Citation Nr: 21024220 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 13-04 230 DATE: April 22, 2021 ORDER Entitlement to an increased rating of 70 percent, but no higher, for posttraumatic stress disorder (PTSD), effective September 24, 2008, is granted, subject to the laws and regulations governing the payment of monetary benefits. Entitlement to an increased rating higher than 70 percent for PTSD, effective May 9, 2011, is denied. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU), effective January 12, 2010, but no earlier, is granted, subject to the laws and regulations governing the payment of monetary benefits. FINDINGS OF FACT 1. Effective September 24, 2008, the severity, frequency, and duration of the Veteran’s PTSD symptoms more closely approximate occupational and social impairment with deficiencies in most areas due to symptoms such as near continuous panic affecting the ability to function independently, appropriately, and effectively, and obsessional rituals that interfere with routine activities. 2. Effective May 9, 2011, the severity, frequency, and duration of the Veteran’s PTSD symptoms do not more closely approximate total occupational and social impairment. 3. Resolving all doubt in the Veteran’s favor, his service-connected disabilities preclude him from securing and following substantially gainful employment, effective January 12, 2010, but no earlier. CONCLUSIONS OF LAW 1. The criteria for a disability rating of 70 percent, but no higher, for PTSD are met, effective September 24, 2008. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. 2. The criteria for a disability rating in excess of 70 percent for PTSD are not met, effective May 9, 2011. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. 3. The criteria for entitlement to a TDIU are met, effective January 12, 2010, but no earlier. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341(a), 4.16 (a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1981 to July 1984. This matter comes before the Board of Veterans’ Appeals (Board) from a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ) rating decision. Although the Veteran appealed a March 2011 rating decision that denied an increased rating higher than 50 percent for PTSD, upon further review, the record shows that he has continuously prosecuted the original service connection claim for PTSD that was filed in September 24, 2008 and granted in a July 2010 rating decision. Brokowski v. Shinseki, 23 Vet. App. 79 (2009) (requiring VA to broadly construe the benefits sought by the Veteran). Thus, for purposes of this decision, the rating decision on appeal is dated July 2010 and the date of the claim is September 24, 2008. The Veteran testified before the undersigned in an April 2018 Board hearing; the hearing transcript is of record. The Board remanded the case to the AOJ in June 2018 for additional development. In September 2019, the Board denied an increased rating higher than 50 percent for PTSD prior to May 9, 2011; but granted an increased rating of 70 percent, effective May 9, 2011. The Veteran appealed the Board’s decision to the U.S. Court of Appeals for Veterans Claims (Court), and pursuant to a joint motion for partial remand (JMPR), in October 2020, the Court vacated the Board’s decision, insofar, as higher ratings were not assigned for the PTSD. The case is now returned for appellate review. The Board also remanded the issue of entitlement to a TDIU in September 2019. On remand, in a July 2020 rating decision, the AOJ granted entitlement to a TDIU, effective May 9, 2011. Given that the present increased rating appeal stems from a service connection claim for PTSD received on September 24, 2008 and the evidence raises the issue of entitlement to a TDIU prior to May 9, 2011, the issue of entitlement to a TDIU prior to May 9, 2011, is still on appeal. See Rice v. Shinseki, 22 Vet. App. 447, 454-455 (2009) (TDIU is a component of a claim for benefits related to that disability, if unemployability is raised by the evidence of record). 1. Entitlement to an increased rating higher than 50 percent for posttraumatic stress disorder (PTSD) prior to May 9, 2011 The Veteran contends that he is entitled to a rating higher than 50 percent for PTSD prior to May 9, 2011. The October 2020 JMPR notes that the Board erred in its previous decision in not considering the evidence that suggests that the Veteran experienced delusions for the period before and after May 11, 2011 [sic], including from the various statements he made about the fellow service member who stabbed him in service coming back to find him. See, e.g., January 2013, VA Form 9; October 2008 statement in support of claim for service connection for PTSD; March 2010 statement in support of claim; January 2011 statement in support of claim; testimony at April 2018 Board hearing; and May 2014 U.S. Social Security Administration (SSA) function report. Under the General Formula for Mental Disorders (General Formula), the Board must conduct a “holistic analysis” that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). The issue in this appeal is