Citation Nr: 21007692 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 11-05 644A DATE: February 10, 2021 ORDER Entitlement to a rating in excess of 50 percent for service-connected posttraumatic stress disorder (PTSD) is denied. Entitlement to special monthly compensation (SMC) based on housebound (HB) status is denied. REMANDED Entitlement to a total disability rating due to individual unemployability based on service-connected disabilities (TDIU) prior to December 3, 2008 is remanded. FINDINGS OF FACT 1. For the entire appeal period, the Veteran’s PTSD is manifested by symptoms resulting in occupational and social impairment with reduced reliability and productivity, without more severe manifestations that more nearly approximate occupational and social impairment with deficiencies in most areas or total occupational and social impairment. 2. During the appeal period, although the Veteran had a service-connected disability or disabilities independently ratable at more than 60 percent from November 20, 2010, he did not have a single service-connected disability ratable at 100 percent at any point during this time period and therefore did not meet the schedular requirements for SMC based on housebound status. CONCLUSIONS OF LAW 1. For the entire appeal period, the criteria for a rating in excess of 50 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9411. 2. The criteria for SMC at the housebound rate are not met. 38 U.S.C. § 1114; 38 C.F.R. §§ 3.350, 3.352. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1968 to August 1970. The Veteran’s awards include the Combat Infantryman Badge. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2008 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In an August 2010 rating decision, the RO awarded entitlement to TDIU, effective from December 3, 2008, the date the Veteran met the schedular requirements for eligibility. However, on March 26, 2008, VA received a claim for an increased rating for PTSD. It was denied in an October 2008 rating decision and appealed to the Board. During the pendency of the appeal, the Veteran filed a VA Form 21-8940, Veteran’s Application for Increased Compensation Based on Unemployability, in which he contended that his PTSD prevented him from being able to secure and follow a substantially gainful occupation. In August 2010, the AOJ issued a rating decision that granted entitlement to a TDIU effective December 3, 2008. A request for a TDIU (whether expressly raised or implied by the record) is not a separate claim for benefits, but rather an attempt to obtain an appropriate rating, either as part of the initial adjudication of a claim or as part of a claim for an increased rating. Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). Once the issue of entitlement to a TDIU is raised, it is “part of the claim for benefits for the underlying disability.” Id. Once entitlement to a TDIU is at issue as part of a claim for an increased rating, a claimant need not appeal a denial by the AOJ for the issue to remain in appellate status. Payne v. Wilkie, 31 Vet. App. 373 (2019); Harper v. Wilkie, 30 Vet. App. 356 (2018). Thus, when the AOJ fails to grant the benefit in full (i.e., entitlement to a TDIU for the entire period on appeal), that portion of the claim that remains unresolved remains on appeal. Therefore, the Board will address whether entitlement to a TDIU is warranted from March 26, 2008 to December 3, 2008. In June 2018, the Board of Veterans’ Appeals (Board) denied these claims and, in response, the Veteran appealed to the higher U.S. Court of Appeals for Veterans Claims (Court). Pursuant to a May 2019 Joint Motion for Remand (JMR), the Court vacated the Board’s decision and remanded these claims back to the Board for further development and readjudication in compliance with the specified directives. The parties to the May 2019 JMR agreed that the Board had erred in its June 2018 decision in not providing an adequate statement of reasons and bases for denying these claims. More specifically, the parties agreed that the Board had failed to address favorable evidence regarding the impact of the Veteran’s PTSD on his occupational functioning. In November 2019, the Board remanded the case for additional development and it now returns for appellate review. The Board notes that additional VA treatment records were associated with the record after the issuance of the July 2020 supplemental statement of the case. However, the VA treatment records are cumulative or redundant of evidence previously of record, or otherwise not pertinent to the claims being decided herein. Therefore, a waiver of the procedural right of the agency of original jurisdiction is not necessary. Increased Rating Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant’s favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. A claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Thus, separate ratings can be assigned for separate periods of time based on the facts found - a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. Entitlement to a rating in excess of 50 percent for service-connected PTSD. The Veteran contends that a higher rating for his PTSD is warranted due to the severity of his symptoms. Such disability is rated under the criteria of DC 9411, which provides ratings under the General Rating Formula for Mental Disorders at 38 C.F.R. § 4.130. Under DC 9411, a 50 percent rating is warranted when there is 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 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. Id. A 70 percent rating is warranted where there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; 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 when there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene), disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. The United States Court of Appeals for the Federal Circuit has held that the evaluation under 38 C.F.R. § 4.130 is “symptom-driven,” meaning that “symptomatology should be the fact-finder’s primary focus when deciding entitlement to a given disability rating” under that regulation. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-117 (Fed. Cir. 2013). The symptoms listed are not exhaustive, but rather “serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating.” Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). In the context of determining whether a higher disability evaluation is warranted, the analysis requires considering “not only the presence of certain symptoms, but also that those symptoms have caused occupational and social impairment in most of the referenced areas” - i.e., “the regulation...requires an ultimate factual conclusion as to the Veteran’s level of impairment in most areas.” Vazquez-Claudio, 713 F.3d at 117-118; 38 C.F.R. § 4.130, DC 9411. Further, when evaluating a mental disorder, the Board must consider the “frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran’s capacity for adjustment during periods of remission,” and must also “assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner’s assessment of the level of disability at the moment of the examination.” 38 C.F.R. § 4.126 (a). One factor for consideration is the Global Assessment of Functioning (GAF) score, which is a scale reflecting the “psychological, social, and occupational functioning in a hypothetical continuum of mental health-illness.” Carpenter v. Brown, 8 Vet. App. 240, 242 (1995) (citing Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)). The Board notes that the revised DSM-5, which, among other things, eliminates Global Assessment of Functioning (GAF) scores, applies to appeals certified to the Board after August 4, 2014, as is the case here. See 79 Fed. Reg. 45, 093 (Aug. 4, 2014). Here, the Veteran’s claim was certified after August 4, 2014 and is therefore to be considered under the DSM-5. However, the Secretary has specifically indicated that all diagnoses completed under DSM-IV may still be applied for any claims pending before the Board. Id. As the record contains prior evaluations performed citing DSM-IV, the Board will also consider the DSM-IV based assessments provided in the Veteran’s record in reaching a decision regarding his claim for increased rating for PTSD. The Board finds that a rating in excess of 50 percent for PTSD is not warranted as the evidence fails to show that such disability is manifested by more severe symptomatology that results in occupational and social impairment with deficiencies in most areas, or total occupational and social impairment. Specifically, there is no evidence, either lay or medical, to establish the presence of symptoms of the frequency, duration and severity necessary to warrant a higher rating. More importantly, there is no indication that the Veteran’s PTSD symptoms resulted in 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; 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. Regarding social impairment, the record shows that the Veteran reported that he continued to be married to his spouse since 1973 and they had a good, loving, and caring relationship. He also maintained a good relationship with his son. On VA examination in July 2008, the examiner stated that the Veteran’s PTSD symptoms moderately impacted his activities of daily living, routine responsibilities, physical health, relationships, leisure activities, and quality of life. The Veteran reported that he retired two years prior to the 2008 examination, but that it was unrelated to the effects of his PTSD. It was also noted that the Veteran routinely exercised at a gym, had hobbies, and routinely drove his wife to work. In his February 2011 VA examination, the examiner determined that while the Veteran isolated himself, he interacted with others appropriately, engaged in social activities, was capable of basic activities of daily living, was able to meet family responsibilities and was able to meet work demands and responsibilities. The examiner determined that while the Veteran isolated himself, he interacted with others appropriately, engaged in social activities, was capable of basic activities of daily living, was able to meet family responsibilities and was able to meet work demands and responsibilities. It was reported that the Veteran attended church, worked on cars as a hobby, and continued to go to the gym. At his January 2020 VA examination, the Veteran reported that his social network consisted of his wife, son, and noted that he continued to attend church. Turning to occupational impairment, at his July 2008 VA examination, as noted, the Veteran explained that he was retired but drove his wife to work daily and then went to the gym to swim and exercise because he found it to be relaxing. He also had a hobby of working on old cars and enjoyed spending time