Citation Nr: 21011311 Decision Date: 03/01/21 Archive Date: 03/01/21 DOCKET NO. 15-03 790A DATE: March 1, 2021 ORDER Entitlement to a rating of 50 percent, but no greater, for posttraumatic stress disorder (PTSD) (previously rated as anxiety) before September 13, 2019, is granted. Entitlement to a rating in excess of 50 percent for posttraumatic stress disorder (PTSD) (previously rated as anxiety) since September 13, 2019 is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) for PTSD (previously rated as anxiety) prior to September 13, 2019 is granted. FINDINGS OF FACT 1. Resolving all reasonable doubt in favor of the Veteran, his PTSD (previously rated as anxiety) has manifested by occupational and social impairment with reduced reliability and productivity due to symptoms of impaired judgment, disturbances in mood and motivation, and difficulty with establishing relationships prior to September 13, 2019. 2. The severity, frequency, and duration of the Veteran’s PTSD (previously rated as anxiety) symptoms did not more closely approximate occupational and social impairment, with deficiencies in most areas at any time during the appeal period. 3. The severity, frequency, and duration of the Veteran’s PTSD (previously rated as anxiety) symptoms did not more closely approximate total occupational and social impairment at any time during the appeal period. 4. The Veteran’s PTSD (previously rated as anxiety) has precluded him from securing or following a substantially gainful occupation prior to September 13, 2019. CONCLUSIONS OF LAW 1. The criteria for a disability rating of 50 percent, but no higher, for PTSD (previously rated as anxiety) have been met prior to September 13, 2019. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.130, Diagnostic Code (DC) 9411. 2. The criteria for a disability rating in excess of 50 percent for PTSD (previously rated as anxiety) have not been met since September 13, 2019. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.130, Diagnostic Code (DC) 9411. 3. The criteria for a total disability rating based on individual unemployability (TDIU) for PTSD (previously rated as anxiety) have been met prior to September 13, 2019. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1969 to November 1970, with additional periods of reserve and national guard service. This appeal arises from a June 2013 rating decision, denying the Veteran’s increased rating claim in excess of 10 percent for the Veteran’s service-connected PTSD, then characterized as anxiety disorder not otherwise specified (anxiety disorder NOS). A June 2020 rating decision recharacterized anxiety disorder NOS as PTSD and increased the rating to 50 percent from September 13, 2019. As this evaluation was less than the maximum benefit allowed under VA law and regulations, the claim for an increased rating remains on appeal for Board consideration. See A.B. v. Brown, 6 Vet. App. 35, 39-40 (1993). Additionally, the June 2020 rating decision granted entitlement to a TDIU, effective September 13, 2019. However, under Rice v. Shinseki, 22 Vet. App. 447 (2009), there remains an issue of entitlement to a TDIU prior to September 13, 2019. The appeal period begins on December 3, 2011, one year before the increased rating claim was filed. See 38 U.S.C. § 5110(b)(2); 38 C.F.R. § 3.400(o)(2). 1. Entitlement to a rating in excess of 10 percent for PTSD (previously rated as anxiety) prior to September 13, 2019 2. Entitlement to a rating in excess of 50 percent for PTSD (previously rated as anxiety) since September 13, 2019 The Veteran contends a higher rating is warranted for his PTSD. He also contends that his PTSD. Resolving all reasonable doubt in favor of the Veteran, the Board concludes that a rating of 50 percent, but no higher, is warranted for the Veteran’s PTSD for the entire appeal period. Ratings are based on a schedule of reductions in earning capacity from specific injuries or combination of injuries. The ratings shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations. 38 U.S.C. § 1155. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Veteran’s PTSD has been evaluated under the General Rating Formula for Mental Disorders (General Rating Formula), Diagnostic Code (DC) 9411. 38 C.F.R. § 4.130. Under the General Rating Formula, a 10 percent rating is warranted when there is occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication. Id. A 30 percent rating is warranted when there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood; anxiety; suspiciousness; panic attacks (weekly or less often); chronic sleep impairment; and mild memory loss (such as forgetting names, directions, recent events). Id. A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. Id. A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. Id. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name. Id. When evaluating mental disorders, the Board must conduct a “holistic analysis” that considers all associated symptoms, regardless of whether they are listed as criteria in the General Rating Schedule. See Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). Assigned ratings must be based on all record evidence bearing on occupational and social impairment rather than solely on the examiner’s assessment of the level of disability on the examination date. 38 C.F.R. § 4.126(a). As a preliminary matter, the Board notes that when the Veteran underwent a VA examination for PTSD in February 2010, he was diagnosed with anxiety disorder NOS because he did not meet the DSM-IV PTSD criteria. The examiner opined that the Veteran’s symptoms were “as likely to remain stable or worsen with retirement and aging” and “could increase in the future, depending upon stressors and