Citation Nr: 21006883 Decision Date: 02/05/21 Archive Date: 02/05/21 DOCKET NO. 12-26 751 DATE: February 5, 2021 ORDER Entitlement to an initial evaluation in excess of 70 percent for posttraumatic stress disorder (PTSD) is denied. Entitlement to service connection for an acquired psychiatric disorder, other than PTSD and major depressive disorder, is denied. Entitlement to a total disability rating based on unemployability for the period prior to March 2, 2013 is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against a finding that the Veteran has total social and occupational impairment. 2. The preponderance of the evidence is against a finding that the Veteran has an acquired psychiatric disorder, other than PTSD and major depressive disorder, which is related to service. 3. Prior to March 2, 2013, the preponderance of the evidence indicates that the Veteran worked full time. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 70 percent for an acquired psychiatric disability, to include PTSD and depression, have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411 (2019). 2. The criteria for service connection for an acquired psychiatric disorder, other than PTSD and major depressive disorder, are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2019). 3. The criteria for entitlement to a grant of TDIU, prior to March 2, 2013, have not been met. 38 U.S.C. §§ 1155, 5107(b) (2012); 38 C.F.R. §§ 3.321, 3.340, 3.341, 4.16 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1967 to March 1970. This case comes before the Board of Veterans’ Appeals (Board) on appeal of December 2009, July 2012, and June 2014 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. In April 2015, May 2017 and May 2020, the appeal was remanded for further development. It now returns to the Board for appellate review. With regard to representation, the Board notes that the Veteran had elected the Georgia Department of Veterans Service to represent him in this case. However, in September 2019, the Veteran filed a new VA Form 21-22a, Appointment of Individual as Claimant’s Representative, appointing Robert L. Poston, Ph.D. for one-time representation. Although the RO sent a letter informing the Veteran that the representative he had chosen was not recognized as a representative, the Board notes that, under 38 C.F.R. § 14.630, a one-time representative does not need to be accredited. The appointment filed in January 2020 is in compliance with the mandates of 38 C.F.R. § 14.630. As such, the Board finds that the appointment is valid, and has listed Robert L. Poston, Ph.D. as the representative in conjunction with these claims only on the title page of this decision. By way of background, the Veteran was awarded service connection for PTSD in a December 2009 rating decision, effective January 2008. Thereafter, the Veteran claimed separate entitlement to service connection for major depressive disorder and adjustment disorder in December 2011, as secondary to his physical disabilities. Service connection for major depressive disorder and adjustment disorder was denied in a July 2012 rating decision. However, in an April 2019 rating decision, service connection for major depressive disorder was granted as secondary to PTSD, and was combined into the rating for PTSD – which was rated as 70 percent disabling. It was specified that the assignment of separate evaluations for the same disability under different diagnoses is not permitted, and as such, the ratings for PTSD and depression were combined. Notably, the United States Court of Appeals for Veterans Claims (Court) has held that claims for service connection for PTSD encompass claims for service connection for all psychiatric disabilities. See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (the scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant’s description of the claim, reported symptoms, and the other information of record). While the Veteran’s claims for service connection for PTSD and major depressive disorder have been previously characterized separately, in accordance with Clemons, the Board now recharacterizes the issue on appeal as a claim of entitlement to service connection for an acquired psychiatric disorder, to include PTSD and depression. Additionally, the Board notes that the Veteran has been diagnosed with adjustment disorder separately from Depression and PTSD. The Veteran claims entitlement to service connection for adjustment disorder. The record contains evidence that adjustment disorder may have a separate etiology than the PTSD and depression. The Board notes that except as otherwise provided in the rating schedule, all disabilities, including those arising from a single disease entity, are to be rated separately, and then all ratings are to be combined pursuant to 38 C.F.R. § 4.25. Esteban v. Brown, 6 Vet. App. 259, 261 (1994). The Court has interpreted 38 U.S.C. § 1155 as implicitly containing the concept that the rating schedule may not be employed as a vehicle for compensating a claimant twice (or more) for the same symptomatology; such a result would overcompensate the claimant for the actual impairment of his earning capacity and would constitute pyramiding of disabilities, which is cautioned against in 38 C.F.R. § 4.14. In Esteban, the Court found that the critical element was that none of the symptomatology for any of the conditions was duplicative of or overlapping with the symptomatology of the other conditions. Therefore, the practical effect of this appellate claim is whether the Veteran’s non-service-connected psychiatric impairment is to be recognized as originating from his service-connected disability. This will be addressed separately as a claim of entitlement to service connection for adjustment disorder. 