Citation Nr: 21012738 Decision Date: 03/05/21 Archive Date: 03/05/21 DOCKET NO. 19-26 484 DATE: March 5, 2021 ISSUES 1. Entitlement to a disability rating in excess of 50 percent prior to January 25, 2017, for other specified trauma and stressor related disorder, previously rated as posttraumatic stress disorder (PTSD), anxiety disorder, (acquired psychiatric disorder). 2. Entitlement to a disability rating in excess of 70 percent from January 25, 2017, for the acquired psychiatric disorder. 3. Entitlement to a total disability rating based on individual unemployability (TDIU). ORDER Entitlement to a rating of 70 percent, but no higher, for the acquired psychiatric disorder is granted from August 4, 2015. Entitlement to a disability rating in excess of 70 percent for the service-connected acquired psychiatric disorder is denied. Entitlement to a TDIU is granted from August 4, 2015, forward. FINDINGS OF FACT 1. The Veteran withdrew his claim for an increased rating on April 14, 2016, and submitted the filing of the new claim on the same day. 2. From August 4, 2015, it was factually ascertainable that the Veteran’s acquired psychiatric disorder manifested with no greater than occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. 3. At no time during the pendency of this claim has the Veteran’s acquired psychiatric disorder manifested with total occupational and social impairment. 4. The Veteran’s acquired psychiatric disorder precludes him from obtaining and following a gainful employment. CONCLUSIONS OF LAW 1. The criteria for a disability rating of 70 percent for the acquired psychiatric disorder, but not higher, have been met from August 4, 2015. 38 U.S.C. § 1155 (West 2014); 38 C.F.R. §§ 4.7, 4.130, Diagnostic Code 9410 (2017). 2. The criteria for a disability rating in excess of 70 percent for acquired psychiatric disorder have not been met or approximated. 38 U.S.C. § 1155 (West 2014); 38 C.F.R. §§ 4.7, 4.130, Diagnostic Code 9410 (2017). 3. The criteria for entitlement to a TDIU have been met. 38 U.S.C. § 1011, 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1989 to December 1995. This matter comes before the Board of Veterans’ Appeals (Board) from a July 2017 rating decision from a Department of Veterans Affairs (VA) regional office (RO). The July 2017 rating decision granted an increased rating of 70 percent for an acquired psychiatric disorder, effective January 25, 2017. The Veteran has appealed for an increased rating and an earlier effective date for the increased rating awarded. These matters are intertwined in that an effective date is determined both by the date of filing and the date that a higher rating is warranted; however, the period for which an increased rating can be considered is also affected by the date of filing. Therefore, this decision will also focus on the date of filing analysis. However, adjudication of a separate earlier effective date claim is not necessary and would be redundant. Stated differently, the Board’s grant of an increased rating to 70 percent effective from August 4, 2015, serves the same purpose as assigning an earlier effective date for the 70 percent evaluation. Further, the Veteran contended in his appeal brief that his service-connected disability prevents him from working. Because a TDIU rating is part and parcel to a claim for an increased rating, see Rice v. Shinseki, 22 Vet. App. 447 (2009), it has been added as an issue. VA’s Duty to Notify and Assist The Veteran Claims Assistance Act of 2000 (VCAA), in part, describes VA’s duties to notify and assist a claimant in substantiating a claim for VA benefits. 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2017). The Veteran in this case has not referred to any deficiencies in either the duties to notify or assist; therefore, the Board may proceed to the merits of the claim. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed.Cir. 2015, cert denied, U.S.C. Oct.3, 2016) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board....to search the record and address procedural arguments when the [appellant] fails to raise them before the Board”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to an appellant’s failure to raise a duty to assist argument before the Board). The Board has reviewed all of the evidence in the Veteran’s claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-130 (2000). Acquired Psychiatric Disability The Veteran’s appeal states two arguments. First, the Veteran argues the increased rating should date back to February 24, 2010, the effective date for the original grant of service connection for an acquired psychiatric. Alternatively, the Veteran argues the effective date of the increased rating should date back to April 15, 2016, because the decision on the claim filed on that date never became final. The assignment of effective dates is generally governed by 38 U.S.C. § 5110 and 38 C.F.R. § 3.400. Unless specifically provided otherwise, the effective date of an award based on a claim for service connection or for an increase of compensation “shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor.” 38 U.S.C. § 5110 (a). The implementing regulation clarifies this to mean that the effective date of an award of service connection or for increased compensation “will be the date of receipt of the claim or the date entitlement arose, whichever is later.” 38 C.F.R. § 3.400. The effective date of an award of increased compensation shall be the earliest date as of which it is ascertainable that an increase in disability had occurred, if application is received within one year from such date. 38 U.S.C. § 5110 (b)(2). The implementing regulation summarizes the criteria for an effective date of an award of increased compensation as the “[e]arliest date as of which it is factually ascertainable that an increase in disability had occurred if claim is received within one year from such date otherwise, date of receipt of claim.” 