Citation Nr: 21007987 Decision Date: 02/11/21 Archive Date: 02/11/21 DOCKET NO. 16-40 029 DATE: February 11, 2021 ORDER Entitlement to a disability rating in excess of 70 percent for posttraumatic stress disorder (PTSD) is denied. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is denied. FINDINGS OF FACT 1. The Veteran's PTSD is not manifested by total social and occupational impairment. 2. The evidence of record does not show that the Veteran was unable to obtain or maintain substantially gainful employment as a result of service-connected disabilities. CONCLUSIONS OF LAW 1. The criteria for a disability evaluation in excess of 70 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5103A, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.130, Diagnostic Code 9411 (2019). 2. The criteria for entitlement to a TDIU have not been met. 38 U.S.C. §§ 1155, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16, 4.18, 4.19 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty in the Unites States Army from August 2009 to August 2012 including service in Afghanistan. He was awarded the Combat Infantryman’s Badge This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In June 2019, the Board denied a disability rating in excess of 50 percent for PTSD and for entitlement to a TDIU. The Veteran appealed the decision to the United States Court of Appeals for Veteran's Claims (Court). The Court vacated the Board decision and remanded the appeal for compliance with the instructions in a Joint Motion for Remand (JMR). In July 2020, the Board remanded these issues to the RO for additional development. The claims were remanded to associate a December 2018 rating decision with the claims file and to obtain up to date VA treatment records. There has been substantial compliance with the remand instructions. Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141 (1999). In October 2020, the RO granted a 70 percent rating for PTSD, effective March 18, 2015, but continued to deny a TDIU. The Board has reviewed the record of evidence comprehensively. Although the Board has an obligation to provide reasons and bases to support a decision, there is no requirement to discuss, in detail, all the evidence submitted by or on behalf of a Veteran. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record, however, does not have to discuss each piece of evidence). The analysis below focuses on the most relevant evidence about what this evidence shows, or fails to show, about the issue on appeal. The Veteran must not assume that the Board has overlooked pieces of evidence that are not discussed explicitly. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the Veteran). Joint Motion for Remand Concerning the first issue of entitlement to an initial disability rating in excess of 50 percent for PTSD, the parties to the JMR indicated that the Board had failed to provide an adequate statement of reasons or bases for its treatment of the December 2018 rating decision and the omitting of a discussion of the favorable evidence and for the failure to adequately address the Veteran’s suicidal ideations. The parties found that the "Board failed to 'engage in [an] holistic analysis in which it assessed the severity, frequency, and duration of the signs and symptoms of the Veteran's service-connected mental disorder; quantified the level of occupational and social impairment caused by those signs and symptoms; and assigned and evaluation that most nearly approximates the level of social and occupational impairment. Id. at pp. 3-4 (citing and syntactically adjusting Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017)). Concerning the issue of entitlement to a TDIU, the parties found that the Board’s determination regarding the level of disability of the Veteran’s PTSD would directly impact the TDIU claim; since the issue of TDIU is inextricably intertwined with PTSD the claim was necessary to remand. See id. at p. 5. Evidence A March 13, 2013 VA treatment record show that the Veteran was going to diesel and auto mechanic school on a full-time basis and had been out of the Army since 2012. See April 2013 Capri, p.2. A March 26, 2015 intake assessment from a Vet Center notes the Veteran reported high anxiety and a tendency to internalize things that were causing him stress. He further reported hypervigilance that made him very jumpy and uncomfortable in crowded places. He denied having suicidal thoughts but endorsed feelings of hopelessness or despair. A flat affect was noted, as were early and middle insomnia. See May 2015 Medical Treatment Record-Government Facility, p.3. The counselor noted that the Veteran attended Auto Diesel College for 13 months and had been working as a heavy equipment mechanic for 1.5 years. See May 2015 Medical Treatment Record-Government Facility, p.8. In April 2015, the Veteran’s girlfriend submitted a statement. She stated that during the 2 years they had been dating she noticed that he had a “lack of trust, patience, willingness to understand situations and other perspectives". She also stated that certain situations caused him to be irritable, anger and "standoffishness". She noted that social gatherings had been particularly difficult for him for the prior year as he could not relax at such events. She stated that he did not like being around lots of people, particularly if he did not know very many of them. She then stated that he shifted frantically in his sleep, yelling or mumbling incoherently. In addition, she indicated that he would wake up breathing very heavily and wide-eyed, sweating and panicky. She