resources.” See February 2010 VA Examination. In February 2011, a VA staff psychologist, after several months of evaluation, diagnosed the Veteran with PTSD under the DSM-IV, noting that he exhibited a “full range of PTSD symptoms.” See February 8, 2011 VA Initial PTSD Intake Report Addendum. Turning to the evidence of record, VA treatment records show that the Veteran was treated for anger issues and emotional numbing from November 2010 to April 2012, and he generally presented in a good or euthymic mood. The Veteran began displaying mood disturbances in March 2012, when his mood changed from consistently euthymic to irritable and dysthymic. See VA Psychiatric Notes dated December 2011 to April 2012. Thereafter, the Veteran regularly exhibited negative mood disturbances and irritability. See VA Psychiatric Notes dated August 2012 to September 2018; See also VA Pulmonary Note dated January 30, 2020. The Veteran underwent a VA examination for PTSD in April 2013. During the examination, he reported retiring five years earlier to care for his brother. He indicated he was disinclined to return to work because of his service-connected skin condition. He reported that two of his brothers recently died, deaths he believed were caused by improper VA treatment. He had been separated from his wife since Hurricane Katrina but denied any serious problems with their relationship. He preferred to live alone, although he lived with his brother until he died in approximately March 2013. The Veteran exhibited a strong emotional response when questioned about his traumatic experiences but reported that he had learned not to let memories of his traumatic combat experiences affect him. He had difficulty sleeping due to his skin condition, and his only prescribed psychotropic medication was no longer effective. He was upset with VA for not explaining the cause of his skin condition, which he believed was caused by exposure to agent orange. Based on the Veteran’s reported and observed symptoms, the examiner opined that the Veteran’s symptoms were not severe enough to interfere with occupational and social functioning or to require continuous medication. However, the examiner noted the Veteran was “perhaps more symptomatic than he is willing to acknowledge.” The examiner reported symptoms of recurrent and distressing recollections of traumatic events, feelings of detachment from others, and chronic sleep impairment. During an August 2013 VA psychological evaluation, the Veteran reported that he “got mad at [his] last compensation exam” and refused to continue with the interview, and that he did not trust VA very much. The staff psychologist noted that the Veteran exhibited “lots of animosity” aimed at the VA, was very irritable at times, and tended to externalize his problems. See VA Psychiatric Notes dated August 29, 2013. Between July 2013 and December 2014, VA treatment records note that the Veteran showed symptoms of poor to fair insight, fair judgment, and sleep impairment. During that period, the Veteran reported sleep disturbances, insomnia, feeling that things “could be better” and that he was “just going through some stuff,” being stressed and “torn up” over his brothers’ recent deaths, and feeling “fed up” with everything. He was dissatisfied with his current lifestyle, including his failure to accomplish certain life plans which he believed was exemplified by the fact that he lived in an RV. He sought information about homelessness and housing assistance programs. His irritation with VA for not explaining the cause of his skin condition also persisted. In December 2014, the Veteran was diagnosed with adjustment disorder with anxiety and insomnia. He reported using alcohol and occasionally taking a “little brown” pill he got from a friend to help him sleep. See VA Psychiatry Note dated December 29, 2014. The Board does not draw further distinctions among which symptoms are attributable to the service-connected PTSD, as there has not been the required differentiation of diagnoses to, in turn, compartmentalize the extent of symptoms that is attributable to the mental disability that is service-connected versus that which is not. See Mittleider v. West, 11 Vet. App. 181, 182 (1998). The Veteran underwent a second VA examination for PTSD in April 2015. During the examination, he reported that he was unemployed due to his skin condition, but he occasionally helped friends with construction jobs. He lived with his wife and they had a fine relationship with no real problems. He had a great relationship with his children and very close relationships with his family. He attended church weekly. He had “one or two” good friends, but he had difficulty forming new relationships due to a pervasive distrust of other people. He reported regularly experiencing intrusive, distressing memories of the war that cause him to isolate from others at times. He was always watching his surroundings and avoiding crowds due to safety concerns. He experienced low mood approximately fifty percent of the time. He resented VA for how he and his brothers were treated and was frustrated by the lack of explanation for his skin condition. He denied verbal or behavioral outbursts associated with irritability, suicidal ideation, and homicidal ideation. He said he “never” drinks alcohol or uses non-prescribed drugs. Based on the Veteran’s reported and observed symptoms, the examiner opined that the Veteran had occupational and social impairment due to mild and transient PTSD symptoms which only decreased his work efficiency and ability to perform occupational tasks during periods of significant stress. The examiner also opined that his skin condition contributed to his subjective distress, and