Citation Nr: 21025017 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 15-41 806 DATE: April 27, 2021 ORDER Entitlement to an effective date of May 30, 2003, but no earlier, for the grant of service connection for posttraumatic stress disorder (PTSD) is granted. Entitlement to an evaluation in excess of 30 percent for PTSD prior to April 29, 2011, and in excess of 50 percent thereafter is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) is denied. REMANDED Entitlement to an evaluation in excess of 20 percent for diabetes mellitus, diabetic neuropathy, to include whether a separate compensable rating for neuropathy is warranted, is remanded. FINDINGS OF FACT 1. The Veteran filed an informal claim for service connection for a psychiatric disability, claimed variously as depression, insomnia, nightmares, and flashbacks, on May 30, 2003. The claim was denied in a March 2005 rating decision. 2. A February 2011 decision from the Board of Veterans’ Appeals (Board) granted the Veteran service connection for PTSD. 3. In a November 2019 decision, the Board granted the Veteran an effective date of June 2, 2003, for service connection for PTSD. Initially an October 2004 effective date was assigned and appealed, with the earlier effective date subsequently assigned. 4. Prior to April 29, 2011, the Veteran’s PTSD was manifested by mild to no more than moderate symptomatology, including anxiety, irritability, sleep disturbance, mild memory loss, resulting occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. 5. From April 29, 2011, the Veteran’s PTSD was manifest by no more than moderate symptomatology resulting in occupational and social impairment with reduced reliability and productivity; occupational and social impairment with deficiencies in most areas or total occupational and social impairment is not demonstrated at any point during the period on appeal. 6. Prior to December 22, 2016, the Veteran does not meet the schedular criteria for TDIU and his service-connected disabilities are not shown to render him unable to obtain and retain substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for entitlement to an earlier effective date for service connection for PTSD of May 30, 2003, but no earlier, have been met. 38 U.S.C. §§ 5107, 5110 (2012); 38 C.F.R. §§ 3.1, 3.151, 3.155, 3.400 (2019). 2. The criteria for an evaluation in excess of 30 percent prior to April 29, 2011, for PTSD have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.130, Diagnostic Code 9434-9411 (2019). 3. The criteria for an evaluation in excess of 50 percent after April 29, 2011, PTSD have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.1, 4.7, 4.130, Diagnostic Code 9434-9411 (2019). 4. The criteria for assignment of a TDIU prior to December 22, 2016, have not been met. 38 U.S.C. §§ 1155, 5110 (2012); 38 C.F.R. §§ 3.321, 3.400, 4.1, 4.3, 4.10, 4.16, 4.73, (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Marine Corps from September 1968 to September 1970, including service in the Republic of Vietnam. A November 2019 Board decision denied entitlement to a disability rating in excess of 30 percent for PTSD prior to April 29, 2011, and in excess of 50 percent thereafter; denied entitlement to a disability rating in excess of 20 percent for diabetes mellitus; and granted an effective date of June 2, 2003 for the grant of service connection for PTSD. The Veteran appealed to the United States Court of Appeals for Veterans Claims (Court), which remanded that decision in an October 2020 Order, based upon a Joint Motion for Partial Remand (JMPR). As an initial matter, the Board observes that in the JMPR the Court identified a clerical error in the Board’s November 2019 decision that required correction. The Court noted that the November 2019 decision contained a clerical error in a finding of fact and conclusion of law that the Veteran was not entitled to service connection for hypertension. The Board acknowledges this error and further observes that the Regional Office (RO) has since granted the Veteran entitlement to service connection for hypertension in a July 2020 rating decision, which decision has not been appealed. As such the Veteran has received a full grant of benefits for this claim. Therefore, the issue of service connection for hypertension is no longer before the Board. 1. Entitlement to an effective date prior to June 2, 2003, for the grant of service connection for PTSD The Veteran seeks entitlement to an effective date prior to June 2, 2003, for the award of service connection for PTSD. Specifically, he contends that he filed an informal claim for service connection for PTSD on May 30, 2003. Generally, the effective date of an evaluation and award of compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim, or the date entitlement arose, whichever is later. See 38 U.S.C. § 5110; 38 C.F.R. § 3.400. The effective date of an award of disability compensation shall be the day following separation from service or the date entitlement arose if the claim is received within one year of separation, otherwise the date of claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110 (b); 38 C.F.R. § 3.400 (b)(2). Prior to March 24, 2015, any communication or action, indicating intent to apply for one or more benefits under the laws administered by VA could be considered an informal claim. Such informal claim must have identified the benefit sought. 