish and maintain effective relationships. Id. A 100 percent rating is warranted 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 inability to perform activities of daily living (including maintenance of minimal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. In addition, when evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the lengths of remissions, and the Veteran’s capacity for adjustment during periods of remission. 38 C.F.R. § 4.126(a). The rating agency shall assign an evaluation based on all 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. Id. However, when evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation on the basis of social impairment. The Board notes that with regard to the use of the phrase “such as” in 38 C.F.R. § 4.130 (General Rating Formula for Mental Disorders), ratings are assigned according to the manifestations of particular symptoms. However, the use of the phrase “such as” in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve only as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Accordingly, the evidence considered in determining the level of impairment under 38 C.F.R. § 4.130 is not restricted to the symptoms provided in the Diagnostic Code. Instead, VA must consider all symptoms of a claimant’s condition that affect the level of occupational and social impairment. The Board acknowledges that psychiatric examinations frequently include assignment of a global assessment of functioning (GAF) score. The American Psychiatric Association has released the Diagnostic and Statistical Manual of Mental Disorders (5th Ed.) (DSM-5), and 38 C.F.R. § 4.130 has been revised to refer to the DSM-5. The DSM-5 does not contain information regarding GAF scores. Effective August 4, 2014, VA amended the portion of its Schedule for Rating Disabilities dealing with mental disorders to remove outdated references to the DSM-IV and replace them with references to the DSM-5. See 79 Fed. Reg. 45,093, 45,094 (Aug. 4, 2014). VA adopted as final, without change, the interim final rule and clarified that the provisions of the final rule did not apply to claims that were pending before the Board, this Court, or the U.S. Court of Appeals for the Federal Circuit on August 4, 2014, even if such claims were subsequently remanded to the agency of original jurisdiction. See 80 Fed. Reg. 14,308 (Mar. 19, 2015). In Golden v. Shulkin, 29 Vet. App. 221 (2018), the Court held that given that the DSM-5 abandoned the GAF scale and that VA has formally adopted the DSM-5, the Board errs when it uses GAF scores to assign a psychiatric rating in cases where the DSM-5 applies. This appeal was certified to the Board in November 2019. As such, the DSM-5 applies, and the GAF scores will not be considered. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no obligation to discuss, in detail, the extensive evidence of record. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board’s analysis will focus specifically on what the evidence shows, or fails to show, as it relates to the Veteran’s claims. 1. Lumbar Spine Disorder The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.204. Withdrawal may be made by the Veteran or by his/her authorized representative. 38 C.F.R. § 20.204. In a November 2020 submission, the Veteran’s attorney indicated that the Veteran was withdrawing his claim for increased schedular ratings for degenerative arthritis of the spine. This request for withdrawal of the issue on appeal meets the content, form, and timing requirements of 38 C.F.R. § 20.204(b) and is, therefore, deemed a withdrawal of the Notice of Disagreement and Substantive Appeal. See 38 C.F.R. § 20.204(c); see also Hembree v. Wilkie, 2020 U.S. App. Vet. Claims LEXIS 1677. As a result, no allegation of error of fact or law remains before the Board for consideration with regard to the issue of entitlement to an increased rating for degenerative arthritis of the lumbar spine. Accordingly, the Board does not have jurisdiction over this issue, and the claim is dismissed. 2. PTSD The Veteran asserts that his PTSD is more disabling than currently evaluated. Specifically, the Veteran asserts he still experienced insomnia and nightmares that affected his ability to go to school. See VA Form 21-4138 Statement in Support of Claim, October 24, 2012. Additionally, the Veteran’s representative argues that the symptoms shown on examination warrant at least a 70 percent rating throughout the appeal period. See VA Form 646 Statement of Accredited Representative in Appealed Case, February 12, 2018; see also Appellate Brief, February 23, 2018. Moreover, the Veteran’s attorney asserts that the Veteran’s psychiatric symptoms, to include irritability anger, and social isolation, have affected his daily living and interpersonal relationships to an extent that he could not work, socialize, or perform adequately in school such that a 70 percent rating was warranted for PTSD from January 4, 2012 to November 10, 2014. See Third Party Correspondence, November 19, 2020. Turning to the evidence, the Veteran was afforded a VA examination in August 2012. The examiner diagnosed parasomnia, not otherwise specified and opined such disorder was manifested with 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. At that time, the Veteran reported some childhood abuse from siblings, he was divorced, and did not have children. He had childhood friends, and had some newer friends. He enjoyed going out to the local bars, playing organized football and soccer, and reading. He had a good relationship with his mom and brother and stayed in touch by cell phone and he was living with his cousin, and they got along “okay.” He reported he was unable to find work after leaving the military and did not know why and that his cousin helped him financially. The Veteran reported he thought about his experiences in Afghanistan, could not sleep, had difficult staying asleep and could not sleep more than four hours, dreamt about Afghanistan four of five times a week and would awaken due to the dreams but would not describe these dreams as nightmares because he did not wake up scared or afraid, and were not frightening dreams. He would be able to go back to sleep after the dreams, but on occasion he would stay up and try to distract himself. The Veteran stated he felt unsafe in his own home at times, and every door had to be locked. Sudden noises, like thunder, would startle him and make him feel edgy, and “drove him crazy.” He always left a light on at night somewhere in the house because when he awakened at night, he wanted to be able to recognize everything around him. He stopped taking medications for sleep because of their addictive nature and he experienced some daytime fatigue resulting in amotivation for household chores. He tried to nap every day, but could only sleep about half of the time. Symptoms attributable to his psychiatric diagnosis included anxiety and chronic sleep impairment. A June 2014 VA treatment record indicates the Veteran was currently attending school for sports marketing, and had some trouble being in class