Citation Nr: 21021381 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 13-09 745 DATE: April 12, 2021 ORDER Prior to March 16, 2011, an initial rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is denied. Beginning March 16, 2011, a rating of 70 percent, but no higher, for PTSD is granted. Prior to March 27, 2012, a total rating based on individual unemployability due to service connected disability (TDIU) is denied. FINDINGS OF FACT 1. For the appeal period prior to March 16, 2011, the Veteran’s PTSD manifested in occupational and social impairment with reduced reliability, and without deficiencies in most areas. 2. For the appeal period beginning March 16, 2011, the Veteran’s PTSD manifested in occupational and social impairment with deficiencies in most areas, and without total occupational and social impairment. 3. For the appeal period prior to March 27, 2012, the evidence did not show that the Veteran’s service-connected disabilities rendered him unable to obtain and maintain substantially gainful employment due to service-connected disabilities. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 50 percent prior to March 16, 2011 for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.125, 4.126, 4.130, Diagnostic Code 9411. 2. The criteria for a rating of 70 percent, but not higher, beginning March 16, 2011 for PTSD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.125, 4.126, 4.130, Diagnostic Code 9411. 3. The criteria for entitlement to a TDIU prior to March 27, 2012 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from January 1966 to November 1969, to include service in the Republic of Vietnam. These matters come to the Board of Veterans’ Appeals (Board) on appeal from an April 2011 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) Portland, Oregon. This case was most recently before the Board in January 2017, at which time the appeal was remanded to the Agency of Original Jurisdiction (AOJ) for further development. The case has now been returned to the Board for appellate action. Increased Rating for PTSD Prior to March 27, 2012 The Veteran generally contends that his psychiatric disorder symptoms are more severe than contemplated by the rating assigned. Specific argument in support of this appeal has not been provided. Disability ratings are determined by application of the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating applies. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). However, the Board must also consider staged ratings. Hart v. Mansfield, 21 Vet. App. 505, 509–10 (2007). The Veteran’s entire history is considered when assigning disability ratings. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). A review of the recorded history of a disability is necessary to make an accurate rating. 38 C.F.R. §§ 4.2, 4.41. The regulations do not give past medical reports precedence over current findings where such current findings are adequate and relevant to the rating issue. Francisco v. Brown, 7 Vet. App. 55 (1994); Powell v. West, 13 Vet. App. 31 (1999). 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). The assignment of a particular diagnostic code is dependent on the facts of a particular case. See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual’s relevant medical history, the current diagnosis, and demonstrated symptomatology. In reviewing the claim for a higher rating, the Board must consider which diagnostic code or codes are most appropriate for application in the veteran’s case and provide an explanation for the conclusion. See Tedeschi v. Brown, 7 Vet. App. 411, 414 (1995). The Veteran’s PTSD is rated under the General Rating Formula for Psychiatric Disabilities (General Rating Formula). 38 C.F.R. § 4.130. Psychiatric disabilities are rated based on the General Rating Formula codified in 38 C.F.R. § 4.130, which provides disability ratings are based on a spectrum of symptoms. “A veteran may qualify for a given disability rating by demonstrating the particular symptoms associated with that percentage, or others of a similar severity, frequency, and duration.” Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013). VA must consider all symptoms of a claimant’s condition that affect the level of occupational and social impairment, including, if applicable, those identified in the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (4th ed. 1994) (DSM-IV) and (5th ed. 2013) (DSM-5). See Mauerhan v. Principi, 16 Vet. App. 436, 442–43 (2002). VA is to engage in a holistic analysis in which it assesses the severity, frequency, and duration of the signs and symptoms of the veteran’s service-connected mental disorder; quantifies the level of occupational and social impairment caused by those signs and symptoms; and assigns an evaluation that most nearly approximates that level of occupational and social impairment. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017). Under the General Rating Formula for Mental Disorders per 38 C.F.R. § 4.130, 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-a 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. 38 C.F.R. § 4.130, Diagnostic Code 9411. A 70 percent rating is assigned for occupational and social impairment with deficiencies in most areas, such as work, school, family relationships, 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 ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. Id. 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; 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. Id. In addition, when evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the lengths of remissions, and the Veteran’s capacity for adjustment during periods of remission. 38 C.F.R. § 4.126(a). The rating agency shall assign an evaluation based on all evidence of record that bears on occupational and social impairment rather than solely on the examiner’s assessment of the level of disability at the moment of the examination. Id. However, when evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation on the basis of social impairment. The Board notes that with regard to the use of the phrase “such as” in 38 C.F.R. § 4.130 (General Rating Formula for Mental Disorders), ratings are assigned according to the manifestations of particular symptoms. However, the use of the phrase “such as” in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve only as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Accordingly, the evidence considered in determining the level of impairment under 38 C.F.R. § 4.130 is not restricted to the symptoms provided in the Diagnostic Code. Instead, VA must consider all symptoms of a claimant’s condition that affect the level of occupational and social impairment. The Board acknowledges that psychiatric examinations frequently include assignment of a global assessment of functioning (GAF) score. The American Psychiatric Association has released the Diagnostic and Statistical Manual of Mental Disorders (5th Ed.) (DSM-5), and 38 C.F.R. § 4.130 has been revised to refer to the DSM-5. The DSM-5 does not contain information regarding GAF scores. Effective August 4, 2014, VA amended the portion of its Schedule for Rating