38 C.F.R. § 3.400 (o)(2). For entitlement to an increase in disability compensation to arise, the service- connected disability must have increased in severity to a degree warranting an increase in compensation. See Hazan v. Gober, 10 Vet. App. 511, 519 (1992) (noting that, under section 5110(b)(2), which provides that the effective date of an award of increased compensation shall be the earliest date of which it is ascertainable that an increase in disability had occurred, “the only cognizable ‘increase’ for this purpose is one to the next disability level” provided by law for the particular disability). Thus, determining whether an effective date assigned for an increased rating is correct or proper under the law requires (1) a determination of the date of the receipt of the claim for the increased rating as well as (2) a review of all the evidence of record to determine when an increase in disability was “ascertainable.” Id. at 521. The Veteran’s first argument would require the current claim to date back to the original claim for service connection, February 24, 2010. The Veteran has asserted that he has continuously pursued the claim; thus, the effective date should relate back to the original claim. The Board does not find this argument persuasive. In a September 2014 rating decision, service connection for PTSD, anxiety disorder was granted with an evaluation of 50 percent effective February 24, 2010. The Veteran was notified in the same month. The Veteran filed an increased rating claim on February 14, 2015, stating that he was requesting an increased evaluation for already approved service-connected PTSD disability. In an April 2015 rating decision, the claim for an increased rating was denied. The Veteran requested reconsideration in June 2015, submitted a VA 21-526EZ, Fully Developed Claim form in June 2015, and filed a notice of disagreement (NOD) in July 2015, stating that his symptoms had worsened over the past years. In October 2015 correspondence, the RO stated “we received your VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, on June 26, 2015, requesting increased evaluation of your service connected PTSD. However, on July 7, 2015, you also submitted a Notice of Disagreement, indicating disagreement with the rating decision of April 22, 2015, with respect to the evaluation assigned for your service connected PTSD (the same issue). We have accepted your Notice of Disagreement on the issue of increased evaluation of your PTSD. The appeals team will make a decision on that claim.” In January 2016 it was noted that the Veteran requested a traditional appeal. On April 14, 2016, the Veteran’s prior representative stated that the Veteran was withdrawing his appeal. On the same day, the Veteran submitted a VA 21-526EZ, Fully Developed Claim form for an increased rating for PTSD. Pertinently, the Veteran was notified in May 2016 that the RO discontinued action on his appeal based on his request dated April 15, 2016. The Veteran was notified that if he did not intend to withdraw his NOD, he had 30 days from the date of this letter to provide the RO with that information. The Veteran has contended that the withdrawal was a procedural misunderstanding. In support of this argument, the Veteran states that the withdrawal was sent on April 14, 2016, and the next day his representative tried to correct the error by filing a new claim. This is not consistent with the record. Both the withdrawal and the filing of the new claim were dated and signed April 14, 2016. Both were received by VA on the same day, April 15, 2016. Further, the mere fact that a claim was withdrawn and a similar claim was filed the same day does not indicate a mistake was made. The withdrawal and refiling of the claim may reflect a choice to focus the claim in on a narrower timeline, during which the actual increase in the disability took place. As discussed in more depth below, this is factually consistent with the progression of the Veteran’s condition, in that the increase took place in the narrow window of review of the refiled claim. Moreover, if it were a mistake, the Veteran and representative were presented with an opportunity to correct the mistake. A May 2016 VA letter stated that if the withdrawal was a mistake, the Veteran should respond with such information within 30 days. No response was received. Therefore, the preponderance of the evidence indicates the withdrawal was neither a mistake nor a procedural misunderstanding. As such, the current claim cannot relate back to the original claim for service connection. The Veteran’s alternative argument is that the increased rating should be effective April 15, 2016, because the June 2016 rating decision issued in response that claim was still pending when the increased rating was granted in the July 2017 rating decision. This argument is persuasive, but only partially correct in that the June 2016 rating decision did not become final and the current claim should date back to the claim received on April 15, 2016. However, the proper effective date relies on more than the date of the claim. It is also dependent on the date when the increased rating was ascertainable. The claim receive on April 15, 2016, was adjudicated in a June 2016 rating decisions. A rating decision will usually become final if no notice of disagreement is filed within one year of the decision. 