Citation Nr: 21014403 Decision Date: 03/12/21 Archive Date: 03/12/21 DOCKET NO. 16-45 889 DATE: March 12, 2021 ORDER Entitlement to an increased rating exceeding 30 percent from November 16, 2010, to March 6, 2012; from August 1, 2012, to October 19, 2013; and from March 1, 2014, for service-connected posttraumatic stress disorder (PTSD), for accrued benefits purposes, is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities, to include consideration on an extraschedular basis, for accrued benefits purposes, is granted. FINDINGS OF FACT 1. Throughout the rating periods on appeal, the Veteran’s PTSD was manifested by 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); his PTSD was not manifested by occupational and social impairment with reduced reliability and productivity. 2. Resolving all reasonable doubt in favor of the Veteran, the Veteran’s service-connected disabilities rendered him unable to obtain and/or maintain substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for entitlement to an increased rating exceeding 30 percent from November 16, 2010, to March 6, 2012; from August 1, 2012, to October 19, 2013; and from March 1, 2014, for PTSD, for accrued benefits purposes, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.7, 4.125, 4.126, 4.130, Diagnostic Code (DC) 9411. 2. The criteria for entitlement to a TDIU due to service-connected disabilities, to include consideration on an extraschedular basis, for accrued benefits purposes, have been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.400, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Army from May 2001 to August 2001, and from January 2003 to March 2004. He passed away in December 2014. In October 2015, the Veteran’s former wife was granted substitution as appellant for accrued benefits purposes, as custodian of their minor children; however, she passed away in February 2020. In June 2020, the Veteran’s former wife’s husband was granted substitution as appellant for accrued benefits purposes, as the new custodian of the Veteran and his former wife’s minor children. This case comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO). In December 2018, the Board issued a decision denying the appellant’s increased rating claim, and remanded the claim for TDIU. The Veteran appealed the Board’s decision to the United States Court of Appeals for Veterans Claims (CAVC), resulting in a November 2019 Joint Motion for Remand (JMR), which vacated the December 2018 Board decision as it pertained to an increased rating for PTSD, and remanded for re-adjudication consistent with its decision. In April 2020, the Board issued a death dismissal of the claims for entitlement to accrued benefits, as the former appellant died during the pendency of the appeal. Subsequently, the current appellant was granted substitution in this appeal on behalf of the former appellant and the Veteran’s minor children, and thus, the claims are properly back before the Board. 1. Entitlement to an increased rating exceeding 30 for service-connected PTSD, for accrued benefits purposes. The appellant contends that an increased rating is warranted for the Veteran’s PTSD throughout the entire period on appeal, as the evidence of record reflects symptoms of a higher rating. The Board notes that the Veteran received several temporary evaluations of 100 percent for his PTSD, however, these temporary rating periods are not on appeal. Disability ratings are determined by applying the criteria set forth in the schedule of ratings. The percentage ratings are based on the average impairment of earning capacity, and individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. When a question arises as to which of two ratings apply under a single diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. While the Veteran’s entire history is reviewed when making a disability determination, where service connection has already been established and increase in the disability rating is at issue, it is the present level of the disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). However, staged ratings are appropriate for an increase rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Additionally, if the positive evidence supporting a claim and the negative evidence indicating a denial of the claim is relatively equal, the Veteran is entitled to the benefit of the doubt. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102, 4.3. Accordingly, any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. Id. The Veteran’s PTSD has been appropriately rated under DC 9411, to which the Veteran has been given a 30 percent disability rating from November 16, 2010, to March 6, 2012, from August 1, 2012, to October 19, 2013, and from March 1, 2014. Under DC 9411, a 30 percent rating is assigned 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 such symptoms 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 rating is assigned 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 and maintaining effective work and social relationships. A higher 70 percent rating is assigned 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 of 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 an inability to establish and maintain effective relationships. The highest rating of 100 percent is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130, DC 9411. The list of symptoms under the rating criteria above are meant to be examples of symptoms that would warrant the respective rating, but are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. Mauerhan v. Principi, 16 Vet. App. 436, 442-42 (2002). However, a veteran may only qualify for a given disability rating under § 4.130 by demonstrating particular symptoms associated with that percentage, or others of similar severity, frequency, and duration, and that those symptoms have resulted in the type of occupational and social impairment associated with that percentage. