Citation Nr: 21010236 Decision Date: 02/24/21 Archive Date: 02/24/21 DOCKET NO. 19-37 855 DATE: February 24, 2021 ORDER Entitlement to a disability in excess of 50 percent for posttraumatic stress disorder (PTSD) prior to March 1, 2018, is denied. Entitlement to a 70 percent disability rating for PTSD from March 1, 2018, is granted. Entitlement to a total disability rating based upon unemployability (TDIU) due to service-connected PTSD is granted. FINDINGS OF FACT 1. Prior to March 1, 2018, at worst, PTSD did not manifest 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, speech that is intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; spatial disorientation; and neglect of personal appearance and hygiene. 2. The competent, credible, and probative lay and medical evidence is in relative equipoise as to whether, from March 1, 2018, the Veteran’s PTSD was, at worst, manifested by occupational and social impairment with deficiencies in most areas such as judgment, thinking, or mood due to such symptoms as: near-continuous panic or affecting the ability to function independently, appropriately, and effectively. 3. The Veteran has now met the percentage requirement for a schedular TDIU since March 1, 2018, and the evidence supports a finding that his service-connected PTSD has been of such nature and severity as to prevent him from securing or following substantially gainful employment. CONCLUSIONS OF LAW 1. Prior to March 1, 2018, the criteria for an initial disability rating in excess of 50 percent for PTSD were not been met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.130, Diagnostic Code (DC) 9411. 2. Resolving reasonable doubt in the Veteran’s favor, from March 1, 2018, the criteria for an initial 70 percent disability, but not higher, for PTSD have been met. 8 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.130, DC 9411. 3. Resolving reasonable doubt in the Veteran’s favor, the criteria for a TDIU due to service-connected PTSD are met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16, 4.18, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the Army National Guard, which service included a period of active duty for training from September 1989 to March 1990 and a period of active duty from December 1990 to June 1991. These matters come before the before the before the Board of Veterans’ Appeals (Board) on appeal from an April 2018 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in which the RO granted service connection for PTSD, evaluated as 50 percent disabling, effective from June 15, 2015. In June 2018, the Veteran, through his attorney, filed a notice of disagreement in which he disagreed with the initial rating assigned and asserted entitlement to a TDIU. See Rice v. Shinseki, 22 Vet. App. 447 (2009). In October 2019, the agency of original jurisdiction (AOJ) issued a statement of the case (SOC) addressing entitlement to an initial rating greater than 50 percent for PTSD and to a TDIU. The Veteran thereafter perfected an appeal of these issues to the Board. Regarding the claims on appeal, which claims were initiated in the legacy appeal system, the Board notes that a review of the Veteran’s claims file shows that the Veteran, through counsel, has also pursued entitlement a higher initial rating for PTSD and to a TDIU in the new appellate system, the Appeals Modernization Act (AMA). Notably, however, after receiving the October 2019 SOC addressing the issues of entitlement to a higher rating for PTSD and to a TDIU, the Veteran did not, despite being given the option to do so, opt-in to the AMA. The Board further notes that the in January 2021, the Veteran, through counsel, filed a VA Form 20-0995, Decision Review Request: Supplemental Claim, in which he seeks review of January and June 2020 rating decision denying a TDIU and a higher rating for PTSD. The Board acknowledges the confusion created by the AOJ in issuing rating decisions continuing the deny benefits that were then pending before the Board. However, counsel is cautioned against the practice of simultaneously attempting to pursue the same claim under both the legacy and the AMA appeals systems. Such practice could result in the unintended withdrawal of the claims from one system and/or delayed adjudication of the Veteran’s claims. Increased Disability Ratings The Veteran contends that the 50 percent disability rating assigned to service-connected PTSD does not contemplate the severity of his symptomatology and that a higher rating should be assigned. He also argues that he is unable to work on account of his PTSD and that a TDIU is therefore warranted. Ratings for service-connected disabilities are determined by comparing the Veteran’s symptoms with criteria listed in VA’s Schedule for Rating Disabilities, which is based, as far as practically can be determined, on average impairment in earning capacity. Separate diagnostic codes identify the various disabilities. 