whether the Veteran’s associated symptoms caused the level of impairment required for a disability rating of 70 percent or higher, prior to May 9, 2011. The Board concludes that resolving all doubt in the Veteran’s favor, his symptoms are productive of the level of impairment required for a disability rating of 70 percent, but no higher, effective September 24, 2008, and resulted in a level of impairment that most closely approximated the level of impairment associated with a 70 percent rating. A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. A 70 percent rating is assigned when 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 worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name. The Veteran noted in an October 2008 statement (received in November 2008) in support of claim for service connection for PTSD that in service, he was asleep when a fellow service member named SPC-4 Santiago came in very intoxicated and began stabbing him while he was in bed. He recalled that he was cut from the side under his left arm and if he did not get up in time it would have been worse. He noted that he went to the hospital where he had eight stiches and that SPC-4 Santiago got a dishonorable discharge and was sent to prison. The Veteran also related the incident in a March 2010 statement in support of claim for service connection for PTSD when he noted that a soldier named Santiago cut him with a razor blade while he was lying in bed. He noted that from that moment on he could not rest at night because of the incident. He also noted that he had been through two marriages and two divorces and that he could not keep a job. In a January 2011 statement in support of claim, the Veteran noted that he got nervous around people and had to keep an eye on everybody because he did not want anyone to attack him again. He indicated that he kept reliving that night in Germany when he was attacked by another soldier for no reason. He noted that he did not even like his grandson to follow him around the house so he would have to stop and tell him not to or stop and pick him up so that he could always have him in sight. When at home alone, he would find that he would keep looking out of the window and would check out any noise. The Veteran noted on his VA-Form 9 dated in January 2013 that he knew Santiago was coming to get him so he could finish what he started. He stated that he always had to watch his back and be alert. He indicated that he did not go to church like he used to or any other place where there would be a lot of people because he could not keep his eye on all of them. SSA records include a May 2014 function report on which the Veteran reported that he was afraid to leave his house because there was a soldier in his past who was trying to get him. He knew he was out there looking for him. The Veteran testified at the April 2018 Board hearing that he knew Santiago was out there; so, he always had to watch out for him. See April 2018 Board hearing transcript, p. 15. The Veteran was granted service connection for PTSD based on this stressor, as well as being in a motor vehicle accident in service where he lost consciousness. See July 2010 rating decision. In evaluating this evidence, the Veteran’s statements with respect to being afraid of encountering the fellow service member who stabbed him in service are consistent with near continuous panic affecting the ability to function independently, appropriately, and effectively. His needing to check noises at home and keep an eye out of the window also are consistent with obsessional rituals that interfere with routine activities. These two aspects of functional impairment are included with the criteria for a 70 percent rating under Diagnostic Code 9411. Other evidence of record, however, suggests more moderate impairment prior to May 9, 2011. In July 2010, the Veteran underwent a VA psychiatric examination. During the examination the Veteran reported he was fired because he missed time from work due to sleep problems, snapping at co-workers, and difficulty concentrating. The Veteran reported he was written up twice. The Veteran reported that he was married for the second time. He stated his relationship with his wife was better due to his treatment. The Veteran reported a good relationship with his three of his four children, but he had a poor relationship with one of his children. The Veteran reported he had a close relationship with his grandchildren. The Veteran denied close or causal friends. The Veteran stated he enjoyed fishing but had not done any the past year. The Veteran reported going to church once a week. The Veteran stated he did yard work for his sister-in-law and for the church. The examiner found the Veteran’s symptoms were moderate to considerable. The examiner found the Veteran’s social adaptability and interactions with others appeared to be moderately to considerably impaired. The examiner found the Veteran’s ability to maintain employment and perform job duties in a reliable, flexible, and efficient manner appeared to be moderately to considerably impaired. The examiner noted that the