with his dog and listening to old music. In his February 2011 VA examination, the Veteran told the examiner that he retired in 2006 after working for 35 years as a train operator. He stated that he planned to work until he was 65 but that he was consistently hearing announcements on the loud speakers asking individuals to be vigilant and aware of suspicious packages. He said that it proved to be to anxiety provoking for him and he decided to retire early. The examiner determined that the Veteran’s severity of symptoms could be classified as mild to moderate. The duration and frequency of his symptoms were chronic and continuous. The examiner noted that the Veteran was not unemployable, and that his PTSD symptoms would not affect his employment. In January 2020, he stated that he retired in 2005 because his job “became like Vietnam.” The Veteran’s extensive VA treatment and non-VA treatment reports, including psychiatric group counseling notes, have been reviewed. The VA treatment reports show that the Veteran participated in group therapy and on a couple of occasions, impaired reality testing was noted. Nonetheless, the medical reports overwhelmingly show that the Veteran was not a risk to himself or others, was goal directed and appropriate to task, and that he verbalized understanding very well. He was alert and oriented. His speech was clear and coherent, insight was good, and his judgment was intact. See VA Treatment Reports and Kaiser Permanente Reports. The Board finds that the symptoms the Veteran described to the July 2008, February 2011, and January 2020 VA examiners, his treatment providers, and in statements (including, but not limited to, sleep impairment; recurrent, involuntary, and intrusive distressing memories; avoidance behavior; irritability; hypervigilance; occasional displays of obsessional rituals, exaggerated startle response; panic attacks; disturbances of motivation and mood; impairment of short and long term memory; and isolative behaviors) and their resulting impact on his social and occupational functioning are contemplated by the currently assigned 50 percent rating. As noted, the July 2008 and February 2011 VA examiners found the Veteran’s impairment to be no more than mild to moderate in severity. Moreover, the January 2020 VA examiner found that the Veteran’s symptomatology was reflective occasional decrease in work efficiency and intermittent periods of inability to perform occupational task, which is commensurate with a lesser 30 percent rating. The Board recognizes that the Veteran has had problems with panic attacks, periodically displays of obsessive rituals, and some delusions and hallucinations (see July 2008 VA examination report, May 2010 Counseling Note, and February 2011 VA examination report). The Veteran has also noted passive suicide ideation. Nonetheless, when considering the Veteran’s total disability picture, the Board finds that his periodic symptoms does not appear to impact his ability to function socially or meet family responsibilities. Overall, throughout the Veteran’s VA treatment reports, he consistently denied experiencing psychotic symptoms and it was noted that he remained goal directed and attentive to task. VA examination reports also show that he denied suicide ideation and although obsessional rituals were noted (seeing something crawl on the wall and rechecking the house alarm), it did not interfere with routine activities. Also, his panic attacks were not described as near-continuous panic attacks affecting the ability to function independently. In this regard, as stated above, in the context of determining whether a higher disability evaluation is warranted, the analysis requires considering “not only the presence of certain symptoms, but also that those symptoms have caused occupational and social impairment in most of the referenced areas” - i.e., “the regulation...requires an ultimate factual conclusion as to the Veteran’s level of impairment in most areas.” See Vazquez-Claudio, supra. Here, the frequency, duration and severity of the Veteran’s symptoms do not cause occupational and social impairment to warrant the assignment of a higher rating. Thus, the Board finds that the Veteran’s PTSD symptoms have not resulted in occupational and social impairment with deficiencies in most areas at any point during the appeal. Ratings in excess of 70 percent are similarly not warranted as the evidence discussed above does not indicate that the Veteran’s PTSD symptoms caused total social and occupational impairment. Additionally, as noted in the Introduction, the AOJ granted a TDIU effective December 3, 2008, the date the Veteran met the schedular requirements for eligibility for his combined service-connected disabilities. The Board notes that the June 2018 Board’s decision did not address the Veteran’s May 2009 statement indicating he had stopped working because he did not “feel that the work environment is safe” due to his PTSD or a May 2009 statement from his physician, Dr. S.A., indicating the Veteran was totally disabled and unable to work due to his PTSD. See May 2009 Claim for Total Disability Benefits Statement of Insured. However, in accordance with the November 2019 Board remand, an opinion was obtained in order to address such issue. In this regard, the January 2020 VA examiner was asked to address the extent to which the functional impairment caused by the Veteran’s