further stated that his anger and temper were becoming a bigger problem as his patience was growing shorter. She then stated that everyone had to "tiptoe around him to not set him off." She stated that when he became angry, he would say very mean and hurtful things. And also retreat within himself and become absolutely silent and refuse to talk. She stated that loud and sudden noises were hard for him, noting that he could not relax on the 4th of July due to anxiety from fireworks. She also noted that he would get road rage while driving. She indicated that he has lost friendships due to his behavior and that her relationship with him had deteriorated. See April 2015 Buddy/Lay Statement. In April 2015, the Veteran was afforded a VA PTSD examination. The examiner noted a diagnosis of PTSD with occupational and social impairment with reduced reliability and productivity was noted. Symptoms of depressed mood, anxiety, suspiciousness, panic attacks, chronic sleep impairment, mild memory loss, impairment of short and long term memory, impaired judgment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances and neglect of personal appearance and hygiene were noted. However, the examiner observed that the Veteran had good hygiene, and he was dressed in clean clothes. His speech flow was slightly abrupt, but content was normal. Vocabulary was indicative of average intellectual functioning. His behavior was cooperative, and his mood appeared anxious with restricted/congruent affect. The examiner reported that the Veteran was not being prescribed psychotropic medications. The Veteran denied suicidal/homicidal ideation and there was no history of psychiatric inpatient hospitalizations reported. The Veteran also denied homicidal and suicidal plans and ideations in PTSD counseling services. His concentration was intact and the Veteran could track questions. Attention and abstraction were also intact. His immediate memory was slightly impaired, judgment appeared good, although the Veteran did note that he has anger outbursts and unprovoked irritability. At the time of the examination, the Veteran was employed full time at a mechanic. The Veteran stated that he had been able to maintain work, but he noted that had irritability, difficulty with collegial relations, and difficulty concentrating. Additionally, the Veteran noted that he had flashbacks at work, which created anxiety and anger reactions. In February 2016, the Veteran was afforded another VA PTSD examination. The examiner noted a diagnosis of PTSD, major depression and insomnia were noted. Differentiation of symptoms was noted as being possible but noted that the Veteran's PTSD was the proximal cause of the major depression and insomnia. Occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment thinking and/or mood was noted. Symptoms of depressed mood, anxiety, suspiciousness, panic attacks, chronic sleep impairment, difficulty in understanding complex commands, impaired judgment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, impaired impulse control and grossly inappropriate behavior were noted. The examiner observed that the Veteran was clean, well-groomed, with obvious attention to personal hygiene and grooming. He made very good and appropriate intermittent eye contact. He was alert and fully cooperative and was fully responsive to the examiner's questions. He was also pleasant and engaging. The examiner opined that the Veteran’s PTSD was worse than when last examined, and his social functioning in particular had crashed. He lost his romantic relationship, and he lived with his sister in the country. He did not like people and did not get along with coworkers. His depression was noted as severe despite multiple medications to attempt to treat PTSD and depression. The examiner reported that the Veteran worries about being intolerant with others on his job, and he keeps them at a distance so as to avoid all conflicts In a March 2016 notice of disagreement (NOD), the Veteran disagreed with the 50 percent rating for PTSD. The Veteran indicated that he had to continue to hold on to a job, because he had to provide for him and his family. The Veteran stated that every morning he woke up with depression and with survivor’s guilt. The Veteran noted that some days he did not feel like getting out of bed, but he did. The Veteran stated he had an emotional cloud over his head and woke up every morning with guilt; but had to keep going. He said he would bury his emotions deep down just to get through the day; then relive the memories in nightmares, if he was able to fall asleep. See March 2016 NOD, p.2. In an August 2016 statement, the Veteran requested a higher rating of 70 to 100 percent, and stated that he feared loud noises, has continuous nightmares and terrors, experiences severe anxiety, nervousness and insomnia. He further stated that he had mood swings and constant panic attacks that leave him sweating through his shirt more than a few times a day. He stated that his relationships have suffered because of his irritability and that he "often cannot rationalize situations and [his] thoughts become cloudy." He stated that this leads him to become abusive towards loved ones. He then stated that he is often withdrawn in social settings "cannot connect to others." He stated that he struggled to complete basic, daily living tasks, to remember doctor appointment, social events and holidays and forgets to pay bills on time. He said even eating is a struggle. He stated that he does not like large crowds, loud noises or loud places. He endorsed having night terrors from