1. Entitlement to an evaluation in excess of 70 percent for an acquired psychiatric disability, to include posttraumatic stress disorder and major depressive disorder The Veteran contends that his posttraumatic stress disorder (PTSD) with depressive disorder warrants an evaluation in excess of 70 percent. The Veteran’s PTSD with depression is currently rated as 70 percent disabling, effective from January 2008. Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity caused by the given disability. Separate diagnostic codes identify the various disabilities. 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 Code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining, including degree of disability, is to be resolved in favor of the Veteran. 38 U.S.C. § 5107 ; 38 C.F.R. §§ 3.102, 4.3. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). In any claim for an increased rating, “staged” ratings may be warranted where the factual findings show distinct time periods when the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). Under the General Formula for Mental Disorders (General Formula), 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); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). The issue in this appeal is whether the Veteran’s associated symptoms caused the level of impairment required for a disability rating of 100 percent. The Board concludes that the Veteran’s symptoms did not cause the level of impairment required for a disability rating of 100 percent. The Veteran’s symptoms more closely approximated the symptoms associated with a 70 percent rating, and resulted in a level of impairment that most closely approximated the level of impairment associated with a 70 percent rating. A noncompensable rating is assigned when a mental condition has been formally diagnosed, but symptoms are not severe enough to either require continuous medication, or to interfere with occupational and social functioning. A 10 percent rating is assigned when mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of occasional stress, or symptoms controlled by medication cause occupational and social impairment. A 30 percent rating is assigned when symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events), cause 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 normal conversation). A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name. VA and private treatment records, the November 2009, June 2014, July 2017, August 2018, February 2019 and August 2020 VA examinations, and the Veteran’s lay statements show that the Veteran’s PTSD with depression was manifested by symptoms associated with a 70 percent rating ( including difficulty in adapting to stressful circumstances, including work or a worklike setting; impaired impulse control). A private March 2020 evaluation is indicative of symptoms associated with a 100 percent rating (including persistent delusions or hallucinations; intermittent inability to perform activities of daily living; disorientation to time or place; memory loss for names of close relatives, own occupation or own name). The Board finds the level of impairment caused by the Veteran’s symptoms more closely approximates the level associated with a 70 percent rating. The Veteran experienced occupational and social impairment with reduced reliability and productivity with deficiencies in most areas. Mental status examinations in VA and private treatment records and the November 2009, June 2014, July 2017, August 2018, February 2019 and August 2020 VA examinations indicate that the Veteran had depressed mood; chronic sleep impairment; mild memory loss; anxiety; suspiciousness; chronic sleep impairment; flattened affect; disturbances of motivation and mood; difficulty in adapting to stressful circumstances, including work or a work like setting; and impaired impulse control, such as unprovoked irritability with periods of violence. During the November 2009 VA examination, the diagnosis of PTSD was confirmed, without any other psychiatric disorder. The Veteran reported that he had not received any treatment for his psychiatric disability. He described symptoms of insomnia, nightmares, cold sweats, fear of loud noises, occurring once a week for about an hour. On mental status evaluation, the examiner noted the Veteran was oriented; appearance, hygiene, and behavior were appropriate; affect and mood were normal; communication, speech, and concentration were within normal limits; the Veteran denied experiencing panic attacks and suspiciousness; there was no evidence of delusions, hallucinations, or obsessional rituals; thought processes were appropriate; judgment, abstract thinking, and memory did not show any impairment; the Veteran denied having suicidal or homicidal ideation; and the Veteran indicated he would chronically isolate from others. The examiner stated the best description of symptoms was that they are productive of occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks although generally functioning is satisfactory with routine behavior, self-care, and normal conversation. In June 2014, the Veteran was afforded another VA examination. The