Citation Nr: 21012523 Decision Date: 03/04/21 Archive Date: 03/04/21 DOCKET NO. 15-36 328 DATE: March 4, 2021 ORDER A disability rating in excess of 30 percent for posttraumatic stress disorder (PTSD), prior to June 5, 2018, is denied. A disability rating in excess of 70 percent for PTSD, from June 5, 2018, is denied. Entitlement to a total disability rating based upon unemployability, prior to June 5, 2018, is denied. FINDINGS OF FACT 1. Prior to June 5, 2018, the Veteran’s PTSD did not manifest in 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. From June 5, 2018, the Veteran’s PTSD does not manifest as 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. 3. Prior to June 5, 2018, the evidence of record does not show that the Veteran was unable to secure or follow substantially gainful employment as a result of service-connected disabilities. CONCLUSIONS OF LAW 1. Prior to June 5, 2018, the criteria for a disability rating in excess of 30 percent for PTSD have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.130, Diagnostic Code 9411. 2. From June 5, 2018, the criteria for a disability rating in excess of 70 percent for PTSD have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.130, Diagnostic Code 9411. 3. Prior to June 5, 2018, the criteria for entitlement to a TDIU have not been met. 38 U.S.C. §§ 1155, 5103, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from July 1966 to July 1969. This case comes before the Board of Veterans’ Appeals (Board) from an appeal of a June 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office. In an August 2020, the RO increased the disability rating for PTSD to 70 percent, effective from June 5, 2018. In this same rating decision, the RO granted entitlement to a TDIU effective from June 5, 2019. As the increased benefits do not constitute a full grant of the benefits sought, the issues remain in appellate status. See AB v. Brown, 6 Vet. App. 35, 39 (1993). Increased Disability Ratings The Veteran asserts that the respective disability ratings assigned to his service-connected PTSD do not adequately contemplate the severity of his symptomatology and that higher disability ratings should be assigned. 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 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 30 percent rating is warranted for 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 symptoms such as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). 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. 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. And, 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. 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). When adjudicating psychiatric claims, the Board has an obligation under Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017) to conduct a three-part “holistic” analysis. The first step of the analysis is to assess the “severity, frequency, and duration of the signs and symptoms” of the Veteran’s condition. The second step is to quantify “the level of occupational and social impairment caused by those signs and symptoms.” The third step is to assign an “evaluation that most closely approximates that level of occupational and social impairment.” See also Mauerhan, 16 Vet. App. 436 (holding that the list of symptoms in the disability rating schedule for psychiatric disabilities is not exhaustive); and see Vazquez-Claudio, 713 F. 3d 112 (holding that the disability rating schedule for psychiatric disabilities reflects “objectively-observable symptomatology,” and “it is the severity of the effects of the symptoms as described by the examiner that determines the rating.”). 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, 713 F. 3d 112. In a June 2014 report, Dr. U., a private clinician at S., indicated that the Veteran meet the diagnostic criteria for PTSD. The Veteran exhibited the exact characteristic symptoms coinciding with this diagnosis, including sleeplessness; insomnia; nightmares associated with the stressful events; headaches; and flashbacks of his experiences in the Republic of Vietnam. Additionally, the Veteran endorsed being hyperalert, hypervigilant, irritable, unfocused, and prone to outbursts of anger. The Veteran disdains loud noises and crowds, which produce self-isolation. A limited psychometric test was positive for PTSD. In a July 2014 lay statement, the Veteran conveyed that he saw and experienced many horrific events during his tour of duty in the Republic of Vietnam, including mortar, rockets, and sniper for and the death and injury of his comrades. The Veteran wrote that he still experiences nightmares related to these events. In March 2015, the Veteran was afforded a VA examination. A psychologist reviewed the claims file; considered the Veteran’s subjective statements; and conducted an appropriate evaluation (hereinafter “VA exam protocols”). This psychologist provided a diagnosis of PTSD, which was productive of 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; or symptoms controlled by medication. Attributable symptoms consisted