Citation Nr: 21013223 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 17-35 817 DATE: March 9, 2021 ORDER Entitlement to a rating of 70 percent for posttraumatic stress disorder (PTSD) to include major depressive episodes and polysubstance use disorder for the period prior to October 24, 2011, and for the period from January 1, 2012, through August 1, 2017, is granted. Entitlement to a rating in excess of 70 percent for PTSD to include major depressive episodes and polysubstance use disorder from August 2, 2017, to April 18, 2018, is denied. Entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU) prior to August 2, 2017, is granted. FINDINGS OF FACT 1. For the periods prior to October 24, 2011, and from January 1, 2012, to April 18, 2018, the preponderance of the probative evidence establishes that the Veteran’s PTSD to include major depressive episodes and polysubstance use disorder was manifested by no more than occupational and social impairment with deficiencies in most areas, and no evidence of total occupational and social impairment. 2. Resolving reasonable doubt in favor of the Veteran, the evidence of record establishes that the effects of the Veteran’s service-connected disabilities rendered him unemployable prior to August 2, 2017. CONCLUSIONS OF LAW 1. The criteria for entitlement to a rating of 70 percent, but no higher, for PTSD include major depressive episodes and polysubstance use disorder for the period prior to October 24, 2011, and for the period from January 1, 2012, through August 1, 2017, have been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 4.7, 4.130, Diagnostic Code 9411 (2020). 2. The criteria for entitlement a rating in excess of 70 percent for PTSD to include major depressive episodes and polysubstance use disorder for the period from August 2, 2017, through April 18, 2018, have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 4.7, 4.130, Diagnostic Code 9411 (2020). 3. For the period prior to August 2, 2017, the criteria for entitlement to a TDIU have been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1982 to May 1986. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). A March 2018 Board decision denied the Veteran’s claims for a compensable rating for hepatitis B, and an effective date prior to August 17, 2011, for the award of service connection for PTSD. The issue of entitlement to a rating in excess of 50 percent for PTSD in August 2, 2017 and in excess of 70 percent prior to April 19, 2018 and the issue of entitlement to a total disability rating based upon individual unemployability prior to August 2, 2017, were remanded. A remand by the Board imposes a concomitant duty to ensure compliance with the terms of the remand. Where the remand orders are not complied with, the Board itself errs in failing to ensure compliance. Stegall v. West, 11 Vet. App. 268 (1998). Upon review, the Board finds that the remand directives have been complied with. Records from Great Plains were associated with the file, and the matter of entitlement to a TDIU on an extraschedular basis was referred to VA’s Director of Compensation Service. Increased Rating General Rating Principles Disability evaluations are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Board will consider not only the criteria of the currently assigned diagnostic code, but also the criteria of other potentially applicable diagnostic codes. Rating Principles: PTSD The Veteran is currently service connected for PTSD to include major depressive episodes and polysubstance use disorder with a rating of 50 percent from August 17, 2011 to October 24, 2011, a rating of 100 percent from October 24, 2011 to January 1, 2012, a rating of 50 percent from January 1, 2012 to August 1, 2017, a rating of 70 percent from August 2, 2017 to April 18, 2018 and a rating of 100 percent beginning April 19, 2018 and thereafter. PTSD is rated under 38 C.F.R. § 4.130, Diagnostic Code 9411, under the General Rating Formula for Mental Disorder. Under the General rating formula for mental disorders, the criteria for a 50 percent rating, are 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; and difficulty in establishing and maintaining effective work and social relationships. The criteria for a 70 percent rating are 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 work-like setting); and the inability to establish and maintain effective relationships. The criteria for a 100 percent rating are 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 Board notes that the Veteran need not exhibit “all, most, or even some” of the symptoms enumerated in the General Rating Formula for Mental Disorders to warrant the assignment of a higher rating. Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). The symptoms listed are not exhaustive, but rather “serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating.” Id. In particular, use of such terminology permits consideration of items listed as well as other symptoms and contemplates the effect of those symptoms on the claimant’s social and work situation. Id. n Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013) the Federal Circuit stated that “a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration.” It was further noted that section “4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas.” Factual Background The Veteran contends that he is entitled to increased ratings for his service-connected psychiatric disorder for the periods in which he is rated as less than 100 percent. As indicated above, the Veteran has a total disability rating of 100 percent for the period from October 24, 2011 to January 1, 2012 and for the period beginning April 19, 2018 and thereafter. Thus, the issues before the Board are entitlement to an initial rating in excess of 50 percent from August 17, 2011 to October 24, 2011, entitlement to a rating in excess of 50 percent from January 1, 2012 to August 2, 2017, and entitlement to a rating in excess of 70 percent beginning August 2, 2017. VA treatment records show that the Veteran was admitted to domiciliary care for homeless Veterans (DCHV) in August 2011. During his time in DCHV, the Veteran attended mental health treatment. August 2011 mental health treatment records note the Veteran as alert and oriented to person, place, time and occasion. The Veteran denied having thoughts about death or harming himself within the prior six months. The Veteran was noted as a little irritable but overall cooperative, with coherent, organized thought process and no evidence of psychosis. The Veteran’s insight and judgment were adequate for treatment. During a follow up appointment in August 2011, the Veteran reported insomnia, waking up four to five times a night; he also complained of intense nightmares every night. The Veteran’s psychiatric medication was increased. A mental status examination noted the Veteran as more relaxed and outgoing compared to his first appointment. The Veteran remained alert and oriented with normal speech. He also exhibited full range affect. Although the Veteran had an anxious mood, he maintained coherent organized thought process with no evidence of mania or psychosis. He denied any suicidal or homicidal ideations. Insight and judgment were adequate for treatment. Notably, during a primary care appointment in August 2011, VA treatment records note that the Veteran demonstrated heightened affect and his cognition did not appear intact. However, the Veteran speech remained clear, and his eye contact was adequate. While subsequent mental status examinations in August 2011 and September 2011 note anxious affect and mildly restricted or depressed mood, the Veteran’s thought process remained coherent and organized with no evidence of psychosis. In September 2011 the Veteran reported some increased feelings of depression. However, the Veteran continued to deny suicidal or homicidal ideation, and the Veteran’s insight and judgment remained adequate for treatment. In early October 2011, treatment records show that the Veteran continued to report increased depressive symptoms. Nonetheless, the Veteran continued to deny suicidal or homicidal ideations and denied any manic symptoms. The Veteran’s anti-depressant medications were increased. The Veteran was admitted into the PTSD program October 24, 2011 and subsequently assessed a 100 percent rating for his PTSD from October 2011 through January 1, 2012. VA treatment records show that the Veteran began mental health treatment for addictive disorder in December 2011. Subsequent treatment records continue to note the Veteran as alert, oriented and cooperative. In July 2012 the Veteran reported significant sleep issues, irritability, impulsivity and decrease in sexual activity. The Veteran reported that his moods can flash quickly back and forth and endorsed symptoms of pressured speech and being hyper talkative. The Veteran reported having racing thoughts most of the time and decreased need for sleep. He also reported feeling lethargic all day. During an initial mental health assessment in August 2012, the Veteran reported having an insatiable urge to eat, difficulty with sleep resulting in him waking two to three times a night and ongoing symptom of irritability including short verbal outbursts with cussing when irritated. The Veteran reported that he continued to be impulsive and engaged in spending sprees. Approximately one week later, the Veteran confirmed being in an altercation at work, in which he “hit a kid at work with a big mouth.” The Veteran denied any suicidal thought or intent but admitted to smoking marijuana more frequently for the escape. Shortly thereafter, on or about August 14, 2012, VA treatment records note that the Veteran endorsed thoughts of harming himself within the past three months. The Veteran was afforded a VA examination in November 2012. His PTSD