Citation Nr: 21014506 Decision Date: 03/12/21 Archive Date: 03/12/21 DOCKET NO. 16-54 807 DATE: March 12, 2021 ORDER Entitlement to a rating in excess of 30 percent for posttraumatic stress disorder (PTSD) prior to April 2, 2013, is denied. Entitlement to an initial rating of 70 percent, but not higher, for PTSD as of April 2, 2013, but not earlier, is granted. Entitlement to a rating in excess of 70 percent for PTSD is denied. Entitlement to an effective date of April 2, 2013, but not earlier, for a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is granted. FINDINGS OF FACT 1. Prior to April 2, 2013, service-connected PTSD was manifested by occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. 2. The evidence is at least in equipoise regarding whether service-connected PTSD was manifested by occupational and social impairment with deficiencies in most areas as of April 2, 2013. 3. At no time during the course of the appeal was service-connected PTSD manifested by total occupational and social impairment except for the period of a temporary total rating. 4. The evidence is at least in equipoise regarding whether the service-connected disabilities alone have precluded the Veteran from securing or following substantially gainful employment as of April 2, 2013. CONCLUSIONS OF LAW 1. Prior to April 2, 2013, the criteria for a rating in excess of 30 percent for PTSD were not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.130, Diagnostic Code 9411. 2. Resolving reasonable doubt in favor of the Veteran, as of April 2, 2013, but not earlier, the criteria for a 70 percent rating, but not higher, for PTSD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.7, 4.130, Diagnostic Code 9411. 3. At no time during the course of the appeal were the criteria for a rating of 100 percent for PTSD met, except for the period of a temporary total rating. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.130, Diagnostic Code 9411. 4. The criteria for an effective date of April 2, 2013, but not earlier, for TDIU are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1970 to February 1972. These matters come before the Board of Veterans' Appeals (Board) on appeal from April 2014 and April 2015 rating decisions from the Agency of Original Jurisdiction (AOJ). While on appeal, a June 2020 rating decision assigned an increased rating of 70 percent for PTSD and entitlement to TDIU, effective January 22, 2020. However, as a higher rating is available and the Veteran is presumed to seek the maximum available benefit, the claim for a higher rating remains on appeal. AB v. Brown, 6 Vet. App. 35 (1993). In March 2015 and September 2020, the Veteran’s attorney contended that the effective date of the increase to 70 percent and the grant of TDIU should have been April 2, 2013. The effective date of the increase will be considered as part of the increased rating claim. This claim was remanded in November 2019 for further development. In light of the treatment records that have been obtained and associated with the record, the obtaining of the requested examination and medical opinions, and the further adjudicatory actions taken by the AOJ, the Board finds that there has been substantial compliance with the prior remand directives. Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97 (2008); Dyment v. West, 13 Vet. App. 141 (1999). In September 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A hearing transcript is of record. In September 2020, the Veteran filed a VA Form 20-0996, Decision Review Request: Higher-Level Review for the claim. The Board notes that this request for review under the Appeals Modernization Act (AMA) is invalid, as the appeal was already certified to the Board and placed on the Board’s docket. Because jurisdiction was established in the Legacy system, the claim will continue in that system. Increased Ratings Disability ratings are determined by the application of the Department of Veterans Affairs’ (VA) Schedule for Rating Disabilities. 38 C.F.R. Part 4. 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 service and the residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321 (a), 4.1. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Under the General Rating Formula, a 30 percent rating is warranted when there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, 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; and difficulty in establishing and maintaining effective work and social relationships A 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 or depression affected 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); and inability to establish and maintain effective relationships. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130, General Rating Formula for Mental Disorders. The Board notes that in accordance with the General Rating Formula, a 100 percent rating is applicable if the manifestations of service-connected PTSD result in total occupational and social impairment. Although the rating formula lists specific symptoms that are indicative of total impairment, the symptoms listed in the rating formula are only examples, and evidence of those specific symptoms is not required to show that the Veteran is totally disabled. In rating a mental disability, VA is required to consider all symptoms that affect social and occupational functioning, and not limit consideration to those symptoms listed in the rating formula. Mauerhan v. Principi, 16 Vet. App. 436 (2002). The primary consideration is whether the manifestations of service-connected PTSD results in a level of social and occupational impairment, regardless of whether the Veteran demonstrates the symptoms listed in the rating formula. When rating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign a rating solely on the basis of social impairment. 