38 C.F.R. Part 4. When rating a service-connected disability, the entire history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). 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. The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Hart v. Mansfield, 21 Vet. App. 505 (2007). PTSD PTSD is evaluated under the General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130, Diagnostic Codes 9201-9440. Pertinent to this appeal, the General Rating Formula for Mental Disorders are as follows: A 50 percent disability rating is assigned 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 in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130, DC 9411. 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. Id. Lastly, 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. Id. 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 impair the Veteran’s occupational and social functional ability. 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. See 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. See Vazquez-Claudio, supra. Prior to March 1, 2018 In a March 2016 VA psychology note, a VA psychologist noted that the Veteran indicated that he wanted to postpone the instant scheduled psychological evaluation for a future date, when he was “abstinent” from substance use. The psychologist reported that the Veteran presented as alert; oriented; appropriately dressed; without assistance or difficulty; with clear, relevant, and coherent speech; appropriately conversant; positively future-oriented; hopeful; optimistic; affect appropriate; mood euthymic; cooperative and pleasant; in no obvious or reported distress; with unremarkable thought process or content; and with grossly intact judgment. Moreover, there was no evidence to suggest delusions or hallucinations; and/or suicidal or homicidal intent. A review of contemporaneous VA treatment records discloses clinical notations that the Veteran’s psychiatric status reflected intact judgment; intact recent and remote memory; and euthymic mood. In March 2016, a VA psychologist indicated that she had reviewed the Veteran’s self-report screenings for depression, anxiety, and PTSD. According to the VA psychologist, there were no urgent needs identified. An April 2016 notification reflects that the Veteran failed to report for a VA PTSD examination that was scheduled for February 2015. See April 11, 2016 C&P Examination (mislabeled in the record). In September 2017, VA received the Veteran’s affidavit. In pertinent part, the Veteran indicated that he began experiencing panic attacks during active duty service in the Gulf. He was afraid of the possibility of SCUD missile attacks and horrified at the sight of dead soldiers in Iraq where firefights had occurred. The Veteran also conveyed subsequent bouts of crying and overwhelming panic. Also, he experienced isolation; feelings of “fight or flight”; headaches; and marital problems. The Veteran attributed this constellation of symptoms to service. In April 2018, the Veteran was afforded a VA PTSD examination. A psychologist reviewed the claims file; considered the Veteran’s subjective accounts of his psycho-medical history; and conducted an appropriate psychometric evaluation. This psychologist provided a current diagnosis of PTSD (noting that the disability had been claimed as acquired psychiatric disorder, depression, anxiety, and panic attack, which are all symptoms of the overall diagnosis of PTSD). The psychologist stated that the degree of the Veteran’s level of occupational and social impairment of PTSD is best summarized as productive of occupational and social impairment with reduced reliability and productivity. As to PTSD symptoms, the psychologist indicated depressed mood; anxiety; panic attacks that occur weekly or less often; chronic sleep impairment; flattened affect; disturbance in motivation and mood; and difficulty in adapting to stressful circumstances, including work or a work like setting. Behaviorally, the Veteran presented as mildly dysthymic with a fairly flat affect. Otherwise, there were no perceptual disturbances; the Veteran’s speech and language were within normal limits; he was casually dressed and well groomed; his thought processes were generally logical and coherent, although bereft of detail and spontaneity; and, there was no evidence of gross cognitive impairment of memory. This psychologist did not indicate that the Veteran endorsed suicidal or homicidal ideations; obsessional rituals; or near-continuous panic. Moreover, according to this psychologist, the Veteran appeared earnest and as a reliable historian. The psychologist indicated that the Veteran was competent to handle his financial affairs. The record then contains no additional, relevant evidence until VA received from the Veteran an affidavit on January 23, 2019. As will be discussed below, the Board finds that, when reasonable doubt is resolved in favor of the Veteran, the Veteran’s affidavit, along with other evidence of record, supports the assignment of a 70 percent rating from March 1, 2018. IN this regard, the Board points out that the Veteran reported that his PTSD symptoms increased in severity after he stopped working, which the Veteran indicated to have been on March 1, 2018. The evidence of record prior to that date, however, does not support the assignment of a rating greater than the currently assigned 50 percent. As noted above, to receive a rating greater than 50 percent for PTSD, there would need to be a showing of 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. 