that his PTSD symptoms contributed to his insomnia. The examiner noted that the Veteran declined to complete the psychological testing and that a February 2015 VA Psychiatry note revealed that he admitted drinking “a shot or two of liquor at night” to help with sleep. She also noted that the Veteran exhibited irritable affect throughout the examination and that there were several documented examples of his irritability and outbursts in his VA treatment records. The examiner reported symptoms including chronic sleep impairment, recurrent and distressing recollections of the past traumatic events; persistent avoidance or efforts to avoid distressing memories, thoughts, feelings, or external reminders associated with traumatic events; persistent and exaggerated negative beliefs or expectations; persistent negative emotional state; feelings of detachment or estrangement from others; irritable behavior and angry outbursts with little or no provocation typically expressed as verbal or physical aggression; hypervigilance; and sleep disturbances. The Veteran testified at a July 2015 hearing that he did not have friends, but he had associates he talked to “every now and then” and “as less as possible.” He did not socialize with people because of his anxiety, he avoided crowds, and he was not involved in community activities. He drank alcohol to help him sleep, and he avoided discussing “certain things” with “associates” he talks to from time to time. He was sometimes depressed because of his brothers’ deaths and his belief that VA was not concerned about him or his brothers. He “got into it” with the [April 2013 VA examiner] when he spoke about the deaths of his two brothers, and he left. He had anger management therapy for two years and he learned how to control “a lot” and he was “a lot calmer.” He had a problem with the fact that VA could not explain the cause of his skin condition but could tell him what it’s not. He denied panic attacks or memory impairment. The Veteran underwent a third VA examination for PTSD in September 2019. During the examination, he reported that he is unemployed due to his skin condition. He and his wife had been separated for over twenty years; however, she gave him a room in her home after his brother died and he lived there for financial reasons. There were few people he felt close to or trusted. He used to enjoy fishing and carpentry, but he could no longer engage in those activities due to his extreme sun sensitivity. He mostly stayed home, except for when he attends Sunday church service. He reported benefitting from past anger management therapy. He denied non-prescription drug use but avoided questions related to alcohol use, stating only that he drinks Crown Royal, one drink per day, “whenever” during the day. He expressed anger toward VA over his brothers’ deaths and continued frustration with VA about his skin condition. Based on the Veteran’s reported and observed symptoms, the examiner opined that the Veteran had 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. However, she remarked that the Veteran’s lack of specificity regarding trauma symptoms may obfuscate impairment or subjective distress. The examiner reported symptoms including suspiciousness; flattened affect; difficulty in establishing and maintaining effective work and social relationships; intense prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic events; persistent avoidance or attempted avoidance of distressing memories, thoughts, or feelings about the traumatic events; persistent negative emotional state; markedly diminished interest in participation in significant activities; feelings of detachment and estrangement from others; persistent inability to experience positive emotions; irritable behavior and angry outbursts with little or no provocation; sleep disturbances; and hypervigilance. The examiner also opined that the Veteran’s irritability may negatively affect his occupational functioning, which could potentially be mitigated by employment in a loosely supervised position with little interaction with the public. Throughout the appeal period, VA psychiatric treatment records consistently show that the Veteran was well groomed, exhibited normal and logical speech, was negative for psychomotor agitation or retardation and obsessive rituals, and denied homicidal or suicidal ideation, hallucinations or delusions. He was always found cooperative with good impulse control. The Board notes that, although a 2009 letter from his spouse indicated that he was physically abusive, there is no evidence of record from 2010 to 2020 that the alleged behavior has reoccurred or continued, nor is there evidence of any other non-domestic violent episodes or encounters with law enforcement. The Board acknowledges the Veteran’s contention that his PTSD and skin condition, which he believes was caused by herbicide exposure in Vietnam, are interrelated and mutually aggravating. See July 2015 Hearing Testimony. However, service connection for his skin condition is already in effect and the associated symptoms are contemplated by the rating assigned in an unappealed rating decision. The Board only has jurisdiction over the Veteran’s PTSD claim. Regarding PTSD, based on a review of the evidence, and resolving reasonable doubt in the Veteran’s favor, the Board finds the severity, frequency, and duration of the Veteran’s PTSD symptoms and resulting level of impairment more closely approximate those contemplated by a 50 percent rating during the entire appeal period. See 38 C.F.R. § 4.126. The evaluation of mental health disorders is ultimately based on the degree of occupational and social impairment; however, this determination is symptom-driven. In