Disabilities dealing with mental disorders to remove outdated references to the DSM-IV and replace them with references to the DSM-5. See 79 Fed. Reg. 45,093, 45,094 (Aug. 4, 2014). VA adopted as final, without change, the interim final rule and clarified that the provisions of the final rule did not apply to claims that were pending before the Board, this Court, or the U.S. Court of Appeals for the Federal Circuit on August 4, 2014, even if such claims were subsequently remanded to the agency of original jurisdiction. See 80 Fed. Reg. 14,308 (Mar. 19, 2015). In Golden v. Shulkin, 29 Vet. App. 221 (2018), the Court held that given that the DSM-5 abandoned the GAF scale and that VA has formally adopted the DSM-5, the Board errs when it uses GAF scores to assign a psychiatric rating in cases where the DSM-5 applies. This appeal was certified to the Board in June 2016. As such, the DSM-5 applies, and the GAF scores will not be considered. A review of the record reveals that the Veteran sought mental health treatment from VA facilities, as well as treatment for his other health needs. To the extent that the Veteran’s treatment records contain information relevant to the severity of his mental health, to include mental health screenings, the Board will summarize this evidence. Turning to the evidence, of record is a January 2000 VA treatment record that indicates the Veteran had some mild to moderate relief from his symptoms of depression, anger, irritability, but still experienced sleep assistance and nightmares. He was self-employed with jewelry work. An additional January 2000 VA treatment record indicates the Veteran had been married for over 13 years to his third wife. He was semi-retired, and his wife shared interested in his rock and gem collecting and jewelry business. He previously worked as a police officer, and his financial status was fair. His mental status examination in January 2000 showed the Veteran was alert; fully oriented; cooperative and pleasant; presented with his wife, and they shared common interests in rocks and gems; denied history of psychiatric treatment, but began treatment at a VA clinic; no psychotic features were noted; difficulty identifying completely the symptoms a few years ago; reported stress resulting in dizziness; PTSD symptoms varying with intensity; no psychotic features noted; easily agitated; illogical anger and rage towards “Orientals”; often in control of his emotions. Of record is a February 2000 VA treatment record that indicates the Veteran reported continued problems with anger; major sleeping problems; nightmares at least twice weekly; self-isolation; avoided contact; depression; and disturbed sleep. He presented as positive, cooperative, verbal, articulate, depressed, intact cognition, related well, and did not have psychotic symptoms. Of record is a May 2000 VA treatment record that indicates the Veteran could not seem to get away from a tendency to block out content of his experiences in Vietnam. He wanted to know if he would ever change how he feels, and does not seem able to separate different emotions nor is psychologically mindful; and the Veteran did not seem to be aware of body state senses as if everything is in one bundle increasing arousal. He retained posture of appearing to function better than he actually did, and continued to be reflected by avoidance of Vietnam. VA treatment records from May 2002 to June 2004 indicate the Veteran reported some improved sleep; nightmares remained the same; less irritable; slight improvement; increased flashbacks; separation from wife due to erectile dysfunction, and anger; verbal altercations at work; improved mood; daytime fatigue; fair sleep with occasional breakthrough nightmares; and hallucinations due to medication. The Veteran indicated he was working full time, danced weekly for fun, and had built his own home. He divorced his wife during this time period, and continued to grieve his divorce. Of record is an April 2007 VA treatment record that indicates the Veteran reported “no periods of normal mood,” suicidal ideation, and that he only cared about his girlfriend. He still carried out enjoyable activities like archery. He reported a sense of hopelessness, helplessness, insomnia, sleep disruption secondary to nightmares, lethargy, and apathy. Of record is a June 2007 VA treatment record that indicates the Veteran had moved in with his girlfriend, was sleeping better, and his mood had improved. His girlfriend indicated she had a lot of debt and would not marry the Veteran for this reason. The treatment provider noted the Veteran looked good, showed obvious signs of significant hyperstartle, and quickly recovered. Of record is a June 2007 lay statement submitted by the Veteran’s girlfriend, R.F. At that time, she stated they began dating in 2006, and had a very loving and long-lasting relationship. She stated that she noticed that he was still loving, but had become a “very angry man with a lot of different emotions,” that varied from rage, depression, and apathy. She stated the Veteran would throw things or verbally lash out on occasion due to uncontrollable anger. His sleep was disturbed, and he would cry out at times, have restless legs, anxiety, and nightmares. At a January 2008 VA social and industrial survey examination, in pertinent part, the examiner noted that the purpose of the examination was to obtain information related to the Veteran’s original claim for service connection for PTSD. The Veteran presented to his appointment wearing casual clothing; appropriately groomed; maintained good eye contact; was forthcoming; mood was sad and tearful when describing his military experiences, as well as how it had been affecting him over the last 10 years; and somewhat anxious, as he was unable to sit still and had psychomotor agitation. In January 2008, the Veteran had been working in security at a casino. He had previously worked in gold and silversmith work until he had an incident when the Veteran got into a physical altercation with a young man. He stated that after the incident with the young man, the Veteran moved to Oregon, and got his security job at the casino. He has held this job for several years. The Veteran reported it was the perfect job for him as he worked early in the morning, alone, and that one of the monitors shows the door to the room where he sat preventing anyone from sneaking up on him. He reported he preferred to be by himself in a room with no windows, that he was able to see everything that was going on around him, and that he was the most comfortable. The Veteran was planning on retiring soon. With regard to his relationships, the Veteran reported in January 2008 that he had been married three times, and divorced three times. During his third marriage, they split their time between Oregon and Arizona due to the Veteran’s shoulder problems. After the incident with the young man in Arizona, the Veteran moved to Oregon and began building a home but struggled to find the motivation to get things done and completed. He began working in the casino, and was sent to California for training. When the Veteran was gone in California for training, his wife was