of anxiety; suspiciousness; and chronic sleep impairment. Behaviorally, the psychologist noted that the Veteran was polite, open, and cooperative. And, the Veteran was appropriately dressed ans showed good body hygiene. Speech was within normal limits as to all indices; affect was appropriate to the content of the Veteran’s speech. Attention and concentration appeared adequate and the Veteran’s immediate recall and remote memory were both intact. Thought processes were logical and organized and there was no evidence of either delusions or hallucinations. The Veteran characterized his current mood as “okay”; however, he endorsed that he has been “guarded” over the past month. In a March 2015 statement, the Veteran conveyed that case law and DC 9411 indicate that he warrants either a 70 percent or a 100 percent disability rating for PTSD. Also, the Veteran insisted that there was no evidence of record which contradicted his contention which was also based upon Dr. U.’s report (as noted above). In an April 2015 letter, Dr. U. submitted a letter. She re-iterated her earlier points and emphasized that the Veteran has become constantly worried about danger. The Veteran also endorses feeling jumpy and nervous. Dr. U. conclude by stating that the Veteran is hopeless about improvement in his state of mental health and his ability to manage his symptoms. In pertinent part, Dr. U. re-conveyed her many earlier points in a letter of January 2016, underscoring that the holidays and the Veteran’s lack of sleep were impacting him mightily. Additionally, the Veteran endorsed problems with his short-term memory. As noted above, to receive a higher disability rating, there would need to be a showing of 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. Such is not disclosed in the evidence of record. Prior to June 5, 2018, the Veteran’s PTSD, at worst, manifested as 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; or symptoms controlled by medication. The Board has considered Dr. U.’s comments as to the Veteran’s endorsement of nervousness; jumpiness; worry; short-term memory problems; and hopelessness. Indeed, these symptoms expand upon those noted by the March 2015 VA psychologist. However, Dr. U. did not opine that this clutch of additional symptoms was productive of occupational and social impairment with reduced reliability and productivity due to such symptoms as those enunciated above. The Board has considered whether the record discloses symptoms analogous to those noted above but finds no evidence of such. See Mauerhan, 16 Vet. App. 436; Vazquez-Claudio, 713 F. 3d 112. The evidence of record does not disclose that the Veteran’s presentation, human interaction, verbal communicative skills, and behavioral repertoire were indicative of an inability to comport himself in a socially appropriated and engaged manner. (The Veteran endorsed that he has goods relationships with his family and friends.) The Veteran reported that he was promoted during his career with two major beverage companies. Also, the Veteran stated that he was in his third year of volunteering as an emergency chaplain. And, even though the Veteran no longer golfs or works on automobiles, he derives enjoyment out of his hobby of fishing. Hence, an holistic Bankhead analysis, discerned though the three steps described above, suggests that the Veteran’s degree 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 routine behavior, self-care, and conversation normal). The Board finds that the Veteran is competent to convey discernable symptoms (viz, exhaustion) 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. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); Bostain v. West, 11 Vet. App. 124, 127 (1998). Therefore, the body of lay evidence warrants minimal probative weight. Overall, the Board finds that the preponderance of evidence is against granting a disability rating in excess of 30 percent disabling for service-connected PTSD prior to June 5, 2018. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. On a June 5, 2018 VA PTSD Disability Benefits Questionnaire form, VA received a report from Dr. B., a private psychologist in the Veteran’s state of residence. This psychologist wrote that he reviewed the Veteran’s claims file. Upon discussing the Veteran’s history, noting the Veteran is now fully retired from supervisory positions in the beverage and textile industries, Dr. B. noted attributable symptoms of depressed mood; anxiety; suspiciousness; panic attacks that occur weekly or less often; chronic sleep impairment; flattened affect; disturbances in motivation and mood; difficulty un establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances, including work and a work-like setting; and suicidal ideation. The psychologist indicated that the Veteran’s PTSD was best summarized as being productive of occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood. This psychologist also noted that the Veteran endorsed nightmares (triggered by war movies); frequent recall of deaths he witnessed in service; anger outbursts; hypervigilance; avoidance