Citation Nr: 21027723 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 11-12 270 DATE: May 6, 2021 ORDER Entitlement to service connection for supraventricular arrhythmia, to include as secondary to exposure to contaminated water at Camp Lejeune, is dismissed. Entitlement to a compensable rating for bilateral hearing loss is dismissed. Entitlement to an initial rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is denied. Entitlement to a total rating based on individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. In April 2021, prior to the promulgation of a decision in the appeal, the Board received notification from the Veteran's representative that a withdrawal of the appeal for the claims for a compensable rating for bilateral hearing loss and entitlement to service connection for supraventricular arrhythmia was requested. 2. Throughout the period on appeal, the Veteran's acquired psychiatric disorder have manifested by symptoms which are most consistent with occupational and social impairment with reduced reliability and productivity. 3. At no time during the appeal period did the Veteran's service-connected disabilities preclude him from obtaining and retaining substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for withdrawal of entitlement to an initial compensable bilateral hearing loss have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 2. The criteria for withdrawal of entitlement to service connection for supraventricular arrhythmia have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 3. The criteria for a disability rating in excess of 50 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.130, DC 9411. 4. The criteria for an award of a TDIU have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.3, 4.15, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1965 through April 1969. This matter comes before the Board of Veterans' Appeals (BVA or Board) on appeal from a January 2009, April 2011, May 2014, March 2015, and November 2015 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). In October 2017, the Board remanded the claim for further development. In a July 2018 decision, the Board denied entitlement to an increased rating in excess of 50 percent for PTSD and to a TDIU. The Veteran appealed to the United States Court of Appeals for Veterans Claims (Court). In a December 2019 Joint Motion for Partial Remand (JMPR), the parties agreed to vacate the July 2018 Board decision and remand these issues back to the Board for further consideration as consistent with the JMPR. The appeal has since returned to the Board. Withdrawal The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 19.55. Withdrawal may be made by the Veteran or by his authorized representative. 38 C.F.R. § 19.55. Entitlement to service connection for supraventricular arrhythmia and to a compensable rating for bilateral hearing loss In April 2021, the Veteran's representative submitted a statement that expressed an intent to withdraw the appealed issues of entitlement to service connection for supraventricular arrhythmia and to a compensable rating for bilateral hearing loss. The Board accepts the Veteran's statement requesting withdrawal of the claims under appeal. There remains no allegations of errors of fact or law for appellate consideration as to these issues. Accordingly, the Board does not have jurisdiction to review the Veteran's appeal as to the issues of entitlement to service connection for supraventricular arrhythmia and a compensable rating for bilateral hearing loss and these claims are dismissed. Increased Rating Disability evaluations are determined by the application of the VA Schedule for Rating Disabilities (Rating Schedule). 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.1. VA should interpret reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability. 38 C.F.R. § 4.2. Any reasonable doubt regarding the degree of disability shall be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two evaluations apply, the higher of the two should be assigned where the disability picture more nearly approximates the criteria for the next higher rating. 38 C.F.R. § 4.7. 1. Entitlement to an initial rating in excess of 50 percent for PTSD Service connection was established for PTSD in a January 2009 rating decision, at which time a 10 percent evaluation was assigned, effective July 9, 2008. The Veteran appealed the initial rating, and during the course of the appeal, in an April 2011 rating decision, the evaluation was increased to 50 percent, effective the date of his grant of service connection July 9, 2008. Because this is less than a total rating, the appeal for a higher still rating remained. For the reasons described below, the Board finds that the Veteran's PTSD does not warrant a rating in excess of 50 percent at any time during the period on appeal. Under Diagnostic Code 9411, a 50 percent rating is warranted when there is occupational and social impairment with reduced reliability and productivity due to symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short-and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent rating is warranted when there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression 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 inability to establish and maintain effective relationships. Id. A 100 percent rating is warranted when there is 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; and memory loss for names of close relatives, own occupation, or own name. Id. In order to be assigned a particular rating, a Veteran need not demonstrate the presence of all, most, or even some, of the symptoms listed as examples in the rating criteria. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). The key element for a rating under the General Formula for Mental Disorders is the degree of social and occupational impairment caused by those symptoms. Further, the United States Court of Appeals for the Federal Circuit has acknowledged the "symptom-driven nature" of the General Rating Formula and 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 similar severity, frequency, and duration." Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116 (Fed. Cir. 2013). The Federal Circuit has explained that "symptomatology should be the fact-finder's primary focus when deciding entitlement to a given disability rating." Id. at 117. Turning to the evidence of record, the Veteran was afforded a VA examination for his PTSD in December 2008. He endorsed periods of irritability and anger. He also detailed an episode of impulsive crying. He also endorsed symptoms of nervousness and retreating to his room in fear of losing his temper in the presence of others. His symptoms were intermittent. He reported no problems with relationships with his coworkers or supervisors at work. He was increasingly more hyperalert and interacted less with others, but otherwise had good control over his symptoms. He reported having a good relationship with his wife and children. Upon examination, his hygiene was appropriate. His speech and concentration was normal. He denied hallucinations, delusions, suicidal ideation and obsessive rituals. The examiner opined that his symptoms were not severe enough to interfere with his social and occupational functioning. At the November 2011 RO hearing, the Veteran reported having panic attacks and uncontrollable anger once a month. His representative narrated that the Veteran isolates and had one friend and one acquaintance. He otherwise had problems getting along with most people. The Veteran confirmed that he had good relationships with two of his children, but not a third child. He endorsed hobbies of fishing and hunting. Concerning work, he testified that he believed that it was a good time to retire because his house was paid for and he did not want to have his conflict with a coworker on his record. Treatment notes in January 2013 document the Veteran's denial of significant mood changes, depression, nightmares, hallucinations, delusions, paranoia, or other cognitive difficulties. In July 2013, the Veteran was afforded another VA examination. The Veteran reported that he had good relationships with his siblings, wife, and children. He endorsed being withdrawn due to difficulty controlling his PTSD symptoms. He reported that he voluntarily retired after conflict with a coworker. He also endorsed hypervigilance, suspiciousness, and flashback. He reported sleeping with two pistols. His current symptoms included depressed mood, anxiety, suspiciousness, mild memory loss, disturbances in mood and motivation, inability to establish or maintain effective relationships, and impaired impulse control. The examiner opined that the Veteran had occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. A February 2014 VA treatment record reveals that the Veteran denied mood changes and his mood and affect were appropriate. Additionally, the Veteran denied significant PTSD symptoms. In a June 2014 VA examination report, the examiner noted diagnoses of PTSD and alcohol abuse. The Veteran confirmed that he had been married for 45 years and maintained contact with his children. He reported no history of suicidal or homicidal ideation. He classified his sleep as pretty good and had occasional nightmares and flashbacks. He had a history of anxiety attacks but had not had one in a year. His daily memory was normal. His current PTSD symptoms included depressed mood and anxiety. The examiner also found that the Veteran had occupational and social impairment due to mild or transient symptoms with decreased efficiency and the ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medication. In December 2016, the Veteran had a negative screen for PTSD. In a September 2017 brief, the Veteran's representative cited to worsening of the Veteran's condition, to include ongoing issues with impulse control. In March 2018, the Veteran underwent another VA examination to evaluate the severity of his PTSD. The examiner determined that the Veteran no longer meets the criteria for a diagnosis of PTSD. He reported that he does things alone most of the time, and related that he had a couple of good friends which he would see every couple of months. He also reported enjoyment in hobbies to include including hunting, fishing, working in his shop, woodworking, and fixing his boat and taking it out on the river. He reported sleep disturbances, which was described as chronic in nature. The examiner further noted intense or prolonged psychological distress, as well as marked physiological reactions due to exposure to cues symbolizing the traumatic event. The Veteran