38 C.F.R. § 38 C.F.R. § 4.130, DC 9411. While the psycho-medical evidence of record prior to March 1, 2018, reflects a two of these symptoms (viz, occupational and social impairment), the psycho-medical evidence of record fails to disclose—or even to suggest—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. Id. Notably, as explained by the United States Court of Appeals for the Federal Circuit (Federal Circuit), the determination of whether a 70 percent disability rating is warranted 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 the general criteria for rating mental disorders. Vazquez-Claudio, 713 F.3d at 117. Section 4.130 requires “not only the presence of certain symptoms[,] but also that those symptoms have caused occupational and social impairment in most of the referenced areas[;]” thus, it “requires an ultimate factual conclusion as to the veteran’s level of impairment in “most areas.” Id.; see 38 C.F.R. § 4.130, DC 9411. Accordingly, “VA must engage in a holistic analysis in which it assesses the severity, frequency, and duration of the signs and symptoms of the veteran’s service-connected mental disorder; quantifies the level of occupational and social impairment caused by those signs and symptoms; and assigns an evaluation that most nearly approximates that level of occupational and social impairment. Bankhead v. Shulkin, 29 Vet. App. 10 (2017). Overall, the Board finds that the evidence relevant to the appeal period prior to March 1, 2018, fails to suggest that the Veteran’s PTSD resulted in deficiencies in most areas. Specifically, the Veteran endorsed that he was working prior to that date. At the time of the April 2018 VA examination, the Veteran reported that he has friends and social relationships and also enjoys playing music, to include in a public setting. He did indicate that he was socially distant from his family and rarely in contact with his seven grandchildren. However, there was no indication at that time of any deficiency in judgment or thinking. Although, as will be discussed below, the Board will resolve reasonable doubt in favor of the Veteran and conclude that his lay affidavit is supportive of a more severe disability picture after he stopped working, the Board cannot conclude that the evidence of record suggest deficiencies in most areas prior to March 1, 2018. In so finding, the Board has considered whether the record discloses symptoms analogous to those noted above but finds no evidence of such. See Mauerhan and Claudio-Vazquez, both supra. The Board has considered the Veteran’s affidavit and other lay accounts. In this regard, the Board notes that competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). However, a layperson is generally not capable of opining on matters requiring medical knowledge. Bostain v. West, 11 Vet. App. 124, 127 (1998). Here, the Board finds that the Veteran is competent to convey discernable symptoms (viz, crying) as well as psycho-medical information conveyed to him by competent clinicians. However, the Veteran lacks the specialized training and clinical psychological expertise to render an opinion as to the severity of PTSD symptomology, especially when one considers the highly technical DSM-5 criteria and the apposite DC. See Jandreau, Bostain, both supra. Therefore, the body of lay evidence warrants minimal probative weight. Here, the Board notes that the neither the Veteran nor his counsel has produced competent psycho-medical evidence to support the contention that the Veteran’s PTSD was more severe than that contemplated by a 50 percent disability rating, prior to March 1, 2018. A claimant still ultimately bears some burden of production. 