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117-18 (Fed. Cir. 2013). As an initial matter, the Board notes that the appellant’s attorney asserted that the December 2014 VA examination of record is inadequate for adjudicative purposes, as it was not until this time that the Veteran was diagnosed with schizoaffective disorder and the examiner’s differentiation of symptoms associated with PTSD and those associated with schizoaffective disorder need clarification. The Board is not persuaded by this assertion. First, the attorney incorrectly noted that the Veteran’s diagnosed schizoaffective disorder began in December 2014, as the record reflects the Veteran had been treated and diagnosed with schizoaffective disorder prior to the December 2014 VA examination, specifically beginning in April 2012. See VA treatment records, April 2012. Secondly, the December 2014 examiner was very clear with the explanation that the symptoms attributable to the Veteran’s PTSD were mild and the Veteran’s non-service-connected schizoaffective disorder symptoms had increased in severity and resulted in suicidal ideation and auditory hallucinations, with consistent reporting of the Veteran’s schizoaffective disorder resulting in symptoms of delusional content, auditory hallucinations, depressive episodes, suicidal ideation, and negative symptoms such as blunted affect. Lastly, the examiner reviewed the evidence of record and conducted an in-person evaluation of the severity of the Veteran’s mental disorder symptoms at that time, to which he provided clear rationale in his description of the disability with consideration of the history of the Veteran’s psychiatric treatment and hospitalizations. Therefore, based on the above, the Board find the December 2014 VA examination is adequate for rating purposes. Medical treatment records throughout the appeal period reflect that the Veteran had continuously received treatment for his PTSD, and experienced mild to moderate symptoms of subdued affect, poor concentration, poor sleep, recurrent nightmares, low energy levels, isolation, depression, and one notation of auditory hallucinations. The medical treatment records reflect several noted hospital admissions, two of which reflect attempted suicides in June 2011 and February 2012. Additionally, the Veteran attended counseling and therapy sessions, and was prescribed several different medications for his PTSD. Lay statements submitted by the Veteran reflect his assertions of two attempted suicide attempts to try to stop the flashbacks and nightmares, and his report of being unable to hold a job due to psychiatric distress and struggling with anxiety and depression every day. See Notice of Disagreement, August 2011. Social Security Administration (SSA) records reflect the Veteran’s reports of experiencing PTSD symptoms of nightmares, trouble sleeping, survivor’s guilt, some irritability, difficulty with memory and concentration, and social withdrawal. Additionally, a mental residual functional capacity assessment noted the following moderately limited affects: ability to perform activities within a schedule, maintain regular attendance, be functional without customary tolerances, work in coordination with or proximity to others without being distracted, complete a normal workday and week without interruptions from psychologically based symptoms, accept instructions and respond appropriately to criticism from supervisors, respond appropriately to changes in the work setting, and maintain socially appropriate behavior and adhere to basic standards of neatness and cleanliness; with no affects on the ability to remember locations and work-like procedures, ability to understand and remember very short and simple instructions, ability to carry out detailed instructions, ability to sustain an ordinary routine without special supervision, and ability to make simple work-related decisions. See SSA records. In an August 2014 mental health note, the examiner observed the Veteran with a mildly dysphoric mood and mildly blunted affect, with good concentration. Recent and remote memory was grossly intact, with all other aspects of psychomotor behavior, speech, and thought processes within normal limits. The Veteran denied any auditory or visual hallucinations, delusions, or suicidal and/or homicidal ideations. See VA treatment record, August 2014. In a December 2014 VA examination, the examiner noted the Veteran’s diagnoses of PTSD, schizoaffective disorder, opiod use disorder, sedative/hypnotic/or anxiolytic use disorder, alcohol use disorder, and cocaine use disorder in early remission. Due to the Veteran having more than one mental disorder diagnosed, the examiner noted that he was able to differentiate which symptoms were attributable to each diagnosis, with the following symptoms attributable to PTSD: intrusion symptoms, physiological/psychological distress in response to trauma triggers, anger/irritability, hypervigilance, and exaggerated startle response. The Veteran’s delusional content, auditory hallucinations, depressive episodes, suicidal ideation/behavior, and negative symptoms (blunted affect) were noted to be associated with his non-service-connected schizoaffective disorder, with his substance use concerns likely exacerbating the Veteran’s delusional content, irritability/anger, depressive episodes, and his overall experience of psychiatric distress. The examiner summarized the Veteran’s PTSD symptoms as rising to the level 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 symptoms controlled by medication. The examiner noted that the Veteran’s level of impairment, relative to PTSD symptomatology, had not changed significantly since the previous examination and