diagnosis was again confirmed as PTSD without any other psychiatric disorders. The examiner assessed the Veteran’s PTSD to be 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 normal routine behavior, self-care, and conversation. The Veteran reported having close relationships with his siblings, wife, and son. He reported attending church regularly and participating in activities with family. PTSD symptoms were noted to include anxiety, suspiciousness, and difficulty in adapting to stressful circumstances, including work or a worklike setting. Other symptoms reported by the Veteran included flashbacks and nightmares. The examiner stated he did not appear to pose any threat of danger to himself or others. In July 2017, the Veteran was afforded another VA examination. The diagnoses were identified as major depressive disorder and PTSD. The symptoms of depression were noted to include depressed mood, sleep disturbance, fleeting passive suicidal ideation, and feelings of hopelessness and helplessness. Symptoms of PTSD were identified as intrusion symptoms, avoidance, arousal and negative alterations/cognitions. The examiner opined that the Veteran’s acquired psychiatric disability was 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 normal routine behavior, self-care and conversation. The examiner estimated that the mental health conditions were equally impairing. Symptoms were noted to include depressed mood; anxiety; suspiciousness; chronic sleep impairment; disturbances of motivation and mood; difficulty in adapting to stressful circumstances, including work or a worklike setting. In August 2018, the Veteran was afforded another VA examination. The Veteran was confirmed to have a diagnosis of PTSD, as well as adjustment disorder with depressed mood. The examiner noted that the Veteran’s spouse was experiencing chronic health issues, and as her primary caregiver, along with her increasing impairment, his depression symptoms have increased. The examiner assessed that the Veteran’s mental health diagnoses were cumulatively productive of occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. The examiner noted that the Veteran’s PTSD was severe and accounted for 75 percent of symptoms – and the adjustment disorder was mild and accounted for 25 percent of symptoms. The examiner listed symptoms of depressed mood; anxiety; suspiciousness; chronic sleep impairment; flattened affect; disturbances of motivation and mood; difficulty in adapting to stressful circumstances, including work or a work like setting; and impaired impulse control, such as unprovoked irritability with periods of violence. As a note, the examiner attributed symptoms of anxiety, suspiciousness, disturbances of motivation and mood, difficulty in adapting to stressful circumstances, and impaired impulse control, such as unprovoked irritability with periods of violence to PTSD. Symptoms of depressed mood, chronic sleep impairment, flattened affect, disturbances of motivation and mood, difficulty in adapting to stressful circumstances, including work or a work-like setting were attributed to adjustment disorder. In August 2020, the Veteran was afforded another VA examination. The examiner confirmed the diagnoses of PTSD and major depressive disorder. It was noted that symptomatology could not be differentiated. The examiner assessed that the Veteran’s mental health diagnoses were cumulatively productive of occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. The Veteran’s symptoms were noted to include depressed mood, chronic sleep impairment, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and difficulty in adapting to stressful circumstances, including work or a work-like setting. The Veteran denied suicidal or homicidal ideation, was well oriented, had clear speech, showed no evidence of delusion or hallucination, had good insight, thought processes, cognition and memory. In addition to VA examinations, the record contains a private psychological evaluation dated in September 2008. Diagnoses were noted as PTSD and depressive disorder. The Veteran reported extreme anxiety and restlessness when left with nothing to do, as well as anger and isolation. The Veteran also reported an excellent relationship with his spouse, as well as numerous friendships and involvement in his Church. Mental status examination showed impulse control, speech, and thought processes were normal; there were issues with impulse control in the past represented by angry outbursts; the Veteran endorsed homicidal ideation, but without immediate intent or plan; the Veteran was oriented; his attention was normal; his concentration and recent memory were impaired; his long term memory appeared to be intact; judgment and insight appeared to fall below normal limits. In June 2013, the Veteran underwent an evaluation for a Social Security Administration claim. A mental status examination showed grooming and hygiene were excellent. The examiner stated the Veteran was exceedingly polite, humble, reserved, calm, and cooperative; his mood was depressed, and affect was flat and constricted, despite moments of tearfulness. The Veteran was noted to have good social skills and good eye contact. Speech, thought processes, and thought content were normal. The Veteran was alert and fully oriented. He reported occasional passive thoughts of suicide, but no intent or plan. He denied homicidal ideation, delusions, and hallucinations, and there were none