symptoms included suspiciousness, stereotyped speech, impaired judgment, disturbance of motivation and mood, difficulty establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, inability to establish and maintain effective relationships, impaired impulse control and intermittent inability to perform activities of daily living. In September 2013, VA treatment records note that the Veteran was reporting suicidal ideation. Although they were poorly systematized, the Veteran expressed fear for his safety, not trusting himself to be alone. The Veteran was also noted to have impaired memory for recent past and limited insight and judgment. A September 2013 report from Great Plains indicates that the Veteran was having “bad thoughts” and was referred by VA for care. He admitted to cutting himself in the past. His mood was san and anxious, and there was an air of despondency about him. Affect was appropriate, blunted, and flat. Thought processes were goal-directed. Obsessive ruminations were endorsed. Insight and judgment were limited. A December 2013 report from Great Plains Regional Medical Center reflects that the Veteran was admitted to the partial hospitalization program due to suicidal ideation. He reported previous episodes of depression in which he felt hopeless and worthless, and that life was not worth living. He denied hearing voices. On mental examination, affect was depressed, but the Veteran denied feeling suicidal. He was logical and goal directed. He denied any perceptual disturbances. He was alert and oriented. Thought content was not tangential, circumstantial, or otherwise impaired. Insight, judgment and impulse control were optimal. Hygiene was adequate and memory was intact. Diagnoses of bipolar disorder, dysthymia, and PTSD were noted. An April 2014 VA social worker statement reflects that the Veteran was in ongoing therapy and was on medication. He struggled with flashbacks, variable sleep, exaggerated startle response. He had to be careful in public not to overrespond to stimuli or situations. On VA examination in May 2017, the examiner indicated that the Veteran’s psychiatric disorder was productive of depressed mood, anxiety, chronic sleep impairment, and disturbances of motivation and mood. He was oriented to time, place, and person. He reported having vague suicidal thought all the time, though he denied current ideation, plan or intent. The examiner diagnosed PTSD and indicated that the disability was productive of occupational and social impairment with reduced reliability and productivity. Records show that the Veteran attended group therapy from May 2017 to December 2017 at a Veteran Center. August 2017 therapy notes indicate that the Veteran was an increased risk for suicidal ideations, after the Veteran reported feeling financially destitute. The Veteran’s spouse was encouraged to get the Veteran admitted to the hospital for immediate stabilization. An August 2017 report from a private psychologist reflects that she evaluated the Veteran over the course of several appointments. He was casually dressed and appropriately groomed. During the interviews, his affect fluctuated noticeably from slightly tense and anxious to tearful, and he gave the impression of someone struggling with depression. He was cooperative throughout the process and his thought processes were logical and goal-oriented, while mood was mildly depressed. She found the Veteran to be precluded from working due to his extreme reactivity to stressors. She also found the Veteran to demonstrate occupational and social impairment with deficiencies in most areas such as work, school, family, judgment, thinking or mood. He had intermittent suicidal ideation and near continuous anxiety/and or depression that affected his ability to function independently. August 2017 VA treatment records note that a licensed social worker met with the Veteran and his spouse. The mental status examination noted the Veteran as friendly and cooperative yet extremely anxious. The Veteran was avoidant of eye contact and had slow calculated speech. The Veteran’s language and speech were fluent and coherent with thought process within normal limits. The Veteran’s thought content was future oriented with no evidence of suicidal ideations, homicidal ideations, audio hallucinations, visual hallucinations or paranoia. The Veteran’s mood was anxious and extremely stressed, but his insight and judgment remained fair. The Veteran’s cognition was intact. VA treatment records show that the Veteran’s social worker had a follow up meeting with the Veteran and his spouse in September 2017. The Veteran showed several pieces of taxidermy and art he created, and shared that he uses art and taxidermy as a coping mechanism to help manage his PTSD symptoms. The Veteran reported ongoing outpatient therapy and denied any active suicidal ideations. The Veteran felt he was managing stressors in his life more effectively. The