Veteran was sober for two months with a long history of alcohol and crack dependence and recommended the Veteran had assistance with money management until he could establish a longer period of sobriety. In February 2011, the Veteran underwent a VA psychiatric examination. The examiner found the Veteran exhibited moderate to considerable symptoms associated with his PTSD. During the examination the Veteran was alert, oriented and attentive. His mood was dysphoric, and his affect was constricted and anxious. The Veteran’s speech reflected his anxiety. The examiner found the Veteran’s thought content was devoid of current auditory or visual hallucination. The Veteran denied current thoughts of hurting himself or others. The Veteran’s memory was moderately impaired for immediate information. During the examination, the Veteran reported he no longer worked. The Veteran stated he quit his job because he could not tolerate the noise, being around people, and he was afraid of going out at night (he worked nights). The Veteran stated he was irritable and usually able to walk away. He reported problems with concentration, which slowed him down and caused him to make mistakes. The Veteran reported that he missed 15 to 20 days of work due to his PTSD. The Veteran was at his job for 3 ½ to 4 months. The Veteran reported that he was married for the second time for the past 3 ½ years. The Veteran stated he had a good relationship with his wife. The Veteran reported a fair relationship with his children and a good relationship with his grandchildren. The Veteran denied having any close friends. He was close with his mother whom he saw daily. The Veteran went to church once a week, cooked, cleaned, and went on dates with his wife. The Veteran reported he bowled once a week. Occupationally, the Veteran reportedly stopped working on January 12, 2010. See, e.g., VA 21-8940 Veterans Application for Increased Compensation based on Unemployability received in April 2011. During the July 2010 VA examination the Veteran reported he was fired because he missed time from work due to sleep problems, snapping at co-workers, and difficulty concentrating. The Veteran reported he was written up twice. The examiner found the Veteran’s ability to maintain employment and perform job duties in a reliable, flexible, and efficient manner appeared to be moderately to considerably impaired. The Veteran stated on examination in February 2011 that he quit his job because he could not tolerate the noise, being around people, and he was afraid of going out at night (he worked nights). The Veteran stated he was irritable and usually able to walk away. He reported problems with concentration, which slowed him down and caused him to make mistakes. The Veteran reported that he missed 15 to 20 days of work due to his PTSD. The Board has weighed the findings on examination in July 2010 and February 2011 of more moderate impairment with the statements and testimony of the Veteran noted above which are consistent with near continuous panic affecting the ability to function independently, appropriately, and effectively, as well as obsessional rituals that interfere with routine activities. Resolving all doubt in the Veteran’s favor, the Board finds that the criteria for the next higher 70 percent for PTSD are met, effective September 24, 2008. Overall, the severity, frequency, and duration of the Veteran’s symptoms more closely approximate occupational and social impairment with deficiencies in most areas due to symptoms such as near continuous panic affecting the ability to function independently, appropriately, and effectively, as well as obsessional rituals that interfere with routine activities. Prior to May 9, 2011, the Veteran’s symptoms did not cause the level of impairment required for a disability rating of 100 percent. The Board notes that the Veteran expressed a history suicidal ideation, which is similar to persistent danger of self-harm, which is contemplated by the 100 percent criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017). However, the severity, frequency, and duration of the Veteran’s suicidal ideation has not risen to the level contemplated by the 100 percent disability rating. The Veteran noted on an October 2009 VA treatment record that he had previously taken 10 aspirin during a relationship problem in 1994. However, he regularly denied thoughts, intent, or a plan involving self-harm in existing treatment records, and during the July 2010 and February 2011 VA examinations. While the Veteran reported being preoccupied with having an encounter with the individual who attacked him with a knife in service, there is no probative evidence that the Veteran is considered delusional as a result of his PTSD. He expressed significant fear about the fellow servicemember being out there and that he might harm the Veteran one day. Because of this fear, he would frequently look out his window and/ or check the doors to his house. He also did not like his grandchild following him around the house. This is more consistent with near continuous panic, and/ or obsessional rituals