Citation Nr: 21006877 Decision Date: 02/05/21 Archive Date: 02/05/21 DOCKET NO. 13-03 426 DATE: February 5, 2021 ORDER Entitlement to an initial rating of 70 percent for posttraumatic stress disorder (PTSD), but no higher, is granted. A total disability rating based on individual unemployability due to service-connected disability (TDIU) is denied. FINDINGS OF FACT 1. The Veteran’s PTSD has been characterized by occupational and social impairment with deficiencies in most areas, including with near continuous depression; the severity, frequency, and duration of the Veteran’s symptoms did not more closely approximate total occupational and social impairment. 2. The preponderance of the evidence is against finding that the Veteran’s service-connected PTSD precludes him from securing or following substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for an initial rating of 70 percent, but no more, for PTSD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. 2. The criteria for the assignment of a TDIU have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1966 to June 1969. This case is before the Board of Veterans’ Appeals (Board) on appeal from February 2011 and October 2020 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). These matters were previously remanded for additional development in December 2017 and February 2020 Board decisions. The Board finds that there has been substantial compliance with those remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that a remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with its remand instructions and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand); see also D’Aries v. Peake, 22 Vet. App. 97, 105 (2008) (holding that only substantial rather than strict compliance with the Board’s remand directives is required under Stegall). In a January 2013 VA Form 9, the Veteran requested a hearing before the Board at a local VA office; however, the requested hearing was cancelled by the Veteran prior to the scheduled hearing. As such, the Board considers the Veteran’s request for a hearing to be withdrawn. See 38 C.F.R. § 20.704(e). The Board notes that the AOJ requested the Veteran submit any relevant private treatment records or submit information with which VA can assist the Veteran in obtaining private treatment records. The Veteran did not respond to the request nor submit private treatment records. The duty to assist is not a one-way street. If a Veteran desires help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining evidence. Wood v. Derwinski, 1 Vet. App. 190 (1991). Thus, the Board finds that VA has satisfied the duty to assist. No further notice or assistance to the Veteran is required to fulfill VA’s duty to assist in development. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); Quartuccio v. Principi, 16 Vet. App. 183 (2002). 1. Entitlement to an initial rating in excess of 50 percent for posttraumatic stress disorder (PTSD) Disability ratings are assigned in accordance with VA’s Schedule for Rating Disabilities and are intended to represent the average impairment of earning capacity resulting from a disability. See 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. When a question arises as to which of two ratings shall be applied under a diagnostic code, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Reasonable doubt regarding the degree of disability will be resolved in the veteran’s favor. 38 C.F.R. § 4.3. The Veteran’s PTSD is rated under the General Rating Formula for Mental Disorders. Under that criteria, a 30 percent rating is warranted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), 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). 38 C.F.R. § 4.130, DC 9411. A 50 percent rating is warranted for occupational and social impairment with reduced reliability and productivity due to such symptoms as, for example: 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. 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, for example: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. A 100 percent rating is warranted for total occupational and social impairment, due to such symptoms as, for example: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. The symptoms listed in VA’s general rating formula for mental disorders are not an exhaustive list, but rather serve as examples of the type and degree of symptoms, or their effects, that would justify a rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). The Board must conduct a “holistic analysis” that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017). “[T]he presence or lack of evidence of a specific sign or symptom listed in the evaluation criteria is not necessarily dispositive of any particular disability level.” Id. at 22. When evaluating a mental disorder, the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran’s capacity for adjustment during periods of remission must be considered. 38 C.F.R. § 4.126(a). The evaluation must be 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 time of examination. Id. Further, a rating cannot be assigned solely based on social impairment. 38 C.F.R. § 4.126(b). This appeal arises from the original assignment of a disability evaluation following an award of service connection. Thus, the severity of the disability at issue is to be considered during the entire period from the initial assignment of the disability, in this case, July 22, 2010, to the present time. Separate ratings can be assigned for separate periods of time based on the facts found, a practice known as “staged” ratings. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). Turning to the evidence of record, at a November 2010 VA PTSD examination, the Veteran reported that he was a high school graduate and had been married for 35 years with three children. Regarding the quality of his social and family relationships, the Veteran reported that he has three siblings, two of whom he has not spoken to in ten years and one sister whom he occasionally talks to. He noted that his mother lives nearby, and described his relationship with her as “so-so, nothing great.” The Veteran reported that he gets angry and yells at his wife about once a week. He reported that he does not want anything to do with most people and avoids them. He noted that he does not have friends. The Veteran also reported a diminished interest in recreational activities, noting that he no longer goes fishing, to the movies or out to dinner, but noted that he enjoys watching sports. He reported that a typical day included cleaning up, fixing something, making dinner and breakfast and doing laundry. He did not report a history of suicide attempts or violence and noted that he used to drink a lot of alcohol but has not been drinking lately. Regarding employment, the Veteran noted that he used to train horses but has not had a full-time job in twenty years. He reported that he worked at a stadium for six weeks in security last year, noting that it was a temporary job and he was currently looking for work. The Veteran reported that the reason for his unemployment was a lack of jobs and stated that he has not applied lately. The examiner noted that his PTSD symptoms may have contributed to difficulty securing full-time employment but it was unclear. On examination, the Veteran was clean and appropriately dressed, his speech was unremarkable, his attitude cooperative, his thought process and content were unremarkable, and his memory and attention were intact. In terms of judgment, the examiner noted that he understands the outcome of behavior and as for insight, the examiner reported that the Veteran understands that he has a problem. The Veteran’s affect was blunted, his mood depressed, and his impulse control was described as fair with no episodes of violence. The examiner found no evidence of delusions, obsessive rituals, or suicidal or homicidal ideation. The examiner reported that the Veteran was now able to maintain minimum personal hygiene but noted that a few months ago he did not take a shower four to five days a week. The examiner opined that the Veteran’s PTSD symptoms resulted in deficiencies in judgment, family relations, work and mood, but not thinking. In terms of mood, the examiner noted that the Veteran was depressed and irritable on a daily basis. In terms of judgment, the examiner reported that the Veteran just recently stopped using alcohol two weeks ago but was formerly using a half bottle of vodka daily to cope with thoughts and feelings from his trauma. The examiner described the Veteran’s PTSD symptoms as chronic and as to the length of remission or capacity for adjustment during remission, the examiner noted “none.” In a September 2010 statement from the Veteran’s wife, she reported that he experiences many mood swings. Some days he is upbeat, but most of the days he is depressed and negative in everything he says and does. She reported that he started drinking alcohol many years ago and drinks to numb himself. She noted that he has never been able to keep a full-time job and reported that the Veteran does not like any social occasions, even with the family. In an April 2011 statement, the Veteran reported that he does not join groups or participate in activities. He reported that he gets angry without any real reason and lashes out at his wife. A June 2011 VA mental health consult noted that the Veteran’s mood was moderately irritable all the time. The Veteran reported anhedonia except for getting some pleasure from watching sports on television. He was found to be depressed, irritable and anxious, and the examiner noted that he feels emotionally detached from others. The Veteran reported that he was semi-retired doing occasional jobs and reported that his work performance in those jobs was good. He reported that his social functioning was “ok” lately. On examination, thought processes were logical, judgment, insight and memory intact; and no suicidal or homicidal ideation or hallucinations or delusions were found. A February 2012 VA mental health note reflects mild chronic PTSD. On examination, the Veteran was adequately groomed, his mood was irritable with neutral, mildly constricted affect, his thought processes were logical, and memory, judgment and insight were intact. The Veteran denied suicidal or homicidal ideation and hallucinations or delusions. An April 2012 mental health note reported that the Veteran’s most prominent PTSD symptoms was irritability and noted that his mood was dysthymic but reactive. A December 2012 VA mental health note reflected mild chronic PTSD. The report noted that the Veteran takes things out on his wife verbally when he is irritated. On examination, the Veteran’s affect was blunted and his mood was irritable and dysthymic. His thought processes, memory, insight and judgment were intact, with no evidence of delusions, hallucinations, suicidal or homicidal ideation. In a January 2013 statement, the Veteran reported that he cannot deal with high stress situations which is why he does not work. He also noted that he regularly must be reminded to shower and change clothes. See January 2013 VA Form 9. At a January 2013 VA mental health consult, the Veteran reported that his energy and motivation were “low” and reported that he has difficulty with some of his extended family on his wife’s side, noting that he coped through the holidays by increasing his drinking. On examination, the Veteran was well-groomed, fully oriented, with a depressed mood and flat affect. His attention and