38 C.F.R. § 3.155 § (a) (as in effect prior to March 24, 2015). Historically, the Board observes that in March 2005, the RO denied the Veteran’s claim for service connection for PTSD. The Veteran appealed this denial and an April 2005 statement of the case (SOC) issued continued the prior denial. The matter was then appealed to the Board and in an October 2007 decision, the Board denied the claim. However, in a January 2008 Board decision, the Board vacated the prior denial and remanded the matter back to the RO for further development. An October 2010 supplemental statement of the case (SSOC) issued that continued the denial of the Veteran’s claim. Once again, the Veteran appealed the matter to the Board, and in a February 2011 Board decision, the Veteran’s claim for service connection for PTSD was granted. In September 2011, the RO issued a rating decision assigning the Veteran’s PTSD a 30 percent rating effective October 26, 2004, and a 50 percent rating from April 29, 2011. In November 2015, the Veteran appealed the effective date of the grant of service connection for PTSD, contending that the matter has been continuously prosecuted since filing an informal claim on May 30, 2003. In November 2019, the Board issued a decision granting the Veteran an earlier effective date of June 2, 2003, for the grant of service connection for PTSD. Finally, the Veteran appealed to the Court, which remanded the matter back to the Board to analyze the Veteran’s contention that he filed an informal claim on May 30, 2003. After careful consideration of the record, the Board finds that VA received an informal claim for service connection for PTSD on May 30, 2003. Specifically, the Veteran’s representative at the time submitted a document indicating the Veteran’s filing of an informal claim for variously claimed psychiatric disorders which have since been characterized as PTSD. Pursuant to 38 C.F.R. § 3.400, this is the earliest date for which service connection may be granted based on a reopened claim. Therefore, the Board finds that the appropriate effective date for the claim for service connection for PTSD is May 30, 2003. 2. Entitlement to an evaluation in excess of 30 percent for posttraumatic stress disorder (PTSD) prior to April 29, 2011, and in excess of 50 percent thereafter Board decisions must be based on the entire record, with consideration of all the evidence. 38 U.S.C. § 7104. The law requires only that the Board address its reasons for rejecting evidence favorable to the claimant. Timberlake v. Gober, 14 Vet. App. 122 (2000). The Board must review the entire record but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000). It is VA’s defined and consistently applied policy 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 service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt it is meant that an approximate balance of positive and negative evidence exists which does not satisfactorily prove or disprove the claim. Reasonable doubt is a substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Disability evaluations are determined by comparing a Veteran’s present symptomatology with criteria set forth in the VA’s Schedule for Rating Disabilities (Rating Schedule), which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran’s entire history is reviewed when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Evidence to be considered in the appeal of the assignment of a disability rating is not limited to that reflecting the then current severity of the disorder. Fenderson v. West, 12 Vet. App. 119 (1999). In cases where an initially assigned disability evaluation has been disagreed with, it is possible for a veteran to be awarded separate percentage evaluations for separate periods based on the facts found during the appeal period (i.e., “staged ratings”). Id. at 126-28; see also Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran’s PTSD has been assigned an evaluation of 30 percent prior to April 29, 2011, and 50 percent thereafter, pursuant to 38 C.F.R. § 4.130, Diagnostic Code 9411. The rating criteria pertaining to the Veteran’s appeal is subsumed into the General Rating Formula for Mental Disorders (General Rating Formula). Under the General Rating Formula, a 30 percent evaluation contemplates 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, or mild memory loss (such as forgetting names, directions, and recent events). Id. A 50 percent evaluation is warranted where the disorder is manifested by occupational and social impairment with reduced reliability and productivity due to such symptoms as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory for example, 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. Id. A 70 percent evaluation is warranted where the disorder is manifested by occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking or mood, due to such symptoms as suicidal ideation; obsessional rituals which interfere with routine activities; speech that is intermittently illogical, obscure, or irrelevant; 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. Id. A 100 percent disability evaluation is warranted when there is total occupational and social impairment, due to such symptoms as: 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 and place; memory loss for names of close relatives, own occupation, or own name. Id. Further, 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). The evidence considered in determining the