around other people. He reported he had been increasingly isolated, and that he had been experiencing nightmares, flashbacks, hypervigilance, and an increased startle response. The Veteran was afforded another VA examination in March 2015. At that time, the examiner diagnosed PTSD, and opined that his PTSD manifested in occupational and social impairment with deficiencies in most areas. The Veteran denied any trauma prior to military service, that he got along well with his mother, grandmother, and siblings, and had friends growing up. He reported lived alone, had one friend who lived close by, and two friends who lived farther away. He stated he had fairly frequent contact with his friend who lived nearby; but that he would rather stay home and isolate, and didn’t like being in crowds due to anxiety. He stated his anxiety began once he returned from deployment. He reported he worked part-time as a football referee, and that his anxiety and desire for isolation hindered getting work and performing his duties as a referee. He reported panic attacks occurring several times a month, nightmares several times a week and daily hypervigilance, difficulty relaxing, flashbacks, unsuccessful attempts to block out memories of combat and nervousness. He also reported sadness, irritability, worry, extreme social discomfort, isolation, becoming easily startled, concentration problems, mild memory problems, difficulty focusing, restlessness, poor quality sleep, and difficulty enjoying things. Symptoms attributable to his PTSD included depressed mood, anxiety, panic attacks that occur weekly or less often, chronic sleep impairment, mild memory loss, such as forgetting names, direction or recent events and disturbances of motivation and mood. Other symptoms included difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, including work or a worklike setting, panic attacks occurring several times a month, nightmares occurring several times a week, and daily hypervigilance. In addition, symptoms included difficulty relaxing, flashbacks, unsuccessful attempts to block out memories of combat, nervousness, sadness, irritability, worry, extreme social discomfort, isolation, becoming easily startled, concentration problems, mild memory problems, difficulty focusing, restlessness, poor quality sleep, and difficulty enjoying things. An August 2015 VA treatment record indicates the Veteran was upset about a recent event involving an argument with his friend. The Veteran reported he became angry and had a panic-like reaction after a friend was upset with his driving, and that he felt people thought he was “cray.” He had not spoken to his friend since that incident, and believed he had not improved. However, the treatment provider reminded the Veteran of recent previous progress in the recent months. The Veteran denied suicidal and homicidal ideation or plan. In a February 2016 VA Form 21-0820 Report of General Information, the Veteran indicated that his PTSD was separate from his parasomnia and he wanted the two conditions to be considered separately. VA treatment record from March 2016 to May 2016 indicate the Veteran was unemployed. Typical mental status examination from this period shows the Veteran presented as oriented to all spheres, appeared stated age, neatly groomed, dressed appropriately, adequate hygiene, cooperative, focused, calm, memory grossly intact, normal speech, logical, realistic thought content, self-aware insight, adequate impulse control, depressed mood and congruent affect. See e.g. VA treatment record, March 1, 2016. VA treatment records from May 2016 to July 2016 indicate the Veteran was struggling with potential homelessness, had recently completed bachelor’s and Master’s degrees, and had recently discontinued psychotropic medications because he preferred the way he felt without the medication. The Veteran had a job but wanted a different one, and was currently working in hospitality. An August 2016 VA treatment record indicates the Veteran continued to work the same job for about 20 hours per week and that he was experiencing some difficulty with customer interactions. He was given a “warning,” but was unconcerned about losing his job. The Veteran was afforded another VA examination in January 2017. At that time, the examiner opined the Veteran’s PTSD was manifested by occupational and social impairment with reduced reliability and productivity. The Veteran reported he had a great childhood, was not currently in a romantic relationship, denied having any children and stated he did not have a social support system. He did not have a roommate, and denied having close relationships with his siblings. He stated he was too busy to have leisure activities. The Veteran was working at ta hotel near the airport, and worked the front desk during the night shift, and he had this job for the last six months. He reported he experienced “anxiety attacks” when interacting with customers, and that this was his first job since separation from active service. He had a Master’s degree in sports management. He was not currently in psychiatric therapy nor was he taking psychotropic medication. The January 2017 VA examiner noted that the Veteran’s symptoms attributable to his PTSD included depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, near-continuous panic or depression affecting the ability to function independently, appropriately and effectively, chronic sleep impairment, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, including work or a work like setting and suicidal ideation. Behavioral observations showed the Veteran was oriented to all spheres, appeared stated age, wore appropriate attire for the occasion, mood was dysthymic with congruent and flattened affect, normal speech, intact cognitive and memory capabilities, no psychotic processes detected, and rapport as guarded. The Veteran endorsed passive, fleeting suicidal ideation such as “it probably would be easier to not have to deal with this anymore,” and stated he had the suicidal thoughts every few days, and described the method of suicide would be overdosing on pills. He denied having a specific suicidal plan or any intent to complete suicide. He stated that he would “never” kill himself. The Veteran was afforded another VA examination in April 2018. At that time, the examiner opined the Veteran’s PTSD manifested in occupational and social impairment with deficiencies in most areas. The Veteran reported he was homeless after he completed his Master’s degree because he lost his VA GI Bill benefits and was evicted. He was not on good terms with his brother, tried to visit college friends, had no interest in dating, drank socially, did not attend church or other social activities, and was not physically active. The Veteran denied suicidal or homicidal ideation and that he complained of anxiety, depression, sleep difficulty due to nightmares, difficulty initiating sleep, trouble maintaining sleep, and sleeping four hours a night on average. Symptoms attributable to his PTSD included depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, chronic