Citation Nr: 21028425 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 16-56 599 DATE: May 11, 2021 ORDER 1. Entitlement to an initial rating in excess of 30 percent for posttraumatic stress disorder (PTSD) (from November 26, 2012 to July 15, 2015) is denied; a 70 percent rating is granted for the PTSD from [the earlier effective date of] July 15, 2015, subject to the regulations governing payment of monetary awards. 2. Entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU) is granted. FINDINGS OF FACT 1. Prior to July 15, 2015, the Veteran's PTSD was not shown to have been manifested by symptoms productive of impairment greater than occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks; symptoms productive of occupational and social impairment with reduced reliability and productivity were not shown; from [the earlier effective date of] July 15, 2015, it is reasonably shown to have been manifested by symptoms productive of occupational and social impairment with deficiencies in most areas; at no time is it shown to have been manifested by symptoms productive of total occupational and social impairment. 2. The Veteran's service-connected PTSD (rated 70 percent) is reasonably shown to be of a nature and severity that render him unable to maintain regular substantially gainful employment. CONCLUSIONS OF LAW 1. The Veteran's PTSD warrants "staged" ratings of 30 percent from November 26, 2012 to July 15, 2015 and 70 percent from [the earlier effective date of] July 15, 2015. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.130, Diagnostic Code (Code) 9411. 2. The schedular criteria for a TDIU rating are met; a TDIU rating is warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16(a), 4.18. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a Veteran who served on active duty from July 1969 to April 1971. These matters are before the Board on appeal from April 2014 and August 2016 rating decisions. In March 2019, a Travel Board hearing was held before the undersigned; a transcript is in the record. In March 2020, the matters were remanded for additional development. 1. A rating in excess of 30 percent for PTSD from November 26, 2012 to July 15, 2015 is denied; a 70 percent rating is granted for PTSD from [the earlier effective date of] July 15, 2015. On August 2013 VA examination, the Veteran reported getting along with his wife of 26 years, and that they had custody of three young grandsons; he got along well with his daughter and grandsons. He reported having normal levels of impatience with them. He reported that he got along well with 2 brothers and 2 sisters, had some friends, and played golf weekly with one friend. He reported feeling anxious in crowds and avoiding large crowds including church. He was able to go to stores for errands, had been involved in watching his grandchildren's sports, and enjoyed fishing and hunting with a grandson. He took medications for sleep, mood, irritability, and anxiety, and recent treatment notes indicated he was doing quite well. He reported retiring the previous year at age 62, taking regular retirement from a contracting job; he had shown up and done his job "ok". On mental status examination, the Veteran's affect was broad, and his mood was euthymic. He was friendly, polite, and cooperative. He appeared to be in no significant emotional distress, and his eye contact, speech, and behavior were normal. His memory was intact. He denied suicidal or homicidal ideation, and there were no delusions or hallucinations, panic attacks, or obsessive-compulsive disorder. He denied depressed mood, excessive anxiety, fear, or nervousness. He reported having upsetting intrusive memories a few times per week, and that certain things like helicopters, current wars, and gunshot/explosive sounds triggered such memories. He avoided talk of his trauma and other various reminders and avoided large crowds; however, he could watch war movies and go to fireworks shows. He reported being distant from others at times. His concentration appeared adequate, and he denied problems with hyperstartle or excessive anger/irritability. He reported some mild hypervigilance, feeling uncomfortable in crowds, and wanting his back to a wall with nobody behind him. He reported interrupted sleep but appeared to function adequately on this amount. The examiner opined that the Veteran's PTSD resulted in occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medication. The examiner opined that the Veteran seemed to have mild PTSD, and seemed to be doing very well with treatment, getting along with his wife and family, maintaining social interactions and enjoyment of leisure pursuits, and doing well at work until regular retirement the previous year. Based on this evidence, a November 2013 rating decision granted the Veteran service connection for PTSD, rated 10 percent, effective November 26, 2012. On February 2014 VA treatment, the Veteran reported that he had learned ways to cope with his disability including medication, talking with other veterans, and a desire not to burden others with his problems. He reported he slept well using Trazodone, and was to switch to Zoloft to address irritability and inability to handle stress. He was encouraged to continue his stress-relieving activity of golfing with his friends. He denied having suicidal or homicidal ideation. On April 2014 VA examination, the Veteran reported that nothing had changed regarding his family since the previous examination. He continued to play golf weekly with friends, he and his grandson were "best friends", and he was teaching the child to play golf; he appeared to be devoted to his grandson and was expending significant effort to insure he has a good future. He reported having "that mean part of me that comes out", which caused some conflict with his wife and grandson. He reported using his carpentry skills working on other people's houses on a part-time basis. The examiner noted that the Veteran had stopped taking psychotropic medication two months prior, which resulted in a predictable increase