noted during the exam. There was also no evidence of obsessions or compulsions, even though he did report frequently checking the doors at night. Memory testing showed generally adequate concentration and mildly impaired short-term memory. Responses to the interview questions were appropriate, and the Veteran had no difficulty with recall of recent or remote information. The diagnoses were posttraumatic stress disorder and depressive disorder. In March 2020, a private mental status evaluation was submitted along with a disability benefits questionnaire. The Veteran was noted to be alert and oriented; had intact judgment and insight; consistent eye contact; poor focus and concentration and had a depressed mood. The Veteran reported sleep disturbance, hypervigilance, increased social isolation and irritability. The private clinical social worker assessed that the Veteran’s symptoms cause difficulty functioning and a severely decreased ability to perform activities of daily living. In an associated disability benefits questionnaire, the Veteran’s mental health diagnoses were noted to be productive of occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood – but not total occupational and social impairment. The examiner noted a slew of symptoms associated with the Veteran’s PTSD, including depressed mood, anxiety, suspiciousness, panic attacks occurring more than once a week, near continuous panic or depression, chronic sleep impairment, impairment of short and long term memory, memory loss for names of close relatives, flattened affect, difficulty understanding complex commands, impaired judgment, impaired abstract thinking, 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, inability to establish and maintain effective relationships, impaired impulse control, spatial disorientation, persistent delusions or hallucinations, disorientation to time and place and intermittent inability to perform activities of daily living. The same provider notes the Veteran is able to manage his financial affairs, and that the Veteran credits his wife with loving support. The Board finds the March 2020 private evaluation and disability questionnaire to be an outlier. First, the two evaluations are inconsistent. Specifically, while the questionnaire indicates that the Veteran is disoriented, has hallucinations and impaired judgment, the evaluation indicates that the Veteran is fully alert and oriented, and that he has intact judgment and insight. Further, the evaluation noted that the Veteran has no suicidal ideation, homicidal ideation or psychosis – while the questionnaire indicated the Veteran has persistent delusions, disorientation to time and space, and memory loss of close relatives. In this regard, the symptoms noted on the March 2020 private questionnaire are very inconsistent with the Veteran’s medical record, including VA examinations before and after. To wit, none of the Veteran’s VA examinations of record, including subsequent to this questionnaire in August 2020, identified symptoms of panic attacks occurring more than once a week, near continuous panic or depression, impairment of short and long term memory, memory loss for names of close relatives, difficulty understanding complex commands, impaired judgment, impaired abstract thinking, inability to establish and maintain effective relationships, impaired impulse control, spatial disorientation, persistent delusions or hallucinations, disorientation to time and place and intermittent inability to perform activities of daily living. Since these findings are so inconsistent with the record, and also conflict in part with the associated private evaluation, this evidence is afforded little probative weight. Review of the claims file shows that the Veteran did not experience symptoms contemplated by a 100 percent rating. To wit, the only evidence which reflects such symptoms – the March 2020 private evaluation and DBQ – is assigned little probative weight due to severe internal inconsistency and inconsistency with the medical record. Further, even the March 2020 private evaluation does not indicate total social and occupational disability. As such, the record does not reflect that the Veteran’s psychiatric disability is productive of total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name. The Veteran’s symptoms throughout the appellate period were either contemplated by or more consistent with a 70 percent rating. Further, while the Veteran has been granted a total disability rating based on individual unemployability due to service-connected disability, he was not totally socially impaired. While VA examinations and VA treatment records show that the Veteran experiences difficulty maintaining effective social relationships, the Veteran reported a good relationship with his spouse, child and community throughout the appellate period. See August 2020 VA examination. In short, the preponderance of the evidence weighs against finding that the severity, frequency, and duration of the Veteran’s symptoms resulted in the level of impairment required for a 100 percent rating. The criteria for a 100 percent or higher rating are not met and the appeal must be denied. 2. Entitlement to service connection for adjustment disorder, as secondary to service-connected disabilities Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). To establish a right to compensation for a present disability, a Veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service.” Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Under 38 C.F.R. § 3.303 (b), an alternative method of establishing the second and third Shedden element is through a demonstration of continuity of symptomatology if the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309 (a). In relevant part, 38 U.S.C. § 1154 (a) requires that the VA give “due consideration” to “all pertinent medical and lay evidence” in evaluating a claim to disability or death benefits. Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.” Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed.Cir.2007). In fact, competent medical evidence is not necessarily required when the determinative issue involves either medical etiology or a medical diagnosis. Id. at 1376-77; see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Once evidence is determined to be competent, the Board must determine whether such evidence is also credible. See Layno, supra (distinguishing between competency (“a legal concept determining whether testimony may be heard and considered”) and credibility (“a factual determination going to the probative value of the evidence to be made after the evidence has been admitted”). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107 (b). The Veteran claims entitlement to service connection for adjustment disorder, as secondary to service-connected disabilities. However, the Veteran is not competent to state that he has a valid diagnosis of an adjustment disorder that is separate and distinct from his diagnosed and already service-connected acquired psychiatric disability to include PTSD and depression, as to do so requires medical expertise and training in the field of psychology or psychiatry. Jandreau, 492 F.3d 1372. As such, the Veteran’s assertion that he has a separate, validly diagnosed adjustment disorder that is related to his period of service is entitled to no probative weight. Id. As explained above, the Board recognizes that the record reflects a diagnosis of adjustment disorder, separate to the service-connected PTSD and depressive disorder. Turning to the medical evidence, the Veteran was provided with VA psychiatric evaluations in November 2009, June 2014, July 2017, August 2018 and August 2020. The November 2009 and June 2014 VA examiners diagnosed the Veteran with PTSD and noted no other psychiatric disorder. Similarly, the July 2017 VA examination does not reflect a diagnosis of adjustment disorder. The first VA examination of record containing an adjustment disorder diagnosis is that of August 2018. The examiner pertinently notes that the Veteran’s adjustment disorder is mild, and commented that the Veteran’s spouse was having increasingly severe health issues, which in turn increased the Veteran’s depressive symptoms. Of record is an addendum opinion dated in February 2019. As to the question of whether the Veteran has an adjustment disorder diagnosis which was caused or aggravated beyond natural progression by a service-connected disability, the examiner noted that she could not speak to the rationale for the 2018 examiner’s diagnosis of adjustment disorder or whether it was caused or aggravated by another disability without mere speculation. The August 2020 VA psychiatric examination also did not diagnose the Veteran with adjustment disorder. Pertinently, the examiner acknowledged that the August 2018 examiner diagnosed the Veteran with PTSD and an adjustment disorder with depressed mood. The examiner noted that at the time of the 2018 examination, the examiner reported that the Veteran’s adjustment disorder was related to his wife’s health condition. However, the 2020 examiner noted that the Veteran was previously diagnosed, treated, and service connected for major depressive disorder and PTSD. The examiner opined that the previous diagnosis of Adjustment Disorder with Depressed Mood was in error and the Veteran’s current diagnoses of PTSD and Major Depressive Disorder, more accurately reflects his current mental status and diagnostic formulation. Review of the Veteran’s VA treatment records does not reflect a diagnosis of adjustment disorder at any point during the appellate period. In June 2013, the Veteran underwent an evaluation for a Social Security Administration claim. The diagnoses were posttraumatic stress disorder and depressive disorder, and no adjustment disorder diagnosis was rendered. Out of six VA examinations, and multiple mental health evaluations, the only diagnosis of adjustment disorder of record is the one contained in the August 2018 VA examination. In fact, the August 2020 examiner notes that the adjustment disorder diagnosis was in error. The Board also notes that while the August 2018 VA examiner diagnosed the Veteran both with PTSD and adjustment disorder, she assigned overlapping symptomatology to both diagnoses. To wit, disturbances of motivation and mood and difficulty adapting to stressful circumstances were attributed to both disorders. In addition, the Board notes that the other symptoms noted to be produced by adjustment disorder, including depressed mood, chronic sleep impairment and flattened affect, had previously been attributed to the Veteran’s service-connected PTSD and depression. Indeed, the July 2017 examiner identified depressed mood and chronic sleep impairment as symptoms of the Veteran’s service-connected PTSD with depression, in addition to disturbances of motivation and mood and difficulty adapting to stressful circumstances. Similarly, the August 2020 VA examination identified all the Veteran’s symptoms, including those identified by the 2018 examiner as produced by adjustment disorder, to the Veteran’s service-connected PTSD and depression. There is no evidence that the 2009, 2014, 2017 and 2020 examiners were not competent. Further, the diagnoses rendered by these examiners were based on the Veteran’s reported symptoms, a review of the medical evidence, and the examiners’ own objective evaluations of the Veteran. As such, the Board finds that these examination reports, especially those in 2017 and 2020 are entitled to significant probative weight as to the presence or lack thereof of an adjustment disorder during the period on appeal. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Board finds that the preponderance of the evidence is against a finding that the Veteran has a validly diagnosed adjustment disorder during the period on appeal that is separate and distinct from the Veteran’s diagnosed and already service-connected generalized anxiety disorder. 38 C.F.R. § 4.125. While an adjustment disorder is noted in the Veteran’s 2018 VA examination, this diagnosis is outweighed by the other four VA examination reports and the private examination report of 2008, and the Social Security Administration evaluation, all of which are consistent in finding that based on the Veteran’s presentation and the medical evidence of record there are diagnoses of PTSD with depression, but no diagnosis of adjustment disorder. The Board also finds probative the August 2020 examiner’s opinion that the diagnosis of adjustment disorder was in error, reasoning that the diagnostic criteria for the Veteran’s service-connected PTSD and depression more accurately reflects his current mental status. As the preponderance of the evidence is against a finding that the Veteran has a valid current diagnosis of a separate and distinct adjustment disorder, service connection for an adjustment disorder is not warranted on any basis. 38 C.F.R. §§ 3.102, 3.303; see Brammer v. Derwinski, 3 Vet. App. at 225. The preponderance of the evidence weighs against a finding that the Veteran has an adjustment disorder. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 5557 (1990); 38 C.F.R. § 3.102. For these reasons, the claim is denied. 3. Entitlement to a total disability rating based on unemployability (TDIU) prior to March 2, 2013 The Veteran claims entitlement to TDIU due to his service-connected disabilities for the period prior to March 2, 2013. The Veteran’s claim for TDIU was filed on March 4, 2013. The law provides that a total disability rating may be assigned where the schedular rating is less than total, when the 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, this disability shall be ratable at 60 percent or more, or if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. See 38 C.F.R. § 4.16 (a). For the purpose of one 60 percent disability or one 40 percent disability in combination, disabilities resulting from a common etiology will be considered as one disability. See 38 C.F.R. § 4.16 (a)(2). The record must reflect that circumstances, apart from non-service-connected conditions, place the Veteran in a different position than other veterans having the same compensation rating. The sole fact that a veteran 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 is whether the Veteran, in light of his service-connected disabilities, is capable of performing the physical and mental acts required by employment, not whether he can find employment. Van Hoose v. Brown, 4 Vet. App. 361 (1993). For the period on appeal, the Veteran’s total service-connected disability evaluation meets the schedular criteria. Prior to March 2, 2013, the Veteran is service connected for PTSD (evaluated as 70 percent disabling), valvular heart disease (evaluated as 10 percent disabling), residuals of a shell fragment would (evaluated as 10 percent disabling), tinnitus (evaluated as 10 percent disabling), and hearing loss (evaluated as noncompensable). The total combined disability evaluation was 80 percent. In his claim, the Veteran, through his representative, asserts that his last gainful occupation ended on March 1, 2013. The Board notes that review of the claims file shows that on the same day of March 4, 2013, the Veteran filed for Social Security Administration Disability benefits, and an SSA determination letter is indicative that the Veteran’s disability also began on March 1, 2013. In fact, in an SSA work history report associated with his application, the Veteran stated he was a senior maintenance technician, working full time until March 2013. This is consistent with the Veteran’s statement in his VA form 21-8940 of March 2013. As stated above, the Veteran is only eligible for entitlement to TDIU “when the veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities.” 38 C.F.R. § 4.16. Based upon the probative evidence of record, the Veteran’s entitlement to a TDIU prior to March 2, 2013, is denied. Although his service-connected disabilities had an impact on his work, he was able to obtain full time substantially gainful employment until March 2013, and remained substantially gainful employment until then. Entitlement to TDIU, prior to March 2, 2013, is not warranted. Jennifer White Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Department of Veterans Affairs 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.