demonstrated recurrent, involuntary, and intrusive distressing memories of the traumatic event and recurrent distressing dreams in which the content and/or effect of the dream was related to the traumatic event. The Veteran was described as well groomed, cooperative, and pleasant in which he made good eye contact, smiled, and laughed a lot during the assessment. He was also observed to have had normal orientation, speech, and thought processes. No psychotic processes or psychomotor agitation were documented. His affect and mood were appropriate, and he demonstrated intact judgment and insight. He denied homicidal and suicidal ideation. The Veteran was noted to be capable of managing his financial affairs. The Veteran's relevant social, occupational, and mental health history was noted, to include mention of the Veteran's last examinations and findings of a PTSD diagnosis with associated symptoms. As to a retrospective medical opinion regarding the impact of the Veteran's service-connected PTSD since the date of the claim, the examiner noted that the Veteran had only intermittent periods of anger and frustration and that prior to retiring, he denied that his symptoms were affecting his ability to get along with others or work. As to whether there had been changes in the severity of the Veteran's PTSD since the date of the claim, the examiner noted the Veteran's most recent negative PTSD screen in December 2016 in which his symptoms appeared to be less severe than that of the date of the claim. Further, the examiner noted that the Veteran no longer met the criteria for PTSD. In further support of this opinion, the examiner cited the negative screen, his current report of symptoms, and the absence of clinically significant impairment in social or occupational functioning. The Veteran submitted to a private psychological examination in March 2021. He reported that he enjoyed his work but was unable to manage his emotional equilibrium in an occupational environment. He endorsed problems with authority figures, supervisors, and coworkers and an inability to effectively communicate or maintain consistent behavior. He noted symptoms of frequent panic attacks, worsening flashbacks, and low frustration tolerance. A formal mental status examination revealed that the Veteran was cooperative, had adequate impulsive control, and was mildly agitated. His mood was described as angry and depressed. His thought content was positive for passive suicidal ideation without plan or intent. He had no homicidal ideation or delusion. There was evidence of thought blocking. He denied hallucinations and was cognitively intact. The examiner opined that the Veteran's PTSD has had a severe impact on his social and occupational functioning since the 1990s. Since 2012, he was severely disabled from most types of social interactions. Further, his PTSD prevented him from functioning safely and effectively in an occupational environment. He had total social and occupational impairment since 2012. Based on the foregoing, the Board finds that the preponderance of the evidence does not support an increased rating in excess of 50 percent for PTSD. Specifically, the evidence does not show the Veteran has occupational and social impairment in most areas, as he has reported maintaining relationships with his family members, interacting with friends, enjoying several hobbies, and watching his grandchildren. The Veteran also stated that the relationship with his wife was "pretty good." Regarding any occupational impairment, it is clear from the record that the Veteran worked for several years, despite his PTSD symptoms. Although the Veteran chose to retire after having an alteration with a single coworker, the record reveals that he did not have a history of disciplinary actions for similar occurrences. Rather, the record supports that the Veteran endorsed no problems with relationships with his supervisors or coworkers prior to this one incident. Additionally, at the RO hearing, the Veteran offered that he had determined that it was time to retire and noted that his house was paid off. He was not forced to retire. Thus, the evidence of record does not demonstrate occupational and social impairment in all or most areas. Additionally, at no point throughout the period on appeal, have the Veteran's symptoms of PTSD manifested to such a degree that more nearly approximates the criteria for a 100 percent disability rating. For example, there is no evidence showing that the Veteran's PTSD was manifested by such symptoms as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; disorientation to time or place; memory loss for names of close relatives, own occupation, or own name; or other manifestations on par with the level of severity contemplated by those symptoms. VA examinations consistently noted good judgment and insight; normal speech, logical thought processes; and cooperative behavior. Therefore, a 100 percent disability rating is not warranted at any point during the appeal period. The Board acknowledges the Veteran's March 2018 statement that his VA examination was inadequate because the examiner spent only 25 minutes with him and did ask him about his symptoms. The Board determines, however, that the March 2018 VA examination report and medical opinion, when read as a whole, contain clear