which he wakes up in a cold sweat, breathing rapidly and disoriented. He stated that his work environment is "very difficult for [him] to handle" as he worked as a mechanic in an environment with loud noises that brought back memories of Afghanistan. He stated that working as a mechanic was not ideal for his condition. See August 2016 Form 9, p.3. In July 2016, the Veteran’s sister submitted a statement. She stated that they moved in together in April 2015. She stated once she moved in with him, that is when she realized how serious his issues were. She stated prior to him entering service he was happy, he hung out with his friends and it took a lot to get him worked up. However, after service she stated he became a different person, going from one extreme to another with no rational explanation. She further stated that he became very negative and that she had to learn how to interact with him depending on his mood, elaborating that she had to learn the cues. She further stated that she was afraid to say the wrong thing and cause him undue stress, depression or anger. She then stated that she had woken up to him yelling and talking in his sleep. She also noted that he did not like large crowds and would get very anxious, waiting for bad things to happen. See August 2016 Buddy/Lay Statement. Also, in July 2016, the Veteran’s ex-girlfriend submitted a statement. His ex-girlfriend stated that she had known him for 12 years but had lost touch until 2011 when he ended his deployment in Afghanistan. At the time she stated that he was optimistic and had plans for the future. However, when he stayed with her for three weeks while on leave, she indicated that she began to see a different person. She stated that he avoided family and friends, and he would decline invitations to dinner and events. He would stay to himself and would not give a reason for his bad mood. She indicated that he would get upset when things were not done around her home the way he liked and would rant for an extended period of time. She stated his mood worsened over the course of their relationship; he would go from happy to suddenly suspicious and argumentative with no known trigger. She indicated he also had issues with remembering things like not being able to recall events, remember conversations, text messages, things he said or actions he took. She recalled other issues as well including the Veteran’s unhealthy binge eating. She also noted that he would become angry suddenly, but she never feared he would become violent with her. See August 2016 Buddy/ Lay Statement. In a December 2016 VA treatment note, a clinician noted the Veteran was experiencing depression and anxiety. The Veteran was always tired, had a low mood, could not be in crowds, was paranoid and would sweat. In terms of PTSD the Veteran was experiencing symptoms of hypervigilance, he constantly checked around, experienced arousal, avoidance, had nightmares most nights and persistent re-experiencing. The Veteran denied any history of suicidal or homicidal history or thoughts. See November 2018 Capri, p.311. In a September 2017 occupational therapy progress note, the Veteran stated that he had been working 16-hour shifts. See December 2018 Capri, p.206. In an October 2018 application for TDIU, the Veteran reported having last worked as a mechanic on October 11, 2018. The Veteran also reported that he had completed 2 years of college. The Veteran listed carpal tunnel syndrome and degenerative joint disease as the disabilities that keep him from gainful employment. However, the Veteran is not service connected for those disabilities. See October 2018 VA 21-8940 Veteran’s Application for Increased Compensation Based on Unemployability. On October 16, 2018, VA received a letter from a VA occupational therapist who stated that the Veteran "continues to work". See October 2018 Medical Treatment Record-Government Facility, p.2. In November 2018, the Veteran was afforded another VA PTSD examination. The examiner noted a diagnosis of PTSD and major depressive disorder, severe. The examiner indicated that it was not possible to precisely differentiate what symptoms were attributable to each diagnosis, in part due to overlapping symptoms. Total occupational and social impairment was noted. The Veteran reported having a girlfriend and being fired from his employer when his symptoms of PTSD and depression interfered with his work, noting that he would arrive late and was often too depressed and anxious to work. It was further noted that he had been currently working for a few months at a heavy equipment shop but had been missing hours to attend VA appointments. He further reported that it took him to fall asleep. And that he only got 4 hours of sleep total a night. Symptoms of depressed mood, anxiety, suspiciousness, near-continuous panic or depression, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, inability to establish and maintain effective relationships and suicidal ideation were noted. The Veteran reported thoughts of suicide from time to time; however, he stated that he did not act on them out of concern for his dog and denied having current intent. It was noted that while his insight was adequate, his impulse control and judgment would fluctuate at times when under stress. It was also noted that the Veteran is irritable all the time. In a March 2020 VA treatment record, the Veteran indicated that he needed to get back on pain medication, because he could not move or work like he used to be able to. He stated that his work performance had declined, and he did not want to lose his job. See