remained mild (notably, the Veteran experienced increased psychiatric distress and associated functional challenges since his previous C&P examination; however, the examiner considered these changes to have occurred within the context of psychopathologies unrelated to the Veteran’s service-connected condition). See C&P Exam, December 2014. Additionally, the examiner explained that the Veteran’s treatment reports indicate there had been no change in the quality of his familial/social relationships, or significant changes in educational/employment functioning, linked to his PTSD. Since the prior examination, the Veteran had divorced, but he did not link this event to his PTSD. He reported having regular visitation with his children every week (a relationship he considered to be strong and loving), and visited his parents two to three times per week (a relationship he considered to be supportive and helpful). The Veteran noted maintaining relationships with several veterans whom he spent time with during treatment, even though his social relationships were limited due to his tendency to isolate himself. The Veteran reported he stopped working due to psychiatric distress, with the examiner noting the Veteran’s difficulty in a work environment due to stress and substance abuse concerns. Id. The examiner reviewed the Veteran’s psychiatric treatment and noted the multiple episodes of hospitalization, residential treatment participation, and prescribed medications from November 2010 to October 2013, to which the examiner stated that the primary diagnoses/presenting complaints for these events were depression, psychosis/schizoaffective disorder, substance use concerns, and suicidal behavior. Notably, the Veteran denied current suicidal or homicidal ideation. Id. The examiner reported that consistent with previous examinations, the Veteran reported mild symptoms associated with PTSD, with the Veteran specifically noting that he had not experienced suicidal ideations or auditory hallucinations in a long time and did not report evidence of hallucinatory experiences during the examination. The examiner explained that the Veteran’s diagnostic picture was complex and severe, as evidenced by multiple psychiatric diagnoses and episodes of acute psychiatric care along with longer-term residential treatment, as well as the Veteran’s significant increase in psychiatric distress and general decline in psychological functioning relative to these symptoms. However, the examiner determined, based on review of the evidence of record, that the changes in the Veteran’s distress and functioning had occurred secondary to severe psychopathology and substance use concerns – concerns that were separate from the Veteran’s PTSD symptomatology. The examiner further concluded that although the Veteran had required increased level of care relative to psychotic symptoms, depression, substance use concerns, and suicidal behavior, his PTSD symptoms appeared to remain consistent with the previous examinations. Previous examinations reflect the Veteran’s symptoms were deemed to manifest in 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 relative to PTSD symptomatology, the December 2014 examiner concurred with the prior assessment and noted there was no evidence of decreased functionality due to an increase in PTSD symptoms since the prior examination. Id. Based on the above, the Board finds that an increased rating exceeding 30 percent is not warranted for the Veteran’s PTSD at any time during the period on appeal. The weight of evidence of record throughout the appeal period is not sufficient to meet the criteria for the next-higher 50 percent rating, as the severity of the Veteran’s PTSD symptoms more closely approximate that of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks; which is commensurate of a 30 percent evaluation under DC 9411. The Board notes that the relevant medical evidence of record, to include VA treatment records and the December 2014 VA examination, shows that the Veteran’s PTSD, during the relevant period, had not manifested with symptoms of such severity, frequency, or duration as to warrant a higher 50 percent rating. While there have been some indications of irritability, angry outbursts, impaired concentration, memory loss, and suicidal attempts, the Board finds that such does not rise to the level which would warrant a finding that he had reduced reliability and productivity. During the most recent December 2014 VA examination, the Veteran did not show any symptoms suggestive of the severity contemplated by a 50 percent rating. Specifically, there was no evidence of flattened affect, circumstantial, circumlocutory, or stereotyped speech, panic attacks, difficulty in understanding complex commands, impaired judgment, impaired abstract thinking, memory loss, or difficulty establishing and maintaining effective work and social relationships. In fact, there was evidence to the contrary. Although the Veteran noted irritability and isolation, he asserted that he maintained a strong and loving relationship with his children and parents, as well as several friendships; he also reported interacting with veterans whom he spent time with during treatment. Thus, it cannot be said that he had difficulty in establishing and maintaining effective relationships. Additionally, while it has been noted in the record that the Veteran had suicidal ideations and auditory hallucinations, which would be symptoms of a higher rating, the Board finds that these symptoms have not shown to rise to a level of reduced reliability/productivity, deficiencies in most areas of work/school/family relations/judgment/thinking/or mood, nor total occupational and social impairment. Indeed, the December 2014 VA examiner specifically noted these symptoms to be associated with Veteran’s