that regard, the Veteran’s PTSD has manifested with symptoms that fall within the 30 percent to 70 percent rating criteria range. Consistent with the lower end of that range, the Veteran endorsed symptoms of depressed mood, anxiety, hypervigilance, suspiciousness, and chronic sleep impairment. The symptoms he endorsed which would approximate a 50 percent rating include flattened affect, disturbance of motivation and mood, and impaired judgment. The symptoms he endorsed which would approximate a 70 percent rating include difficulty in adapting to stressful circumstances and impaired impulse control. During the appeal period, the Veteran suffered several “stressors” not accounted for in his February 2010 VA examination, including the deaths of his two brothers, the threat of homelessness upon the death of his brother, and a severe and prolonged skin flareup. The Veteran’s worsening symptoms coincided with the inception of those stressors and continued in manifestations affecting his mood, work, interpersonal relationships, and judgment. It also appears that the Veteran started drinking and using non-prescribed drugs to help him sleep at that time. He avoided discussing his traumatic experiences and resulting symptoms with VA examiners, even when doing so was to his detriment, evidencing impaired judgment. The evidence shows persistent negative emotional states, moods, and beliefs, such as his belief that VA is responsible for his brothers’ deaths. Finally, given the Veteran’s belief that his skin condition was caused by agent orange and his frustration with VA not identifying its etiology, the chronic eruptions imply somatic reminders of his traumatic combat experiences that manifest for longer duration than symptoms such as distressing memories or flashbacks and result in more frequent or prolonged reactive or avoidant behavior such as isolation, insomnia, alcohol use, irritability, negative moods, and anxiety. In terms of social impairment, the effects of PTSD have been mild to moderate throughout the appeal period. The Veteran has reported that he isolates himself from others and appears to avoid socializing outside the home. He has reported having few friends, and at the July 2015 hearing, he replaced the term “friend” with the term “associate.” The Veteran also appears to have a pervasive distrust of other people, does not participate in community activities and avoids crowds. The Board notes that while the Veteran indicates he rarely leaves his home, he adds that this is primarily due to his skin condition. The Veteran reportedly attends church weekly. Also, he reported having good relationships with his family, although he lived separately from his wife for nearly fifteen years before moving into a room in her home in 2015 for financial reasons. In terms of occupational impairment, the effects of PTSD have been moderate. The Veteran has been unemployed throughout the appeal period, although the evidences indicates he retired to care for his brother, and he did not return to work because of his skin condition. However, the evidence also indicates the Veteran’s anxiety increases with the severity of his skin condition. The 2015 examiner noted the Veteran’s well-documented irritability and outbursts and VA treatment records thereafter show continued irritability. The 2019 VA examiner opined that the Veteran’s irritability may negatively affect his occupational functioning, which could potentially be mitigated by employment in a loosely supervised position with little interaction with the public. In light of the Veteran’s moderate social impairment and occupational impairment throughout the entire appeal period, the Board resolves all reasonable doubt in his favor to finds that a 50 percent rating, but no higher, is warranted for the entire appeal period. An even greater increase to 70 percent is not warranted. While the Veteran did experience symptoms contemplated by the 70 percent rating, the evidence overall does not demonstrate the level of impairment associated with a 70 percent rating. The totality of the evidence indicates the Veteran intermittently struggled with nonviolent anger and irritability during the appeal period. He consistently reported benefiting from prior anger management treatment and he denied anger outbursts. He was generally found to be cooperative with good impulse control. He denied panic attacks and his depressed moods have not affected his ability to function independently. He has been well groomed and oriented to time and place. In fact, examinations have consistently noted his speech as normal or adequate. His thought process has generally been linear. He is still able to maintain social relationships, particularly with family. Based on this evidence, the Veteran’s symptoms do not more nearly approximate occupational and social impairment, with deficiencies in most areas at any time during the appeal period and thus, the assignment of a 70 percent rating is not warranted. Likewise, the evidence does not demonstrate the level of impairment associated with a 100 percent rating. In reviewing the symptoms that could approximate such a rating, the Board finds the Veteran does not experience gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, intermittent inability to perform activities of daily living, disorientation to time or place, or memory loss for names of close relatives, own occupation, or own name. Additionally, the nature, severity, and duration of his current symptomatology does not more closely approximate total social and occupational impairment. In sum, a 50 percent rating for PTSD, but no higher, is warranted for the entire period on appeal. 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 3.102, 4.3. 