explanations in support of the VA examiner's opinions and findings following a thorough physical examination and review of the pertinent records, lay statements, and medical principles. See Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012) (holding that examination reports are adequate when, as a whole, they sufficiently inform the Board of a medical expert's judgment on a medical question and the essential rationale for that opinion). This VA examination is adequate to decide the Veteran's PTSD claim as the examination report is very thorough and contains findings of the Veteran's current symptoms as well as a detailed explanation of his medical history. Additionally, when read in concert with the other medical and lay evidence, the Board finds sufficient evidence to decide the claim. The Board also acknowledges the Veteran's assertion that his symptoms support an increased rating of at least 70 percent because they have caused an occupational and social impairment with deficiencies in most areas. As a lay witness, the Veteran is competent to report his medical history and observable symptomatology. See Layno v. Brown, 6 Vet. App. 265, 469-79 (1994). However, the Veteran is not competent to determine the severity of PTSD, because this determination requires specialized knowledge beyond that of a lay witness. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In evaluating the Veteran's increased rating claim, the Board is aware that the symptoms listed under the 50 and 70 percent ratings are essentially examples of the type and degree of symptoms for that rating, and that the Veteran need not demonstrate those exact symptoms to warrant a higher rating. See Mauerhan, supra. However, the Board finds that the record does not show the Veteran manifested symptoms that equal or more nearly approximate the criteria for a 70 percent (or higher) rating at any point during the appeal period. Relatedly, although the Veteran has detailed issues with panic attacks, there is no evidence that demonstrates that these panic attacks were near continuous. Rather, the Veteran testified that these attacks occurred once or twice a year. At the March 2021 private examination, the Veteran reported frequent panic attacks. However, there was no detailed information supporting that these interfered with his activities of daily living and/or functioning, or otherwise, rose to the level of near continuous panic attacks. The Veteran's representative has also asserted that the Veteran has obsessive rituals. However, no medical examiner has confirmed the presence of obsessive rituals. Further, if present, there is no indication that these impair the Veteran's ability to perform routine activities. Additionally, although the July 2013 VA examination noted unprovoked periods of violence and impaired impulse control, the presence of such symptoms are not supported by a thorough review of the record or explained within the examination. Contrarily, the record supports that the Veteran has no legal history of violent acts. Moreover, the Veteran has endorsed the ability to control his irritability and anger by removing himself from the aggravating situation without physical or verbal violence. His one incident of violence in response to continual provocation presents as an anomaly to the Veteran's behavior throughout the record. The frequency of symptoms is not to be ignored when establishing the appropriate rating. Additionally, the Board does not ignore that the March 2021 private examiner has opined that higher rating, including a total rating of 100 percent, is warranted. The Board grants little probative value to the March 2021 examiner's opinions because they are wholly contrary to the Veteran's own reporting of maintaining good relationships with a few friends, family members, and his wife during the period at issue. Further, the Veteran has maintained various hobbies and has consistently been noted to have intact concentration with full orientation and adequate grooming and thought content. He was also frequently noted to be cooperative. It is also acknowledged that passive suicidal thoughts were documented in the March 2021 private examination. The Board considered the ruling in Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017). Here, the Court found that suicidal ideation is only listed as a symptom in the criteria for a 70 percent disability rating. Id. Thus, the Court found "the language of the regulation indicates that the presence of suicidal ideation, alone, that is, a veteran's thoughts of his or her own death or thoughts of engaging in suicide-related behavior, may cause occupational and social impairment with deficiencies in most areas." Id. The evaluation of mental disorders requires consideration of the effects of each of the veteran's mental symptoms on his or her social and occupational situation to determine the severity of the symptom. Id. Put differently, although suicidal ideation alone may cause occupational and social impairment with deficiencies in most areas, it does not follow that suicidal ideation automatically warrants a 70 percent disability rating. The focus is on whether those suicidal ideations are of the severity and frequency to cause occupational and social impairment with deficiencies in most areas. The totality of the Veteran's symptoms, including