38 U.S.C. § 5107(a); Cromer v. Nicholson, 455 F. 3d 1346 (Fed. Cir. 2006). As will be discussed below, in June 2020, the Veteran’s attorney submitted an opinion from a private vocational specialist, dated in April 2020. Arguably, the 2020 private vocational consultant’s report (infra) could be construed as “competent psycho-medical evidence”; however, this consultant stated that, [I] would like to explain my function as a vocational expert—a role different from, but complementary to, that of a medical expert (i.e., an examining physician—in the adjudication process. In disability claims, an examining physician applies his (sic) expert medical knowledge to define the physical and/or psychological limitations of a claimant’s [disability]. Vocational experts, on the other hand, accept these medical findings and use their expertise of the labor market to consider the employability of a claimant. See June 29, 2020 Medical Treatment Record—Non-Government Facility, p. 1 (mislabeled in the record) (emphasis added) Applying the private consultant’s explanatory proviso to the non-gendered realm of psychology: “In disability claims, an examining psychologist applies expert psychological knowledge to define the psychological limitations of a claimant’s disability.” Thus, this consultant makes clear that the role of such a consultant is in no way analogous to that of person who is qualified through education, training, or experience to offer psychological diagnoses, statements, or opinions. See 38 C.F.R. § 3.159(a)(1). As such, although this evidence is relied upon in determining whether a TDIU is warranted, the Board concludes that it is not probative as to the severity of the PTSD in the context of assigning a disability rating based on severity of psychological features. Overall, the Board finds that the preponderance of evidence is against granting a disability rating in excess of 50 percent disabling for service-connected PTSD prior to March 1, 2018. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. From March 1, 2018 As noted, on January 23, 2019, VA received an affidavit from the Veteran. Also received that day was the Veteran’s VA Form 21-8940 (Veteran’s Application for Increased Compensation Based on Unemployability) in which the Veteran reported that he was prevented from working on account of his PTSD; the Vet earn stated that he last worked on March 1, 2018, and became too disabled to work on that date. In the January 2019 affidavit, the Veteran conveyed that he suffers from panic attacks that take away from his ability to focus. The Veteran noted that he had experienced such at his worksite on several occasions. He reported that after he left his employment, his PTSD symptoms worsened. Episodes have occurred on average about once a week. These episodes frighten the Veteran as they are erratic and induce feelings akin to passing out. After each episode, the Veteran conveyed that it takes hours to recover and the rest of the day becomes disrupted. And, even the memory of these episodes puts the Veteran in a “protective mode, on edge.” These episodes also cause debilitating headaches, which are productive of the worst pain that the Veteran has ever experienced. More than pain these PTSD headaches prevent the Veteran from activities that require focus, concentration, non-impaired vision, and rational thought. Upon a “psychological attack,” according to the Veteran, he seeks out “safe places”—even in public. At times (such as in big box stores), there are no “safe places,” which induces panic of such a degree that it inhibits the Veteran’s breathing. Even though, the Veteran struggles to remain positive, his PTSD attacks are so unpredictable that he must teeter in a realm of fearful uncertainty and consistent struggle. In a January 23, 2019 letter, the Veteran’s counsel wrote that the Veteran’s PTSD symptoms are indicative of those contemplated by a 70 percent disability. Here, counsel underscored the analogous symptomatology scheme as noted in Mauerhan and Vazquez-Claudio. Counsel also took especial note of the symptoms subjectively endorsed by the Veteran in his affidavit, as noted immediately above. The Veteran was afforded another VA PTSD examination in June 2019. A psychologist reviewed the claims file; considered a portion of the Veteran’s subjective accounts of his psycho-medical history; and conducted an appropriate psychometric evaluation. This psychologist indicated that the Veteran’s PTSD 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. This psychologist indicated a litany of associated symptoms, namely, depressed mood; anxiety; panic attacks that occur weekly; chronic sleep impairment; disturbances of motivation and mood; and difficulty in adapting to stressful circumstances, including work or worklike setting. Behavioral observations showed that memory and concentration were fair to good; and insight and judgment were fair to good. Otherwise, findings were unremarkable. The psychologist emphasized psychometric testing results and inventories. Even though the Veteran’s PTSD on the PCL-5 indicates the presence of severe symptoms of PTSD (including hypervigilance and jumpiness), the psychologist found this “bothersome” because on a different test, the Veteran indicated that his health is about the same as it was a year ago—overall 75 percent in good health. Based upon these “bothersome” psychometric results, the psychologist re-conveyed