that interfere with routine activities, which are two of the criteria for a 70 percent rating for PTSD. None of the VA treatment records prior to May 9, 2011, or VA examination reports found that the Veteran was delusional. An October 2009 VA treatment record notes that there were no delusions. The February 2011 VA examiner found that the Veteran’s speech reflected his anxiety, but his thought content was devoid of current auditory or visual hallucination. The Veteran’s other remaining symptoms were either contemplated by or more consistent with a 70 percent rating. Further, while pursuant to the Board’s decision this date, the Veteran has been granted a total disability rating based on individual unemployability due to service-connected disability, effective January 12, 2010, he was not totally socially impaired. In short, while a 70 percent rating is warranted for the Veteran’s PTSD, effective September 24, 2008, the preponderance of the evidence weighs against finding that the severity, frequency, and duration of the Veteran’s symptoms resulted in the level of impairment required for a 100 percent rating. 2. Entitlement to an increased rating higher than 70 percent for PTSD, effective May 9, 2011 The Veteran contends that effective May 9, 2011, he is entitled to a 100 percent rating for his PTSD. According to the JMPR that was granted by the Court, the Board erred by not fully considering evidence demonstrating that the Veteran was unable to work due to his PTSD, effective May 9, 2011. As noted in the introduction, since the Court’s remand, the AOJ has granted entitlement to a TDIU, effective May 9, 2011. Also, pursuant to this Board decision, entitlement to a TDIU is assigned from January 2010. Thus, for purposes of this decision it is conceded that the Veteran is unable to work. The determinative issue is whether he is also totally socially impaired as of May 9, 2011. The Board concludes that the Veteran’s symptoms did not cause the level of impairment required for a disability rating of 100 percent. The Veteran’s symptoms more closely approximated the symptoms associated with a 70 percent rating and resulted in a level of impairment that most closely approximated the level of impairment associated with a 70 percent rating. An October 2011 VA examination shows the Veteran’s symptoms caused occupational and social impairment with reduced reliability and productivity. The Veteran had symptoms of anxiety; suspiciousness; chronic sleep impairment; mild memory loss; difficulty in establishing and maintaining work and social relationships; and difficulty in adapting to stressful circumstances including work and a worklike setting. The examiner found that the Veteran’s PTSD alone did not render the Veteran unable to secure or maintain employment. The examiner noted that Veteran’s PTSD caused a moderate level impairment with decreased reliability, efficiency, and difficulty relating to others. In April 2019, the Veteran underwent another VA examination. The Veteran had noted symptoms of depressed mood; anxiety; suspiciousness; panic attacks more than once a week; chronic sleep impairment, disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty adapting to stressful circumstances, including work or a work like setting; and inability to establish and maintain effective relationships. The examiner found the Veteran’s symptoms caused occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood. The examiner found that since the Veteran was last examined in 2011, the Veteran continued to live with his wife of 12 years. The examiner stated there was frequent conflict in the marriage due to the Veteran’s irritability. The Veteran isolated himself at home and stayed in his room much of the time. The examiner stated he had no friends and isolated himself socially. The Veteran went to church regularly but did not make friends. The examiner noted the Veteran last worked in 2010. The examiner stated the Veteran stopped working due to feeling overwhelmed and stressed. The examiner stated that per the medical records and the current examination the Veteran’s had significant anxiety, depressed mood, and irritability. Although the Veteran went to church regularly, he did not form friendships and he isolated himself at home. The Veteran’s anxiety and depressed mood would impair his ability to concentrate and follow through on work related activities. The Veteran’s irritability would impair his ability to get along with others in a work like environment. VA treatment records prior to December 2015 indicate that the Veteran had nightmares and sleep disturbance that would improve with medication, flashbacks; depression; was anti-motivated; avoided crowds; and was anxious and hypervigilant. The Veteran’s mental health status examination consistently demonstrated the Veteran as well groomed; cooperative with good eye contact; normal motor and speech; linear thoughts; anxious mood with congruent affect; some concentration issues; intact insight and judgment; and no suicidal or homicidal ideations. In May 2011, the Veteran’s psychiatrist stated that the Veteran was under his