passive suicidal thoughts, have only resulted in reduced reliability and productivity. Notably, the notation of passive thoughts is only found in the March 2021 private report. Despite the notation, there are no further details noted that describe what statements constituted passive suicidal thoughts or how such thoughts interfered with the Veteran's overall functioning. Throughout the existing record, the Veteran has denied suicidal thoughts. To the extent that passive suicidal thoughts or suicidal ideation exist. there is no evidence that persistent suicidal ideations that have interfered significantly with the Veteran's functioning in social relationships or occupational tasks. Rather, even when passive suicidal ideation was documented, he had no plan or intent. Despite such reporting, he maintains activities of daily living and various relationships. Thus, the suicidal ideations in conjunction with his other symptoms do not cause occupational and social impairment with deficiencies in most areas to warrant a higher rating. In summary, although the Veteran has reported symptoms, to include impaired impulse control, the Board finds that the Veteran's service-connected PTSD more nearly approximated the level of disability contemplated by the 50 percent rating. The Board finds that the Veteran's deficiencies must be due to symptoms listed for that rating level, or others of similar severity, frequency and duration. Vasquez-Claudio, supra. Here, the symptoms noted during the VA examinations during the appeal period are, at worst, of similar severity, frequency, and duration of those noted under the criteria for a 50 percent rating. Thus, a rating in excess of 50 percent for the service-connected PTSD is denied. 2. Entitlement to a total rating based on individual unemployability (TDIU) The Veteran contends that his service-connected disabilities prevent him from working. A total disability rating for compensation purposes may be assigned where the schedular rating is less than total and where it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a service-connected disability ratable at 60 percent or more or 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. 38C.F.R.§4.16 (a). 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 or her age or to the impairment caused by nonservice-connected disabilities. See 38C.F.R.§§4.16, 4.19; see also Van Hoose v. Brown, 4 Vet. App. 361 (1993). To meet the requirement of "one 60 percent disability" or "one 40 percent disability," the following will be considered as one disability: (1) disability of one or both lower extremities, including the bilateral factor, if applicable; (2) disabilities resulting from one common etiology; (3) disabilities affecting a single body system; (4) multiple injuries incurred in action; and (5) multiple disabilities incurred as a prisoner of war. Id. Substantially gainful employment is defined as work which is more than marginal and which permits the individual to earn a living wage. Moore v. Derwinski, 1 Vet. App. 356 (1991). Marginal employment may also be held to exist, on a facts-found basis (including, but not limited to, employment in a protected environment such as a family business or sheltered workshop), when earned annual income exceeds the poverty threshold. 38C.F.R.§4.16. Initially, the Board notes that the Veteran's service-connected disabilities include: PTSD (50 percent disabling), diabetes mellitus (20 percent disabling), tinnitus (10 percent disabling), pseudophakia, associated with diabetes mellitus (10 percent) and bilateral hearing loss (0 percent disabling). The Veteran's service-connected disabilities result in a combined rating of 60 percent as of July 9, 2008 and 70 percent as of November 15, 2013. Therefore, the Veteran currently meets the schedular requirements for TDIU. With the threshold requirements satisfied, the Board must examine whether the Veteran is unable to secure or follow a substantially gainful occupation as a result of his service-connected disabilities. In this case, the Board finds that consideration of a total rating based on unemployability is not warranted. As discussed more fully below, the most probative and credible evidence shows that the Veteran's service-connected disabilities have not rendered him unable to obtain or maintain substantially gainful employment. In his May 2015 Application for Increased Compensation Based on Unemployability, he mentioned that his service-connected PTSD and diabetes were the primary service-connected disabilities preventing him from securing or following any substantially gainful occupation. The Veteran also noted that his supraventricular arrhythmia prevented him from securing or following any substantially gainful occupation; however, this disorder will not be considered as the Veteran is not service connected for such. The Veteran also reported that he has not worked since January 2012 at which time he worked as a Fed-Ex courier for twenty-five years. The Veteran further reported that he left his job due to his disabilities. In a September 2014 Eye Conditions DBQ, the examiner stated that the Veteran's service-connected pseudophakia did not impact his ability to work. In a July 2015 Diabetes Mellitus DBQ, the examiner stated that the Veteran's service-connected diabetes did not impact his ability