level of impairment under § 4.130 is not restricted to the symptoms provided in the General Rating Formula. Instead, VA must consider all symptoms of a claimant’s condition that affect the level of occupational and social impairment. The Board notes at the outset that the Court has previously provided direction on the interpretation and the application of the factors for evaluation of the several ratings under the General Rating Formula in 38 C.F.R. § 4.130 in Bankhead v. Shulkin, 29 Vet. App. 10 (2017). In now looking to the Court’s points in Bankhead for guidance, the Board should not confine its analysis only to identifying the presence of certain symptoms to determine the appropriate rating under the General Rating Formula, but also must draw fact-based conclusions as to whether those symptoms have caused the level of occupational and social impairment associated with a particular disability rating. Id. at 14. See also Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013). Indeed, the Board acknowledges that the presence of suicidal ideation alone conceivably might cause occupational and social impairment with deficiencies in most areas, consistent with a 70 percent rating. Bankhead, 29 Vet. App. at 19. Nonetheless, in evaluating symptoms and signs to determine their effect on the level of occupational and social impairment in order to arrive at an appropriate disability rating, the Board will look to their severity, frequency, and duration, consider their impact as a whole and make a quantitative assessment accordingly. Id. at 26-27. See also Vazquez-Claudio, 713 F.3d at 115-17. See generally Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table); Gilbert v. Derwinski, 1 Vet. App. 49, 52 (1990); Mittleider v. West, 11 Vet. App. 181, 182 (1998). As noted above, the Veteran’s PTSD has been assigned an evaluation of 30 percent prior to April 29, 2011, and 50 percent thereafter. After reviewing the evidence of record under the laws and regulations as set forth above the Board concludes that an evaluation in excess of 30 percent is not warranted throughout the period prior to April 29, 2011. Further, the Board finds that a preponderance of the evidence weighs against the assignment of an evaluation greater than 50 percent thereafter. Prior to April 29, 2011 Turning to the record, at a July 2004 VA mental health consultation, the Veteran reported that he had recently completed alcohol dependence treatment and his condition was in early remission. He reported experiencing symptoms of sadness, fluctuating moods, irritability, and lack of interest in previously pleasurable activities. He was diagnosed with a mood disorder, although the provider was unclear if this was a separate diagnosis from his alcohol dependence disorder history. A January 2007 VA treatment note found that the Veteran met the criteria for a diagnosis of PTSD. He reported issues with sleep disturbance, irritability, moodiness, and social withdrawal. In July 2010, the Veteran was afforded a VA examination in connection with his claim. At the time of the examination, the Veteran presented for the examination in disheveled clothes and a very dirty cap. He did not make eye contact with the examiner at all during the interview. His speech was impoverished and slow. His affect was flat, and his mood was depressed. The examiner noted that the Veteran was extremely distracted and that he had extremely slow processing. The examiner noted that the findings were very unusual and further compared faking severe pathology versus being so depressed the Veteran had no concentration or motivation to do the tests. The Veteran was intact to person and to time, but not to the name of the office building; however, he did know the name of the city. The Veteran demonstrated a paucity of ideas and did not offer conversation. Rather, he only answered questions and he was often vague. There was no evidence of delusions and the Veteran demonstrated an understanding of outcome of behavior. The Veteran’s behavior was noted as inappropriate because he did not make eye contact throughout the examination. The Veteran did not demonstrate any obsessive or ritualistic behavior, although he reported experiencing hypervigilance. The Veteran reported panic attacks 5 to 6 times per week that were severe in effect and on his functioning. There was no evidence of homicidal thoughts, but the Veteran reported daily suicidal thoughts without a plan. The examiner found that the Veteran’s extent of impulse control was good and there were no reported episodes of violence. Further, the examiner found that the Veteran was able to maintain minimum personal hygiene and there were no problems with activities of daily living. The examiner noted that a review of the Veteran’s substance abuse and mental health records reflect no description of a demeanor similar to what was presented at the time of this examination. Specifically, the examiner highlighted that as recently as a June 2010 mental health interview, the Veteran was reported to present in a cooperative, logical manner and to always have good eye contact. The Veteran reported that his most severe symptoms were hypervigilance, feelings of estrangement, a continued need to isolate himself, and avoidance behaviors. Upon clinical examination, the examiner found that the Veteran was not currently disturbed by his PTSD symptoms. Although the Veteran met the criteria for a PTSD diagnosis, the