caught having an affair resulting in the Veteran’s third divorce. The Veteran was in a new relationship and had been with his new girlfriend for two years, and she had cancer. She reported being “very concerned about him and wanting the end of her life to be enjoyable with him, but with his irritability, anger management issues, and struggles with motivation to complete things,” she was unsure if she could stay with him during the end of her life. The Veteran reported he was not very active socially, and had recently been going to support groups with other Veterans. He enjoyed the company of the other Veterans, and could tolerate it for thirty to forty-five minutes, but would then have to go home due to anxiety. The Veteran reported enjoying hunting, fishing, and the outdoors; he reported he had little motivation to participate in those activities recently. The January 2008 examiner noted that the Veteran appeared to have some paranoia as the home he was building had a main room, one small window, and a metal roof so that “people cannot know what he is doing.” The Veteran was worried about satellites peering through his metal roof to see what he was doing inside of the home. The Veteran had lived in Oregon for several years, and lived with his girlfriend. The house was incomplete, it did not have a bathroom or finished kitchen. They had a living room and bedroom with a loft and working fireplace, so they were able to stay warm. They did not have hot water, and the Veteran found it difficult to find the motivation to hook up his hot water heater. Other examples of the unfinished house included unfinished floors, dirt in some parts of the house, compost toilet, no working restroom, and no sink in the kitchen. His home was located on three acres, he had little interaction with his neighbors, and the neighbors stayed away from him due to his “gruff character.” At a March 2008 VA psychiatric examination, the Veteran’s current psychosocial functioning showed the Veteran was working at a casino monitoring security screens, and had held the job for several years; the Veteran planned on retiring sometime in 2008. The Veteran was in a strained relationship, and his girlfriend had terminal cancer and had chosen to not seek further intervention. He reported he went out dancing for fun, and vaguely reported some alcohol use. The March 2008 examiner noted the Veteran reported six separate stressors, and noted that the Veteran reported having a memory resurgence after 20 years; and noted a number of inconsistencies where some stressors were not mentioned in the treatment records reviewed. The examiner noted that the description of stressor events, their exact nature, and the number of stressors was unclear and inconsistent. The examiner noted that standardized PTSD assessment showed the Veteran did not attend appropriately to item content in responding to a number of items, and therefore the test results were best assumed to be invalid. The examiner noted the scores showed a likelihood of distortion, and some indication that there was deliberate distortion. In conclusion, the examiner found the Veteran did not have a diagnosis of PTSD, and that the Veteran did not attribute symptoms clearly to the allowable and corroborated stressor events. His symptoms related were very dramatic and not verifiable. Therefore, the March 2008 examiner diagnosed major depressive disorder, recurrent, mild, or moderate with mixed personality disorder traits. VA treatment records from June 2009 to February 2010 indicate the Veteran had memories that resulted in avoiding other people; experience startle without dissociation; lightheadedness; disturbed sleep, partially by restless leg syndrome and nightmares; awakening intermittently throughout the night; gasping in sleep; awakening feeling tired; depression; lack of energy; irritability; anger; being withdrawn and isolating; helplessness; hopelessness; low self-esteem; anhedonia, with some suicidal ideation; sleep exacerbating depression; being on edge; being defensive; anxiety; intrapersonal relationship conflicts; significant anger; anticipation of danger and/or violence; seemed at ease with his treatment provider; showed willingness to move ahead with treatment; and participated in group therapy. Of record is a March 2011 private treatment record, and evaluation by S.A., M.S., LPC. At that time, S.A. noted the Veteran had anxiety; panic attacks; tension; depression; sleep disturbance; nightmares; night sweats; anger; irritability; hypervigilance; and intrusive thoughts. Mental status evaluation in the March 2011 private treatment evaluation showed the Veteran presented as clean; appropriately dressed; well-groomed; cooperative; chatty in discussing his frustration with VA; and denied delusions, but reported stress hallucinations frequently when he sees or hears things that were not there. His thought content was linear and concise; reasoning and judgment were within normal limits; he was able to express his issues clearly and responded to direct questions appropriately; able to apply focus and concentration for a period of about 60 minutes; appetite was fine and same as usual; low energy; motor activity was normal but a bit elevated; tone of voice was normal and pace was fast; sex drive was present but unable to function; awakened at night three to four times; tossed and turned, and had to sleep in a separate bed from his girlfriend; suicidal ideation when he had a shotgun held to his mouth but his brother stopped him years prior; and denied homicidal ideation. His present social context in March 2011 showed the Veteran lived with his girlfriend for five years; hardly spoke to his girlfriend, but was determined to help her at the end of her life; felt it was a chore to give his girlfriend a hug because she did not reciprocate; retired from working three years prior; never got involved with community groups; and felt hunting and fishing now felt like a chore. The Veteran reported he no longer did anything with his girlfriend; that she told him to “get out a couple times” because he treated her badly, but he denied it; they slept in separate bedrooms; still had nightmares; and felt he needed to self-isolate to prevent violence toward others. At a March 2011 VA psychiatric examination, the Veteran reported he made jewelry for several years and owned his own business, and also worked in surveillance at a local casino for several years. He reported he retired in 2007 at the age of 62, and that he had frequent conflicts due to his irritability during his working career. He reported poor concentration, easily fatigued, and suffered a loss of motivation. With regard to relationship, the Veteran reported he began dating his significant other about five years prior, and that the relationship was close and stable. She was suffering from cancer, and he had significant concern. The Veteran had been married and divorced three times, and reported all of his relationships had been damaged by his inability to get close to others. He acknowledged he had difficulty experiencing and expressing loving feelings, was easily irritated, was told he was a negative person, had little interest