sleep impairment, flattened affect, impaired judgment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationship and difficulty adapting to stressful circumstances, including work or a worklike setting. Behavioral observations showed the Veteran presented on time for the appointment, was casually dressed, normal motor activity, guarded, maintained eye contact, normal speech, dysphoric mood, constricted affect, attention on task, memory grossly intact, thought process and content linear and oriented to all spheres. The examiner noted that the Veteran was originally diagnosed with parasomnia disorder not otherwise specified at his August 2012 VA examination because the Veteran did not meet the full criteria for a diagnosis of PTSD at that time. However, in subsequent examinations, the Veteran met the full criteria for PTSD, and that diagnosis was confirmed at that time and noted that the symptoms of parasomnia, to include nightmares and insomnia, are accounted for in the Veteran’s PTSD diagnosis. June 2018 VA treatment records that indicate the Veteran was brought to the hospital by sheriffs after writing a concerning email. The Veteran stated he wanted to go home, and he was “just mad”; and that his anxiety and depression were a one out of ten severity. He appeared guarded, and denied suicidal and homicidal ideation. The Veteran was afforded another VA examination in July 2019. At that time, the examiner opined the Veteran’s PTSD manifested in occupational and social impairment with deficiencies in most areas. He reported he had “nonexistent” relationships with his family members, and indicated he struggled to make and maintain social relationships. He stated it was “not good.” He was living with a roommate, and worked part-time customer service for a sports team. He described his relationships with his coworkers and supervisors as “okay,” and had been working there for a year. He took psychotropic medication, and reported that they were helpful and that he participated with individual therapy/counseling, and reported that was helpful. Symptoms attributable to his PTSD included depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, chronic sleep impairment, mild memory loss, such as forgetting names, directions or recent events, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, including work or a worklike setting and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. Behavioral observations showed the Veteran arrived on time, was alert, oriented to all spheres, was casually dressed, adequately groomed, made appropriate eye contact, calm mood, affect was congruent and speech was logical, intact, and goal-directed. The examiner noted that the Veteran initiated spontaneous conversation on a few instances, normal thought processes, denied audio and visual hallucinations and delusional thoughts, denied homicidal and suicidal ideation and/or self-injurious intent, appeared to be a reliable historian, was polite, cooperative, and put forth a strong effort during the evaluation. The examiner noted the Veteran did not meet the criteria for a diagnosis of parasomnia, and the current diagnosis was PTSD. The examiner noted that the Veteran would be likely to evidence occasional tardiness and/or absenteeism, prone to making careless errors, leaving tasks incomplete, and/or taking an inordinate amount of time to complete tasks and struggled with anger or irritability with could lead to verbal or physical outbursts of anger with coworkers, supervisors, and/or customers. In a June 2020 Correspondence, the Veteran stated that his PTSD symptoms manifested in an inability to work with other students during group assignments, difficulty to focus with strangers around, anxiety in public situations, feeling stigmatized, sitting in the farthest corner of the room or closest to the exist, resulting in difficulty participating in class, avoiding others, failing classes, inability to maintain a job, and frequently changing jobs, constant state of anxiety, depression, and anger, an inability to deal with people for full-time employment, homelessness, an inability to find a job, anger problems and short temper, resulting in confrontations with his roommate. In a June 2020 lay statement submitted by the Veteran’s cousin, C.H., C.H. stated that the Veteran had changed after his military service. In this regard, C.H. noted that after his military service, the Veteran spent most of his time alone, drinking, and smoking and that he was hesitant to interact, lashed out, unable to hold a job for more than a few weeks at a time, distant, uncomfortable in class and required financial assistance. A November 2020 private opinion by Dr. M.C. was submitted. In his statement, Dr. M.C. stated that the Veteran had become progressively more mentally ill and dysfunctional since separation from active service in most settings that required interpersonal interactions. The Veteran had been consistently described as unpredictable, irritable, expressing inordinate anger, and potentially violent. The Veteran’s symptoms had become so severe that he stopped participating in activities he enjoyed prior to service, such as socializing, sports, recreational activities, or frequent engagements with his family. Dr. M.C. found the Veteran was unable to appropriately function in basic social settings and any modern occupational environment and while the Veteran had tried numerous times to return to the workforce, his lack of concentration, inability to handle stressful circumstances, threatening behavior, persistent thoughts of violence, and lack of task completion had caused repeated failures in gainful occupational settings, despite his intelligence and level of education. Dr. M.C. noted the Veteran was marred in social settings for the same reasons, and lived a primarily reclusive lifestyle living on the fringe of society. The November 2020 private provider noted that the Veteran reported that he was never able to engage in regular employment following discharge from the military due to his anger and irritability and that he could never stay at one job for more than a few weeks. He then decided to pursue a Master’s degree but has never used his degree in any meaningful fashion. He stated that he had never done anything well following his service and reported he felt perpetual anxiety, difficulties being in crowds, and panic attacks in public. The Veteran also reported hypervigilance, nightmares, dissociative episodes, intrusive memories of Southwest Asia, irritability, excessive anger, desire for social isolation, and loss of enjoyment of his day to day life. The Veteran reiterated, with anger, that his symptoms became overwhelming, including pervasive nightmares regarding the warzone, intrusive memories, periods of dissociation, and a steady decline in his capacity to function in all spheres of his life. He reported that he could not get thoughts of violence out of his mind, and was beginning to worry if he could control his behavior; and this resulted in self-isolation for fear of hurting others. Notably, the