non-service-connected disorder. Furthermore, while the record revealed notations of the Veteran’s PTSD symptoms being of a moderate severity level, the Board notes that, when considered with the evidence in its totality, these notations are outweighed by the December 2014 VA examiner, who explicitly stated that the Veteran’s symptoms had not changed significantly from previous examinations, which remained of a mild symptomatology. The Board finds the December 2014 examiner’s opinions to be highly probative evidence, which weighs against the claim, as it was provided by a competent psychologist who reviewed all of the medical records, including consideration of the Veteran’s lay assertions in conjunction with an examination of the Veteran. The December 2014 examiner provided adequate rationale, and the facts discussed by the examiner accurately reflect the medical evidence of record. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Moreover, the medical evidence associated with the description of the Veteran’s PTSD as “moderate” does not indicate that his symptoms were of such a severity to warrant a higher rating. Indeed, the November 2013, August 2014, September 2014, November 2014, and December 2014 VA treatment records, in which the examiners characterized the Veteran’s PTSD symptoms as moderate, do not reflect symptoms specifically attributable to his PTSD that more closely approximate a rating higher than the currently assigned 30 percent evaluation. These records note the Veteran to have been without any impairment in his thought processes or reports of suicidal thoughts or hallucinations, and ultimately lack findings or reported symptoms indicative of reduced reliability and productivity, or impaired social relationships due to his PTSD. Ultimately, the ponderance of the evidence does not indicate that the frequency, severity, and duration of the Veteran’s PTSD symptoms warrant the assignment of a 50 percent rating in this case. Similarly, an even higher rating of 70 percent is not warranted as the evidence does not reflect the Veteran exhibited obsessional rituals which interfere with routine activities, speech intermittently illogical/obscure/irrelevant, near-continuous panic or depression affecting the ability to function independently, impaired impulse control, neglect of personal hygiene and appearance, difficulty adapting to stressful circumstances, or inability to establish and maintain effective relationship causing occupational and social impairment with deficiencies in most areas. Additionally, a higher rating of 100 percent is not warranted as the evidence does not reflect the Veteran exhibited 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, disorientation to time or place, or memory loss for names of close relatives, own occupation, or own name causing a total occupational and social impairment. The Board notes that the lay assertions of the Veteran have been considered. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). To the extent that the Veteran or appellant argued that a higher rating for PTSD is warranted, these assertions are outweighed by more probative evidence provided by the examination of a qualified medical professional. See Jones v. Brown, 7 Vet. App. 134, 137-138 (1994). Furthermore, the symptoms described in the Veteran’s lay statements are consistent with those noted in the VA treatment records and the examination report, which fail to show a 50 percent rating, or even higher rating, is warranted. As such, the lay statements do not provide any basis upon which to assign any higher rating. Therefore, the Board concludes, based on consideration of the medical and lay evidence, an increased rating exceeding 30 percent during any period on appeal for the Veteran’s service-connected PTSD is not warranted. In reaching this determination, the Board has considered the doctrine of giving the benefit of the doubt to the Veteran, under 38 U.S.C. § 5107 and 38 C.F.R. § 3.102, but does not find that the evidence is of such approximate balance as to warrant its applications. Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). 2. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities, to include consideration on an extraschedular basis, for accrued benefits purposes. The appellant contends that the Veteran was unemployable due to his service-connected disabilities. Generally, a TDIU rating may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation resulting from a single service-connected disability ratable at 60 percent or more, or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). In determining whether unemployability exists due to a service-connected disability or disabilities, consideration may be given to the Veteran’s level of education, special training, and previous work experience; however, age and impairment caused by nonservice-connected disabilities are not factors for consideration. Unemployability associated with advancing age or intercurrent disability may not be used as a basis for assignment of TDIU. 38 C.F.R. §§ 3.341, 4.16, 4.19. Also, it is necessary that the record reflect some factor(s) that places the Veteran in a different category than other veterans with equal ratings of disability. The sole fact that a veteran is unemployed or has difficulty obtaining employment is not enough. The ultimate question is whether the veteran can perform the physical and mental acts required by employment, not whether the veteran can find employment. See Van Hoose v. Brown, 4 Vet. App. 361 (1993). The Veteran’s service-connected disabilities include the following: PTSD, rated as 10 percent disabled from April 18, 2008, 30 percent disabled from November 16, 2010, temporary 100 percent disabled from March 6, 2012, 30 percent disabled from August 1, 2012, temporary 100 percent disabled from