in social activity, did not have friends, did not socialized, and denied any history of violent or assaultive behavior. With regard to leisure activities, the Veteran reported he had lost interest in most of the things he used to enjoy, and did not have any leisure activities. At his March 2011 VA examination, the Veteran reported he received medication management for his PTSD and depression and attended two therapy groups and individual counseling as needed. Additionally, he reported he was easily fatigued; suffered from insomnia; had poor concentration’ felt worthless; and had thoughts of death and dying. He rated his typical level of depression at a 7 or an 8 out of 10 intensity. Mental status examination at his March 2011 VA examination showed the Veteran was on time; appropriately dressed; neat and well-groomed; polite; cooperative; spoke clearly and used gestures in an appropriate manner; good eye-contact; no tics or tremors noted; did not demonstrate odd or unusual behaviors or mannerisms; speech was clear and his speech patterns, tones, and non-verbal communication was appropriate; spoke with average vocabulary and expressed himself fully; no neologisms; no evidence of delusions or hallucinations; thought processes were coherent and logical, well-focused, not tangential, and no loosening of associations or flights of ideas were noted; mood was depressed; mood and affect were congruent and appropriate; with endorsed symptoms of depression without manic or hypomanic episodes; anxiety; panic; was fully oriented; intact memory; average intellect; fair concentration and attention; intact insight; appropriate judgment; appropriate impulse control; without obsessive or ritualistic behavior; without suicidal or homicidal ideation, plan, or intent; good appetite; and without any decrements in activities of daily living. The March 2011 examiner noted the Veteran retired in 2007 at the age of 62, and worked in a variety of occupations. The examiner noted the Veteran experienced significant problems with irritability, poor concentration, fatigue, and general loss of motivation associated with depression. He reported all of his relationships had been damaged by his irritability, emotional distance, and inability to have loving feelings; and expressed a general loss of motivation for social interactions. The examiner opined the Veteran’s PTSD manifested in signs and symptoms that result in deficiencies in most of the following areas such as work, school, family relations, judgment, thinking, and mood. Of record is a January 2012 private treatment provider psychiatric evaluation provided by S.A., M.S., LPC. At this time, S.A. found the Veteran had PTSD, and displayed all the symptoms of exposure, re-traumatization, avoidance, and arousal symptoms. The Veteran experienced anxiety; was “wound tight”; depressed; had problems concentrating; lacked energy to take on tasks; had a hard time “getting going”; had regular intrusive thoughts; did not sleep much; had nightmares; experienced night sweats; rage, anger, and high irritability; was cynical and suspicious of others; had a high startle rection; and had extreme hypervigilance. S.A. opined that due to the severity of his anxiety, anger problems, and depression he experienced, the Veteran should not be in the work force due to negative consequences that would happen which was why he retired years ago. S.A. noted the Veteran was only provided $700 a month through social security because he worked for himself as a gold smith in Arizona; and that he had been living in sub poverty. Additionally, in January 2012, S.A. observed the Veteran was extremely suspicious of others, depressed, hyper aroused, vigilant, always positioned himself to watch the exists and outside the office, and had severe problems with anger resulting in fights when provoked. S.A. noted the Veteran jumped every time the dog barked. The Veteran reported that he cared for his dying girlfriend until she passed, was suffering from grief, had minimal communication with her, admitted he was a difficult angry person, and was aware that he hid and isolated. He reported that he was always “looking”; anything not in place sent him into high alert; checked reflections; positioned himself to plan escape routes; checked unusual noises; and reacted with anxious survival techniques when stressed or confronted. S.A. again noted that the severity of his PTSD and depression made it doubtful he could ever function in a job. As noted above, the Veteran’s claim was most recently before the Board in January 2017, when it was remanded to the RO to afford the Veteran an additional VA examination. The directed VA examination was afforded in September 2018. At that time, the examiner found the Veteran had PTSD that was chronic and mild, and that his depression and insomnia were part and parcel with his PTSD diagnosis. The examiner noted his depression was mild, did not require medication, or caused occupational interference. The examiner opined the occupational and social impairment of his PTSD manifested in a mental condition that had been formally diagnosed, but symptoms were not severe enough either to interfere with occupational and social functioning or to require continuous medication. At his September 2018 VA examination, in pertinent part, the Veteran reported he had a girlfriend in 2006 to 2012, and she died in 2012. He owned and operated a jewelry store in Arizona from 1992 to 2008, until he sold his business. Then, he was employed at a casino, began working part-time, eventually began working full-time, and sustained employment for ten years in security surveillance. He stated he had no disciplinary actions, never missed a day at work, and voluntarily retired at age 62. He spent time at home on his property. Mental status examination from September 2018 showed the Veteran arrived on time; was accompanied by his girlfriend; was pleasant and appropriate; dressed casually and in a western style; had a prominent mustache that was consistent with his overall impression; asked for his girlfriend to join the assessment; did not need to have his chair against the wall; did not jump when his phone rang; did not react with a startle reaction to any random, unexpected noises, or voices outside of the office; did not exhibit any bizarre or unusual behaviors; thought process was logical, sequential, and goal-directed; thought content was absent any bizarre elements; described experiencing a number of dramatic stressors, any of which would be unusual but reporting that he experienced several such stressors in one tour of duty was considered very unusual; mood was essentially euthymic; affect had a broad range and was reactive, and appropriate or congruent with expressed thoughts and emotions; smiled and laughed on several occasions; was never tearful; oriented in all domains; memory was without obvious impairment; immediate recall and concentration were adequate; demonstrated an adequate fund of general information; verbal abstract reasoning was adequate; and judgment was adequate. Symptoms attributable to his PTSD at the September 2018 VA examination included depressed mod; anxiety; chronic sleep