3. Entitlement to a TDIU prior to September 13, 2019 The Veteran contends he is unable to secure or maintain substantially gainful employment due to his service-connected skin condition and his PTSD. His claim for a TDIU was inferred at the July 2015 hearing. He filed a formal claim for a TDIU in January 2019. See VA Form 21-8940. A June 2020 rating decision favorably found that the Veteran was unable to secure or follow a substantially gainful occupation as a result of his skin condition because he cannot handle chemicals or be outdoors; and as a result of his PTSD because there are few people he feels close to or trusts, he cannot work due to his skin condition and sensitivity, and his irritability could affect his occupational functioning, which may be mitigated by a loosely supervised position involving little interaction with the public. A TDIU was awarded, effective September 13, 2019. Resolving all reasonable doubt in favor of the Veteran, the Board finds that a TDIU is warranted prior to September 13, 2019. Total disability ratings for compensation may be assigned when a veteran is unable to secure and 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); see Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993) (the ultimate question is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether he can find employment). Consideration may be given to the Veteran’s level of education, special training, and previous work experience when arriving at this conclusion; factors such as age or impairment caused by nonservice-connected disabilities are not to be considered. 38 C.F.R. §§ 3.341, 4.16, 4.19. Section 4.16(a) provides a rating hurdle for schedular consideration of a TDIU. If there is only one such disability, this disability shall be ratable at 60 percent or more; 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. Id. In light of the Board’s decision above, the Veteran’s service-connected PTSD is now rated at 50 percent prior to September 13, 2019. The Veteran is also service connected for nummular/asteatotic eczema with superimposed folliculitis, rated at 30 percent disabling from December 14, 2009 and 60 percent from July 8, 2013. As such, he meets the schedular criteria for a TDIU prior to September 13, 2019. The Veteran reports that he has not worked since January 2013 due to his service-connected skin condition and PTSD. See VA Form 21-8940. However, the evidence indicates the Veteran has not gainfully worked since 2008. A review of the record shows that the Veteran is a high school graduate and attended trade school to obtain a general contractor’s license. He worked in restaurants prior to joining the military. After service, the Veteran worked as an electrical, plumbing and framing contractor and at an aluminum plant. The Veteran retired from those jobs in 2008 to care for his brother. See April 2013 VA Examination. He did not return to full-time work because of his skin condition, although he occasionally did odd construction jobs for friends. See April 2015 VA Examination. As explained in detail above, the Veteran experiences moderate irritability due to his PTSD, has difficulty adapting to stressful situations, is suspicious of others, and is crowd avoidant. VA treatment records and his VA examinations show that the Veteran’s primary triggers for irritability are his belief that VA is responsible for his brothers’ deaths and his expectation, and his skin condition coupled with his belief that VA should be able to explain its etiology. Although he denies a tendency toward angry outbursts due to his irritability, the 2015 VA examiner notes that his VA treatment records are full of documented examples. Subsequent VA treatment records show frequent irritability and irritable moods. With regards to his skin condition, the Veteran experiences severe symptoms. At the July 2015 hearing, the Veteran testified that he breaks out from head to toe, he scratches until he bleeds, and he can’t take hot showers, wear cologne or jewelry, use scented soaps, or be exposed to the sun. See July 2015 Hearing Testimony. Based on a review of all the evidence of record, and resolving reasonable doubt in the Veteran’s favor, his service-connected skin condition and PTSD would reasonably preclude him from securing and maintaining substantially gainful employment consistent with his education and work experience. The Veteran obtained his contractor’s license but has only worked in jobs requiring outdoor exposure. Therefore, he would not have the training or work experience to obtain a minimally supervised, non-physical labor job with minimal public interaction, such as in an office setting. The evidence of record shows that the Veteran’s skin condition would significantly affect his ability to perform as a contractor because he cannot be outdoors and cannot handle chemicals. Moreover, any jobs requiring physical labor would likely involve significant interaction with other individuals, including coworkers and supervisors. The Board finds it reasonable to believe that his PTSD and related psychiatric symptoms, specifically irritability, and suspiciousness would reasonably result in significant difficulty functioning in an occupational environment consistent with his past employment because these symptoms, and his difficulty interacting with others, would likely negatively impact interactions with coworkers and supervisors. Therefore, resolving all reasonable doubt in the Veteran’s favor, the criteria for TDIU have been met. Accordingly, the claim for TDIU is granted prior to September 13, 2019. C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Jones, Catherine J. 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.