concentration were normal, his memory, thought process, judgment and insight were intact, and delusions, hallucinations, suicidal or homicidal ideation were not present. A February 2013 VA mental health entry noted that the Veteran continued to isolate himself but reported that he was going to start working at a baseball stadium for the next six weeks and was looking forward to this. He reported difficulties communicating with his wife. On examination, his mood was mildly depressed, and the examiner diagnosed the Veteran with mild, chronic PTSD. An April 2013 VA mental health note described the Veteran’s mood as dysphoric and impulse control as good. Speech was clear, concise and spontaneous, thought processes were logical, organized and goal-oriented, insight was fair, judgment intact, concentration and attention were normal, and the Veteran denied suicidal and homicidal ideation and hallucinations. The Veteran reported that he had been working at a baseball stadium for the past few months and enjoyed his time there. See April 2013 mental health consult. At a September 2013 VA mental health status examination, the Veteran reported that he was doing “ok”, noting that his granddaughter still says he complains occasionally but he feels likes he is doing better. The Veteran reported that he was planning on working at the baseball stadium again in the spring, and the examiner noted that the Veteran had not re-enrolled in therapy at the Vet Center. On examination, the Veteran was diagnosed with chronic mild PTSD. His energy and motivation were described as fair, mood was normal, affect appropriate, concentration and attention were normal, memory, insight, thought process were intact, judgment was adequate, and no delusions, hallucinations, suicidal or homicidal ideation was found. At a December 2014 VA mental health consult, the Veteran reported that his mood was the same, stating “I am always depressed”. He reported that he has trouble with most of his relatives and noted that he was having more arguments with his wife. The Veteran reported that he used to race buggy horses but last did so ten years ago because of his move to Florida. He admitted to crying spells. On examination, his affect was depressed, sad and congruent with mood. His speech was normal, spontaneous, logical and coherent; his thinking was not disordered, disorganized or fragmented. He was adequately groomed and alert and oriented to person, place and time. His insight and judgment were adequate and there was no evidence of paranoia, delusions or hallucinations. The Veteran denied suicidal or homicidal ideation and was again diagnosed with chronic mild PTSD. A July 2016 entry in the VA treatment records noted PTSD with a history of depression and an October 2016 entry noted that the Veteran’s PTSD symptoms were stable. A July 2017 entry again noted that the Veteran’s PTSD symptoms were stable and the Veteran denied suicidal thoughts. Primary care notes dated in October 2017 reflect that the Veteran’s PTSD symptoms were stable with mild depression and noted that the Veteran declined to see mental health. At a December 2017 PTSD examination, the examiner found that symptoms of the Veteran’s PTSD included anxiety and suspiciousness, and opined that his PTSD caused 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. On examination, the Veteran’s grooming was adequate, his mood euthymic and affect was mildly constricted. His thoughts were organized, speech was normal, and attitude was guarded. There were no signs or symptoms of hallucinations or delusions and the examiner noted that the Veteran did not pose any threat of danger or injury to himself or others. The examiner noted that the Veteran’s PTSD was stable. At this examination, the Veteran reported that he used to attend church but stopped and noted that his routine was relatively normal in that he works around the house, cares for his dog and granddaughter and attends sports events with his wife. The Veteran reported that he was currently retired. A December 2018 VA treatment note reflects that the Veteran denied any significant depression or suicidal thoughts and notes that he has a history of PTSD but refused to see mental health. A November 2019 VA psychology consult reflects that the Veteran did not want to come to the mental health appointment but was referred by his physician due to stress management and drinking alcohol and gaining weight. On examination, the Veteran was neatly groomed with adequate hygiene. His mood and affect were appropriate to the situation and consistent with mood, his thought process was realistic and coherent; he was found to be self-aware and understands the likely outcome of his behavior. The Veteran did not report hopelessness, suicidal or homicidal ideation. A January 2020 mental health consult noted that the Veteran had been doing better and abstaining from alcohol. He reported improvement in mood and functioning and was socializing a bit and engaging in enjoyable activities which were helping his mood. On examination, the Veteran was neatly groomed with adequate hygiene. His mood and affect were appropriate to the situation and congruent with thought content. His thought process was realistic and coherent, insight was self-aware, and the examiner noted that his judgment was intact as he understood the likely outcome of behavior. No perceptual disturbances were noted and the Veteran did not report suicidal or homicidal ideation. A May 2020 entry in the VA treatment records noted chronic PTSD symptoms that are stable and reported that the Veteran declined any other help. At a July 2020 PTSD examination, the examiner, Dr. C., found that symptoms of the Veteran’s PTSD included depressed mood, anxiety, suspiciousness, chronic sleep