impairment; and disturbances of motivation and mood. Behavioral observations showed the Veteran was appropriately dressed; short stature, weight proportionate; no ambulation restrictions; speech was normal in rate, volume, and rhythm; psychomotor was normal; behavioral style was critical and spent a good amount of time criticizing providers and women in general; mood was euthymic, and was observed in the waiting room walking with a friend, very socially; affect was appropriate to content; eye contact was intermittent; perceptions were unimpaired; mild memory loss to dates, but was otherwise intact; good insight; good judgment; thought processes were logical and goal-directed; thought content was appropriate; and there were no suicidal or homicidal ideations. The September 2018 VA examiner noted the Veteran was gainfully employed throughout his history, and the Veteran’s reports suggested occupationally that he experienced insufficient symptoms to receive disciplinary actions, termination, or excessive absences. The examiner noted the Veteran owned and operated a jewelry store for 16 years, ending in 2008, which suggested he was able to interact appropriately with the public, employees, and others in the nature as a business owner; and his final job ended when he voluntarily resigned at age 62 without disciplinary actions, excessive absences, or any indications that he had a disability affecting his work. The Veteran noted he had friends, arrived at the appointment with his friend and neighbor, and did not appear to pose any threat of danger or injury to himself or others. Based on the foregoing, the Board finds that an initial rating in excess of 50 percent, prior to March 16, 2011, for PTSD is not warranted. In this regard, the Board finds that such disability did not manifest as occupational and social impairment with deficiencies in most areas or total occupational and social impairment. Occupational and social impairment with deficiencies in most areas was not demonstrated. Impairment to mood was demonstrated as the Veteran reported anger; significant sleeping problems; regular nightmares; self-isolation; depression; anxiety; anger; irritability; flashbacks; brief suicidal ideation; uncontrollable anger; some paranoia; social anxiety; hyperstartle; lightheadedness; lack of energy; amotivation; fatigue; helplessness; hopelessness; low self-esteem; and anhedonia. Additionally, impairment to family relations was demonstrated in the Veteran’s several divorces and strained relationship with his girlfriend. Specifically, the Veteran and his girlfriend reported that their relationship was strained due to her cancer treatments and his anger and/or irritability. The Veteran’s girlfriend indicated he was a loving person who suffered from angry outbursts. The Veteran had also reported three marriages, both that ended in divorce. However, it is not clear these separations and divorces were solely related to his PTSD. Rather, the Veteran reported his first marriage was very short (two or three months), his second marriage ended due to her criminal activities, and his third marriage ended due to her infidelity. Moreover, some impairment to work was demonstrated as the Veteran was employed throughout the period on appeal, and he did report that his psychiatric symptoms resulted in difficulty interacting with coworkers. Specifically, at his goldsmithing position, the Veteran had a verbal and physical altercation with a young man resulting in his leaving that job; and he reported he was happy with his security job because he could work alone and watch the door that led to where the Veteran sat. However, the Veteran was consistently fully and gainfully employed, and retired on his own accord. Notably, the Veteran consistently reported he planned on retiring at a certain time, and then did so without any incident related to his psychiatric symptoms. The Board notes that the Veteran has consistently presented as appropriately dressed, oriented, and did not demonstrate impaired thinking or judgment. No impairment to thinking or judgment was demonstrated or alleged by the Veteran. Judgment was not impaired as it was consistently found to be intact prior to March 16, 2011. School was not attempted during the appeal period. With regards to social impairments, the Veteran reported that he participated in group therapy for short periods of time; had some hobbies but found he did not enjoy them as much; and experienced significant difficulty in accomplishing tasks, such as finishing building his home. However, in spite of his psychiatric limitations, the Veteran continued to have a regular and consistent relationship with his girlfriend, attended support groups with other Veterans, and reported he enjoyed their company; and participated in hunting, fishing, and enjoyed the outdoors on occasion. Moreover, the Veteran did not allege, and the record does not establish, obsessional rituals which interfere with routine activities, speech that was intermittently illogical, obscure, or irrelevant, near-continuous panic or depression affecting the ability to function independently, appropriately and effectively, impaired impulse control, spatial disorientation, neglect of personal appearance and hygiene, difficulty in adapting to stressful circumstances or an inability to establish and maintain effective relationships. Therefore, a 70 percent rating is not warranted prior to March 16, 2011. However, beginning in March 16, 2011, the Board finds that a rating of 70 percent, but not higher, for PTSD is warranted. In this regard, the Board finds that such disability manifested with occupational and social impairment with deficiencies in most areas, but without total occupational and social impairment. Occupational and social impairment with deficiencies in most areas was demonstrated, beginning March 16, 2011. Specifically, the Board notes that at a March 2011 VA examination, the examiner pined the Veteran’s PTSD manifested in signs and symptoms that resulted in deficiencies in most of the following areas such as work, school, family relations, judgment, thinking, and mood. The March 2011 examiner noted the Veteran experienced significant problems with irritability, poor concentration, fatigue, and general loss of motivation associated with depression; and the Veteran reported all of his relationships had been damaged by his irritability, emotional distance, and inability to have loving feelings; and expressed a general loss of motivation for social interactions. Therefore, a 70 percent rating is warranted beginning March 16, 2011. However, the record reflects that the Veteran’s symptoms have not been consistent with total occupational and social impairment such that a 100 percent rating is warranted at any point during the appeal period. The Veteran had been consistently employed full-time until his volunteer retirement at age 62, was in long-term relationships with his third wife until their divorce, and then was in a long-term relationship with his girlfriend until her death. He stated he had no disciplinary actions at his last employment, never missed a day at work, and voluntarily retired at age 62. Such does