of crowds; depression; nervousness; fluctuating weight; and irritability. Moreover, the Veteran endorsed that chronic PTSD affected his life and diminished functioning, especially his ability to sustain employment. Nevertheless, this psychologist noted that the Veteran was fully oriented and “aware” during evaluation. A review of the Veteran’s VA treatment discloses frequent complaints about PTSD symptoms. The Veteran was afforded extensive therapy services with a VA social worker. These records show that the Veteran was prescribed an alpha-blocker (Prazosin) for insomnia and nightmares. Chronic PTSD is listed on the Veteran’s active problems list. In October 2019, the Veteran was afforded a VA examination. A psychiatrist performed VA exam protocols. A diagnosis of chronic PTSD was provided. This psychiatrist indicated that the Veteran’s PTSD was best summarized as being productive of occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood. The psychiatrist reported symptoms of depressed mood; anxiety; suspiciousness; panic attacks more than once a week; mild memory loss; circumlocutory speech; impaired abstract thinking; disturbance of motivation and mood; difficulty adapting to stressful circumstance, including work and a worklike setting; difficulty in establishing and maintaining effective work and social relationships; suicidal ideation; and impaired impulse control. The Veteran behaved in a calm and collected manner; was well groomed; made good eye contact; appeared logical and goal-directed; displayed normal speech at all indices; denied homicidal ideation; and maintained “passive” suicidal ideations (such as thinking that he would be better off dead or driving off the road). However, the Veteran did not have any current scheme or intent to harm himself. In an October 2020 brief, the Veteran’s representative advanced that the severity of the Veteran’s PTSD warrants a 100 percent disability rating. The representative argued that the Veteran’s symptoms clearly demonstrate such. As noted above, to receive a higher disability rating, there would need to be a showing of total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, for the veteran’s own occupation, or own name. Such is not disclosed in the evidence of record. At worst, the evidence of record discloses that the Veteran’s PTSD manifests as occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood. The Board has considered the Veteran’s extensive inventory of symptoms. While these symptoms indicate that PTSD is productive of deficiencies in most areas, even taken as a totality this inventory does not rise to the level of being productive of total occupational and social impairment. Stated differently, The Board has considered whether the record discloses symptoms which are analogous to those which are indicative of total occupation and social impairment but finds no evidence of such. See Mauerhan, 16 Vet. App. 436; Vazquez-Claudio, 713 F. 3d 112. The evidence of record shows that the Veteran ceased his volunteer chaplaincy work; however, the Veteran indicated that participates in American Legion (AL) programming and interacts with other in support-like settings at VFW. Thus, albeit limited, by his own account the Veteran is not completely socially impaired. While the evidence shows that his social interactions are few (AL and VFW), they still exist. Hence, an holistic Bankhead analysis, discerned though the three steps described above, suggests that the Veteran’s degree of occupational and social impairment best approximates occupational and social impairment with deficiencies in most areas occupational and social impairment with deficiencies in most areas, The Board finds that the Veteran is competent to convey discernable symptoms (viz, nervousness) 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. See Jandreau, 492 F.3d 1372, 1377 n.4; Bostain, 11 Vet. App. 124, 127). Therefore, the body of lay evidence warrants minimal probative weight. Overall, the Board finds that the preponderance of evidence is against granting a disability rating in excess of 70 percent disabling for service-connected PTSD from June 5, 2018. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Accordingly, the criteria for a schedular rating in excess of 30 percent prior to June 5, 2018, and in excess of 70 percent afterwards, for PTSD have not been met, and the claim is denied. TDIU Prior to June 5, 2018 The Veteran asserts that he warrants the grant of a TDIU prior to June 5, 2018. 