PTSD alone impaired his ability to meet the demands of a job, whether sedentary or physical, and the timeframe in which such impairment arose. The examiner explained that the Veteran’s mood issues that derived from PTSD due to his time in Vietnam caused moderate impairment in his ability to function socially and occupationally as he is prone to increased levels of anxiety, intrusive thoughts, and sleep disturbance that cause challenges with consistent performance. However, the examiner concluded that the Veteran appeared to be physically capable of performing job duties, and with a flexible work schedule and mental health support, to include medication management and therapy services, it was likely that his work performance would improve. Again, as set forth above, by history and currently, the record shows that the Veteran’s PTSD alone is not productive of total occupational impairment. The Board has considered whether staged ratings under Fenderson, supra. and Hart, supra, are appropriate for the Veteran’s service-connected PTSD; however, the Board finds that the Veteran’s symptomatology referable to such disability been stable throughout the entirety of the appeal period. Therefore, assigning staged ratings for is not warranted. Further, neither the Veteran nor his representative has raised any other issues (with exception of SMC), nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Based on the foregoing, the Board finds that a rating in excess of 50 percent for PTSD is not warranted. In reaching the foregoing determination, the preponderance of the evidence is against such aspects of the Veteran’s claim. Therefore, the benefit of the doubt doctrine is not applicable and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 2. Entitlement to SMC based on HB status. In May 2018, the Veteran’s representative argued that the issue of entitlement to special monthly compensation (SMC) by reason of being permanently housebound was raised by the record. Pursuant to 38 U.S.C. § 1114 (s), SMC is payable, as relevant, if by reason of a veteran’s service-connected disability or disabilities, they are permanently housebound. The requirement of “permanently housebound” will be considered to have been met when the veteran is substantially confined to such veteran’s house or immediate premises due to a service-connected disability or disabilities which it is reasonably certain will remain throughout such veteran’s lifetime. See 38 U.S.C. § 1114 (s); 38 C.F.R. § 3.350 (i)(2). Special monthly compensation at the housebound rate is payable where a veteran has a single service-connected disability rated as 100 percent and: (1) has additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems, or (2) is permanently housebound by reason of service-connected disability or disabilities. 38 U.S.C. § 1114 (s); 38 C.F.R. § 3.350 (i). When a Veteran is awarded TDIU based on a single disability and receives schedular disability ratings for other conditions, SMC based on the statutory housebound criteria may be awarded so long as the same disability is not counted twice, i.e., as a basis for TDIU and as a separate disability rated 60 percent or more disabling. See 75 Fed. Reg. 11,229, 11,230, Summary of Precedent Opinions of the VA General Counsel (March 10, 2010) (withdrawing VAOPGCPREC 6-1999 in light of Bradley v. Peake, 22 Vet. App. 280 (2008)). An August 2010 rating decision awarded the Veteran a TDIU from December 2008 to May 2014 based on his service-connected disabilities (multiple). While a medical assessment of the impact of the Veteran’s PTSD on his ability to work in his job as a station manager for a city rail transport system was discussed, the determination also clearly noted that “[e]ntitlement to individual unemployability is granted because you are unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities.” A March 2015 rating decision increased the Veteran’s service-connected renal insufficiency with hypertension to 60 percent disabling, subsequently increasing the Veteran’s combined disability rating to 100 percent, effective May 2014. The RO then terminated the TDIU in lieu of the Veteran’s new combined 100 percent rating. The Veteran’s representative argued that the Veteran is entitled to SMC because he was originally granted a TDIU based solely on his service-connected PTSD. However, a TDIU may be assigned where the schedular rating is less than total and it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of either (1) a single service-connected disability ratable at 60 percent or more, or (2) two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is a sufficient additional service-connected disabilities to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). In this case, the Veteran would not meet the threshold criteria to qualify for a TDIU based on his PTSD alone. His PTSD has never been rated at least 60 percent disabling. Moreover, the evidence noted above does not support preclusion of all forms of substantially gainful employment solely because of PTSD. VA examination and treatment reports dated from 2008 through 2011 do not show that the Veteran’s PTSD alone rendered him unemployable. Additionally, in this regard, the January 2020 VA examiner was asked to address the extent to which the functional impairment caused by the Veteran’s PTSD alone impaired his ability to meet the demands of a job, whether sedentary or