not constitute total social impairment. Moreover, the Veteran has not displayed gross impairment in thought processes or communication nor has the record shown that he is a persistent danger of hurting himself or others or grossly inappropriate behavior. The Veteran has reported some passive and transient suicidal ideation, and denied homicidal ideations. However, homicidal or suicidal attempts were never attempted or started during the appeal period. There is no evidence that the Veteran has experienced hallucinations or delusions, or obsessive rituals. The Board notes one occasion the Veteran reported hallucinations that was as a result of medication, and he stopped taking that medication. Further, the Veteran has not displayed disorientation to time or place, or memory loss for names of close relatives, his prior occupations, or his own name. Additionally, there is no evidence or allegation that he was unable to maintain minimal personal hygiene. The Board notes that the Veteran did not have a completed bathroom in his home, nor did he have hot water; however, this did not prevent the Veteran from always presenting as adequately groomed. Mental status examinations during the appeal period consistently found the Veteran’s grooming and hygiene to be appropriate, adequate, or good. There is no evidence or allegation that the Veteran’s psychiatric symptoms manifested in interference or difficulties resulted in the inability to perform activities of daily life, to include maintenance of minimal hygiene. Moreover, this is not a disability picture indicating total occupational and social impairment at any time during the appeal period. Therefore, a 100 percent rating is not warranted for any period on appeal. In assessing the severity of his psychiatric disorder, the Board has considered the competent lay assertions regarding symptoms experienced and observed. See, e.g., Layno v. Brown, 6 Vet. App. 465, 470 (1994) and Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). However, the criteria needed to support higher ratings as the required medical findings that are within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-138 (1994). As such, the lay assertions are not considered more persuasive than the objective medical findings which, as indicated above, do not support assignment of any higher rating pursuant to any applicable criteria at any point pertinent to this appeal. The Board notes the contentions of the Veteran that his psychiatric disorder is more severe than currently shown on examination; and the Board observes that the Veteran, while competent to report his observable symptoms, he is not competent to report that his mental health symptoms are of sufficient severity to warrant a higher rating under VA’s tables for rating such disabilities because such an opinion requires medical expertise which he has not been shown to have. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Charles v. Principi, 16 Vet. App. 370 (2002). Despite the foregoing, the Board acknowledges the Veteran’s reports of psychiatric symptoms, to include difficulty with motivation, depression, less socialization, difficulty controlling his anger, difficulty with tasks, avoiding crowds, interpersonal conflicts on occasion, angry outbursts, and irritability. However, even after considering such contentions as to the effects of the disability on his daily life, the Board finds that the criteria for a higher rating are not met. See Lendenmann, supra. The Rating Schedule contemplates such impairment under the ordinary conditions of daily life. 38 C.F.R. § 4.10; see also Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007). This argument is therefore without merit. The Board has considered whether additional staged ratings under Hart, supra is appropriate; however, the Board finds that his symptomatology has been stable throughout each period on appeal. Therefore, assigning additional staged ratings is not warranted. The Veteran and/or his representative has not raised any other issues, nor have any other issues been reasonably raised by the record in regard to the increased rating claim adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017). Accordingly, the Board finds that a rating in excess of 50 percent prior to March 16, 2011 and a rating in excess of 70 percent thereafter for PTSD is not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. Entitlement to a TDIU Prior to March 27, 2012 The Veteran generally asserts he is entitled to a TDIU prior to March 27, 2012. Specific argument in support of this appeal has not been provided. Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that if there is only one such disability, such disability shall be ratable as 60 percent or more, and if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). Rating boards should submit to the Director of Compensation Service for extraschedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities but who fail to meet the percentage standards set forth in 38 C.F.R. § 4.16(a). See 38 C.F.R. § 4.16(b). Unlike the regular disability rating schedule, which is based on the average work-related impairment caused by a disability, “entitlement to a TDIU is based on an individual’s particular circumstances.” Rice v. Shinseki, 22 Vet. App. 447, 452 (2009). Therefore, when adjudicating a TDIU claim, VA must take into account the individual veteran’s education, training, and work history. Hatlestad v. Derwinski, 1 Vet. App. 164 (1991) (level of education is a factor in deciding employability); see Friscia v. Brown, 7 Vet. App. 294 (1994) (considering Veteran’s experience as a pilot, his training in business administration and computer programming, and his history of obtaining and losing 19 jobs in the previous 18 years); Beaty v. Brown, 6 Vet. App. 532 (1994) (considering Veteran’s 8th grade education and sole occupation as a farmer); Moore v. Derwinski, 1 Vet. App. 356 (1991) (considering Veteran’s master’s degree in education and his part-time work as a tutor). Age may not be considered as a factor when evaluating unemployability or intercurrent disability, and it may not be used as a basis for a total disability rating. 38 C.F.R. § 4.19. There must be a determination that the service-connected disabilities are sufficient to produce unemployability without regard to advancing age or a non-service-connected disability. 