Veteran refused housing assistance and was homeless due to his fear of hurting others. He endorsed persistent insomnia, anxiety, difficulties with focus and concentration, social isolation, emotional distancing, withdrawn from society, easily irritated, hypervigilant, impaired concentration and memory, extreme mood volatility, progressive nightmares, nighttime diaphoresis, periods of dissociation, extensive anger and anxiety when dealing with simple interpersonal interactions, inappropriate, frightening, depressed mood, decreased appetite, anhedonia, frequent flashbacks, and deficiencies in memory. He also reported he found himself to be claustrophobic and extraordinarily anxious. The November 2020 private provider noted that the Veteran reiterated that his persistent feelings of irritability, complete withdrawal from social situations, fatigue, worsening relationship with his family, weight fluctuations, insomnia, total despair, hopelessness, and guilt. The Veteran stated he continued to check doors and windows and was struggling with his activities of daily living. Moreover, the Veteran continued to try to work, but described innumerable confrontations with coworkers and concerns withs tress associated with fulltime employment that could result in physical violence. Dr. M.C. noted the Veteran did not show any indication of improvement, and continued to have difficulty controlling his temper and experienced passive suicidal ideation. Dr. M.C. further noted that the Veteran’s description of his PTSD symptoms completely marred his capacity for intimate relationships, and the Veteran had no desire to interact with others on anything but a superficial level. The Veteran used cannabis to calm his symptoms, and noted that he had never regained the ability to interact reasonably with others since his separation from active service. The November 2020 private provider noted that mental status examination showed the Veteran presented as cooperative, appropriate, that he had fair impulse control, that his speech was flat in rate, tone, and volume, that he had speech latency, moderately agitated, depressed mood, congruent affect, with significant anger, passive suicidal ideation without plan or intent. The Veteran also denied homicidiality, delusions or illusions while somewhat tangential thought processing, that was circumstantial but without flight of ideas or looseness of associations, some preservation regarding military topics, no endorsement of any perceptual alterations such as auditory, visual, or tactile hallucinations and was cognitively intact. In conclusion, Dr. M.C. opined that the Veteran’s PTSD was profoundly disabled as a result of his psychiatric symptoms and that during the time the Veteran was enrolled as a Master’s degree student, the symptoms were “extraordinarily severe.” In this regard, Dr. M.C. noted the Veteran’s income for the two years following his completion of the Master’s degree were a living wage, but far diminished compared to the extent of his education. The Veteran was able to find work, but was unable to maintain positions due to the severity of his PTSD symptoms, and that the Veteran had given up his full-time employment out of concern that his symptoms would manifest in violence towards others. Dr. M.C. noted the Veteran was “nonviable economically due to the intensity and frequency of his PTSD symptom constellation, which do not allow him to function reasonably in occupational settings.” Dr. M.C. opined that the Master’s program allowed him to maintain a “veneer of functionality for several years,” but that after leaving the “comfortable and nurturing academic environment, his intense fear of interpersonal interaction obstructed his ability to obtain work commensurate with his education and experience, leading to severe job and financial instability.” Dr. M.C. noted the Veteran repeatedly lost jobs due to his anger and anxiety, and described a genuine fear that the requirements of full-time work would overwhelm his fragile coping mechanisms. Dr. M.C. opined the Veteran has been incapable of consistently meeting the requirements of gainful employment due to the severity of his PTSD since at least April 2016, and “likely far earlier.” Moreover, Dr. M.C. noted the Veteran had become progressively social isolated, emotionally numb, and manifested a decreased capacity for appropriate interactions with coworkers, family, and friends as well as the characteristics of his dysfunctionality included frequent episodes of impaired impulse control, extreme anger, low frustration tolerance, irritability, threatening behaviors. The provider noted that by 2016, the Veteran had become extraordinarily negativistic, lost interest in any pleasurable activities, and became irritable and reclusive, and had prominent loss of focus and concentration with feelings of intense anger. Dr. M.C. noted the Veteran had become progressively more isolated since graduation from his Master’s degree program, turned to unhealthy coping mechanisms that had astoundingly detrimental effects on his life and was effectively cutting himself off from society. Dr. M.C. noted the Veteran’s reliance on extensive avoidance and withdrawal to cope with his severe PTSD is one of the most prominent barriers to improving his psychosocial situation or receiving adequate treatment. The November 2020 private provider noted that the Veteran’s description of his PTSD symptoms included diminished focus and concentration, poor interpersonal interactions, increased irritability, pervasive fatigue which were prohibitive to engaging in a modern occupational setting. Dr. M.C. opined the Veteran suffered from extraordinarily severe PTSD symptomatology, including volatile and unpredictable behavior, irritability, fear of losing control, anger, severe anxiety, and the incapacity to engage reasonably with other individuals preclude the Veteran from functioning in any workplace environment. Dr. M.C. opined that the Veteran had been unsuitable for consistent and meaningful work due to his psychiatric symptoms since 2016; and that “without regular and intensive psychiatric treatment, it is extremely unlikely [the Veteran] will be capable of returning to full-time, gainful employment,” and the Veteran was “entirely psychiatrically disabled and unemployable.” Further review of the record shows that the Veteran receives VA treatment providers for various disabilities. However, there is no indication from the treatment notes of record that the Veteran has reported mental health symptoms that are worse than those noted above. Based on the foregoing, prior to November 11, 2014, an initial rating of 70 percent is warranted for his PTSD with parasomnia. In this regard, the Board finds that such disability was manifested by occupational and social impairment with deficiencies in most areas and without total occupational and social impairment. Impairment to mood was demonstrated as the Veteran reported sleep impairment, disturbing dreams of Afghanistan that would wake him up at night, feeling unsafe in his home, difficulty with sudden noises