Citation Nr: 21022453 Decision Date: 04/15/21 Archive Date: 04/15/21 DOCKET NO. 12-15 689 DATE: April 15, 2021 ORDER For the increased rating periods from February 20, 2009 through February 28, 2017, and from July 1, 2017 through February 6, 2018, an increased disability rating of 70 percent for service-connected schizophrenia is granted; a disability rating in excess of 70 percent from February 20, 2009 through February 28, 2017, and from July 1, 2017 through September 23, 2019, is denied. From February 20, 2009 through February 6, 2018, a total disability rating for compensation purposes based on individual unemployability due to service connected disabilities (TDIU) is granted. FINDINGS OF FACT 1. During the relevant rating periods on appeal, from February 20, 2009 through February 28, 2017, and from July 1, 2017 through February 6, 2018, the severity, frequency, and duration of the symptoms of the service connected schizophrenia more nearly approximated occupational and social impairment with deficiencies in most areas. 2. During the relevant rating periods on appeal, from February 20, 2009 through February 28, 2017, and from July 1, 2017 through September 23, 2019, the severity, frequency, and duration of the symptoms of the service connected schizophrenia did not manifest as total occupational or social impairment. 3. From February 20, 2009 through February 6, 2018, the Veteran was unable to maintain substantially gainful employment as a result of service connected disabilities. CONCLUSIONS OF LAW 1. Resolving reasonable doubt in the Veteran’s favor, from February 20, 2009 through February 28, 2017, and from July 1, 2017 through February 6, 2018, the criteria for an increased disability rating of 70 percent for the service connected schizophrenia have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.3, 4.7, 4.130, Diagnostic Code 9201. 2. From February 20, 2009 through February 28, 2017, and from July 1, 2017 through September 23, 2019, the criteria for an increased disability rating in excess of 70 percent for service connected schizophrenia have not been met or more nearly approximated. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.3, 4.7, 4.130, Diagnostic Code 9201. 3. Resolving reasonable doubt in the Veteran’s favor, from February 20, 2009 through February 6, 2018, the criteria for a TDIU have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.340, 3.341, 4.15, 4.16, 4.18, 4.19, 4.25. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant, had active service from September 1975 to May 1978. This matter came before the Board of Veterans’ Appeals (Board) on appeal from a September 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. The remaining issues on appeal have been before the Board on multiple occasions. In each instance the remaining issues on appeal were remanded for additional development. Review of the record reflects that all prior remand directives have been satisfied and the instant matter is ripe for adjudication. See Stegall v. West, 11 Vet. App. 268, 271 (1998). During the course of this appeal, over the course of multiple rating decisions, the RO granted a temporary total rating for the service-connected schizophrenia for the period from March 1, 2017 through June 30, 2017, granted a 70 percent disability rating from February 6, 2018, and granted a total 100 percent disability rating from September 24, 2019. Further, in a February 2021 rating decision, the RO granted a TDIU from February 6, 2018. As such, the Board need only consider entitlement to a TDIU for the period prior to that date. The Veteran testified before a Veterans Law Judge (VLJ) during May 2014 and February 2018 video conference hearings, and transcripts of those proceeding are of record. The VLJ who presided over the May 2014 and February 2018 hearings is no longer with the Board. Accordingly, in June 2020, the Board sent the Veteran a letter offering the option to request another Board hearing within thirty days. The Veteran did not subsequently request a new hearing before the Board. 1. Increased Disability Rating for Schizophrenia Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) found in 38 C.F.R. Part 4. 38 U.S.C. § 1155. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. Where there is a question as to which of two disability 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. It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where an increase in an existing disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The relevant temporal focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. Hart v. Mansfield, 21 Vet. App. 505 (2007). Under Diagnostic Code 9201, a 30 percent rating will be assigned for a mental disability which is productive of 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, and mild memory loss (such as forgetting names, directions, recent events). A 50 percent rating will be assigned for a mental disability which is productive of occupational and social impairment with reduced reliability and productivity due to symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks occurring 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 or 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 will be assigned for occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking, or mood due to symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); and an inability to establish and maintain effective relationships. A 100 percent rating will be assigned for total occupational and social impairment due to symptoms such as gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, a persistent danger of hurting herself or others, an intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene), disorientation to time or place, and memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130. The Secretary of VA, acting within the authority to adopt and apply a schedule of ratings, chose to create one general rating formula for mental disorders. 38 U.S.C. § 1155; see 38 U.S.C. § 501 (2012); 38 C.F.R. § 4.130. By establishing one general formula to be used in rating more than 30 psychiatric disorders, there can be no doubt that the Secretary of VA anticipated that any list of symptoms justifying a particular rating would in many situations be either under- or over inclusive. The Secretary’s use of the phrase “such symptoms as,” followed by a list of examples, provides guidance as to the severity of symptoms contemplated for each rating, in addition to permitting consideration of other symptoms, particular to each veteran and disorder, and the effect of those symptoms on the claimant’s social and work situation. This construction is not inconsistent with Cohen v. Brown, 10 Vet. App. 128 (1997). See Mauerhan v. Principi, 16 Vet. App. 436, 442 (1992). 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, the rating specialist is to 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’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). See 38 C.F.R. § 4.126. If the evidence demonstrates that a claimant suffers symptoms or effects that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the diagnostic code, the appropriate, equivalent rating will be assigned. The schedular rating criteria rate by analogy psychiatric symptoms that are “like or similar to” those explicitly listed in the schedular rating criteria. Mauerhan, 16 Vet. App. at 443. The Federal Circuit has embraced the Mauerhan interpretation of the criteria for rating psychiatric disabilities. Sellers v. Principi, 372 F.3d 1318, 1326 (Fed. Cir. 2004). In Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (2013), the Federal Circuit held that VA “intended the General Rating Formula to provide a regulatory framework for placing veterans on a disability spectrum based upon their objectively observable symptoms.” The Federal Circuit stated that “a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration.” It was further noted that “§ 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas.” See also Bankhead v. Shulkin, 29 Vet. App. 10 (2017) (indicating that the Board should consider the severity, frequency, and duration of the signs and symptoms of a mental disorder when determining the appropriate rating). Having reviewed the evidence of record, lay and medical, the Board finds that, from February 20, 2009 through February 28, 2017, and from July 1, 2017 through February 6, 2018, the severity, frequency, and duration of the symptoms of the service connected schizophrenia more nearly approximated occupational and social impairment with deficiencies in most areas, to warrant the grant of an increased 70 percent disability rating for the aforementioned rating periods on appeal. The Board notes that the instant matter stems from an increased rating claim received by VA on December 7, 2009; however, the evidence of record, to include a July 2013 Vocational Assessment, supports that the Veteran first became entitled to a 70 percent disability rating during the one-year look-back period on February 20, 2009, the day following the last day on which the Veteran was able to work substantially gainful employment. See Hart, 21 Vet. App. 505. As such, the Board finds the rating period on appeal appropriately begins from February 20, 2009. VA received a Mental Capacity Assessment dated December 2009. Per the assessment report, the Veteran had a marked inability to carry out detailed instructions, maintain attention and concentration for extended periods of time, perform activities within a schedule, maintain an ordinary routine, work in coordination with others, or make simple work-related decisions. Further, the Veteran had an extreme inability to work a full day without interruption from psychiatric symptoms. The Veteran received a VA mental health examination in August 2010. At the conclusion of the examination the VA examiner found that the mental health symptoms did not result in total occupational and social impairment; however, it did cause deficiencies in most areas. Specifically, the Veteran had deficiencies in thinking, family relations, work, and mood. A new VA mental health examination was performed in June 2016. Upon