38 C.F.R. §§ 3.340, 3.341, 4.16. The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. A high rating in itself is recognition that the impairment makes it difficult to obtain or keep employment. The ultimate question, however, is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether he or she can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). In the instant case, as of the date of this decision, prior to March 16, 2011, the Veteran was service-connected for PTSD, now rated as 50 percent prior to March 16, 2011; and 70 percent from March 16, 2011 to March 27, 2012; bilateral hearing loss rated as noncompensable prior to December 16, 2011, and 50 percent thereafter; status post AC separation repair right shoulder rated as 10 percent prior to December 16, 2011, and 20 percent thereafter; tinnitus aurium rated as 10 percent; right ankle abrasion rated as noncompensable; verruca vulgaris right hand, removal cutaneous verruca right little finger rated as noncompensable; and excision stone distal submaxillary duct rated as noncompensable. His combined evaluation for compensation is 80 percent prior to March 16, 2011, and 90 percent from March 16, 2011 to March 27, 2012. Thus, the schedular criteria for TDIU have been met for the entire period on appeal. Here, the evidence is against finding that the Veteran is precluded by his service connected disability from obtaining and maintaining any form of gainful employment consistent with his education, experience, and skillset prior to March 27, 2012. The record shows that the highest level of education attained by the Veteran is high school. During service, the Veteran’s military occupational specialty (MOS) included Aircraft Repairman. His employment history is described in the preceding section and incorporated herein. Specifically, a September 2018 VA examination indicates the Veteran worked self-employed as a jeweler for 16 years until 2008, and then worked in casino security for 10 years until he voluntarily retired. The ultimate question is whether he is capable of performing the physical and mental acts required by employment, not whether he can find employment. 38 C.F.R. § 4.16(a); Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). The Board notes the psychiatric treatment records and evaluations as noted in the preceding section, and the Board’s determination of the Veteran’s claim for an increased rating for his service-connected PTSD as discussed above and incorporates such herein. In addition, turning to the evidence, a February 2000 VA treatment record indicates the Veteran self-reported he worked most of his life as an auto-electrician, and also worked as a reserve police officer for about ten years; and was currently self-employed in jewelry. He reported he had or have had the following: dropping out of jobs for no special reason or reasons; inability to advance in jobs; PTSD symptoms determine the type of job he could handle rather than being able to choose a job equal to his abilities; have had problems with anger outbursts in the work setting with co-workers; had problems concentrating at work; often fatigued at work due to sleep disturbances; not been able to find a job he could like; concentration would be a problem if he tried to study or read class materials; had given up on being able to do meaningful employment or obtain meaningful education. At a January 2008 VA social and industrial survey examination, in pertinent part, the Veteran reported a work history that included bus driver, working in a plywood factory, part-time police officer, bartender, automotive electrician, welder for a construction company, maintenance man at a truck stop, fish and game department trapper, self-employed jeweler (gold and silversmith work), and security for a casino. At his January 2008 VA examination, the Veteran reported two instances of verbal and physical altercations with others during work. Specifically, the Veteran reported he was working as a trapper for the fish and game department outside of Portland, Oregon, when he confronted and threatened a man taking pictures. Next, the Veteran reported an incident when he physically grabbed and assaulted a young man while working as a jewelry. Additionally, at his January 2008 VA examination, the Veteran reported his current security job at the casino was the “perfect job for him,” because he was able to work early mornings, alone, and could watch the door that led to him. He preferred to be by himself in a room with no windows, and he could see everything going on around him. On an average day, the Veteran reported he woke up at 4:30 and arrived at work at 5:00 a.m.; he stayed in his secure room all day, and did not go out unless it was for necessities. He felt safe in that security room where he watched the monitors for the casino. In support of his claim, the Veteran submitted a VA Form 21-8940 Veterans Application for Increased Compensation Based on Unemployability, and indicated that his PTSD prevented him from securing or following any substantially gainful employment from 2007 to the present. The Veteran reported he last worked in April 2007 in casino security surveillance, and worked 40 hours per week at this job from January 1999 to April 2007. He reported the most he earned was $2,900 a month during his casino security surveillance. The Board notes that the January 2012 private psychiatric evaluation by S.A. was described in the preceding section, and is incorporated herein. In pertinent part, S.A. opined that due to the severity of his anxiety, anger problems, and depression he experienced, the Veteran should not be in the work force due to negative consequences that would happen which was why he retired years ago, and noted that the severity of his PTSD and depression made it doubtful he could ever function in a job. At a March 2012 VA audiological examination, the examiner noted the Veteran’s bilateral hearing loss and tinnitus impacted his ability to work. With regard to his hearing loss, the examiner noted the Veteran had difficulty hearing, his ex-boss had to repeat, and he could not pick out specific noises in a crowd and avoided crowds. The examiner noted that his hearing loss would make it difficult to obtain or maintain gainful employment. Specifically, the Veteran worked as a government trapper, and his hearing loss would make it difficult to hear game when hunting. Additionally, the Veteran worked in a casino for ten years, and that the noisy environment would make it difficult to carry on a conversation or hear customers. The Veteran also reported that he had difficulty hearing his boss and would have trouble hearing in most situations, even with his hearing aids; and because of his reduced speech recognition ability, he would at times hear but not understand. The Veteran reported that his hearing loss caused him to stay away from people. The examiner remarked that his hearing loss would make it difficult to hear on the phone, and would be a significant handicap in most job situations and affect his ability to effectively communicate. With regard to tinnitus, the examiner noted it did not impact his ability to work, but that it bothered him during his daily life and resulted in the Veteran staying away from others and heard banging in his hears all the time. Based on the foregoing, the Board finds that the Veteran is not entitled to a TDIU prior to March 27, 2012. The Board has carefully considered the Veteran’s statements regarding the effects of the Veteran’s service connected PTSD on his employability. Although the Veteran experienced some limitations as a result of his service-connected disabilities, and these have been found to cause some impact on his daily functioning and earning capacity, that impact was considered in the scheduler ratings currently assigned. Simply stated, if he did not have impairment with his service connected PTSD, there would be no basis for the combined rating prior to March 27, 2012. The fact that he was