examiner noted that it was at a mild to moderate level at that time. The examiner also noted that the psychometric data indicated a more severe level of symptoms, but the examiner explained that this may be because the Veteran was reporting his feelings from the past. Finally, the examiner noted that the validity of this examination was questionable based on the Veteran’s presentation in contrast to what appeared in the records. Ultimately, in considering the evidence discussed above, as well as all other evidence of record, the Board finds that the evidence does not support the assignment of an evaluation in excess of 30 percent for an acquired psychiatric disorder with PTSD symptoms prior to April 29, 2011. The Veteran did not report difficulty in occupational or social functioning sufficient to more closely approximate a higher evaluation, and at no time does the objective evidence of record find the Veteran suffered from impaired abstract thinking, speech, judgment, insight, or ability to understand complex commands. Although the July 2010 VA examination reports that the Veteran presented unkempt for the examination, the examiner found that the Veteran was capable of maintaining minimum standards of personal hygiene. Moreover, while the July 2010 VA examiner found the Veteran’s behavior to be inappropriate for the examination, the examiner further explained that the Veteran’s behavior was not consistent with recently reported appropriate behavior at an examination only one month prior. Additionally, even considering the Veteran’s subjective reports of symptoms, the July 2010 VA examiner determined upon clinical examination that the Veteran was experiencing only a mild to moderate level of impairment from his PTSD at the time of the examination. Even though the Veteran may have experienced some symptoms congruent with a higher evaluation during this period, the Board finds the Veteran’s symptomatology most closely approximates that contemplated by a 30 percent evaluation for the period prior to April 29, 2011. From April 29, 2011 Another VA examination was conducted in April 2011. At the time of the examination a diagnosis of PTSD was confirmed. The Veteran presented with inappropriate appearance and hygiene that showed an inability to maintain minimal personal hygiene. However, the examiner noted that this seemed to be more a function of economics rather than mental illness. His orientation was within normal limits and his behavior was appropriate. The Veteran had poor eye contact during the examination. His affect and mood were depressed. The Veteran’s communication and speech were within normal limits, as was his concentration. Panic attacks were absent and there was no suspiciousness present. At the time of the examination there were no delusions or hallucinations observed. There was no obsessive-compulsive behavior and the Veteran’s thought processes were appropriate. He was able to understand directions. The Veteran did not have slowness of thought and he did not appear confused. His judgment was not impaired, and his abstract thinking was normal. The Veteran’s memory was within normal limits and there was no evidence of suicidal or homicidal ideation. A VA treatment note from October 2012 reveals that the Veteran reported having had 3 episodes of exacerbated anxiety consistent with panic attacks without clear precipitating factors. He further reported that his irritability and feelings of anger had improved. Additionally, it was noted that the Veteran continued to have problems with social isolation, however, he denied suicidal ideation and feelings of hopelessness. Additionally, in a VA treatment note from April 2016, it was noted that the Veteran was cooperative and maintained good eye contact. At the time of the encounter, he presented with his wife. The examiner noted that the Veteran was alert and oriented in all 4 spheres. His mood was good, and his affect was congruent to his mood. His speech was logical and coherent, and his thought process and content were linear. There was no evidence of suicidal ideation or perceptual disturbances. The Veteran’s insight and judgment were good, and his abstraction was intact. The Veteran reported continued frequent nightmares and insomnia and low level of energy; however, the examiner noted that this did not appear to be psychiatric in origin. Likewise, a VA treatment not from May 2018, reveals that the Veteran presented with normal psychomotor activity at the time of the encounter. The examiner noted that the Veteran was alert and oriented across all four spheres. His mood was good and his affect was bright. The Veteran’s speech was logical and coherent. His thought process and content were linear without suicidal ideation or perceptual disturbances. The Veteran’s judgment was good, and his insight was fair to good. The Veteran reported that his sleep quality, energy level, and motivation had all improved and he was generally more active. Further, he reported that his social interactions remained limited, but he denied any increase in his anxiety or depression and denied any feelings of hopelessness or suicidal ideation. Based on the evidence discussed above, as well as a number of treatment records and lay statements generated throughout this stage of the appeal, the Board finds that an evaluation in excess of 50 percent is not warranted after April 29, 2011. During this period, the Veteran exhibited a