38 C.F.R. § 4.126. In determining the appropriateness of ratings assigned to a Veteran's disability, the Global Assessment of Functioning (GAF) scores assigned by medical providers will be considered. While the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (5th Ed.) (DSM-5) does not incorporate the use of GAF scores, the Secretary of VA has specifically indicated that DSM-5 is to be applied to claims certified to the Board on or after August 4, 2014. 79 Fed. Reg. 45094 (Aug. 4, 2014). As the claim here was certified prior to that date, GAF scores, which are part of the DSM-IV, are applicable. A GAF score of 41 to 50 contemplates serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job). A GAF score of 51 to 60 contemplates moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co- workers). 1. Entitlement to increased ratings for PTSD An April 2014 rating decision established service connection for PTSD, and assigned an initial 30 percent rating, effective January 31, 2006. In March 2015, the Veteran disagreed with the rating assigned. A July 2020 rating decision assigned a 70 percent rating for PTSD, effective January 22, 2020. During the course of the appeal, a temporary total rating was assigned from November 6, 2014, to December 31, 2014. The Veteran has continued to disagree with the assigned ratings. From July 2006 to September 2006, the Veteran was hospitalized for VA residential rehabilitation treatment. He received treatment for PTSD during hospitalization. On discharge, the Veteran’s thought processes were clear; abstract reasoning, judgment, and delayed memory were within normal limits; suicidal and homicidal ideation were denied; and auditory or visual hallucinations were denied. He was noted to have moderate attention difficulties. His GAF score at discharge was 45. The report of an October 2006 VA psychiatric evaluation shows that the Veteran reported good family relationships. His affect was mildly irritable, and mood was mostly sad. He reported moderate anxiety. Memory, judgment, and insight were good. The Veteran's GAF score was 45. VA counselling records from March 2007, May 2007, September 2007, January 2008, April 2008, and July 2008 show ongoing counselling with GAF scores of 45. VA counselling records of October 2008 and January 2009 show GAF scores of 50. VA treatment notes of May 2009 report the Veteran had a constricted affect and irritable mood. He reported continued social isolation, problems with anger, and family conflict. The GAF score was 45. VA counselling notes of July 2010 show a GAF score of 50. At a November 2010 VA examination, the examiner diagnosed a mood disorder primarily characterized by irritability. The Veteran reported good relationships with his children and a marriage of many years. He was not involved in social or religious organizations. The VA examiner found the impairment best characterized as intermittent periods of occasional decrease in work efficiency and productivity especially as it relates to others. The GAF score was 60. The Veteran submitted an April 2013 Disability Benefits Questionnaire (DBQ) completed by his VA treating psychologist, Dr. N.A. Dr. N.A. found the Veteran’s occupational and social impairment best summarized as deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. The GAF score was 50. On VA examination in January 2014, the Veteran indicated generally good family relationships and that he gets along with others. He reported work as a freelance artist, but not full time. The Veteran was fairly well groomed. Affect was constricted, and mood depressed. He denied thoughts of harming himself or others and denied psychotic symptoms. The examiner characterized the PTSD as causing decreased work efficiency and ability to perform occupational tasks only during periods of significant stress. Over six weeks in November and December 2014, the Veteran was hospitalized for VA residential PTSD treatment. A November 2014 psychological assessment on admission showed linear and goal-directed thought process, good attention and concentration, and no evidence of psychosis. The December 2014 discharge summary reports good judgment and insight; more mild, calm mood; euthymic affect; and no evidence of memory impairment. During March 2015, an evaluation was conducted by a private psychologist, which included review of the claims file, VA medical records, and service records. The psychologist concluded that the Veteran had markedly impaired social and occupational functioning in most areas, such as work, family relationships, and judgment. Moreover, the psychologist found that the Veteran’s PTSD impaired his ability to stay on task and adapt to work settings. The psychologist was unaware of any occupations the Veteran could sustain and concluded that the Veteran was unemployable due to service-connected PTSD. During an August 2016 VA examination, the Veteran reported good family relationships. The Veteran was neatly groomed. Thought process was logical, linear, and goal directed. Mood was “ok” with congruent affect. No impairment in attention, concentration, or memory was observed. Insight, judgment, and impulse control were intact. The examiner found occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily. The examiner concluded that the Veteran currently had anxiety, which contributed to only mild occasional functional limitations related to PTSD. VA social work counselling notes of October 2018 report that the Veteran was seeking to improve coping skills for irritability. His speech was normal, mood was euthymic, and affect was congruent. Attention, short and long-term memory, and judgment all appeared within normal limits. VA social work notes of June 2017 show ongoing