having impairments or difficulties does not provide a basis to grant TDIU. Further, the Veteran himself asserted that he continued to work full-time for many years at one job, and maintained full-time employment until April 2007. The Board notes that the Veteran was employed until April 2007 as security in a casino, and had remained employed full-time with the same employer beginning in 1999. Notably, the Veteran himself asserted that he did not have any disciplinary actions, absences, and voluntarily retired at age 62. His employment history is notable that the Veteran maintained long-term regular employment with each employer, with a variety of different jobs. He was able to work for 16 years self-employed as a jeweler, which required work with the public and customers as well as his employees. Additionally, the Board notes the private evaluation by S.A. that the Veteran was unemployable as a result of his PTSD. Specifically, S.A. noted the severity of his PTSD symptoms, to include anxiety, anger, and depression. S.A. opined that the Veteran could not work or function in a job due to these negative consequences in the work force. However, the Veteran was able to secure and follow a substantially gainful occupation. Additionally, the Board notes that the private opinion by S.A. is based on incorrect facts, namely, that the Veteran retired due to the negative consequences of his psychiatric symptoms. However, the record reflects, and the Veteran himself asserted, that he voluntarily retired once he reached retirement age; the Veteran repeatedly indicated that he planned on retiring several years prior to his retirement, and then retired on his own accord. This opinion is therefore afforded little, if any, probative weight. Moreover, the Veteran was substantially and regularly employed for the entire period prior to his voluntary retirement in 2007, and was able to earn more than the poverty threshold for each year that he was employed; without any gaps in employment whatsoever. 38 C.F.R. § 4.16(a) (directing that marginal employment will be deemed to exist when earned income does not exceed the poverty threshold). With regard to his employment, the Veteran himself reported his security job was “perfect” for him, and that he was the most comfortable at this job despite his PTSD symptoms. Thus, the Board finds that his employment as a self-employed jeweler and casino security, as reported by the Veteran, was substantially gainful (i.e. not marginal). Moreover, the Board notes that the Veteran himself asserts that he was capable of employment; and throughout the period on appeal, the Veteran maintained employment and stayed with each employer for many years. Although the Veteran’s tax income data is unavailable, there is no evidence to show that his annual income fell below the poverty threshold as determined by the United States Department of Commerce, Bureau of the Census. Notably, the Veteran himself reported he had an income of $2,900 a month in his job as casino security. Marginal employment may also be held to exist, on a facts found basis that includes, but is not limited to, employment in a protected environment such as a family business or sheltered workshop when earned annual income exceeds the poverty threshold. Here, the evidence does not establish, and the Veteran has not alleged, that such employment was a family business or sheltered workshop or that such employment was for physically disabled or mentally handicapped adults. Although the Veteran asserts that his employment was precluded due to his mental health symptoms, and the Veteran is actually unemployable, the evidence demonstrates otherwise. In this regard, the Board notes the Veteran was able to maintain regular employment for many consecutive years and earned an income well above the poverty threshold. The Veteran also maintained regular employment requiring 40 hours of work on a weekly basis. Accordingly, the Board finds that considering the facts of this case, to include the hours of employment, the skills required, and the salaries provided, it is not established that the Veteran’s employment was marginal employment. The Board acknowledges that the Veteran is competent to report the symptoms of his disabilities. Barr v. Nicholson, 21 Vet. App. 303 (2007) (lay testimony is competent to establish the presence of observable symptomatology); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. Sept. 14, 2009). The Board recognizes that the Veteran has stated that he had problems with cognitive difficulties, psychiatric symptoms, and physical limitations. The evidence, however, shows that the Veteran is not unable to obtain and maintain employment due to his service-connected disabilities. Based on the foregoing, and in consideration of the pertinent medical findings, including his reports at the various VA examinations of record and during treatment at VA medical centers, where he indicated his barriers to employment included problems getting along with others, daytime fatigue, and other psychiatric symptoms, the Board finds that the Veteran is not unable to secure and follow a substantially gainful occupation by reason of his service connected disabilities. In this regard, as discussed in the preceding section, the Veteran’s PTSD has been found to result in, at most, occupational and social impairment with reduced reliability and productivity prior to March 16, 2011, and occupational and social impairment with deficiencies in most areas from March 16, 2011 to March 27, 2012. Thus, such disability is not shown to render the Veteran unable to secure or follow a substantially gainful occupation. Moreover, the Veteran’s bilateral hearing loss has been rated as noncompensable prior to December 16, 2011 and 50 percent thereafter, and as noted above, the problems form the basis of the evaluation assigned. Additionally, the Veteran does not assert that his other service-connected disabilities impacted his ability to work, and the functional impairment related to his other disabilities are not for consideration. Therefore, based on the foregoing, the Board finds that, while the Veteran’s PTSD results in some impairment in occupational functioning, which is represented by his currently ratings assigned, and such disabilities do not render him unable to secure or follow a substantially gainful occupation. Further, as noted above, the Veteran maintained regular full time employment until April 2007; and earned far above the poverty threshold. Additionally, as noted above, the Veteran’s psychiatric symptoms were stable within each applicable period upon appeal, and has manifested in occupational and social impairment in reduced reliability or deficiencies in most areas. Therefore, the Board finds that the Veteran’s service-connected disabilities do not render him unable to secure and follow a substantially gainful occupation prior to March 27, 2012. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable, and entitlement to a TDIU is not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. SONJA S. AN Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mariah N. Sim, 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.