number of symptoms, including irritability, and difficulty in establishing and maintaining effective work and social relationships resulting in occupational and social impairment with reduced reliability and productivity. However, the Veteran’s PTSD does not result in serious symptoms with deficiencies in most areas, such as work, school, family relations, judgment, thinking or mood. Specifically, although the Veteran’s appearance and personal hygiene were noted as inappropriate at the time of the April 2011 VA examination, it was also noted that the this was more likely due to economic factors and not mental health issues. Thereafter, the Veteran’s appearance and hygiene are not noted to be an issue. Further, the Veteran is consistently reported to exhibit appropriate behaviors with logical and coherent speech and thought processes. Moreover, the Veteran’s spatial orientation is consistently reported to be intact in all spheres. Although panic attacks were reported during this period, they were not described as being near-continuous affecting the Veteran’s functioning. At no time during this period is the Veteran reported to have suicidal ideation or impaired impulse control. As such, the Board finds that a preponderance of the evidence indicates that the Veteran’s PTSD does not result in severe symptomatology so as to warrant an evaluation greater than 50 percent after April 29, 2011. Thus, the Board concludes that the type and degree of symptoms demonstrated during the appeal period are of similar frequency and severity as those contemplated for a 30 percent disability rating prior to April 29, 2011, and for a 50 percent rating thereafter. Vazquez-Claudio v. Shinseki, 713 F.3d at 112. The Board acknowledges the Veteran’s contentions that his service-connected PTSD warrants evaluations greater than those assigned herein. However, in determining the actual degree of disability, an objective examination is more probative of the degree of the Veteran’s impairment. Furthermore, the opinions and observations of the Veteran alone cannot meet the burden imposed by the rating criteria under 38 C.F.R. § 4.130 with respect to determining the severity of his service-connected acquired psychiatric disorder with PTSD symptoms. See Moray v. Brown, 2 Vet. App. 211, 214 (1993); see also Davidson v. Shinseki, 581 F.3d 1313 (2009). Overall, the Board concludes that the evidence discussed above, as well as all other evidence of record not specifically addressed including VA treatment records, supports no more than a 30 percent evaluation prior to April 29, 2011, or a 50 percent evaluation thereafter for the Veteran’s PTSD. As the evidence preponderates against higher ratings there is no basis to find reasonable doubt. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 3. Entitlement to a total disability rating based on individual unemployability (TDIU) Pursuant to the Court’s October 2020 Order, the issue of entitlement to TDIU has been raised by the record in the November 2015 VA Form 9. See Rice v. Shinseki, 22 Vet. App. 447 (2009). A total disability rating may be assigned where the schedular rating is less than total when the disabled person 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, this disability shall be ratable at 60 percent or more, or 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. See 38 C.F.R. § 4.16 (a). From December 22, 2016, the Veteran’s total combined rating is 100 percent. He also has been assigned special monthly compensation at the housebound rate. Therefore, the focus will be on the period prior to December 22, 2016, for consideration of a TDIU. Prior to December 22, 2016, the Veteran has a single service-connected disability for posttraumatic stress disorder (PTSD). Prior to April 29, 2011, the Veteran’s PTSD was rated at 30 percent disabling, and rated as 50 percent disabling thereafter. Therefore, for this period, the Veteran’s highest total combined rating is 50 percent for a single disability, which does not meet the schedular requirements for a TDIU. Where the schedular percentage requirements are not met, entitlement to TDIU benefits on an extraschedular basis may be considered when the Veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities; consideration is given to the Veteran’s background including his employment and educational history. 38 C.F.R. § 4.16 (b). The Board does not have the authority to assign an extraschedular total disability rating for compensation purposes based on individual unemployability in the first instance. Bowling v. Principi, 15 Vet. App. 1 (2001). The Board acknowledges the Veteran’s contention that he is entitled to a TDIU because his noted usual occupation as a farm laborer is not substantially gainful employment. However, as discussed above, the Veteran’s total combined rating for the period prior to December 22, 2016, is 50 percent. Therefore, the Board has considered whether the Veteran’s disability picture warrants referral for consideration of an extraschedular evaluation for TDIU. However, the Board finds that a remand for referral of the Veteran’s claim for consideration of TDIU is not warranted in this case. There is no competent medical evidence of record which indicates the Veteran’s service-connected disability alone precluded him from obtaining or maintaining gainful employment. In this regard, the Veteran was afforded multiple VA examinations for his PTSD for the period prior