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). Prior to June 5, 2018, the Veteran had the following service-connected disabilities: 1) PTSD at 30 percent, effective from May 16, 2015; 2) migraine headaches at 10 percent, effective from March 18, 2011; 3) diabetes mellitus type 2 at 20 percent, effective from September 8, 2014; 4) bilateral tinnitus at 10 percent, effective from March 18, 2011; 5) right lower extremity diabetic peripheral neuropathy at 10 percent, effective from September 8, 2014; 6) left lower extremity diabetic peripheral neuropathy at 10 percent, effective from September 8, 2014; 7) left lower extremity femoral nerve diabetic peripheral neuropathy at 10 percent; effective from September 8, 2014; 8) right lower extremity femoral nerve diabetic peripheral neuropathy at 10 percent; effective from September 8, 2014; 9) bilateral hearing loss at a noncompensable rating, effective from March 18, 2011; and 10) malignant skin neoplasm at a noncompensable rating, effective from March 18, 2011. Thus, the Veteran did not meet the schedular requirements for entitlement to a TDIU prior to June 5, 2018. Nevertheless, the Board will assess whether entitlement to a TDIU was warranted based upon exceptional circumstances. Upon a January 2011 VA skin diseases examination, a VA physician indicated that Veteran’s malignant neoplasm did not impact the Veteran’s ability to work. Upon a January 2012 VA headaches examination, a VA physician indicated that Veteran’s migraine headaches did impact the Veteran’s ability to work. Here, the physician wrote that the Veteran was now retired, but in the past the Veteran had to rest in a quiet room for usually a day until his headache resolved. Upon a January 2012 VA hearing loss examination, a VA audiologist noted that hearing loss did impact the Veteran’s ability to work. In the words of the Veteran even though he was able to work until he retired, hearing loss was annoying and distracting at times. Upon a March 2015 VA mental health examination, the psychologist opined that PTSD was productive of 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; or symptoms controlled by medication. Upon a March 2015 VA diabetes mellitus examination, a clinician opined that the Veteran’s diabetes mellitus did not impact the Veteran’s ability to work. Upon a March 2015 VA diabetic sensory-motor peripheral neuropathy examination, a clinician indicated that the Veteran’s 4 discrete lower extremity diabetic peripheral neuropathy disabilities collectively did not impact the Veteran’s ability to work. The evidence shows that the Veteran completed his high school degree. And, the evidence shows that the Veteran retired during this time after many years of professional experience in the beverage and textile industries, to include supervisory positions. And, the Veterans military occupation specialty (MOS) was that of a tactical command chief. While the Veteran asserts that his service-connected disabilities rendered him unable to obtain or retain employment consistent with her education and experience prior to June 5, 2018, the evidence of record shows that the Veteran has high school education and a host of professional experiences, to include supervisory functions, in the beverage (food services) and textile industries. Moreover, the Veteran has voluntary chaplaincy experience. Collectively, the Board finds that this combination of education and work experiences, prior to June 8, 2018, were more-than-sufficient for the Veteran 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). The Board recognizes that prior to June 5, 2018, the Veteran experienced headaches that required retreat to a quiet room; annoyance from hearing loss; and mild or transient PTSD symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress. However, these limitations did not rise to the level of rendering the Veteran totally impaired physically, occupationally, or socially. Indeed, the evidence of record does not reveal that any one of his service-connected disabilities, or the entirety of his service-connected disabilities, precluded him from obtaining and maintaining gainful employment prior to June 5, 2018. Prior to June 5, 2018, the Veteran’s job skills would have lent themselves to employment in any supervisory capacity or (in light of his extensive professional experiences) a training capacity, in the food services and textile industries. Here, the Board notes that many employers, prior to June 5, 2018, offered accommodations pursuant to the ADA, to allow for downtime due to disabilities. In the Veteran’s case, it would have been feasible for an employer to provide breaks in quiet settings where the Veteran could collect himself during periods of mild or transient PTSD symptoms and headaches and the annoyance associated with hid service-connected hearing loss disability. As already noted, the Veteran did not meet the schedular requirements for entitlement to a TDIU prior to June 5, 2018. And, the evidence of record fails to reveal that exceptional circumstances existed prior to June 5, 2018 which would warrant consideration under 38 C.F.R. § 4.16(b). The rating schedule was created as a guide to evaluating disabilities resulting from all types of diseases and injuries encountered, and the percentage ratings that are assigned represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and their residual conditions in civil occupations. 38 C.F.R. § 4.1. 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. Accordingly, a TDIU on an extraschedular basis prior to August 6, 2018, is denied. Timothy Berryman 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.