that would make him edgy or “crazy”, leaving a light on at night, daytime fatigue, anxiety, a desire for isolation, hypervigilance, flashbacks, intrusive thoughts, nervousness, sadness, irritability, worry, extreme social discomfort, concentration and memory problems, and a lack of social activities. Additionally, impairment to mood was shown with symptoms of anxiety, social isolation, and difficulty in social settings. Some impairment to family relations was shown as the Veteran reported he had a good relationship with his mother and brother, stayed in touch with his family by phone and that he lived with his cousin, and got along “okay.” The Veteran noted he preferred to stay alone and had difficulty in crowds, and had difficulty performing his work as a football referee. Moreover, his cousin, C.H. noted the Veteran spent most of his time alone, lashed out towards family, and became significantly distant towards family members and did not interact in family settings. However, the Veteran reported he had a good relationship with his mother and brother, got along well with is grandmother and siblings, had friends with whom he had frequent contact, and maintained his employment as a part-time football referee. Moreover, the Veteran reported, and the evidence shows that the Veteran’s social relationships were impaired due to his PTSD. Although the Veteran consistently reported good relationships with his family, and maintained regular and frequent contact with his friends, the Veteran has also demonstrated significant interference with intimate relationships, and an inability to appropriately engage with family, friends, and coworkers. Some impairment to work due to his PTSD was also demonstrated. In this regard, the Veteran reported he worked as a football referee. Although he reported he preferred to self-isolate, he also reported he continued to be able to work as a football referee, with only some interference; and was able to maintain employment that required preforming in a public setting. However, the Veteran has been shown to have significant difficulty in maintaining regular employment and reported numerous conflicts with coworkers, supervisors, and others. Notably, the Veteran held several jobs in a few years and Dr. M.C. noted that the Veteran’s income did not adequately represent his education level, and the severity of his psychiatric symptoms resulted in being cut off from society due to his desire for isolation. No impairment to thinking was demonstrated. Judgment was not impaired as it was consistently found to be intact or good during the period on appeal. School was attempted during the appeal period and the Veteran reported some difficulty being in class with others. However, the Board notes that the Veteran successfully completed a Master’s degree during the appeal period. Therefore, the Board finds that the Veteran’s PTSD showed occupational and social impairment with deficiencies in most areas. Based on the foregoing, a rating in excess of 70 percent is not warranted for his PTSD throughout the period on appeal. Specifically, the record reflects that the Veteran’s symptoms have not been consistent with total occupational and social impairment such that a 100 percent rating is warranted at any point. In that regard, the Veteran has not displayed gross impairment in thought processes or communication, nor has the record shown that he is a persistent danger of hurting himself or others or grossly inappropriate behavior. The Veteran has reported some suicidal ideation. However, homicidal or suicidal attempts were not reported and the Veteran noted that he would never kill himself. Moreover, there is no evidence that the Veteran has experienced hallucinations or delusions, or obsessive rituals. Further, the Veteran has not displayed disorientation to time or place, or memory loss for names of close relatives, his prior occupations, or his own name. Additionally, there is no evidence or allegation that he was unable to maintain minimal personal hygiene. Mental status examinations during the appeal period consistently found the Veteran’s grooming and hygiene to be appropriate, adequate or good. There is no evidence or allegation that the Veteran’s psychiatric symptoms manifested in interference or difficulties resulted in the inability to perform activities of daily life, to include maintenance of minimal hygiene. Additionally, the Board notes that the Veteran was able to maintain regular employment working as a hotel clerk throughout this period on appeal and that he maintained relationships with mother, brother, grandmother and siblings. Therefore, the Board finds that the Veteran’s PTSD parasomnia has not resulted in total occupational and social impairment at any time during the appeal period. In assessing the severity of his PTSD, the Board has considered the competent lay assertions regarding symptoms experienced and observed. See, e.g., Layno v. Brown, 6 Vet. App. 465, 470 (1994) and Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). However, the criteria needed to support higher ratings as the required medical findings that are within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-138 (1994). As such, the lay assertions are not considered more persuasive than the objective medical findings which, as indicated above, do not support assignment of any higher rating pursuant to any applicable criteria at any point pertinent to this appeal. The Veteran’s belief that he is entitled to a higher rating for his PTSD is outweighed by the objective medical findings of record. That is, the Board assigns greater probative value to the pertinent objective findings on the VA examination report and treatment records that were recorded following physical examinations of the Veteran, than to the Veteran’s general belief that he is entitled to a higher rating. The Board notes the contentions of the Veteran and his attorney that the Veteran’s PTSD is more severe than currently shown on examination because of his insomnia, nightmares, and other psychiatric symptomatology and the Board observes that the Veteran, while competent to report his observable symptoms, she is not competent to report that the Veteran’s mental health symptoms are of sufficient severity to warrant a higher rating under VA’s tables for rating such disabilities because such an opinion requires medical expertise which he has not been shown to have. 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). Despite the foregoing, the Board acknowledges the assertions that such symptoms, and their effects on his social and occupational functioning, warrant a higher rating. However, even after considering such contentions as to the effects of the disability on his daily life, the Board finds that the criteria for a higher rating are not met. The Rating Schedule contemplates such impairment under the ordinary conditions of daily life. 38 C.F.R. § 4.10; see also Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007). This argument is therefore without merit. Consideration has been given to assigning additional staged ratings. However, at no time during the period in question has the disability warranted a higher schedular rating than that assigned, and the disability has been stable throughout each appeal period. Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran has not 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 v. Shulkin, 28 Vet. App. 366 (2017). Accordingly, the Board finds that the preponderance of the evidence is for the assignment of an initial rating of 70 percent for his PTSD prior to November 11, 2014; and against the assignment of a rating in excess of 70 percent at any point during the period on appeal. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Entitlement to a TDIU The Veteran contends that his psychiatric symptoms, in combination with his physical disabilities, prevent him from obtaining and maintaining substantially gainful employment. In this regard, the Board notes that the Veteran contends that his PTSD with parasomnia, degenerative arthritis of the spine, and radiculopathy of the right lower extremity result in only being able to work a “part sedentary job.” See VA Form 21-8940, July 5, 2019. Moreover, the Veteran’s attorney asserts that the Veteran has made numerous attempts to rejoin the workforce, but that his PTSD symptoms have resulted in extended periods of homelessness and prevented maintaining gainful employment warranting a TDIU. See Third Party Correspondence, November 19, 2020. Specifically, his attorney points to symptoms including persistent danger of self-harm, intermittent inability to perform activities of daily living, and fear of losing control. Id. 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 extraschedular 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). See 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 v. Shinseki, 22 Vet. App. 447, 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); see 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). An assessment of TDIU entitlement based on the combined effects of all service-connected disabilities should address all such disabilities. Therefore, the cumulative effects (functional impairment) of all service-connected disabilities should be addressed in determining if the service-connected disabilities prevent substantially gainful employment. Floore, 26 Vet. App. 376; accord Geib v. Shinseki, 733 F.3d 1350, 1353-54 (Fed. Cir. 2013). In making such a determination, the Board must determine, as a question of fact, both the weight and credibility of the evidence. Equal weight is not accorded to each piece of evidence contained in a record and every item does not have the same probative value. The Board must analyze the credibility and probative value of all material evidence submitted by and on behalf of a claimant, account for the evidence that it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Struck v. Brown, 9 Vet. App. 145, 152 (1996); Caluza v. Brown, 7 Vet. App. 498, 506 (1995); Gabrielson v. Brown, 7 Vet. App. 36, 40 (1994); Abernathy v. Principi, 3 Vet. App. 461, 465 (1992); Simon v. Derwinski, 2 Vet. App. 621, 622 (1992); Hatlestad, 1 Vet. App. at 169. The Veteran’s credibility affects the weight to be given to his or her testimony and lay statements, and it is the Board’s responsibility to determine the appropriate weight. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). The Board is mindful that under 38 C.F.R. § 4.16(a), marginal employment shall not be considered substantially gainful employment. Marginal employment shall be found if a veteran’s income does not exceed the poverty threshold established by the United States Census Bureau or, when income does exceed the poverty threshold, it may be shown on a facts found basis, which includes, but is not limited to, employment in a protected environment. Id.; Ortiz-Valles v. McDonald, 28 Vet. App. 65, 71 (2016). Although VA has not defined what constitutes work “in a protected environment,” the Board nevertheless must consider its applicability on a facts found basis. “Substantially gainful employment” is defined as an occupation that provides an annual income that exceeds the poverty threshold for one person, irrespective of the number of hours or days that a veteran actually works and without regard to a veteran’s earned annual income. See Faust v. West, 13 Vet. App. 342 (2000). The central inquiry in determining whether a veteran is entitled to TDIU is whether a veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability. See Hatlestad v. Derwinski, 5 Vet. App. 524, 529 (1993). The determination as to whether a total disability is appropriate should not be based solely upon demonstrated difficulty in obtaining employment in one particular field, which could also potentially be due to external bases such as economic factors, but rather to all reasonably available sources of employment under the circumstances. See Ferraro v. Derwinski, 1 Vet. App. 326, 331-32 (1991). In evaluating a veteran’s employability, consideration may be given to the level of education, special training and previous work experience in arriving at a conclusion, but not to age or impairment caused by non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. The ultimate question is whether he is capable of performing the physical and mental acts required by employment, not whether he can find employment. 38 C.F.R. § 4.16(a); Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). As of the date of this decision, service connection is in effect for PTSD with parasomnia, at 70 percent disabling; degenerative arthritis of the lumbar spine at 20 percent disabling prior to July 26, 2019, and 40 percent disabling thereafter; tinnitus, at 10 percent disabling from January 4, 2012; and radiculopathy of the right lower extremity, at 10 percent disabling from January 4, 2012. The combined rating is 80 percent disabling from January 4, 2012 to July 26, 2019, and 90 percent disabling beginning July 26, 2019. The criteria for consideration of TDIU pursuant to 38 C.F.R. § 4.16(a) have therefore been met throughout the period on appeal. Consequently, the remaining inquiry is whether such service-connected disabilities render him unable to secure and follow a substantially gainful occupation consistent with his educational and occupational background for this appeal period. In connection with his claim, the Veteran submitted a VA Form 21-8940, Veterans Application for Increased Compensation Based on Unemployability, in July 2019. In such application, he indicated that his PTSD, a lumbar spine disorder, and radiculopathy of the right lower extremity prevented him from securing or following substantially gainful occupation. Specifically, he reported that he could only perform part sedentary work. He reported he completed a Master’s degree in Sports Management. He had maintained consistent employment since March 2016 and was still gainfully employed. With regard to the Veteran’s employment history, in his July 2019 VA Form 21-8940, he reported that his employment night audit at a hotel from March 2016 to February 2017; customer relations at