care for PTSD and that he was unable to work due to his PTSD disability. The Veteran also underwent an assessment by a social worker. The social worker discussed with the Veteran his inability to maintain a relationship or employment, anger episodes, and events that resulted in his incarceration for shooting someone in the back (prior to the appellate period). The Veteran described difficulty maintaining sleep, nightmares, crowd avoidance, isolation, exaggerated started response, hypervigilance, and chronic anger episodes. In January 2013, the Veteran began volunteering, but generally avoided his family during the holidays. In May 2014, the Veteran contacted VA due increased depression, but denied suicidal ideations. In September 2014, the Veteran reported his depression had worsened due to an extramarital affair. In August 2015, the Veteran reported he had family stress, marriage difficulties, and worsening sleep issues. In February 2018, the Veteran requested medication for his psychiatric disorders. The Veteran reported that he had been incarcerated for the past two years for stalking a woman he was dating. The Veteran did not report any suicidal or homicidal ideations. Since February 2018, VA treatment records indicate that the Veteran had nightmares, sleep disturbances, anxiety, hypervigilance, and irritability. Treatment records note that the Veteran was in a bowling league, volunteered, went to night school; and enjoyed spending time with his grandchildren. The Veteran’s mental health status examinations since that time indicated the Veteran was alert; well groomed; cooperative; had a depressed mood; was fully orientated; spontaneous speech and normal pattern; cognition was fully intact; affect was full range with appropriate to contact; thought process organized; judgment and insight were intact; denied hallucinations; suicidal ideation; and homicidal ideations. In April 2018, the Veteran testified at a Board hearing. The Veteran stated since he was diagnosed with PTSD his symptoms had gotten worse. The Veteran stated that his medication did not work. He stated that he did not want to be around other people. The Veteran stated that he last worked in 2010. He stated that working was caused to have emotional breakdowns and to self-medicate with drugs and alcohol. The Veteran reported that at work he would have verbal alterations with people and hit two people at work. The Veteran reported that he did not have any friends. The Veteran stated that he was estranged from two of his children. The Veteran did have a good relationship with one of his children and his grandchildren. The Veteran stated that he had homicidal thoughts. The Veteran stated that sometimes he had suicidal thoughts. The Veteran’s spouse also testified at the April 2018 Board hearing. The Veteran ‘s spouse testified they had been married for 11 years. She stated that the Veteran was very anxious. She stated that the Veteran was okay if he was around family. The Veteran’s spouse noted that they never go out except for church. VA treatment records dated from April 2019 to June 2020 note that the Veteran was working part-time at a funeral home. A March 2020 VA treatment record notes that while his anxiety level was the same and he had to apologize recently to his wife for an angry outburst, he enjoyed bowling and playing dominos with his brother. Occupationally, as noted, given that entitlement to a TDIU has been assigned, the Veteran is shown to be totally occupationally impaired in terms of assessing the severity of his PTSD. Socially, however, while the Veteran has severe impairment, he is not shown to be totally socially impaired. The Veteran continued to live with his wife of 12 years, although there was frequent conflict in the marriage due to the Veteran’s irritability. The Veteran isolated himself at home and stayed in his room much of the time. The examiner stated that he had no friends and isolated himself socially. The Veteran went to church regularly but did not make friends. In September 2014, the Veteran reported his depression had worsened due to an extramarital affair. In August 2015, the Veteran reported he had family stress, marriage difficulties, and worsening sleep issues. In February 2018, the Veteran reported that he had been incarcerated for the past two years for stalking a woman he was dating. Since February 2018, VA treatment records indicate that the Veteran had nightmares, sleep disturbances, anxiety, hypervigilance, and irritability. Treatment records also note, however, that the Veteran was in a bowling league, volunteered, went to night school; and enjoyed spending time with his grandchildren. The Veteran and his wife testified at the April 2018 Board hearing that he did not want to be around other people and that he did not have any friends. While he had a good relationship with one of his children and his grandchildren, he was estranged from two of his children. The Veteran stated that sometimes he had suicidal thoughts. The Veteran’s spouse noted that they never go out except for church. The Veteran noted on a VA treatment record in March 