counselling. Speech was normal. Mood was slightly depressed, and affect was full. There was no evidence of thought disorder. In September 2019 testimony before the Board, the Veteran testified that he had a sometimes troubled relationship with his spouse. He stated that the PTSD was worse since the August 2016 VA examination. VA counselling notes of October 2019 state that the Veteran and his spouse had separate sections of the house. His thought process was logical; mood was overall pretty good; affect was full and brighter; insight was fair; and judgment was fair. At a January 2020 VA examination, the symptoms reported included suicidal ideation and circumstantial speech. The examiner remarked that the Veteran did not appear to pose any threat of danger or injury to self or others. The examiner found deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood. The Veteran’s PTSD has been rated 30 percent from January 31, 2006, to November 6, 2014; 100 percent from November 6, 2014, to December 31, 2014, under 38 C.F.R. § 4.29; 30 percent from January 1, 2015, to January 22, 2020; and 70 percent from January 22, 2020. The Board finds that a review of the record shows an overall impairment that more closely approximates the criteria for a 30 percent rating prior to April 2, 2013, and 70 percent as of April 2, 2013. Based on the evidence of record, the Board finds that, for the rating period prior to April 2, 2013, the Veteran’s PTSD more nearly approximated occupational and social impairment with occasional decrease in work efficiency due to such symptoms as depressed mood, anxiety, chronic sleep impairment, and mild memory loss. Specifically, May 2007 VA counselling notes show that the Veteran reported depressed mood. The October 2006 psychiatry evaluation assessed moderate anxiety and sleep impairment. The Board has considered the Veteran’s assigned GAF scores. Prior to April 2, 2013, the Veteran’s GAF scores ranged from 45 to 60, suggesting a more severe impairment. Nevertheless, these scores are inconsistent with the objective observations in the VA treatment records and VA examination reports, and therefore are not persuasive. Further, GAF scores are just one component of the Veteran's disability picture. An examiner's classification of the level of psychiatric impairment, by words or by a GAF score, is to be considered but is not determinative of the percentage rating to be assigned. 38 C.F.R. § 4.130; Barr v. Nicholson, 21 Vet. App. 303 (2007). Symptoms reflected in the record prior to April 2, 2013, were primarily depressed mood, anxiety, low frustration tolerance, and chronic sleep impairment. Social isolation was reported, but the Veteran reported a marriage of over 40 years and generally good relationships with family members. The Board finds the evidence more consistent with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, indicating a 30 percent rating. The Board also finds that, for the rating period prior to April 2, 2013, the level of occupational and social impairment due to PTSD symptoms did not meet or more nearly approximate the criteria for a higher 50 percent rating. A review of the evidence for that period of appeal is not consistent with occupational and social impairment with reduced reliability and productivity. Impairment due to symptoms such as circumstantial, circumlocutory, or stereotyped speech, panic attacks more than once a week, difficulty in understanding complex commands, impairment of short- and long-term memory, impaired judgment, and impaired abstract thinking are not described in the record at the severity, duration and frequency to support a 50 percent rating. VA inpatient records of June 2006 show “fair judgment” on admission and counselling records describe difficulty with social relationships. That evidence alone is not sufficient to support a higher rating. Therefore, the Board finds that the preponderance of the evidence is against the assignment of a rating in excess of 30 percent prior to April 2, 2013. After a review of the evidence, the Board finds that as of April 2, 2013, the weight of the competent and probative lay and medical evidence demonstrates that the service-connected PTSD has more nearly approximated occupational and social impairment with deficiencies in most areas due to such symptoms as: anxiety, social isolation, unprovoked irritability, and difficulty in adapting to stressful circumstances (including work or a worklike setting). Specifically, the April 2, 2013 DBQ states that the Veteran experienced occupational and social impairment with deficiencies in most areas due to symptoms of anxiety, impaired impulse control (such as unprovoked irritability with periods of violence) and difficulty in adapting to stressful circumstances (including work or a worklike setting). VA counselling notes of February 2014 report social isolation and a March 2015 private evaluation report constant irritability with angry outburst toward loved ones. The Board notes that the DBQ was completed by a VA psychologist and the Veteran’s treating psychologist of over ten years, therefore the Board considers the findings competent and credible. Moreover, an established counselling relationship offers the opportunity for a more thorough understanding of the Veteran’s symptoms and impairment. Thus, the Board finds the DBQ highly probative. The Board acknowledges that the November 2010, January 2014, and August 2016 VA examiners found the Veteran’s occupational and social impairment less severe. However, those findings were based on a single interview with the Veteran. In contrast, the April 2013 DBQ conclusions were reached following over ten years of interviews and treatment. Therefore, the Board finds that the weight of the probative treatment records, April 2013 