a call center from February 2017 to February 2018; and customer relations for a sports team from August 2018. The Veteran reported he worked eight hours daily for the sports team, and earned $10,700.00 in the past twelve months; and that he lost approximately 128 hours of work due to his disabilities. See VA Form 21-4192, Request for Employment Information in Connection with Claim for Disability, August 1, 2019. He reported he worked about 28 hours weekly. Id. At a July 2012 VA examination, the examiner found the Veteran’s tinnitus did not impact his ability to work. At an August 2012 VA psychiatric examination, the examiner opined the Veteran’s parasomnia manifested with occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. The Veteran reported that he was unable to find work after leaving the military, and was not sure why. At an August 2012 VA examination for the Veteran’s lumbar spine disorder, the examiner opined the Veteran’s lumbar spine disorder impacted his ability to work due to increased fatigue and decreased stamina. A June 2014 VA treatment record indicates the Veteran was currently attending school for sports marketing, and had some trouble being around other people in class. At an April 2015 VA examination for the Veteran’s lumbar spine disorder, the examiner opined the Veteran’s lumbar spine disorder impacted his ability to work due to affected bending and lifting. At an April 2015 VA audiological examination, the examiner opined the Veteran’s tinnitus impacted his ability to work because it was “annoying,” as described by the Veteran. VA treatment records from May 2016 to August 2016 indicate the Veteran recently completed bachelor’s and Master’s degrees. He reported he had a job, but wanted one in a different field. He worked about 20 hours per week and had been given a “warning” because he swore at a customer. He was unbothered by the idea of losing his job and noted that he did not like his job because it involved interactions with customers. At other times, the Veteran indicated he wanted to continue working at his current job. The Veteran was concerned with homelessness, and at times was homeless, because he lost some VA benefits after completing his Master’s degree and was placed in transitional housing. Prior to May 2016, the Veteran indicated he was unemployed for three years. Notably, a July 2016 VA treatment record indicates that the Veteran had anxiety around people, and that he believed this was his primary obstacle to obtaining employment that was more in line with his abilities and training. See VA treatment record, July 12, 2016. At a January 2017 VA psychiatric examination, the examiner opined the Veteran’s PTSD manifested with occupational and social impairment with reduced reliability and productivity. The Veteran was employed. At an April 2018 VA examination for the Veteran’s lumbar spine disorder, the examiner opined the Veteran’s lumbar spine disorder impacted his ability to work due to losing zero to one week of work; and difficulty with bending, walking, and standing for prolonged periods. At a July 2019 VA examination for the Veteran’s lumbar spine disorder, the examiner opined the Veteran’s lumbar spine disorder impacted his ability to work due to increased pain and interference with standing and walking. The examiner noted the Veteran had to stand and/or walk for eight to ten hour shifts due to working as customer service representative. At a September 2019 VA audiological examination, the examiner noted that his tinnitus impacted his ability to work due to difficulty concentrating and listening; and being distracted when on the phone. In correspondence received in November 2020, the Veteran’s tax information submitted to the Social Security Administration between 2006 to 2019 indicate the Veteran’s taxed social security earnings were as follows: 2006 was $2,020.00; 2007 was $2,301.00; 2008 was $15,130.00; 2009 was $20,654.00; 2010 was $23,986.00; 2011 was $25,036.00; 2012 was $11.00; 2013 was $0; 2014 was $0; 2015 was $0; 2016 was $11,369.00; 2017 was $26,151.00; 2018 was $10,863.00; and 2019 was $18,612.00. The Board notes the June 2020 and November 2020 statements submitted by the Veteran and his cousin, and the November 2020 evaluation and opinion of Dr. M.C. discussed supra, and incorporates them herein. Based on the foregoing, the Board finds that the Veteran is not entitled to a TDIU. The Board has carefully considered the appellant’s statements regarding the effects of the Veteran’s service connected PTSD with parasomnia, degenerative arthritis of the spine, and radiculopathy of the right lower extremity on his employability. Although the Veteran experienced some limitations as a result of his service-connected disabilities, and these have been found to cause some impact on his daily functioning and earning capacity, that impact was considered in the scheduler ratings currently assigned. Simply stated, if he did not have impairment with his service connected PTSD with parasomnia, lumbar spine, tinnitus, and right lower extremity radiculopathy, there would be no basis for the 80 percent combined disability prior to July 26, 2019; and the 90 percent combined rating beginning July 26, 2019. The fact that he was having impairments or difficulties does not provide a basis to grant TDIU. Further, the Veteran himself asserts that he is only limited to “part sedentary work,” and not fully prevented from substantially gainful employment as a result of his service-connected disabilities. Additionally, the Board notes that the Veteran was unemployed for a period of three years prior to March 2016. However, the Veteran was in the process of obtaining a Master’s degree, and was in school full time. He reported that after leaving the military, he could not find a job and that he started school sometime in 2014. Thereafter, the Veteran was able to successfully find employment as a customer service representative and night auditor at a hotel in 2016. Moreover, as discussed above, the impact of the Veteran’s service-connected PTSD, lumbar spine disorder, and radiculopathy of the right lower extremity, and their impact, are considered in the schedular ratings assigned. Additionally, the Board notes that beginning in March 2016, the Veteran was able to secure and follow a substantially gainful occupation. In this regard, the Veteran was substantially and regularly employed for the entire period beginning March 2016 and was able to earn more than the poverty threshold for each year that he was employed; with a six month employment gap between February 2018 to August 2018. 