October 19, 2013, and 30 percent disabled from March 1, 2014; right ankle, peroneal tendon tear, rated as 20 percent disabled from June 21, 2006, temporary 100 percent disabled from December 13, 2006, and 20 percent disabled from March 1, 2007; and scar of the right ankle, rated as noncompensable from December 13, 2006. Based on this, the Veteran has a combined schedular rating of 40 percent; and therefore, does not meet the schedular requirements for TDIU under 38 C.F.R. § 4.16(a). Nevertheless, where a veteran does not meet the schedular requirements of 38 C.F.R. § 4.16(a), the Board may nevertheless refer the claim to the Director of Compensation Service (“Director”) or extraschedular consideration if the veteran is unable to secure and/or maintain substantially gainful employment by reason of service-connected disabilities. See Wages v. McDonald, 27 Vet. App. 233 (2015). In August 2019, following the December 2018 Board remand for additional development, VA forwarded the appellant’s claim to the Director for consideration under an extraschedular basis, as the Board is precluded from granting an extraschedular rating in the first instance. See Bowling v. Principi, 15 Vet. App. 1 (2001). In October 2019, the Director issued an advisory opinion, denying entitlement to TDIU on an extraschedular basis due to the Veteran’s service-connected disabilities not rising to the level of precluding gainful employment. See Miscellaneous C&P Correspondence, October 2019. Subsequently, in October 2019, the Director issued another advisory opinion requesting that the Veteran’s SSA records be provided for review. See VA Memo, October 2019. After obtaining and reviewing the SSA records, the Director issued another advisory opinion in January 2021, once again, denying entitlement to TDIU on an extraschedular basis due to the Veteran’s service-connected disabilities not rising to the level of precluding gainful employment. See VA Memo, January 2021. However, despite this denial and the Board’s requirement to obtain the Director’s decision before awarding extraschedular benefits, the Board is not bound by the Director’s decision or otherwise limited in its scope of review of that determination. See Wages at 236-38. Therefore, the Board will review the Director’s determination de novo. After review of the record, the Board finds that the Veteran’s service-connected psychiatric and right ankle disabilities rendered him unemployable. In March 2019, the former appellant submitted the requisite VA 21-8940 for TDIU, which revealed that the Veteran became unemployed in March 2012. The record reflects that the Veteran had a high school education, and previously held positions as a carpenter, cashier, laborer, and security guard. See VA Form 21-8940; see also SSA records. SSA records reflect the Veteran had difficulties squatting, standing, walking (able to walk for 2 minutes before needing to stop and rest), kneeling, talking, hearing, understanding, following directions/instructions, concentrating (able to pay attention for only 5 minutes), getting along with others, finishing what he started, and memory loss due to his service-connected right ankle disability and PTSD. Additionally, a mental residual functional capacity assessment for the Veteran’s PTSD noted the following moderately limited affects: ability to perform activities within a schedule, maintain regular attendance, be functional without customary tolerances, work in coordination with or proximity to others without being distracted, complete a normal workday and week without interruptions from psychologically based symptoms, accept instructions and respond appropriately to criticism from supervisors, respond appropriately to changes in the work setting, and maintain socially appropriate behavior and adhere to basic standards of neatness and cleanliness. See SSA records. In lay statements submitted by the Veteran and the appellant’s attorney it was noted that the Veteran could not hold a job for more than a month, with the Veteran’s conditions being deteriorated to the point that it was questionable if he would be able to successfully engage in employment, as he displayed non-existent coping skills that deterred his ability to maintain employment. See Notice of Disagreement, August 2011; see also Third-Party Correspondence, September 2012. In a December 2014 VA PTSD examination, the examiner noted the Veteran’s symptoms of intrusion, physiological/psychological distress in response to trauma triggers, anger/irritability, hypervigilance, exaggerated startle response, difficulties in a work environment due to stress and substance-use concerns, and an increase in psychiatric distress as evidenced by multiple episodes of acute psychiatric care. The examiner concluded that the Veteran had occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication. See C&P Exam, December 2014. Based on the above, to include consideration of the Veteran’s work history, education, and medical assessments, the Board notes that the VA examiner, SSA medical consultants and adjudicators, and the Veteran’s lay statements reflect that his service-connected disabilities impacted his ability to work, to the point of the Veteran being unable to obtain employment, or if he did, his employment would not be maintained long-term. Therefore, the Board finds that the probative evidence of record is in favor of the Veteran not being able to secure and/or maintain any substantially gainful occupation due to his service-connected disabilities. As such, and resolving all reasonable doubt in favor of the Veteran, the Board concludes that entitlement to TDIU on an extraschedular basis is warranted; and the claim is granted. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Hodges, Associate 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.