DBQ from a treating psychologist, March 2015 private evaluation, and the Veteran’s hearing testimony are at least in equipoise to the findings of the November 2010, January 2014, and August 2016 examiners. Therefore, the Board finds the evidence is in relative equipoise regarding the assignment of a rating of 70 percent as of April 2, 2013. Resolving reasonable doubt in favor of the Veteran, the Board finds that entitlement to a rating of 70 percent rating as of April 2, 2013, is warranted. Thus, entitlement to a rating of 70 percent is granted as of April 2, 2013. Gilbert v. Derwinski,1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The Board also finds that throughout the period on appeal, the level of occupational and social impairment due to PTSD symptoms have not met or more nearly approximated the criteria for a higher 100 percent disability rating. The Board finds that a rating in excess of 70 percent for service-connected PTSD is not warranted at any time throughout the appeal because the severity, duration and frequency of reported symptoms do not rise to the level of total occupational and social impairment. The evidence does not suggest gross impairment in thought processes or communication; grossly inappropriate behavior; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation, or his own name. The evidence shows that the Veteran maintained familial relationships. While, the Veteran and spouse reportedly used separate areas of the home more recently, the evidence does not show total social impairment that is required to assign a 100 percent rating. The Board has considered lay statements from the Veteran regarding the severity of PTSD symptoms for the relevant period of appeal. The Veteran is competent to report symptoms, such as irritability, anxiety and depressed mood, because that requires only personal knowledge as it comes to him through his senses. Layno v. Brown, 6 Vet. App. 465 (1994). However, the opinions and observations of the Veteran do not meet the burden for higher ratings imposed by the rating criteria under 38 C.F.R. § 4.130 with respect to determining the severity of the service-connected psychiatric disability throughout the appeal. Given these facts, the Board finds that throughout the appeal, total occupational and social impairment are not shown, therefore, a rating in excess of 70 percent for PTSD must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107. 2. Entitlement to a rating in excess of 70 percent for PTSD The Board finds that throughout the period on appeal, the level of occupational and social impairment due to PTSD symptoms have not met or more nearly approximated the criteria for a higher 100 percent rating. The Board finds that a rating in excess of 70 percent for service-connected PTSD is not warranted at any time throughout the appeal because the severity, duration and frequency of reported symptoms do not rise to the level of total occupational and social impairment. The evidence does not suggest gross impairment in thought processes or communication; grossly inappropriate behavior; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation, or his own name. The Board has considered lay statements from the Veteran regarding the severity of PTSD symptoms for the relevant period of appeal. The Veteran is competent to report symptoms, such as irritability, anxiety and depressed mood, because that requires only personal knowledge as it comes to him through his senses. Layno v. Brown, 6 Vet. App. 465 (1994). However, the opinions and observations of the Veteran do not meet the burden for higher ratings imposed by the rating criteria under 38 C.F.R. § 4.130 with respect to determining the severity of his service-connected psychiatric disability throughout the appeal. Accordingly, the Board finds that throughout the appeal, total occupational and social impairment are not shown, therefore, a rating in excess of 70 percent for PTSD must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107. 3. Entitlement to an earlier effective date for TDIU Entitlement to a TDIU was originally established in a June 2020 rating decision. An effective date of January 22, 2020 was established. The Agency of Original Jurisdiction stated that January 22, 2020, was the earliest date that the Veteran's service-connected disability met the schedular requirements for consideration of the assignment of TDIU. In March 2015, the Veteran submitted a VA Form 21-8940, Veteran's Application for Increased Compensation Based on Unemployability. That form contains the Veteran's assertions that he could not work due to PTSD. The Veteran last worked full time in 1995 as an art instructor. The record indicates that the Veteran's highest level of education was a bachelor’s degree. In correspondence of March 2015 and September 2020 the Veteran’s attorney requested an earlier effective date for entitlement to a TDIU, specifically April 2, 2013. A TDIU claim is treated as a claim for increased compensation, and the effective date rules for increased compensation apply to a TDIU claim. Hurd v. West, 13 Vet. App. 449 (2000). In general, the effective date of an award of increased compensation shall be the earliest as of which it is factually ascertainable that an increase in disability had occurred, if an application is received within one year from that date. Otherwise, the effective date will be the date of VA receipt of the claim for increase, or date entitlement arose, whichever is later. 38 U.S.C. § 5110(a), (b)(2); 38 C.F.R. § 3.400(o); Harper v. Brown, 10 Vet. App. 125 (1997). Unless otherwise provided, the effective date of an award of increased rating shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of the application therefor. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400(o)(1). The effective date of an award of increased compensation may be established at the earliest date as of which it is factually ascertainable that an increase in disability had occurred, if the application for an increased rating is received within one year from that date. 38 U.S.C. § 5110(b)(2); 38 C.F.R. § 3.400(o)(2). Total disability ratings are authorized for any service-connected disability or combination of service-connected disabilities, provided the schedular rating is less than total, when the disabled person is unable to secure and maintain substantially gainful employment because of the severity of the service-connected disabilities. If there is only one service-connected disability, it must be rated at least 60 percent. If there are two or more disabilities, at least one must be rated at least 40 percent disabling and there must be sufficient additional service-connected disability to bring the combined rating to at least 70 percent. 38 C.F.R. §§ 4.15, 4.16(a). Disabilities resulting from common etiology or single accident or affecting both upper and lower extremities are considered as one collective disability for the purpose of determining whether the threshold minimum rating requirements are met. In exceptional circumstances, where the Veteran does not meet the percentage requirements, a total rating may be assigned on a showing that the individual is indeed unable to obtain or retain substantially gainful employment because of service-connected disability or disabilities. 38 C.F.R. § 4.16(b). A June 2020 rating decision established entitlement to TDIU, effective January 22, 2020, the date of a VA PTSD examination. Effective April 2, 2013, the Veteran is now service-connected for PTSD rated 70 percent. As the Veteran has a single service-connected disability rated 60 percent or more, the Veteran meets the schedular criteria for consideration of the assignment of TDIU. 38 C.F.R. § 4.16(a). Therefore, consideration of entitlement to TDIU pursuant to 38 C.F.R. § 4.16(a) is warranted. An April 2013 DBQ completed by the Veteran’s VA treating psychologist, Dr. N.A., concluded that the Veteran’s PTSD symptoms resulted in occupational and social impairment with deficiencies in most areas. Dr. N.A. noted employment problems on the DBQ. Because he is the Veteran’s VA treating psychologist, the Board finds Dr. N.A.'s opinion to be competent, credible, and persuasive. Although Dr. N.A. did not provide a detailed rationale, the finding was based on a treatment relationship of over ten years duration, which weighs in favor of the opinion and finding. In a private March 2015 vocational evaluation, after review of the Veteran's claims file, medical records, service record, and interviewing the Veteran, in an extensive, detailed report, the examiner, a former VA psychologist, concluded that the Veteran was unemployable due to service-connected PTSD. The examiner stated that the Veteran’s ability to stay on task and adapt to work settings was impaired due to PTSD. The psychologist was unaware of any occupations the Veteran could sustain and concluded that the Veteran was unemployable. The Board has reviewed the private March 2015 vocational evaluation and finds the private psychologist’s opinions to be competent, credible, and persuasive. The private psychologist concluded that the Veteran's PTSD effectively precluded the Veteran from securing or following a substantially gainful occupation. The Board finds the March 2015 opinion to be highly probative because it is supported by a detailed rationale and provided by a trained medical professional, in this case a psychologist. Further, the examiner, after review of the entire claims file, specifically identified and discussed the Veteran's occupational history and its relationship to the Veteran's disability. Accordingly, the March 2015 private opinion is found to carry significant weight. Among the factors for assessing the probative value of a medical opinion are the physician's access to the claims file and the thoroughness and detail of the opinion. Hayes v. Brown, 5 Vet. App. 60 (1993) (it is the responsibility of the Board to assess the credibility and weight to be given the evidence); Wood v. Derwinski, 1 Vet. App. 190 (1992). The probative value of medical evidence is based on the physician's knowledge and skill in analyzing the data, and the medical conclusion he reaches; as is true of any evidence, the credibility and weight to be attached to medical opinions are within the province of the Board. Guerrieri v. Brown, 4 Vet. App. 467 (1993). The Board acknowledges that there may be contradictory evidence of record. However, because of the detail and thoroughness of the private March 2015 vocational evaluation, the Board finds that the evidence is at least in equipoise regarding whether the collective impact of the service-connected disabilities precluded the Veteran from securing or following substantially gainful employment from April 2, 2013, the date the Veteran first met the schedular criteria for a TDIU. Accordingly, based on the foregoing, and resolving doubt in the Veteran's favor, the Board finds that the service-connected disability prevented the Veteran from securing or following a substantially gainful occupation consistent with his education and occupational experience since April 2, 2013, the date of which the Veteran met the schedular criteria for consideration of the assignment of TDIU. Accordingly, resolving reasonable doubt in favor of the Veteran, the Board finds that entitlement to TDIU is warranted. Thus, entitlement to a TDIU is granted as of April 2, 2013, but not earlier. Gilbert v. Derwinski,1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Duke, 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.