July 2012 Capri, p.12. In an April 2020 VA treatment note and correspondence, the Veteran requested a refill of medication since he would be leaving the following morning for work and would be returning on May 8th at the latest. See July 2020 Capri, p.9. In an August 2020 mental health note, a clinician indicated that the Veteran’s suicide risk was moderate to low. The Veteran denied a plan or intent to commit suicide or had a suicide attempt in the past. However, the Veteran indicated that he had access to means to cause harm and access to firearms, but indicated the firearms were only used for hunting and relaxation. See September 2020 Capri, p.7. In October 2020, the Veteran’s girlfriend submitted a letter. She stated that she had been in a relationship with the Veteran for a year and worried about him. She indicated that the Veteran was kind, selfless, loving and had a big heart. However, he was very guarded and triggered was triggered by things others normally would not react to. She gave the example when the Veteran attended a work conference where he had to interact with people and customers. She stated on the first day of the conference when the crowd started to grow, the Veteran had a meltdown/ panic attack and had to immediately leave. She stated that the Veteran told her that he could not be around large crowds without having sight of an exit and becoming frantic. As a result of the incident she indicated the Veteran lost his job. In addition, she stated that completing tasks such as going to the grocery store would cause him anxiety. Furthermore, she noted that she lived with the Veteran for a year and witnessed him yelling throughout the night, waking up with panic, sweating and trying to catch his breath. She stated that it would take her several minutes to calm him down and to get him to realize who she was. She also noted that one night she reached over him to grab a remote to turn on the TV; the Veteran woke up and grabbed her arm and did not realize who she was, until after she repeated it several times. Also, she stated when the Veteran would go through depression related to his time in the military, he would become cold, aggressive, closed off, isolate himself and would barely speak to anyone. In addition, she noted that stress from work or co-workers put him in a downward spiral. At the time of the statement, she indicated that the Veteran was so concerned with working and providing for his family, that he did not have the time to concentrate on his mental health. See January 2021 Buddy/ Lay Statement, p.2. Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule). 38 C.F.R. Part 4. The Rating Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be ascertained, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Staged ratings are appropriate when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119, 126 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a Veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. PTSD is evaluated under either the General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130, Diagnostic Codes 9201 - 9440 (2016). Pertinent to this appeal, the General Rating Formula for Mental Disorders rates PTSD as follows: A 70 percent disability rating is assigned when 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 that is intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); and inability to establish and maintain effective relationships. A 100 percent disability rating is assigned 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; and memory loss for names of close relatives, for the veteran's own occupation, or own name. 38 C.F.R. § 4.130, Diagnostic Code 9411. 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. When determining the appropriate disability evaluation to assign, the Board's primary consideration is the Veteran's symptoms, but it must also make findings as to how those symptoms impact the Veteran's occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013); Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). Because the use of the term "such as" in the rating criteria demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, the Board need not find the presence of all, most, or even some, of the enumerated symptoms to award a specific rating. Mauerhan, supra. Nevertheless, as all ratings in the general rating formula are also associated with objectively observable symptomatology and the plain language of the regulation makes it clear that the Veteran's impairment must be "due to" those symptoms, a veteran may only qualify for a given disability by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio, supra. The presence of suicidal ideation alone, that is, a veteran's thoughts of his or her own death or thoughts of engaging in suicide-related behavior, may cause occupational and social impairment with deficiencies in most areas. See Bankhead 29 Vet. App. at 20 (affirming that suicidal ideation does not require suicidal intent, a plan, or preparatory behavior). PTSD In an October 2020 rating decision, the Veteran was awarded a 70 percent disability rating effective March 18, 2015, the date service connection was granted. In a November 2018 VA examination the Veteran indicated that he lived alone and had been divorced since 2012 to 2013. The Veteran stated he had a girlfriend of six months who stayed with him frequently but did not live with him. However, in October 2020, the Veteran’s girlfriend indicated that she had been living with the Veteran for a year. The Veteran stated since a previous evaluation that there had been no