2020, however, that he enjoyed bowling and playing dominos with his brother. The Board finds the level of impairment caused by the Veteran’s symptoms more closely approximates the level associated with a 70 percent rating, effective May 9, 2011. The Veteran experienced occupational and social impairment with reduced reliability and productivity with deficiencies in most areas. The Board notes that the Veteran expressed suicidal ideation, which is similar to persistent danger of self-harm, which is contemplated by the 100 percent criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017). However, the severity, frequency, and duration of the Veteran’s suicidal ideation has not risen to the level contemplated by the 100 percent disability rating. The Veteran regularly denied thoughts, intent, or a plan involving self-harm in existing treatment records, and during the October 2011 and April 2019 VA examinations. In addressing the Court’s remand and the JMPR, while the Veteran was fearful of running into the fellow servicemember who stabbed him in service, his statements are more consistent with near continuous panic and/ or obsessional rituals that interfere with his ability to function independently. He was not shown to be delusional due to his PTSD symptoms. VA treatment records and VA examinations dated from August 2011 to June 2020 specifically show the Veteran did not have any delusions. While the Veteran had strained relationships and did not go out much, and also struggled with anger issues, he reportedly continued to work part-time at a funeral home. A September 2015 VA treatment record notes that he was a referee for junior high football and also did parks and recreational work. A March 2018 VA treatment record notes that he coached high school football part-time. Vocational rehabilitation records show that he entered a program to become a barber. In March 2019, he reportedly enjoyed a bowling league, going to night school, volunteering, and spending time with his grandchildren. These are not findings that rise to the level of total social impairment. In short, the preponderance of the evidence weighs against finding that the severity, frequency, and duration of the Veteran’s symptoms resulted in the level of impairment required for a 100 percent rating, effective May 9, 2011. The criteria for a 100 percent or higher rating are not met and the appeal must be denied. 3. Entitlement to a TDIU effective prior to May 9, 2011 The Veteran contends that he is unemployable because of his service-connected disabilities. He is presently assigned a TDIU, effective May 9, 2011. As a result of the grant of a 70 percent rating for PTSD in this Board decision, the Veteran meets the schedular criteria for a TDIU, effective September 24, 2008. The question for the Board is whether the Veteran’s service-connected disabilities rendered him unemployable prior to May 9, 2011. Resolving all doubt in the Veteran’s favor, the Board concludes that the preponderance of the evidence weighs in favor of finding that the Veteran’s service-connected disabilities rendered him unemployable, effective January 12, 2010, but no earlier. Total disability ratings for compensation based on individual unemployability may be assigned where the schedular rating is less than total if it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of (1) a single service-connected disability ratable at 60 percent or more, or (2) as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. See 38 C.F.R. §§ 3.340, 3.34l, 4.16(a). Entitlement to a TDIU requires the presence of impairment so severe that it is impossible for the average person to secure and follow a substantially gainful occupation. See 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. In reaching such a determination, the central inquiry is “whether the veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability.” Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Consideration may be given to the veteran’s level of education, special training, and previous work experience in arriving at a conclusion, but not to his age or the impairment caused by non-service- connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. The Court has held that the term "unable to secure and follow a substantially gainful occupation" in 38 C.F.R. § 4.16 has two components. First, there is an economic component which essentially contemplates an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. Second, there is a non-economic component dealing with the individual veteran's ability to "follow and secure" employment. For the second component, attention must be given to: (a) the veteran's history, education, skill and training, (b) the veteran's physical ability (both exertional and non-exertional) to perform the type of activities (e.g., sedentary, light, medium, heavy or very heavy) required by the occupation at issue, with relevant factors such as lifting, bending, sitting, standing, walking, climbing, grasping, typing, reaching, auditory and visual, and (c) whether the veteran has the mental ability to perform the type of activities required by