mental status examination noted the Veteran as friendly and cooperative albeit anxious. The Veteran was avoidant of eye contact and had slow calculated speech. Nonetheless, the Veteran’s thought process remained within normal limits. There was no evidence of suicidal ideation, homicidal ideation, audio hallucinations, visual hallucinations or paranoia. The Veteran’s mood was calm, with a congruent affect. The Veteran’s judgment and insight remained fair and cognition remained intact. An October 2017 VA letter informed the Veteran that his high risk for suicide flag was deactivated based on a review of the Veteran’s case by the suicide prevention team, who determined that the Veteran’s suicide risk level decreased. During a November 2017 follow up appointment the Veteran’s VA licensed social worker continued to note the Veteran as friendly and cooperative albeit extremely anxious with avoidant eye contact, fluent and coherent speech, thought process within normal limits and future oriented thought content. There continued to be no evidence of suicidal or homicidal ideations, no evidence of audio or visual hallucinations and no evidence of paranoia. The Veteran’s mood was calm with a congruent affect and the Veteran’s judgment and insight remained fair. The Veteran’s cognition remained intact. At a December 2017 follow up appointment with his social worker, the Veteran expressed some frustration regarding his housing issues. When the Veteran expressed that he hoped his social worker would not end up reading about him in the newspaper, his social worker asked if the Veteran was considering suicide. The Veteran denied having a plan or intent to harm himself and outlined his safety chain, stating that he would talk to his wife, his pastor other church members or call the hotline rather than initiating self-harm. The Veteran’s mental status examination continued to note the Veteran as friendly and cooperative yet extremely anxious. The Veteran’s language and speech were noted as fluent and coherent and the Veteran’s thought process remained within normal limits. There was no evidence of suicidal ideations, homicidal ideations, audio hallucinations, video hallucinations or paranoia. The Veteran’s mood was noted as frustrated and agitated, but the Veteran’s judgment and insight remained fair. The Veteran’s cognition was intact. Notably, December 2017 Veterans Center treatment records note that the Veteran endorsed suicidal and homicidal thoughts with a plan, and the Veteran also expressed mistrust of VA. February 2018 VA treatment records note that the Veteran’s wife reported that the Veteran’s PTSD was escalated due to a physical and verbal assault by another Veteran at a non-VA PTSD group therapy session. The Veteran’s spouse reported that the Veteran was not suicidal or homicidal and noted that the Veteran continued to receive treatment at the Veteran Center. An August 2020 private vocational assessment reflects that the Veteran reported symptoms of anxiety, hypervigilance, the tendency to isolate and avoid the general public, unprovoked anger and irritability, depressed mood, impaired memory and concentration, flashbacks, and intrusive thoughts, and that these symptoms existed prior to August 2017. He indicated that his hypervigilance left him distracted an unable to concentrate. He constantly had to evaluate and assess his environment. He was significantly isolated and lived in a controlled environment. His flashbacks occurred daily and were unpredictable. He also had symptoms of depression including impaired motivation, unprovoked irritability, suicidal ideation, and anger. Entitlement to an initial rating in excess of 50 percent from August 17, 2011 to October 24, 2011 Entitlement to a rating in excess of 50 percent from January 1, 2012 through August 1, 2017 Entitlement to a rating in excess of 70 percent from August 2, 2017 to April 18, 2018 The aforementioned evidence reflects that, throughout all periods of the appeal, the Veteran’s psychiatric disorder has been manifested by consistent symptoms of impaired judgment, depression, disturbances in motivation and mood, suicidal ideation, isolative behavior, sleep difficulties, nightmares, flashbacks, irritability, and difficulty maintaining relationships. In the opinion of the Board, the frequency, severity and duration of these symptoms have been productive of occupational and social impairment with deficiencies in work, family relationships, judgment and mood. In reaching this determination, the Board notes that the evidence has varied an symptoms have occasionally waxed and waned throughout the appeal periods. However, such symptomatology is consistent with a higher 70 percent rating. Notably, the United States Court of Appeals for Veterans Claims (Court) has held that suicidal ideation generally rises to the level contemplated in a 70 percent evaluation. Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017). Accordingly, the Board finds that a 70 percent rating is warranted for the period prior to October 24, 2011, and for the period from January 1, 2012, to August 1, 2017. However, at no point during the periods on appeal is the service-connected PTSD with major depressive episodes and polysubstance abuse been shown to have met the criteria for a rating in excess of 70 percent. As noted, a 100 percent rating requires total occupational and social impairment due to symptoms such as gross impairment in thought processes or communication; persistent delusions; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of closes relatives, own occupation, or own name. Although no particular symptom is required, the probative evidence does not show such symptoms as delusions, hallucinations, disorientation to time or place, severe memory loss, gross impairment in thought process, persistent danger to himself or others, or grossly inappropriate behavior. While the Veteran was noted to have been involved in altercations in at August 2012 and at the Vet Center in February 2018, with homicidal thoughts also noted in 2017, the Veteran’s wife later indicated in February 2018 that he was not homicidal and continued with treatment. Similarly, the presence of suicidal ideation, intent, and plan has been indicated with hospitalization on a few occasions, but at other times the Veteran has denied suicidal ideation and has indicated good support. Therefore, persistent danger to self or others is not demonstrated. Nor has the Veteran presented with symptoms of similar severity. Notably, with respect to social functioning, the record reflects that although the Veteran is socially withdrawn and isolated, he is married, reported some involvement with his church, and participated in group therapy. Thus, it cannot be said that he has “total” social impairment, and such is consistent with the findings on examination. The Board acknowledges the findings of the November 2012 examiner, and as pointed out by the Veteran’s representative, that the Veteran has intermittent inability to perform activities of daily living, including inability to maintain minimal personal hygiene, which is characteristic of a 100 percent rating. However, such a finding is not noted consistently in other records. The remainder of the symptoms noted on the 2012 examination and in other records including the 2017 private psychologist report, including inability to establish and maintain effective relationships and impaired impulse control, are contemplated in the 70 percent rating assigned. Accordingly, the criteria for a 100 percent rating have not been more nearly approximated. Without evidence of more serious social impairment, a higher rating is not warranted. Overall, the Veteran has not demonstrated symptoms consistent with or approximating the general level of impairment warranting a 100 percent evaluation or akin to the symptoms as found in the rating criteria. Mauerhan, supra. In finding that a higher rating is not warranted, the Board has considered the Veteran’s statements regarding the severity of his psychiatric symptoms, as well as the statement from his sister on the difficulties stemming from his psychiatric disorder and the medical opinions of “total” occupational impairment. As addressed below, the Board finds that the Veteran’s PTSD with major depressive episodes contributes to his employability but nonetheless the weight of the lay and medical evidence weighs against a finding of total occupational and social impairment. Certainly, as a lay person, the Veteran is competent to attest to the symptoms that he experiences, and lay witnesses are competent to describe what they have observed. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). Generally, he has been credible in these statements supporting a 70 percent rating as well as TDIU rating (as addressed below). However, as it pertains to the specific criteria for a 100 percent schedular rating under Diagnostic Code 9411, the totality of the lay and medical evidence—when considering the type, severity and frequency of symptoms - weighs against a finding of “total” occupational and social impairment, or a level of disability more nearly approximating “total” occupational and social impairment. Regardless, with respect the overall severity of PTSD, the Board finds the medical impressions and opinions to be far more probative of the degree of impairment than the lay statements as it pertains to the extent of the overall psychological, occupational and social impairment due to PTSD. Accordingly, the Board finds that a 70 percent rating, but no higher, for PTSD to include major depressive episodes and polysubstance use disorder for all periods on appeal is warranted. In reaching this decision, the Board has considered the benefit-of-the-doubt doctrine. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). TDIU Legal Criteria Total disability will be considered to exist where there is present any impairment of mind and body that is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is unable to secure or follow a substantially gainful occupation because of service-connected disabilities, provided that the veteran meets the schedular requirements. If there is only one service-connected disability, this disability should be rated at 60 percent or more; if there are two or more disabilities, at least one should be rated at 40 percent or more with sufficient additional service-connected disabilities to bring the combination to 70 percent or more. For the purposes of one 60 percent disability or one 40 percent disability in combination, the following will be considered as one disability (1) Disabilities of one or both upper extremities, or of one or both lower extremities including the bilateral factor, if applicable (2) disabilities resulting from common etiology or a single accident (3) disabilities affecting a single body system (4) multiple injuries incurred in action, or (5) multiple disabilities incurred as a prisoner of war. 38 C.F.R. § 4.16(a). The ability to work sporadically or obtain marginal employment is not substantially gainful employment. 38 C.F.R. § 4.16(a); Moore v. Derwinski, 1 Vet. App. 356, 358 (1991). Marginal employment, i.e., earned annual income that does not exceed the poverty threshold for one person, is not considered substantially gainful employment. 38 C.F.R. § 4.16(a). In determining whether unemployability exists, consideration may be given to the veteran’s level of education, special training, and previous work experience, but it may not be given to his age or to any impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. Where the schedular criteria for TDIU is not met, a TDIU may still be awarded in all cases where service-connected disabilities preclude gainful employment regardless of the percentages awarded under 38 C.F.R. § 4.16(b). However, the Board does not have the authority to assign an extraschedular TDIU rating in the first instance, but it can review the record and determine whether an appropriate case is to be referred to the Director of Compensation Service for extraschedular consideration. Bowling v. Principi, 15 Vet. App. 1, 8-10 (2001). 2. Entitlement to a TDIU prior to August 2, 2017. A December 2018 rating decision granted the Veteran TDIU beginning August 2, 2017. The Veteran is seeking entitlement to TDIU prior to August 2017. In a March 2019 Board decision, this matter was remanded and referred to the director of compensation for extraschedular consideration. The December 2019 memorandum from the Director of Compensation concluded that the severity of the Veteran’s service-connected disabilities does not establish entitlement to TDIU prior to August 2, 2017. However, regardless of the Director’s opinion, the Veteran now meets the criteria for a schedular TDIU. The Veteran is currently service connected for PTSD with major depressive episodes and polysubstance abuse. Per the Board’s decision as set forth above, the Veteran’s PTSD has been granted a rating of 70 percent beginning from August 2011 to October 23, 2011, and from August 2012. The Veteran has a 100 percent rating beginning April 19, 2018. The Veteran is also service connected for left ear hearing loss, right eyebrow scar and hepatitis B with noncompensable ratings. Based upon the Board’s decision, the Veteran meets the criteria for entitlement to a schedular TDIU. See 38 C.F.R. § 4.16. Vocationally, the Veteran has a high school education. In an October 2017 statement, the Veteran contends that from 1986 to 2016 he worked hundreds of temporary and entry level jobs but could not maintain any position longer than three months at a time. The Veteran also asserted that he suffers memory loss due to his service-connected PTSD. A Social Security Administration Audit reflect that the Veteran’s reported earnings were under $3,000 in 2012, under $2,000 in 2013, and under $10,000 in 2016. The Veteran's reported earnings for the years in which he had earned income were below the poverty threshold for an individual under age 65. See Department of Commerce, Bureau of the Census, Poverty Thresholds, https://www.census.gov/data/tables/time-series/demo/income-poverty/historical-poverty-thresholds.html; Bowling v. Principi, 15 Vet. App. 1, 7 (2001) (substantially gainful employment refers to, at the minimum, the ability to earn a living wage, and is not engaged in substantially gainful employment if annual income below the poverty threshold for one person). Based on the Veteran’s work history and reported earnings, the evidence of record suggests that for the period prior to August 2, 2017, the Veteran has had no more than marginal employment. The Board finds that the evidence of record is in relative equipoise with respect to the Veteran’s entitlement to TDIU prior to August 2, 2017. VA treatment