social or family changes. However, it was noted during the examination that the Veteran had been working for a few months at a heavy equipment shop. Furthermore, the Veteran reported during the November 2018 VA examination that he worked as a mechanic for a year and a half; but was fired when his symptoms of PTSD and depression interfered with his work. The Veteran stated that his employer fired him for violating standards of behavior for not being able to be talked to, arriving late and often being unable to work due to depression and anxiety. Based on a review of the evidence, the Board concludes that the Veteran's symptoms do not cause the level of impairment required for a disability rating of 100 percent. The claims file reflects that the Veteran denied delusions and hallucinations, was oriented to time, place, date and person, and appropriately groomed and dressed. In addition, based on the Veteran’s November 2018 the Veteran was able to perform activities of daily life and oriented to time or place since he indicated that he was up able to get up at 6:00 am for work, he had a valid driver’s license and was able to drive places, including to his VA examination, he was able to use his phone and manage his own money, he showered once a day and was able to independently dress groom and feed himself. The Veteran did indicate that he did not shop at stores when there were too many people being in the store, so his girlfriend did the shopping. Furthermore, while the VA examiner indicated that the Veteran had total occupational and social impairment, the Veteran did not exhibit symptoms of memory loss for names of close relatives, own occupation, or own name, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, neglect of personal appearance or hygiene, intermittent inability to perform activities of daily life and disorientation to time and place. The examiner indicated that he arrived early for his appointment and completed paperwork independently, with no unusual misspellings in the paperwork. The examiner stated that the Veteran was adequately groomed and fully oriented. The examiner indicated that there was no evidence of psychotic ideation. The Veteran did report that he had thoughts of suicide from time to time, and last felt suicidal when he was finishing a fence at his new home. However, the Veteran stated that he did not act on those feelings and reported no current intent or plan to harm himself. The examiner ultimately found that the Veteran was increased but not imminent risk for suicidal ideation. The Veteran's treatment records were reviewed and there is no evidence to suggest that the Veteran's mental health disability causes 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 cause total occupational and social impairment. With respect to suicidal ideations, they were very infrequent, often denied, and there is no evidence that they impaired occupational or social function. There was no evidence of an need for intervention by counselors or attending clinicians. As to occupational and social functioning, the Board notes that the Veteran has been employed. While the medical and lay evidence has highlighted that the Veteran has impaired impulse control, there is no evidence that he has exhibited unprovoked irritability with periods of violence. The Veteran, his brother and his girlfriends all confirmed that the Veteran has never been violent or threatened physical violence against another person. The record also shows, based on the Veteran’s relationship with his girlfriends and his brother, that he is capable of establishing and maintaining effective social relationships. With the exception of the April 2015 VA examination, all the examiners denied that the Veteran neglected his personal appearance and hygiene. The Veteran has reported social and occupational functioning problems, but these problems are contemplated and reflected in the assigned 70 percent rating. The Veteran does have some deficiencies in several areas, but the greater weight of evidence demonstrates that it is to a degree that is contemplated by the 70 percent rating. In determining that a rating in excess of 70 percent is not warranted, the Board has considered the Veteran's contentions that his PTSD is more severe, but for the reasons discussed above concludes that the Veteran's level of social and occupational impairment does not warrant a rating in excess of 70 percent rating for any time during the period of the appeal. In summary, for the reasons and bases set forth above, the Board concludes that an increased rating greater than 70 percent is not warranted for the period on appeal. TDIU The Veteran contends that the severity and frequency of his PTSD has rendered him unable to secure or follow substantially gainful employment. In order to establish entitlement to a TDIU due to service-connected disabilities, there must be impairment so severe that it is impossible for the average person to follow a substantially gainful occupation. See 38 U.S.C. § § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. In reaching such a determination, the central inquiry is "whether the veteran's service-connected disabilities alone are of sufficient severity to produce unemployability." Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Consideration may be given to the Veteran's level of education, special training, and previous work experience in arriving at a conclusion, but not to his age or to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. § §§ 3.341, 4.16, 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). "Substantially gainful employment" is that employment "which is ordinarily followed by the nondisabled to earn their livelihood with earnings common to the particular occupation in the community where the veteran resides." Moore (Robert) v. Derwinski, 1 Vet. App. 356, 358 (1991). "Marginal employment shall not be considered substantially gainful employment." 