impairment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships and difficulty adapting to stressful circumstances, including work or a work like setting. The examiner opined that his PTSD caused occupational and social impairment with reduced reliability and productivity. On examination, the Veteran was neatly dressed and groomed. His memory was intact, speech was of normal rate and tone, his thoughts were organized and coherent, mood appeared dysthymic with flat affect. He denied suicidal and homicidal ideation. The Veteran reported that his sleep was disturbed due to difficulty falling asleep. In terms of employment, after service, the Veteran reported working odd jobs, delivering phone books, construction jobs and training horses for 15 years. The examiner noted that the Veteran found it difficult to secure employment and had not worked in twenty years. An October 2020 addendum provided by the July 2020 examiner further addressed the Veteran’s level of occupational impairment. Dr. C. opined that the Veteran would have moderate impairment in an occupational setting. He noted that the Veteran may experience anxiety and hypervigilance that would impact an occupational setting. He noted that he may have difficulty with sleep that could impact punctuality and tardiness. Dr. C. reported that the Veteran may feel uncomfortable in crowded or novel environments, and may at times have difficulties interacting with coworkers, the public and supervisors. He also reported that the Veteran may exhibit difficulties in coping with stressful situations. Analysis The Veteran contends that the severity of his PTSD more closely approximates the 70 percent rating criteria. See April 2011 notice of disagreement and January 2013 VA Form 9. The Board agrees and finds that the Veteran’s PTSD has resulted in deficiencies in most of the areas of functioning needed for a 70 percent rating, including work, family relations and mood. The Board finds statements from the Veteran and his wife to be competent, credible and entitled to significant probative weight. Relying on these statements as well as VA examinations and Mental Health consults, the Board finds that the Veteran is entitled to a 70 percent evaluation, but no higher, for the entire period on appeal. With regards to mood, the evidence shows that the Veteran experiences near continuous depression which affects his ability to function independently, appropriately and effectively, as well as instances of unprovoked irritability. VA mental health consults and VA examinations throughout the appeal period consistently indicate that the Veteran experiences a depressed, irritable mood. See November 2010 VA examination; June 2011, February and December 2012, January, February and April 2013, December 2014 VA mental health consults; and July 2020 VA examination. For example, the November 2010 VA examiner noted that the Veteran was depressed and irritable on a daily basis. A June 2011 mental health consult noted that the Veteran’s mood was moderately irritable all the time. An examiner noted that the Veteran’s most prominent PTSD symptom was irritability. See April 2012 mental health note. In a December 2014 VA mental health consult, the Veteran reported that his mood was the same, stating “I am always depressed” and admitted to crying spells. His near-continuous depressed mood leads to a diminished interest in recreational activities, with the Veteran noting that he no longer goes fishing, to the movies, or out to dinner. Further, his wife reported that he experiences mood swings and is upbeat on some days but depressed and negative most days in the things he says and does. See September 2010 statement. In terms of unprovoked irritability, the Veteran reported that he gets angry at his wife without any real reason and yells at her. See April 2011 statement, November 2010 VA examination and December 2012 mental health note. Regarding deficiency in the area of work, the evidence reflects that the Veteran’s PTSD symptoms cause moderate occupational impairment, with difficulty in adapting to stressful circumstances, including work and difficulty in maintaining effective work relationships. See July 2020 VA examination and October 2020 addendum. The July 2020 examiner, Dr. C. opined that the Veteran’s PTSD caused reduced reliability and productivity, resulting in moderate occupational impairment. Dr. C. noted that the Veteran may experience difficulties interacting with others, anxiety, hypervigilance and difficulty sleeping resulting in tardiness, all of which would impact the Veteran in an occupational setting. Further, the November 2010 VA examiner opined that the Veteran’s PTSD resulted in deficiencies in most areas, including work, which is indicative of a 70 percent evaluation. Although a December 2017 VA examiner opined that the severity of the Veteran’s PTSD resulted in occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, after conducting a longitudinal review of the evidence, the Board finds that the preponderance of the evidence reflects a more severe level of occupational impairment that more closely approximates the 70 percent rating criteria. Regarding the Veteran’s level of social impairment and family relations, the record reflects an inability to establish and maintain effective family relationships indicative of a 70 percent evaluation. Specifically, the Veteran reported that he has three siblings, but has not spoken to two of them in ten years and speaks to his sister once in a while. His mother lives nearby and he describes his relationship with her as “so-so, nothing great.” He noted difficulties with his extended family and reported that he coped through the holidays by drinking. See January 2013 and December 2014 VA mental health consults. The Veteran’s wife