38 C.F.R. § 4.16(a) (directing that marginal employment will be deemed to exist when earned income does not exceed the poverty threshold). Thus, the Board finds that his employment in customer service, from March 2016 to the present, as reported by the Veteran, was substantially gainful (i.e. not marginal). Moreover, the Board notes that the Veteran himself asserts that he is capable of employment, albeit “part sedentary.” See VA Form 21-8940, July 5, 2019. The Board notes the opinion of Dr. M.C. that the Veteran was essentially unemployable beginning in 2016 as a result of his psychiatric symptoms. Specifically, Dr. M.C. found that the Veteran was unsuitable for consistent and meaningful work due to his psychiatric symptoms since 2016. Moreover, the Board notes the June 2020 and November 2020 statements submitted by the Veteran and his cousin, indicating the Veteran had an inability to maintain regular employment, and specifically that the Veteran could not hold down a job for more than a “few weeks at a time.” However, SSA tax records indicate that the Veteran maintained employment that provided an annual income that exceeded the poverty threshold for one person throughout the period on appeal, excluding the time period the Veteran was enrolled as a full-time Master’s degree student, and the years 2016 and 2018. In this regard, the Veteran did not earn income that exceeded the poverty threshold was from the years 2012 to 2015, the years he spent as a student; and in 2016, when the Veteran earned $11,369.00 and the poverty threshold was $11,880.00. However, the Veteran graduated from his Master’s program in May 2016, and worked for only half of the remainder of 2016 immediately following graduation. In 2018, the Veteran’s income fell below the poverty threshold of $12,140.00 because he had an income of $10,863.00. During this time, the Veteran reported he worked in customer relations and experienced a six month period of unemployment. Again, as noted above, for many years and throughout the period on appeal, this six month period is the only time the Veteran had a significant employment gap. The Veteran was able to continuously pursue and obtain employment throughout the period on appeal, and notably, the Veteran has maintained his employment from August 2018 to the present with sports team. Moreover, throughout the period on appeal, the Veteran has maintained all employment for many months and stayed with each employer for at least one year. Although the Veteran’s tax income data is available, and shows that on occasion his annual income fell below the poverty threshold as determined by the United States Department of Commerce, Bureau of the Census, marginal employment may also be held to exist, on a facts found basis that includes, but is not limited to, employment in a protected environment such as a family business or sheltered workshop when earned annual income exceeds the poverty threshold. Here, the evidence does not establish, and the Veteran has not alleged, that such employment was a family business or sheltered workshop or that such employment was for physically disabled or mentally handicapped adults. Although the Veteran and his attorney assert that his employment was precluded due to his mental health symptoms, and the Veteran is actually unemployable, the evidence demonstrates otherwise. In this regard, the Board notes the Veteran was able to maintain regular employment for many consecutive months, to years, immediately following graduation from a Master’s degree program. Additionally, the Veteran was able to participate and successfully complete a full-time Master’s degree program for a number of years. Accordingly, the Board finds that considering the facts of this case, to include the hours of employment, the skills required, and the salaries provided, it is not established that the Veteran’s employment was marginal employment. To the extent that the Veteran contends his employment was sheltered employment, the Board finds that it was not. The Board observes that the examples of “protected environment” used in the text of 38 C.F.R. § 4.16(a): the family business and sheltered workshop. The term “sheltered workshop” is not defined in title 38 of the Code of Federal Regulations, but several state codes define “sheltered workshop” in the following ways: “a facility designed to provide gainful employment for individuals with severe disabilities who cannot be absorbed into the competitive labor market or to provide interim employment for such individuals when employment opportunities for them in the competitive labor market do not exist” (Louisiana); “a facility, or any portion thereof, operated by a nonprofit organization, corporation, partnership, limited liability company or association whose purpose is to provide meaningful work or training activities to individuals with developmental disabilities....” (Oklahoma); “an occupation-oriented facility operated by a not-for-profit corporation, which, except for its staff, employs only persons with disabilities” (Missouri); “an occupation-oriented facility operated by a nonprofit agency, public or private, which except for its staff, employs only handicapped persons” (New Jersey). La. R.S. § 39:1604.4; 63 Okl. St. § 1-865.2; § 178.900 R.S.Mo.; N.J. Stat. § 34:16-40. In this case, the Veteran’s post-service employment was as a customer service representative for various employers, to include a national hotel chain and a professional sports team, and such employment was not provided to him to as a result of his disabilities nor because competitive labor market employment did not exist. Rather, the Veteran himself repeatedly reported he sought different employment for one reason or another, and had some difficulty finding jobs at times as demonstrated by his six month employment gap. Moreover, the Veteran reported either quitting or being terminated as a result of his psychiatric symptoms or other symptoms associated with his service connected disabilities. Moreover, the Board notes the contentions of the Veteran’s attorney that his psychiatric symptoms resulted in being prevented from maintaining gainful employment that warrants entitlement of a TDIU. However, as discussed above, the Veteran has maintained regular employment and earned income that generally exceeded the poverty threshold. Thus, these arguments are therefore without merit. The Board acknowledges that the Veteran is competent to report the symptoms of his disabilities. Barr v. Nicholson, 21 Vet. App. 303 (2007) (lay testimony is competent to establish the presence of observable symptomatology); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. Sept. 14, 2009). The Board recognizes that the Veteran has stated that he had problems with cognitive difficulties, psychiatric symptoms, and physical limitations. The evidence, however, shows that the Veteran is not unable to obtain and maintain employment due to his service-connected disabilities. Accordingly, the Board finds that entitlement to a TDIU is not warranted. While the Veteran clearly had problems with his service-connected PTSD with parasomnia, degenerative arthritis of the spine, and radiculopathy of the right lower extremity, these problems form the basis of the evaluations assigned. Moreover, the Board notes that beginning March 2016, the Veteran was employed; and thus, capable of substantially gainful employment; and as such, entitlement to a TDIU is not warranted. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mariah N. Sim, 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.