examination the Veteran displayed a number of significant mental health symptoms, to include disturbances of motivation and mood, difficulty establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, including work or a worklike setting, and persistent delusions or hallucinations. While the VA examiner opined that the symptoms resulted in reduced reliability and productivity, when considering the fact that the Veteran had symptoms generally contemplated by both the 70 and 100 percent rating criteria, and when considering all the other evidence of record, the Board finds that the symptoms shown at the time of the June 2016 VA mental health examination were of a severity, frequency, and duration more in line with occupational and social impairment with deficiencies in most area. The Veteran testified at a February 2018 Board videoconference hearing. At that time, the Veteran testified to continuing to hear voices. Further, the Veteran testified to no longer having much of a social life. While the Veteran continued to work a part-time job as a security guard/monitor, the Veteran testified to having significant difficulties at work. During free time, the Veteran would stay indoors due to paranoid delusions concerning people wanting to kill him. Further, the Veteran testified to having severe anger issues two to three times per month (like or similar to impaired impulse control). In fact, on one occasion the Veteran pulled a gun on a panhandler who was harassing him for not giving the panhandler money. As the Veteran did not assault the panhandler, and as the Veteran credibly testified to not having any further incidents involving the gun, the Board does not find that the Veteran’s anger issues caused him to be a persistent danger of hurting others. The Board notes that throughout the course of this appeal VA has received extensive lay and medical evidence, to include VA and private treatment records and various lay statements and testimony. While there is some conflicting evidence of record, overall, the evidence supports that the Veteran mental health symptoms during the relevant rating periods on appeal were of such severity frequency and duration to result in occupational and social impairment with deficiencies in most areas. After a review of all the evidence, lay and medical, the Board finds that, from February 20, 2009 through February 28, 2017, and from July 1, 2017 through February 6, 2018, the severity, frequency, and duration of the symptoms of the service connected schizophrenia more nearly approximated occupational and social impairment with deficiencies in most areas, as required for a disability rating of 70 percent under Diagnostic Code 9201. As discussed above, a VA examiner in August 2010 specifically found that the Veteran’s mental health symptoms resulted in deficiencies in most areas, and a significant portion of the lay and medical evidence of record, to include VA and private treatment records and various lay statements and testimony, support such a finding. For these reasons, resolving all reasonable doubt in favor of the Veteran, the Board finds that the lay and medical evidence shows that an increased disability rating of 70 percent is warranted for the service connected schizophrenia for the rating periods from February 20, 2009 through February 28, 2017, and from July 1, 2017 through February 6, 2018. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7, 4.130, Diagnostic Code 9201. The Board acknowledges that the schizophrenia symptoms have resulted in significant social and occupational impairment, hence, is assigning a 70 percent disability rating in the instant decision for the relevant periods on appeal that recognizes serious symptoms and serious occupational and social impairment that affects various aspects of the Veteran’s life; however, the evidence of record does not reflect that during the relevant periods on appeal the symptoms were so severe, or frequent, or of such duration to cause total occupational and social impairment to warrant a 100 percent total schedular disability rating. 38 C.F.R. §§ 4.3, 4.7. Concerning social impairment, while the evidence reflects that the Veteran is severely impaired in social functioning, the evidence does not support that such impairment is total. At the time of the August 2010 VA mental health examination, the Veteran had been living with a girlfriend for the previous three years. While they argued, they generally had a good rapport. Per the report from the June 2016 VA mental health examination, at that time the Veteran was living with his wife and 35 year old stepson. At the time of the February 2018 Board videoconference hearing, the Veteran testified to still being married, although he was withdrawn from the relationship. Further, the Veteran testified to having one friend. Such evidence shows that, while significantly impaired, the Veteran’s social functioning was not total. On the question of occupational impairment, the record reflects that, throughout a significant portion of the relevant rating period on appeal, the Veteran worked