38 C.F.R. § § 4.16(a) The regulatory scheme for a TDIU provides both objective and subjective criteria. Hatlestad, supra; VAOPGCPREC 75-91 (Dec. 27, 1991) 57 Fed. Reg. 2317 (1992). The objective criteria set forth at 38 C.F.R. § § 3.340(a)(2), provide for a total rating when there is a single disability or a combination of disabilities that results in a 100 percent schedular evaluation. Subjective criteria, set forth at 38 C.F.R. § § 4.16(a), provide for a TDIU when, due to service-connected disability, a veteran is unable to secure or follow a substantially gainful occupation, and has a single disability rated 60 percent or more, or at least one disability rated 40 percent or more with additional disability sufficient to bring the combined evaluation to 70 percent. 38 C.F.R. § §§ 3.340, 3.341, 4.16(a). In exceptional circumstances, where the veteran does not meet the aforementioned percentage requirements, a total rating may nonetheless be assigned upon a showing that the individual is unable to obtain or retain substantially gainful employment. 38 C.F.R. § § 4.16(b). The Veteran is service-connected for: 1) PTSD at 70 percent from March 18, 2015; 2) right shoulder strain at 10 percent from August 23, 2012;3) thoracolumbar strain at 10 percent from August 23, 2012; 4) bilateral foot strain at 10 percent from August 23, 2012; 5) tinnitus at 10 percent from August 23, 2012; 6) right lower extremity radiculopathy associated with thoracolumbar strain at 10 percent from August 23, 2012; 7) and left lower extremity radiculopathy associated with thoracolumbar strain at 10 percent from August 23, 2012. The combined rating was 90 percent from March 18, 2015. Therefore, the Veteran met the schedular requirements for entitlement to a TDIU from March 18, 2015. See 38 C.F.R. § § 4.16(a). A review of the evidence of record reveals the Veteran earned 2 years of college education and was an infantryman while in-service from August 2009 to August 2012. After separation from service, the Veteran went to trade school for 13 months and obtained a certification to become a diesel mechanic and did work as a mechanic. In an August 2017 occupational therapy consult note, the Veteran reported that he worked as a mechanic. According to the Request for Employment Information in Connection with Claim for Disability Benefits, as of November 2018, the Veteran was employed as a Service Technician in the Reserves earning $14,600.16 a year. The Veteran’s employment began in July 2018 and it was noted that the Veteran did not have any disabilities that would prevent him from performing his duties. Prior to his current employment, the Veteran worked as a mechanic from July 2018 to October 2018 earning $49,000 per year. On his initial application for a TDIU, the Veteran indicated that he was employed as a mechanic from July 02, 2018 to October 11, 2018. Based on the evidence of record, the Board finds TDIU is not warranted. As discussed above, the Veteran's PTSD does not cause total occupational impairment. There is persuasive evidence in the record which demonstrates that the Veteran will experience limitations working, but he is not prevented or precluded from obtaining or sustaining substantial gainful employment. While the Veteran asserts that his PTSD symptoms have caused an inability to obtain work, the evidence of record does not support his position or support his claim for a TDIU. Given the Veteran's work experience and the impact he experiences from his physical and mental disabilities, the Board cannot say that the Veteran's service-connected PTSD, or the combination of his service connected disabilities, prevent him from obtaining or maintaining substantially gainful employment with the ability to work consistent with his education and skills. The Veteran was a mechanic for many years. After he left the military in August 2012, he went to trade school for 13 months and received a certification as a diesel mechanic. There is no evidence that he is unable to leave the home, drive a personal automobile, use communication devices such as telephone or simple computer. He is also able to manage his own finances. Holistic evaluation of the medical evidence of record weighs against finding the Veteran unable to obtain or maintain substantially gainful employment. In addition, as recently as April 2020 the Veteran reported that he was currently working, when he requested a refill of medication since he would be traveling for work and returning no later than May 8th. Furthermore, in a statement submitted in October 2020 by the Veterans girlfriend she indicated that the Veteran was more concerned with working and providing for his family then his mental health. She also stated that stress from work or his co-workers would cause him to downward spiral. Although the Veteran’s medical history reflects that his PTSD symptoms have caused him some impairment at work and have led to his termination from one employer, the overwhelming evidence in the record, including the Veteran’s own statements, show that he has been able to secure or follow a substantially gainful occupation despite his PTSD symptoms. J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Long-Ellis, 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.