the occupation at issue, with relevant factors such as memory, concentration, and ability to adapt to change, handle work place stress, get along with coworkers and demonstrate reliability and productivity. See Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). Effective September 24, 2008, the Veteran’s service-connected disabilities are (1) PTSD, rated (pursuant to this Board decision) 70 percent, effective September 24, 2008; (2) frostbite of the right foot, rated as 20 percent disabling, effective August 26, 2013; and 30 percent disabling, effective November 17, 2015; (3) frostbite of the left foot, rated as 20 percent disabling, effective August 26, 2013; and 30 percent disabling, effective November 17, 2015; (4) residuals of facial scars, rated as 10 percent disabling, effective September 2, 2011; (5) tinnitus, rated as 10 percent disabling, effective August 26, 2013; (6) painful scar of the left posterior axillary status post assault, rated as 10 percent effective August 2020. The Veteran’s combined disability rating is 70 percent, effective September 24, 2008. Thus, the Veteran’s combined schedular rating for service-connected disabilities meet the schedular criteria for a TDIU, effective September 24, 2008. See generally 38 C.F.R. § 4.25, Table I – Combined Ratings Table. While the Veteran meets the schedular criteria for a TDIU, effective September 24, 2008, he reported that stopped working on a full-time basis in January 2010. See, e.g., April 2011 VA 21-8904 Veterans Application for Increased Compensation Based on Unemployability, noting last working full-time on January 12, 2010. He listed his work history as steel fabricator, and working in a paint factory, selling furniture, and selling lumber. His highest level of education was high school. However, more recent vocational rehabilitation records note the Veteran appears to be training to become a barber. A July 2010 VA psychiatric examination notes that the Veteran reported he was fired because he missed time from work due to sleep problems, snapping at co-workers, and difficulty concentrating. The Veteran reported he was written up twice. The examiner found the Veteran’s ability to maintain employment and perform job duties in a reliable, flexible, and efficient manner appeared to be moderately to considerably impaired. A February 2011 VA psychiatric examination the Veteran reported he no longer worked. The Veteran stated he quit his job because he could not tolerate the noise, being around people, and he was afraid of going out at night (he worked nights). The Veteran stated he was irritable and usually able to walk away. He reported problems with concentration, which slowed him down and caused him to make mistakes. The Veteran reported that he missed 15 to 20 days of work due to his PTSD. The Veteran was at his job for 3 ½ to 4 months. A disability report associated with the Veteran’s SSA records in 2010 note that he reported emotional or mental problems that limited his ability to work. In May 2011, the Veteran’s psychiatrist stated that the Veteran was under his care for PTSD and that he was unable to work due to his PTSD disability. The Veteran also underwent an assessment by a social worker. The social worker discussed with the Veteran his inability to maintain a relationship or employment, anger episodes, and events that resulted in his incarceration for shooting someone in the back (prior to the appellate period). The Veteran described difficulty maintaining sleep, nightmares, crowd avoidance, isolation, exaggerated started response, hypervigilance, and chronic anger episodes. While the Veteran is in receipt of a TDIU, effective May 9, 2011, resolving all doubt in his favor, the record shows that he was unemployable prior to that date, as early as January 12, 2010, the date he reportedly stopped working full-time and met the criteria for a TDIU. While the VA examiners in July 2010 and February 2011 did not specifically find the Veteran was unemployable due to his PTSD, it was noted that his employment impairment was considerable. Moreover, a TDIU determination is left to the Board’s discretion, not a medical examiner’s discretion. See Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013). A medical examiner’s role is limited to describing the effects a disability, or disabilities, have upon a person’s ordinary activity. See Floore v. Shinseki, 26 Vet. App. 376, 381 (2013). Similarly, the Veteran is competent to report symptoms that he experiences which are observable through his senses. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). Based on the evidence of record, all doubt is resolved in the Veteran’s favor that his service-connected disabilities rendered him unemployable, effective January 12, 2010. An effective date prior to this date is not warranted, as the Veteran reportedly was working on a full-time basis at that time. See, e.g., April 2011 VA 21-8904 Veterans Application for Increased Compensation Based on Unemployability, S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Sarah B. Richmond, 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.