a part-time job, albeit with great difficulty. While the Veteran was unable to work a full-time schedule due to mental health symptoms, the Veteran was able to work upwards of 20 hours per week. As such, it cannot be said that during the remaining periods on appeal the Veteran’s occupational impairment was total. In fact, at the February 2018 Board videoconference hearing, the Veteran’s representative conceded that a 70 percent, rather than a 100 percent, disability rating was warranted, at least in part, based upon the fact that the Veteran was working a part time job at that time. The Board acknowledges that during the remaining periods on appeal, the Veteran had persistent delusions or hallucinations, which is commonly associated with the 100 percent rating criteria. Nonetheless, for the reasons discussed above, the evidence does not support that the Veteran had total social or occupational impairment during the relevant rating periods on appeal; therefore, the evidence does not support a finding that the Veteran’s delusions or hallucinations were of such severity, frequency, or duration to result in total social or occupational impairment. Review of all the evidence of record, lay and medical, to include VA and private treatment records and various lay statements and testimony, supports a finding that the severity, frequency, and duration of the symptoms of the service connected schizophrenia did not result in total occupational and social impairment during the increased rating period on appeal. As such, the Board finds that a total 100 percent disability rating is not warranted at any point during the rating periods from February 20, 2009 through February 28, 2017, and from July 1, 2017 through September 23, 2019. Extraschedular Claim Not Raised The Board finds that neither the Veteran nor the record has raised a claim for extraschedular rating under 38 C.F.R. § 3.321(b) for any period for the increased rating issue on appeal. See Thun v. Peake, 22 Vet. App. 111 (2008); Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record); Yancy v. McDonald, 27 Vet. App. 484, 494 (2016), citing Dingess v. Nicholson, 19 Vet. App. 473, 499 (2006), aff’d, 226 Fed. Appx. 1004 (Fed. Cir. 2007) (holding that when 38 C.F.R. § 3.321(b)(1) is not “specifically sought by the claimant nor reasonably raised by the facts found by the Board, the Board is not required to discuss whether referral is warranted”). 2. TDIU From February 20, 2009 through February 6, 2018 Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities (Rating Schedule), which is based on the average impairment of earning capacity. 38 U.S.C. § 1155. Total disability is considered to exist when there is any impairment which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. Total disability may or may not be permanent. 38 C.F.R. § 3.340(a)(1). Total ratings are authorized for any disability or combination of disabilities for which the Rating Schedule prescribes a 100 percent evaluation. 38 C.F.R. § 3.340(a)(2). TDIU may be assigned when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. The service-connected disabilities, employment history, educational and vocational attainment, and all other factors having a bearing on the issue will be addressed in both instances. 38 C.F.R. § 4.16(a),(b). If there is only one such disability, it must be rated at 60 percent or more; if there are two or more disabilities, at least one disability must be rated at 40 percent or more, with sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). For the above purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable, (2) disabilities resulting from common etiology or a single accident, (3) disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric, (4) multiple injuries incurred in action, or (5) multiple disabilities incurred as a prisoner of war. 38 C.F.R. § 4.16(a). If a veteran’s disabilities do not meet the objective combined rating percentage criteria of 38 C.F.R. § 4.16(a), it then becomes necessary to consider whether the criteria for referral for extraschedular consideration are met under § 4.16(b) criteria. It is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. Submission to the Director, Compensation and Pension Service, for extraschedular consideration is warranted in all cases of veterans who are unemployable by reason of service-connected disabilities, but who fail to meet the percentage standards set forth in § 4.16(a). 38 C.F.R. § 4.16(b). Individual unemployability must be determined without regard to any non service connected disabilities or a veteran’s advancing age. 38 C.F.R. §§ 3.341(a), 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). The sole fact that a veteran 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, but the ultimate question is whether a veteran is capable of performing the physical and mental acts required by employment, not whether a veteran can find employment. Id. at 361. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in a veteran’s favor. 