38 C.F.R. § 20.1103 (2017). However, when new and material evidence is received within the appeal period, it will toll finality of that decision until the new evidence is addressed. Lang v. Wilkie, 971 F.3d 1348 (Fed. Cir. 2020); 38 C.F.R. § 3.156 (b). Here, evidence that was both new and material, a June 2017 compensation and pension examination, was received within one year of the June 2016 rating decision. It went unaddressed until the July 2017 rating decision. As such, the June 2016 rating decision did not become final and the July 2017 rating decision related back to the April 15, 2016, claim for an increased rating. However, establishing the date of claim is not the end of the inquiry as to when the effective date for the increased rating should be granted. The date that the increase was ascertainable is the second half of this inquiry. As discussed more fully in the next section, August 4, 2015, is the date an increased rating of 70 percent was ascertainable. As this fell within in the year prior to the date of claim for an increased rating, August 4, 2015, is the proper effective date for the grant of an increased rating of 70 percent. 38 U.S.C. § 5110 (b)(2). Disability evaluations are determined by the application of VA’s Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4 (2017). The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1 (2017). Where there is a question as to which of two evaluations shall be applied, the higher evaluation 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. It is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified; findings sufficiently characteristic to identify the disease and the disability therefrom are sufficient; and above all, a coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21 (2017). When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran’s capacity for adjustment during periods of remission. 38 C.F.R. § 4.126; Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013). The rating agency shall assign an evaluation based upon all the evidence of record that bears on occupational and social impairment, rather than solely upon the examiner’s assessment of the level of disability at the moment of the examination. Id. When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation solely on the basis of social impairment. Id. In accordance with 38 C.F.R. §§ 4.1, 4.2 (2017) and Schafrath v. Derwinski, 1 Vet. App. 589 (1991), the Board has reviewed all evidence of record pertaining to the history of the Veteran’s service-connected disability. The Board has found nothing in the historical record which would lead to the conclusion that the current evidence of record is not adequate for rating purposes. The Board notes that, when it is not possible to separate the effects of a non-service-connected condition from those of a service-connected disorder, reasonable doubt should be resolved in the claimant’s favor with regard to the question of whether certain signs and symptoms can be attributed to the service-connected disability. Mittleider v. West, 11 Vet. App. 181, 182 (1998); see also 38 C.F.R. § 3.102. The Veteran’s disability is rated under 38 C.F.R. § 4.130, Diagnostic Code 9410. The rating criteria are as follows. A 50 percent rating is warranted for 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 judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing effective work and social relationships. A 70 percent rating is warranted for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; 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); inability to establish and maintain effective relationships. A 100 percent rating is warranted 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; memory loss for names of close relatives, own occupation, or own name. The “such symptoms as” language of the diagnostic codes for mental disorders in 38 C.F.R. § 4.130 means “for example” and does not represent an exhaustive list of symptoms that must be found before granting the rating of that category. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). However, as the Court also pointed out in that case, “[w]ithout those examples, differentiating a 30 percent evaluation from a 50 percent evaluation would be extremely ambiguous.” Id. The Court went on to state that the list of examples “provides guidance as to the severity of symptoms contemplated for each rating.” Id. Accordingly, while each of the examples needs not be proven in any one case, the particular symptoms must be analyzed in light of those given examples. Put another way, the severity represented by those examples may not be ignored. Here, the Veteran has been diagnosed with multiple acquired psychiatric disorders to include PTSD, other specified trauma and stressor related disorder, major depressive disorder, anxiety disorder and unspecified personality disorder. In this case, it is not necessary to separately address the symptoms of the service-connected conditions from the non-service-connected conditions because the weight of the evidence indicates that the symptoms of the service-connected conditions cannot be satisfactorily distinguished from the non-service-connected conditions. See Mittleider, 11 Vet. App. 181 (when it is not possible to separate the effects of a service-connected disability and a nonservice-connected disability, reasonable doubt must be resolved in the appellant's favor and the symptoms in question must be attributed to the service-connected disability). This is not a conclusion without controversy; the May 2016 examiner states that the symptoms from the personality disorder can been distinguished, but the acknowledges how similar