physical, and the timeframe in which such impairment arose. The examiner explained that the Veteran’s mood issues that derived from PTSD due to his time in Vietnam caused moderate impairment in his ability to function socially and occupationally as he is prone to increased levels of anxiety, intrusive thoughts, and sleep disturbance that cause challenges with consistent performance. However, the examiner concluded that the Veteran appeared to be physically capable of performing job duties, and with a flexible work schedule and mental health support, to include medication management and therapy services, it was likely that his work performance would improve. As such, the Board concludes that the criteria for SMC based on housebound status have not been met. 38 U.S.C. §§ 1114 (s), 5121; 38 C.F.R. §§ 3.350, 3.352, 3.1000. Therefore, the appeal is denied. REMAND 3. Entitlement to a TDIU prior to December 3, 2008. Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that if there is only one such disability, such disability shall be ratable as 60 percent or more, and if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16 (a). Rating boards should submit to the Director of Compensation Service for extra-schedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities but who fail to meet the percentage standards set forth in 38 C.F.R. § 4.16 (a). See 38 C.F.R. § 4.16 (b). 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. 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). The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. A high rating in itself is recognition that the impairment makes it difficult to obtain or keep employment. The ultimate question, however, is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether he or she can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). As an initial matter, the Board notes that the Veteran does not meet the schedular criteria for a TDIU prior to December 3, 2008. In this regard, as stated in the Introduction, the Board will address whether entitlement to a TDIU is warranted from March 26, 2008 to December 3, 2008. The Board notes that, prior to December 3, 2008, the Veteran was service connected for PTSD, evaluated as 50 percent from November 25, 2001; diabetes with erectile dysfunction, evaluated as 20 percent from November 25, 2001; and hypertension, evaluated as noncompensable from March 26, 2008. As of March 26, 2008, the Veteran had a combined rating of 60 percent. He does not have a single disability evaluated as 60 percent disabling or more, or one disability evaluated at 40 percent or higher and the combined rating for all of his disabilities is 70 percent. The Board is precluded from assigning a TDIU rating on an extra-schedular basis under 38 C.F.R. § 4.16 (b) in the first instance. However, as noted previously, the Board may refer the matter to the Director, Compensation Service, for consideration of entitlement to TDIU on an extra-schedular basis. In March 2009, the Veteran submitted a VA Form 21-8940, Veterans Application for Increased Compensation Based on Unemployability. In such application, he indicated that his PTSD prevented him from securing or following a substantially gainful occupation. He reported that he last worked in 2005 and became too disabled to work that same year. He further indicated that he had not sought employment since he became too disabled to work. He indicated that he did not have any other education and training prior to becoming too disabled to work, and completed four years of high school. With respect to the impact the Veteran’s service-connected disabilities had on his ability to secure or follow a substantially gainful occupation, the July 2008 and February 2011 VA examiners concluded that the Veteran was not unemployable due to his PTSD. In April 2010, the Veteran submitted a life insurance form, which stated that the Veteran reported that he did not feel like the work environment was safe. A private physician concluded that the Veteran was totally disabled and unable to work due to his PTSD. In February 2020, a VA examiner was asked to address the extent to which the functional impairment caused by the Veteran’s PTSD alone impaired his ability to meet the demands of a job and the timeframe in which such impairment arose. The examiner concluded that Veteran’s mood issues that derived from PTSD due to time in Vietnam caused moderate impairment in his ability to function socially and occupationally as he was prone to increased levels of anxiety, intrusive thoughts, and sleep disturbance that caused challenges with consistent performance. However, the examiner explained that the Veteran appeared to be physically capable of performing job duties, and with a flexible work schedule and mental health support, to include medication management and therapy services, it was likely that his work performance would improve. Accordingly, the Board finds that the claim should be submitted to the Director, Compensation Service, for extra-schedular consideration for a TDIU under 38 C.F.R. § 4.16 (b). Accordingly, the case is REMANDED for the following action: Refer this matter to the Director, Compensation Service, for consideration of assignment of an extra-schedular TDIU under the provisions of 38 C.F.R. § 4.16(b). C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Brennae L. Brooks, 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.