38 C.F.R. § 4.3. In Faust v. West, 13 Vet. App. 342 (2000), the United States Court of Appeals for Veterans Claims (Court) defined “substantially gainful employment” as an occupation that provides an annual income that exceeds the poverty threshold for one person, irrespective of the number of hours or days that a veteran actually works and without regard to a veteran’s earned annual income. In Hatlestad v. Derwinski, 5 Vet. App. 524, 529 (1993), the Court held that the central inquiry in determining whether a veteran is entitled to a TDIU is whether a veteran’s service connected disabilities alone are of sufficient severity to produce unemployability. The determination as to whether a total disability is appropriate should not be based solely upon demonstrated difficulty in obtaining employment in one particular field, which could also potentially be due to external bases such as economic factors, but rather to all reasonably available sources of employment under the circumstances. See Ferraro v. Derwinski, 1 Vet. App. 326, 331-332 (1991). In evaluating a veteran’s employability, consideration may be given to the level of education, special training, and previous work experience in arriving at a conclusion, but not to age or impairment caused by non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. Marginal employment is not considered substantially gainful employment and generally is deemed to exist when a veteran’s earned income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. Marginal employment may also be held to exist in certain cases when earned annual income exceeds the poverty threshold on a facts-found basis. Consideration shall be given in all claims to the nature of the employment and the reason for termination. 38 C.F.R. § 4.16(a). Marginal employment, odd-job employment, and employment at half the usual remuneration is not incompatible with a determination of unemployability if the restriction to securing or retaining better employment is due to disability. 38 C.F.R. § 4.17(a). The ultimate issue of whether a TDIU should be awarded is not a medical issue, but rather is a determination for the adjudicator. See Moore v. Nicholson, 21 Vet. App. 211, 218 (2007) (ultimate question of whether a veteran is capable of substantial gainful employment is not a medical one; that determination is for the adjudicator), rev’d on other grounds sub nom, Moore v. Shinseki, 555 F.3d 1369 (Fed. Cir. 2009). Although VA must give full consideration, per 38 C.F.R. § 4.15, to “the effect of combinations of disability,” VA regulations place responsibility for the ultimate TDIU determination on VA, not a medical examiner’s opinion. Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013); 38 C.F.R. § 4.16(a); see also Smith v. Shinseki, 647 F.3d 1380, 1385-86 (Fed. Cir. 2011) (VA is not required to obtain an industrial survey from a vocational expert before making a TDIU determination but may choose to do so in an appropriate case). At the outset the Board will address the Veteran’s employment history. The evidence of record, to include multiple VA Form 21-8940, Veteran’s Application for Increased Compensation Based on Unemployability, filings, reflect that the Veteran last worked full time on February 19, 2009. Subsequently, from April 2011 though November 2019, the Veteran worked various part-time security jobs, earning approximately $850 to $1,024 per month. As discussed in the introduction, in a February 2021 rating decision, the RO awarded a TDIU from February 6, 2018, the date a 70 percent disability rating for service-connected schizophrenia was awarded. It its findings of facts, the RO specifically noted that the Veteran had been performing part-time security work and earning $1,000 per month from September 2017 to February 2019. The RO found that such earnings fell below the poverty threshold for 2017, and thus did not constitute substantially gainful employment. See Faust, 13 Vet. App. 342. The Board will not disturb this favorable finding. Concerning the TDIU period prior to September 2017, per a February 2019 VA Form 21-8940, the Veteran worked a part-time security job (16-20 hours per week) with a different security firm from April 2011 through September 2017. Per the Veteran, the highest gross earnings per month was $847.36, approximately $10,168.32 per year, which was below the poverty threshold for one person in 2011. In 2011, the federal poverty level for the 48 contiguous United States was $11,484.00. See United States Census Bureau, Poverty Thresholds, 2011, available at https://www.census.gov/data/tables/time-series/demo/income-poverty/historical-poverty-thresholds.html (last visited April 13, 2021). For these reasons, the Board finds that the Veteran was not substantially gainfully employed during the relevant TDIU rating period on appeal, from February 20, 2009 through February 6, 2018. In this case, due to the Board’s grant of an increased disability rating for the service connected schizophrenia, the combined disability rating eligibility criteria for a TDIU under 38 C.F.R. § 4.16(a) have been met for the entire rating period on appeal, from February 20, 2009 