reported that he does not like social occasions with family and noted that they hardly ever go anywhere as a family. See September 2010 statement. The Veteran does not have friends and seeks to isolate and avoid others. See November 2010 VA examination and February 2013 VA mental health entry. Further, the November 2010 VA examiner reported deficiency in the Veteran’s judgment, noting that he recently stopped using alcohol but was formerly using half a bottle of vodka daily to cope with thoughts and feelings from his trauma. Finally, the Board notes that the frequency and duration of the Veteran’s PTSD symptoms have been described as “chronic” with the November 2010 VA examiner stating that there was no remission, and thus, no capacity for adjustment during remission. In conclusion, the Board finds the evidence is in relative equipoise as to whether the Veteran’s PTSD has caused deficiencies in most areas of functioning; specifically mood (depression, anger, irritability), work (difficulty in adapting to stressful circumstances), and family relationships (prefers to isolate socially). Consequently, the criteria for a higher 70 percent rating have been met throughout the appeal period. While the Board accepts that the Veteran’s PTSD affects his occupational and social functioning, the objective evidence of record does not demonstrate symptoms contemplated by the 100 percent rating criteria that result in total occupational and social impairment. Specifically, the preponderance of the evidence does not show gross impairment in thought processes or communication, inability to maintain minimal personal hygiene, persistent delusions or hallucinations, persistent danger of hurting self or others, disorientation to time or place or memory loss for name of close relatives or own name. For the entirety of the appeal period, the Veteran has consistently denied suicidal and homicidal ideation and delusions and hallucinations have not been found on examination or noted by the Veteran. He has consistently been found to have logical, sequential and coherent thought processes with an intact memory and to be oriented to time and place. See VA examinations and mental health treatment notes dated from November 2010 through July 2020. Although the Veteran reported instances of an inability to maintain minimal personal hygiene, noting that he has to be reminded to shower, (see January 2013 VA Form 9) which is a symptom indicative of a 100 percent evaluation; as just discussed, the Veteran does not experience other symptoms contemplated by a 100 percent evaluation. Further, during VA mental status examinations throughout the years, the Veteran was described as neatly dressed and adequately groomed. In sum, the Veteran’s PTSD symptoms do not more closely approximate a 100 percent evaluation. Accordingly, the Board finds that the preponderance of the evidence is against the assignment of an evaluation higher than 70 percent for his service-connected PTSD. In reaching this determination, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, because the preponderance of the evidence is against the claim, this doctrine is not for application. 38 U.S.C. § 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 2. Entitlement to TDIU A total rating for compensation may be assigned where the schedular rating is less than total when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). Total disability will be considered to exist when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340(a). A Veteran’s service-connected disabilities, employment history, educational and vocational attainment, and all other factors having a bearing on the issue must be addressed. Age may not be considered as a factor in evaluating service-connected disability; and unemployability, in service-connected claims, associated with advancing age or intercurrent disability, may not be used as a basis for a total disability rating. 38 C.F.R. § 4.19. The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. A higher rating alone is a recognition that the impairment makes it difficult to obtain and maintain employment. The question is whether a veteran is capable of performing the physical and mental acts required by employment, not whether the veteran can find employment. Van Hoose v. Brown, 4 Vet. App. 361 (1993). The central inquiry is “whether [a] veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability.” Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). The applicable regulations place responsibility for the ultimate TDIU determination on the VA, not a medical examiner. Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013). TDIU is to be awarded based on the judgment of the rating agency. Floore v. Shinseki, 26 Vet. App. 376, 381 (2013). Initially, the Board notes that the Veteran now meets the schedular criteria for a TDIU as he has a single service-connected disability rated at 60 percent or more, specifically, a 70 percent evaluation for PTSD. See 38 C.F.R. § 4.16(a). The Veteran contends that his PTSD prevents him from working. He stated that he has difficulty adapting to stressful circumstances which is why he does not work. See April 2011 NOD and January 2013 VA Form 9. In this case, the Board finds that the preponderance of the evidence is against finding that the Veteran is unable to secure or follow a substantially gainful occupation due to his service-connected PTSD. Although the record reflects that the Veteran has remained unemployed or employed in temporary, seasonal jobs for approximately twenty years, the medical evidence does not reflect that the Veteran’s PTSD alone is severe enough to produce unemployability. Throughout the appeal period, the severity of the Veteran’s PTSD was evaluated by several clinicians, none