records opine that the Veteran’s hepatitis B and hearing loss do not interfere with the Veteran’s ability to obtain and maintain substantially gainful activity. An April 2012 VA examination noted that the Veteran’s hearing loss does not affect his ability to work. A June 2017 VA examination for hepatitis B notes no objective evidence of worsening since 2011. Moreover, there was no objective clinical evidence indicating residual liver disease, no associated complications nor sequelae as of February 2017 hepatologist. The Veteran’s skin was noted to turn yellow occasionally, with the last time begin in 2009. The Veteran was noted to have no current signs or symptoms and no incapacitating episodes due to liver disorder. With respect to the Veteran’s PTSD, a May 2017 VA examination notes that the Veteran’s PTSD results in occupational and social impairment with reduced reliability and productivity. Conversely, an August 2020 opinion vocational rehabilitation consultant F.F. opines that the Veteran has been unable to secure and follow substantially gainful employment due to his service-connected psychiatric condition and left ear hearing loss since at least August 2011. He further opined that since at least September 2011, the Veteran’s service-connected hepatitis B has further precluded the Veteran from following substantially gainful employment. F.F. also noted that the Veteran’s psychiatric disabilities interfere with his ability to maintain concentration, persistence and pace, while the Veteran’s symptoms of irritability, anger outbursts and isolative tendencies associated with his psychiatric disability render the Veteran unable to satisfy the requirements of interpersonal communication. F.F. notes that the Veteran’s hearing loss impacts productivity, pace and quality of work due to the potential for missed information. Finally, he notes that due to chronic fatigue and occasional abdominal discomfort associated with hepatitis B the Veteran would be distracted and unable to sustain concentration on work tasks for two consecutive hours. The Board finds that this opinion is adequate as it is based on a review of the evidence of record and a vocational interview with the Veteran. Moreover, the vocational consultant addressed the negative evidence of record including VA examinations which note that the Veteran’s hepatitis B and hearing loss do not have an impact on the Veteran’s ability to work. Consistent with the August 2020 opinion, as discussed above, the record shows that for the period prior to August 2017, the Veteran’s PTSD symptoms included mood swings, angry outbursts, irritability, periods of depression and intermittent suicidal ideations. Moreover, the Veteran also reported periods of impulsivity including insatiable urges to eat as well as spending sprees. The evidence also notes that the Veteran gotten into at least one altercation with a teenager at work, and at least one argument with a fellow group therapy participant. Additionally, the Veteran reported symptoms of sleep disturbance and nightmares. The August 2017 private psychologist report found the Veteran to be unemployable due to his psychiatric disorder. This evidence supports a finding that for the period prior to August 2017, the Veteran’s PTSD interferes with the Veteran’s ability to maintain concentration persistence and pace, as well as the Veteran’s ability to engage in interpersonal communication. Based on the positive and negative opinions of record, the Board finds that the evidence is in relative equipoise regarding the Veteran’s entitlement to TDIU for the period prior to August 2017. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 55-59. Finally, in rendering this determination, the Board has also considered whether the Veteran is entitled to special monthly compensation (SMC). VA has a duty to maximize benefits and therefore must consider whether an award of TDIU based on a single disability is warranted, for the sole purpose of determining eligibility to SMC at the housebound rate. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2010). SMC is payable where a veteran has a single service-connected disability rated as 100 percent disabling and has additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems. See 38 C.F.R. § 3.350(i)(1). A separate award of a TDIU predicated on a single disability may form the basis for an award of SMC. Bradley v. Peake, 22 Vet. App. 280 (2008). However, even if the Board were to determine that the Veteran’s TDIU was predicated solely on his service-connected psychiatric disorder, as the Veteran does not have service-connected disability or disabilities independently ratable at 60 percent, SMC is not warranted. Based on the foregoing, entitlement TDIU for the period prior to August 2, 2017, is granted. G. E. Wilkerson Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Alicia Wimbish 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.