to work. In a September 2015 Hearing Loss examination, the examiner noted that the Veteran's service-connected hearing loss impacts his daily life, including the ability to work to the extent that he has trouble hearing in groups, with environments with background noise. Due to his disability, he has to ask for repetition and has sensitivity to high-pitched sounds. Similarly, in a September 2015 Tinnitus examination, the examiner noted that the Veteran's service-connected tinnitus impacts his daily life, including the ability to work, to the extent that it is a constant annoyance and interferes with his ability to concentrate. Again, a March 2018 PTSD C&P examination indicated that the Veteran's service-connected PTSD had resolved and that prior to retiring in January 2012, the Veteran noted that he denied that his symptoms were affecting his ability to get along with others or work. In March 2021, a private examiner found that the Veteran the Veteran's PTSD caused total occupational impairment due to his aggression, irritability, anger, violence, threatened behavior, dissociative periods, volatility, and unpredictability. Considering the aforementioned, the Board finds that a TDIU is not warranted. The Veteran has alleged that he is unable to work due to his service-connected PTSD, diabetes, and eye disabilities. However, after a thorough review of the record, the Board finds that the preponderance of the evidence shows that the functional limitations imposed by the Veteran's service-connected disabilities did not render him unable to perform the mental or physical tasks necessary to follow a substantially gainful occupation during the period on appeal. The Board does not dispute that the Veteran experienced some occupational impairment due to his service-connected disabilities during the relevant time periods on appeal. Evidence shows complaints of physical limitations resulting from his service-connected disabilities. However, the Board finds that such impairment was adequately compensated by the assigned schedular ratings. Loss of industrial capacity is the principal factor in assigning disability ratings. See 38 C.F.R. §§ 3.321 (a), 4.1. Indeed, 38 C.F.R. § 4.1 specifically states: "Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability." See Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993) (noting that the disability rating itself is recognition that industrial capabilities are impaired). The Board has considered entitlement to TDIU based only upon the Veteran's service-connected disabilities and finds that although they may have impacted his ability to obtain and maintain employment, they did not wholly prevent him from securing or following gainful employment. The Veteran has completed on year of college post-high school. Based on his physical limitations, it is conceded that he would experience some problem with hearing and concentrating due to hearing loss and tinnitus. However, his ability to speak, communicate, and concentration effectively has not been severely restricted. Further, he maintains the ability to work at jobs with various physical demands. His service-connected disabilities would not preclude this type of employment. In addition, such a position would provide income above the poverty level. For example, the Veteran would have been qualified in sorting and assembling industries based on his education and experience. The Board is not finding that these are the only positions which the Veteran would have been able to obtain but lists them as some examples of the types of work which would not be precluded by the service-connected disabilities. These jobs comport with the physical limitations imposed by his service-connected disabilities. Similarly, the Veteran retained the mental capacity to perform such work when considering the limitations assessed by PTSD. To this point, while the Veteran has some issues with irritability and anger, he has demonstrated adequate coping mechanisms and impulse control during the period at issue. The Board does not ignore that the Veteran had an alteration with one employee in his last job. However, this incident appears to be an isolated event with an employee who often unsuccessfully provoked the Veteran in the past as addressed above. Otherwise, the Veteran generally prevented with adequate control over his mental symptoms to the point where he had no persistent disciplinary issues noted at work. The Board also has considered the March 2021 VA examiners' opinion and lay statements supporting that the Veteran is unable to work. The ultimate question of whether a Veteran is capable of substantially gainful employment is for the adjudicator. Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013). In this matter, the record has not demonstrated that the Veteran's service-connected disabilities, either singly or in combination, has prevented him from securing and following gainful employment. The preponderance of the evidence is against finding that the Veteran's service-connected disabilities have prevent him from securing and following substantially gainful employment. As such, his claim for TDIU is denied, and referral for extraschedular consideration is not warranted. Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N.B. Mmeje, 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.