of whom determined that his PTSD symptoms were severe enough to render him unemployable or resulted in total occupational impairment. Most recently, Dr. C. provided details on the ability of the Veteran to function in an occupational setting, explaining that the Veteran may experience anxiety and hypervigilance, may feel more uncomfortable in crowded or novel environments and may be tardy to work due to difficulty sleeping. He also opined that the Veteran would have difficulty in adapting to stressful circumstances and difficulty establishing and maintaining effective work relationships. However, ultimately, Dr. C. concluded that the Veteran’s PTSD symptoms resulted in reduced reliability and productivity while working, rather than rendering him unable to work. See July 2020 VA examination. Significantly, when requested to further opine on the impact of the Veteran’s PTSD symptoms on his ability to function in an occupational environment, Dr. C. stated that the Veteran would experience “moderate” impairment in an occupational setting, rather than severe or total impairment. See October 2020 addendum. Further, the November 2010 VA examiner described deficiencies in most areas including work but did not find that the severity of the Veteran’s PTSD resulted in total occupational impairment. She reported that the Veteran’s PTSD “may have” contributed to difficulty securing employment. However, the Board finds that difficulty securing employment is contemplated by the higher 70 percent evaluation currently assigned which is recognition that his impairment due to PTSD makes it difficult to obtain and maintain employment. The Board accords great weight to the November 2010 and July 2020 VA examiners’ opinions regarding the level of occupational impairment caused by the Veteran’s PTSD. The VA examiners are experienced with assessing disability impairments and their findings are consistent with the other evidence of record. Moreover, the Board finds that difficulty interacting with and being around people or crowds does not in itself render the Veteran unemployable. The Veteran would still be able to obtain and maintain a form of employment where he was not required to frequently interact with others. Further, the Board finds that the possibility of being tardy for work due to difficulty falling asleep at night, is not sufficient to render the Veteran unemployable. In addition, mental status examinations consistently reflect that the Veteran’s thought processes are logical, and goal directed; his memory intact, concentration and attention are normal and note that the Veteran is self-aware and understands the likely outcome of his behavior. The Board finds that thought and cognitive processes, including concentration, memory and attention, as well as insight and judgment are important to occupational functioning and these processes and characteristics have been found to be intact and normal throughout the appeal period. Finally, the Board notes that VA treatment records consistently describe the Veteran’s PTSD as “mild” and a December 2017 examiner opined that his PTSD caused occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. Although the Board does not find that these two assessments accurately represent the severity of the Veteran’s PTSD, the salient point to make is that even after affording significant probative weight to the medical evidence describing the most severe level of occupational impairment caused by PTSD; the Board finds that the medical evidence still does not show that the Veteran’s PTSD alone is severe enough to produce unemployability. In terms of the Veteran’s education, the Board notes that he is a high school graduate. Regarding his employment history, the Veteran reported that he previously worked full time as a janitor until 1994. See May 2020 VA Form 21-8940. In a December 2014 VA mental health consult, the Veteran noted that he previously trained horses and raced buggy horses for 15 years but last did so ten years ago because he moved away to Florida. See also July 2020 VA examination. Most recently, the Veteran reported that he worked in temporary seasonal employment in security at a baseball stadium from 2015 to 2020. See May 2020 VA Form 21-8940. In 2013, the Veteran noted that he was going to start working at a baseball stadium and was looking forward to it. He later noted that he had been working at the stadium for the past few months and enjoyed his time there. See February and April 2013 mental health consults. The Veteran subsequently reported that he planned on working at the baseball stadium again in the spring. See September 2013 VA mental health treatment note. Although the Board acknowledges that the Veteran is not currently working, the record does not show that he has been terminated from a job due to PTSD symptoms and it is unclear whether the Veteran has been actively seeking employment. In November 2010, he noted that the reason for his unemployment was a lack of jobs and stated that he had not applied to any jobs recently. In a June 2011 mental health consult, the Veteran reported that he was semi-retired doing occasional jobs and reported that his work performance in those jobs was good. At a December 2017 PTSD examination, the Veteran reported that he was currently retired. Again, the Board notes that the central inquiry is whether the veteran is capable of performing the mental acts required by employment, not whether he can find employment. As discussed in detail above, the Board does not find that the Veteran’s PTSD is so severe as to render him unable to secure or follow a substantially gainful occupation. Jennifer White Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Alison M. Mecone, 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.