the symptoms are to the other specified trauma or stress disorder. A July 2015 examiner stated they conditions were too similar to distinguish the symptoms. Further, the private opinion provided in October 2019 indicates it is not possibly to differentiate symptoms due to the complex overlap of the mental disorders. Therefore, affording the benefit of the doubt to the Veteran, the appropriate rating should consider all symptoms attributable to a psychiatric disorder when rating the Veteran’s disability. The analysis of these symptoms largely focuses on the period from one year prior to the date of claim, April 15, 2016, through present. This does not mean that records prior to April 15, 2015, are not considered, indeed they must be considered to determine if any increase occurred in the period between April 15, 2015, and April 15, 2016; however, this analysis will focus on the period a higher rating can be assigned rather than on periods for which the Board does not have the authority grant a higher rating. Prior to August 4, 2015, the record does not support a disability rating greater than 50 percent for an acquired psychiatric disorder. The Veteran’s records indicate his symptoms most closely approximated an occupational and social impairment with reduced reliability and productivity during this period. In May 2015 the Veteran’s psychologist indicated his symptoms included depressed, anxious, and irritable mood, intrusive memories, nightmares, insomnia, heightened arousal, hypervigilance, avoidant behaviors, isolating behaviors, anhedonia, and lack of concentration; noting that in the most acute cases the Veteran had difficulty leaving his home. Treatment records in the surrounding period are consistent with this summary of symptoms. In April 2015 the Veteran reported altercations with a neighbor that make him anxious and irritable. He noted insomnia symptoms and fear of losing control. No physical altercations were noted, and neither were any suicidal or homicidal ideations. In June 2015 he continued to report a problem with his neighbor and related that he was banned from the property manager’s office after complaining about the problem and slamming the door in anger. The Veteran indicated he did not get violent and continued to deny suicidal and homicide ideations. A later note indicated the Veteran was able to resolve this conflict on his own by apologizing. Another progress note from June 2015 noted a memory impairment, emotional detachment, and note the Veteran maintains monthly contact with his mother. In July 2015 the Veteran continued to deny any suicidal or homicidal ideation but reported short-term memory problems. He was noted as being well groomed. He also remarked that he was helping take care of his aunt for the past two weekends. These symptoms are not consistent with a disability rating greater than 50 percent. A rating of 70 percent would require an occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgement, thinking, or mood. Although, the Veteran had an irritable mood that led to altercations with his neighbor and property management, he was able to resolve these issues independently. This indicated his social impairment, while present, did not result in deficiencies in areas like a workplace or school. His family relationships were reportedly intact, with contact with his mother and aunt. Thinking capacity may have been impaired by memory problems, but the Veteran was able to recall conflicts and resolutions with his neighbors and no specific examples of the memory impairment were noted. While the Veteran reported anxiousness and depressed mood, his ability to function independently remained intact. Overall, his symptoms, as reported, were not consistent with severity and frequency demonstrated by an occupational and social impairment with deficiencies in most areas. However, the record indicated an increase in symptoms in an August 4, 2015, treatment record. This was the first time in the record that the Veteran reported suicidal ideation with passive thoughts of dying. He also reported difficulty concentrating, poor appetite, feeling tired, feeling depressed, and responded it was “extremely difficult” to do work, take care of things at home or get along with others. Transient thoughts of suicide and death are present in treatment records intermittently from August 4, 2015, forward. In December 2015 the Veteran indicated he was limiting his activities outside the house to daylight hours. In June 2016 a compensation and pension examiner noted the Veteran was “somewhat groomed” with holes in his pants and toothpaste stains on his mouth. The Veteran’s symptoms included a depressed mood anxiety, a sleep impairment, difficulty maintaining effective work and social relationships, and difficulty adapting to stressful circumstance, including in worklike settings. A letter from the Veteran’s psychologist in January 2017, reiterated many of these symptoms and noted that the combination of paranoia and volatility resulted in impaired judgement. An October 2019 private provider stated the Veteran had symptoms of suicidal ideation, auditory and visual hallucinations, suffered from a chronic sleep impairment, had impaired judgement, difficulty establishing and maintain relationships, difficultly adapting to stressful circumstance, disturbances of motivation and mood, affecting his ability to function and intermittent inability to perform activities of daily living. The provider indicated these symptoms related back to April 2016, when the Veteran filed the current claim. The disability picture presented by these reports was one of increased frequency and severity