at the conclusion of her report that the Veteran’s PTSD symptoms cause occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational task The Board acknowledges this VA psychologist’s opinion; however, the Board assigns diminished probative weight to it. Firstly, as noted above, the April 2018 VA psychologist opined that the Veteran appeared earnest and as a reliable historian. The June 2019 psychologist did not address this behavioral finding of less-than-one year prior. And, more glaringly, this June 2019 psychologist did not consider the Veteran’s January 23, 2019 affidavit, which presents a totally different subjective assessment of the severity and occupational limitations of his PTSD. As noted, the Veteran is competent to report discernable episodes of panic; headaches; lack of focus; feelings akin to passing out; fear; and pain. See Jandreau, supra. The Board finds that the Veteran’s lay account is facially plausible, internally consistent, and consistent with other evidence (the June 2019 psychologist’s reporting of symptoms of depressed mood; anxiety; panic attacks that occur weekly; chronic sleep impairment; disturbances of motivation and mood; and difficulty in adapting to stressful circumstances including work or worklike setting). As noted above, to receive a higher disability from March 1, 2018 there would need to be a showing of 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. The Board does not find that the Veteran’s PTSD from March 1, 2018 fully manifests in the above-noted ways. However, the Veteran’s host of discernable symptoms, as articulated in his January 23, 2019 affidavit, demonstrate PTSD symptom of similar severity, frequency, and duration. See Vazquez-Claudio, supra. Moreover, the Board finds that these symptoms impair the Veteran’s occupational and social functional ability profoundly. See id.; Mauerhan, supra. Indeed, this impairment approximates that of occupational and social impairment with deficiencies in most areas. The Board has also considered whether, at any time since March 1, 2018 the symptoms of and impairment caused by the Veteran’s PTSD have more nearly approximated total social and occupational impairment during the relevant time period, such that a 100 percent schedular rating is warranted, but finds that they have not. Although, as will be discussed in further detail below, the evidence demonstrates that the Veteran’s PTSD has rendered him unemployable, the evidence does not suggest that the social impairment more nearly approximates total. Although the Veteran seemingly experiences a strained familial relationship. he does maintain friendships and social network. Thus, a 100 percent evaluation is not warranted. See 38 C.F.R. § 4.130, DC 9411 (requiring “[t]otal occupational and social impairment” to establish entitlement to a 100 percent disability evaluation under the general rating formula for mental disorders). As such, the Board finds that the competent lay and psycho-medical evidence related to the period from March 1, 2018 forward, is at least at equipoise. As such the benefit of doubt accrues to the Veteran and the Board grants a 70 percent disability rating for the Veteran’s service-connected PTSD from March 1, 2018 (but no earlier). See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. TDIU A TDIU may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disability. See 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16. A veteran is eligible for a rating of TDIU if either one service-connected disability is rated at least 60 percent disabling or multiple service-connected disabilities yield a combined rating of 70 percent (with at least one of those disabilities rated 40 percent or more). 38 C.F.R. § 4.16(a). Given the Board’s determination that the Veteran’s PTSD is more appropriately rated as 70 percent disabling, the Veteran has now met the schedular criteria for a TDIU due to that disability since March 1, 2018. While the minimum rating requirements are met, the Veteran must first and foremost be shown to be unable to secure or follow substantially gainful employment as a result of his service-connected disability or disabilities in order to establish entitlement to TDIU. Although no VA examiner has concluded that the Veteran’s PTSD unemployable, there is an indication that the Veteran would have difficulty in adapting to stressful circumstances, including work. Additionally, a review of the evidence reflects that the Veteran completed his high school education and approximately 5 years of college, without earning a degree. The Veteran’s professional experience consists of working for a large power authority as an assistant control room operator and control room operator from 1995 through March 2018. He left the authority’s employ in April 2016; however, the Veteran returned as a contract employee in December 2016 and stayed in that capacity until March 