to December 22, 2016. Specifically, at the time of the July 2010 VA examination, the Veteran reported that he was employed as a field hand, landscape laborer on a part-time basis. He had been working in this capacity for the past 2 to 5 years. He reported that in the prior 12-month period he lost less than 1 week of time. He further reported that he had 3 jobs in the previous 10 years. Prior to that he reported that he was incarcerated. In April 2011, the VA examiner found that the effects of PTSD symptoms on the Veteran’s employment and overall quality of life included the Veteran being incarcerated for drug distribution. The examiner further explained that the best description of the Veteran’s current impairment due to his PTSD was that his symptoms cause occupational impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks although generally the Veteran functions satisfactorily with routine behavior, self-care, and normal conversation. Likewise, the VA treatment records from February 2005 reveal that the Veteran reported full time employment with a seed company. In January 2012, the Veteran reported that he worked part-time driving a tractor and shoveling dirt. Later in August 2012, the Veteran reported that his PTSD has negatively impacted his employment, to include recent alcohol abuse. Then in February 2013, the Veteran reported that he was unemployed since November 2012. He further reported that he lost his job due to a mistake, but that he had trouble gaining employment due to his challenge to being around others and skepticism. Significantly, neither VA examiners from 2010 nor from 2011 opined that the Veteran was rendered incapable of obtaining and sustaining gainful employment due to his PTSD. Rather, at the time of the VA examinations the Veteran reported that he was employed as a farm laborer on both a full time and part-time basis. Moreover, VA treatment records indicate that the Veteran reported that in November 2012 he lost his job because he made a mistake and not as due to his PTSD. Although the Veteran reported difficulty in gaining employment, at no time during the period prior to December 22, 2016, is the Veteran shown to be unable to secure and maintain gainful employment. Although the Veteran believes that he could not secure or follow a substantially gainful occupation as a result of his service-connected PTSD the more persuasive medical evidence is against the claim. The Board notes that, as a lay person, lacking in medical training and expertise, the Veteran cannot provide a competent opinion on a matter as complex as whether he can secure or follow a substantially gainful occupation as a result of service-connected disability. See, e.g., Davidson v. Shinseki, 581 F.3d at 1313. Any probative value of the Veteran’s own conclusions is far outweighed by that of the competent medical evidence that indicates his service-connected PTSD was not productive of impairment that would rise to the level of unemployability. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Consequently, because the preponderance of the evidence indicates that the Veteran was not unemployable by reason of his service-connected PTSD, referral of this case to the Director of the Compensation and Pension Service for extra-schedular consideration under 38 C.F.R. § 4.16 (b) is not warranted. See 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16. REASONS FOR REMAND The Veteran is currently service-connected for diabetes mellitus, for which he received a 20 percent evaluation pursuant to Diagnostic Code 7913. The Veteran contends that his diabetes mellitus deserves a higher rating for the entire period on appeal. The Board notes that the Veteran was last afforded a VA diabetes mellitus examination in May 2017. While the mere passage of time since the last VA examination does not, in and of itself, warrant additional development, the Board finds that the May 2017 examination is too remote to be considered a contemporaneous medical examination sufficient to ascertain the current level of disability. See Green v. Derwinski, 1 Vet. App. 121, 124 (1991); Caffrey v. Brown, 6 Vet. App. 377 (1994); Palczewski v. Nicholson, 21 Vet. App. 174 (2007). Accordingly, the Veteran should be afforded a contemporaneous VA examination which assess the current level of his service-connected diabetes mellitus and ensures the evaluation of this disability will be a fully informed one. Additionally, since the last VA examination, the Veteran has asserted that he experiences neuropathy as a complication of his diabetes mellitus. On remand the examiner will be directed to consider these symptoms. The matters are REMANDED for the following action: Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected diabetes mellitus, emphasis should be on the neuropathy for this examination. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria, to include whether separate ratings for the neuropathy symptoms are warranted. It should be noted that the Veteran is competent to attest to factual matters of which he had first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner is requested to address the Veteran’s contention that he has lost sensation on the top of his feet, and to determine the nature of this symptoms as it relates to the Veteran’s service-connected diabetes mellitus. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Scanlan, 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.