of psychological symptoms ascertainable on August 4, 2015. Prior to this date there were no reports of suicidal ideation, the Veteran did not show signs of intermittent inability to perform activities of daily living, and his judgement was not noted as impaired. This increase in symptomatology most closely approximates the 70 percent rating criteria and a finding that the Veteran’s service-connected acquired psychological disability resulted in a social and occupation impairment with deficiencies in most areas. The Veteran’s symptoms are expected to cause deficiencies in work and school settings due to an impaired ability to concentrate and difficulty establishing relationships. Deficiencies in judgment are noted by the Veteran’s psychologist. Deficiencies in thinking and mood are indicated by suicidal ideation and paranoia. Thus, the Veteran’s symptoms support a higher rating of 70 percent as of August 4, 2015. A total rating is not warranted. Although there are infrequent indications of hallucinations and trouble performing activities of daily living, the frequency and severity of the Veteran’s symptoms, as a whole, do not result in a total social and occupational impairment. The Veteran is not disoriented by his symptoms. He does not pose a persistent threat to others or himself. The Veteran reported hallucinations only once, and that was to a private examiner. He did not mention them in treatment records and the singular report does not indicate any interference with social or occupational functioning. There are a few notes about the Veteran’s poor grooming. However, these notes often suggest it is the Veteran’s physical disability and pain that are the primary cause of this deficiency. Further, these are infrequent episodes that note minor defects in grooming. It is unlikely that these would result in a total inability to function in the social or occupational realm. Therefore, the weight of the evidence is against assigning a total disability rating. It is noted that there was a July 2015 examination that suggested the Veteran was overreporting symptoms based on a symptom inventory. Responses indicated the Veteran’s responses were invalid. Although this weighs against the Veteran’s reported symptoms, this was only one incident. Further, as noted above the weight of the evidence, including treatment records and treating physician statements support the higher rating of 70 percent. Consideration has been given to assigning additional staged rating; however, at no time during the period in question has the disability warranted more than the assigned ratings. See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). In addition to the medical evidence above, the Board has considered the lay evidence in the form of the Veteran’s correspondence and testimony. A layperson is competent to testify in regard to the onset and continuity of symptomatology. Heuer v. Brown, 7 Vet. App. 379, 384 (1995); Falzone v. Brown, 8 Vet. App. 398, 403 (1995); Caldwell v. Derwinski, 1 Vet. App. 466 (1991). However, even affording the Veteran full competence and credibility, nothing in the statements shows impairment more closely approximating the criteria for higher staged ratings. TDIU TDIU may be assigned, where the schedular rating is less than total, when the veteran is unable to secure or follow substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. §§ 3.340, 3.341, 4.16. In order to meet the schedular criteria for entitlement, the veteran must have either: (i) one disability rated at 60 percent or more; or (ii) two or more disabilities, with at least one disability rated at 40 percent or more and sufficient additional disability bringing the combined rating to at least 70 percent. 38 C.F.R. § 4.16(a). The Veteran meets the schedular threshold for the period he is rated at 70 percent for his service-connected acquired psychiatric disorder. Prior to August 4, 2015, there is no evidence of an ascertainable increase in the Veteran’s symptoms related to employability. As discussed above, the Board cannot grant an increased rating prior to August 4, 2015, based on the rules regarding effective dates. The Veteran is not service connected for any other condition. The Veteran has submitted evidence that he has not been employed for the entire period he has been rated at 70 percent. Records indicate he has a high school education without any specialized training or experience. As noted above, the Veteran’s acquired psychiatric disorder results in depressed, anxious, and irritable mood, intrusive memories, nightmares, insomnia, heightened arousal, hypervigilance, avoidant behaviors, isolating behaviors, anhedonia, and lack of concentration; as well as, infrequent hallucinations and minor deficiencies in performing activities of daily living. A private examiner indicated in an October 2019 report that these symptoms would preclude the Veteran from sustaining employment due to the normal stresses of competitive employment. Specifically, the Veteran’s concentration problems would prevent him from engaging in many jobs requiring multi-step tasks. His sleep impairment would preclude employment in hazardous environments. His irritability and impaired judgment would interfere with work relationship, including close supervision. The combination of the Veteran’s symptoms and lack of specialized education would at least as likely as not preclude him for securing and following and substantially gainful occupation. Therefore, entitlement to TDIU from August 4, 2015, forward, is warranted. R. M. KELLY Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Reed, 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.