2018. Such work entailed operating and maintaining large power generators and associated control systems. The Veteran’s military occupational specialty (MOS) was a chemical operator specialist. The Veteran has also stated that he is interested in music. Here, the Board notes that the April 2018 VA psychologist indicated that the Veteran has a “very smooth R&B voice that matches a singing voice.” Despite this interest in music and smoothness of voice, the evidence of record does not disclose that the Veteran has been substantially and gainfully in the music business. As discussed above, the Veteran credibly described that his service-connected PTSD manifests in frightening episodes that occur on average about once a week. These episodes frighten the Veteran as they are erratic and induce feelings akin to passing out. After each episode, it takes hours to recover and the rest of the day becomes disrupted. These episodes also cause debilitating headaches, which are productive of the worst pain that the Veteran has ever experienced. More than pain these PTSD headaches prevent the Veteran from activities that require focus, concentration, non-impaired vision, and rational thought. The Board notes that the Veteran’s work history discloses that the Veteran has extensive professional experience in the utility industry—working with large power generators and associated control systems. And, the Veteran’s MOS suggests some degree of vocational proficiency in the chemical industry. As the Veteran has never completed a degree program, it remains unclear whether the Veteran’s high school and 5 years of college have provided a specialized background in other industries or vocational endeavors. The Veteran’s education and work at a large power authority demonstrate that the Veteran has sufficient skills to obtain and maintain substantial employment considering his specific education and specific work in several professions. See Withers v. Wilkie, 30 Vet. App. 139 (2018). Nevertheless, the severity of the Veteran’s PTSD symptomatology shows that work in the utility (or chemical industry) would pose potential hazards and difficulties, associated with “lack of focus,” episodes that induce feelings akin to passing out, and difficulty in adapting to stressful circumstances, including work or worklike setting. Further, the Veteran has submitted the report of a private vocational assessment, completed in April 2020, by P.M., a certified rehabilitation counselor. The report of the private vocational assessment shows that P.M. completed a thorough review of the claims file and engaged in an extensive discussion of the evidence of record, as well as outlining the Veteran’s education and work history. Upon review of the evidence, M.P opined that it is at least as likely as not that the Veteran’s PTSD has prevented him from following substantially gainful employment since at least March 2018. M.P. opined that the severity of the Veteran’s PTSD would preclude him from being able to perform the essential work functions of his past employment. Based on the evidence of record, the Board finds that the disabling effects of the Veteran’s PTSD more likely than not have rendered the Veteran unable to obtain or maintain substantially gainful employment. In so concluding, the Board notes that the ultimate question of whether a Veteran is capable of substantially gainful employment is not a medical question, but rather a determination that must be made by an adjudicator. See Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013) (interpreting 38 C.F.R. § 4.16(a)). Overall, in consideration of the private vocational assessment, the Veteran’s lay affidavits, and the VA examiners’ findings regarding the severity of PTSD symptomatology, and in consideration of the Veteran’s employment history, education, and vocational attainment, the Board finds that the Veteran’s service-connected PTSD has, as likely as not, been of such nature and severity as to prevent him from securing or following substantially gainful employment. Accordingly, and with resolution of all reasonable doubt in the Veteran’s favor, the Board finds that a TDIU due to PTSD is warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. As for the current award of a TDIU due to PTSD the Board will not specify the effective date of the award and allow the RO to do so, in the first instance. See Urban v. Principi, 18 Vet. App. 143, 145 (2004) (per curiam order) (“To the extent that [the appellant] is arguing that the Board must assign, sua sponte, an effective date once it awards a rating of TDIU on appeal from an RO decision, such an argument is unavailing unless an NOD is then of record as to the downstream issue of an effective date for the assignment of that rating.”) KRISTIN E. NEILSON Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. J. Komins, 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.