through February 6, 2018. From February 20, 2009, the Veteran had a combined disability rating of 70 percent or more, with at least one disability rated at 40 percent or more, which included service connection for schizophrenia, rated as 70 percent disabling, chronic prostatitis, rated as 10 percent disabling, and hemorrhoids and erectile dysfunction, rated as noncompensable (0 percent). See 38 C.F.R. § 4.16(a). As discussed above, during the course of this appeal VA received a Mental Capacity Assessment dated December 2009. Per the assessment report, the Veteran had a marked inability to carry out detailed instructions, maintain attention and concentration for extended periods of time, perform activities within a schedule, maintain an ordinary routine, work in coordination with others, or make simple work-related decisions. Further, the Veteran had an extreme inability to work a full day without interruption from psychiatric symptoms. During the course of this appeal, VA received a private opinion letter from the Veteran’s treating VA physician in October 2011. Per the letter, the VA physician opined that the symptoms of the service-connected schizophrenia prevented the Veteran from gainful employment. The VA physician explained that the Veteran was unable to handle normal situations such as following directions and interacting with co-workers and the general public. VA also received a private vocational assessment dated July 2013. Per the vocational assessment report, the Veteran ceased working full time in February 2009 when he was “no longer able to function effectively in the general labor market due to ongoing symptoms resultant of his psychiatric condition and behavioral difficulties and chronic incontinence due to his chronic prostatitis.” In reviewing the evidence of record, the vocational expert discussed the evidence showing that psychiatric symptoms resulted in marked limitation in the ability to perform employment responsibilities and complete a full workday. Further, the vocational expert also reviewed the evidence concerning the Veteran’s prostatitis symptoms. At the conclusion of the vocational assessment, the vocational expert opined that, since February 2009, the Veteran was unable to engage in any substantially gainful employment due to a combination of service-connected mental health symptoms and frequent urinary incontinence caused by the chronic prostatitis. Further, at the conclusion of the June 2016 VA mental health examination, the VA examiner also addressed the question of unemployability. Per the opinion report, the Veteran would not be able to work more than four hours per day due to mental health symptoms and the need to take frequent urinary breaks due to the chronic prostatitis. Additionally, at that time the Veteran no longer appeared to be able to cope with the demands of working as a security guard. It was noted that the Veteran should not be working with the public due to symptoms of anxiety and paranoia. The VA examiner went on to note that the evidence of record supported that the Veteran was no longer able to adequately perform at work. At the conclusion of the opinion the VA examiner specifically opined that the Veteran’s service-connected disability symptoms was severely impacting the Veteran’s ability to gain and maintain substantially gainful employment. Having reviewed all the evidence of record, lay and medical, the Board finds that, from February 20, 2009 through February 6, 2018, the Veteran has been unable to maintain substantially gainful employment as a result of service connected disabilities. As discussed above, the Veteran’s VA physician in October 2011 opined that the Veteran was unable to obtain or maintain substantially gainful employment due to service-connected mental health symptoms. Further, a private vocational expert in July 2013 opined that the service connected schizophrenia and chronic prostatitis would prevent engaging in any substantially gainful employment. The findings of a VA examiner in a subsequent June 2016 VA opinion report supports these employability findings. Further, additional lay and medical evidence of record, to include VA and private treatment records and various lay statements and testimony, support that the Veteran was unable to work substantially gainful employment during the period from February 20, 2009 through February 6, 2018. (Continued on the next page)   For the above reasons, and resolving reasonable doubt in favor of the Veteran, the Board finds that service-connected disabilities, specifically symptoms of the service-connected schizophrenia and chronic prostatitis, prevented the Veteran from maintaining substantially gainful employment for the period from February 20, 2009 through February 6, 2018. For these reasons, the Board finds that a TDIU is warranted from February 20, 2009 (the day after the Veteran’s last day of full-time employment) through February 6, 2018. 38 C.F.R. §§ 3.340, 3.341, 4.16. J. PARKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Blowers, 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.