in symptoms such as irritability and poor sleep; he had since resumed taking his medications and woke frequently at night, though generally to use the bathroom. He reported anxiety symptoms. On mental status examination, the Veteran was cooperative with good grooming and hygiene. His mood was euthymic, and his affect was appropriate and broad, though he expressed significant irritability when discussing concerns regarding his disability rating. His psychomotor activity level was normal, and speech was clear and fluent. His thought processes appeared logical and goal-directed. His thought content was appropriate. His immediate and remote memory appeared grossly intact. His reality testing was within normal limits, and he did not report experiencing hallucinations or appear to be experiencing delusions. His insight seemed fair, and his judgment was good. He denied having suicidal or homicidal ideation. The examiner opined that the Veteran's PTSD resulted in occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medication. The examiner opined that the current level of the Veteran's PTSD symptoms remained mild; he reported having had periods in the past when his symptoms were worse, but his current medication regimen had been helping with irritability and occasional low mood. The examiner commended him on his devotion to his family, his interest and involvement in his grandson's life, a long career of hard work, and his ongoing use of carpentry talents to help others while also helping his family. Based on this evidence, an April 2014 rating decision continued the 10 percent rating for PTSD. On September 2014 VA treatment, the Veteran reported sleeping well using Trazodone, which had been increased, and he was tolerating Zoloft daily. He reported that his current stress was trying to get a VA loan for refinancing his house. He denied having suicidal or homicidal ideation, depression, or anxiety. On mental status examination, his sleep, energy, and interest were good/improved, and his stress tolerance and anger control were fair. His appetite and motivation were good, and irritability was decreased. He denied crying. His grooming was good, attitude was within normal limits, and eye contact was normal. His mood was within normal limits and affect was euthymic. His thought form and content were logical, concentration was intact, and speech was within normal limits. He did not have psychotic symptoms. His insight and judgment were intact. On January 2015 VA treatment, the Veteran reported that things with his family were about the same, but his teenaged adopted grandson was a bright spot. He reported tinkering with cars and teaching his grandson as much as he was interested. He denied having suicidal or homicidal ideation, and indicated he was sleeping much better with medication. On mental status examination, his sleep, energy, and interest were good/improved, and his stress tolerance and anger control were fair. His appetite was good, irritability was decreased, and motivation was good. His attitude and mood were within normal limits, eye contact was normal, and affect was euthymic. His thought form and content were logical, concentration was intact, and speech and psychomotor activity were within normal limits. His insight and judgment were intact. On July 15, 2015 VA examination, the Veteran reported there had been no changes in his living situation or social support since the previous examination; he lived with his wife of 28 years and a teen-aged grandson, whom he and his wife had raised since he was a toddler. He reported that his wife sustained a severe back injury in a car accident in February 2015, which caused increased stress in the household due to her physical limitations. He reported that he had not worked since he retired from construction in 2012 because he was 62 and hated the people for whom he worked. He reported having increased depression in the previous month, with significant depression about 20 out of 30 days. He reported having feelings of hopelessness at least a couple of times a week. He denied homicidal or suicidal ideation. He reported having "a lot" of anxiety since his wife's injury, which caused his "whole world [to be] upside down". He reported having full- blown panic attacks 3 or 4 times a week. He reported chronic sleep disruption despite taking Trazodone. He reported that concentration was getting difficult and he was forgetting things. He denied changes in appetite, weight, or concerns about money management. He reported unwanted memories of Vietnam in the previous month and daily thoughts of Vietnam, but denied nightmares. He reported avoiding memories and potential reminders of Vietnam. He reported that he no longer went to AMVETS, and was uncomfortable around large crowds of people. He reported negative thoughts and self-blame related to Vietnam. He reported having anxiety and fear that he may "do something [he] may regret", and that he no longer enjoyed hunting and shooting with his grandson. He reported decreased interest in activities, and that he did not like to leave the house. He reported feeling distant from others and having difficulty experiencing positive emotions. He reported increased irritability and hypervigilance, depressed mood, anxiety, panic attacks that occur weekly or less often, chronic sleep impairment, and mild memory loss. On mental status examination, the Veteran was calm and cooperative throughout. No significant disturbances of affect, communication, or thought processes were noted, and he was fully oriented. His memory was largely intact. He denied current suicidal or homicidal thoughts, intention, or plan. The examiner noted that the Veteran reported chronic sleep difficulties, and opined that this would likely impact his ability to perform occupational tasks that require promptness or alertness. The examiner opined that the reported irritability would likely impact on ability to perform occupational tasks that require interaction with other individuals, and his reported ease of startle would likely impact ability to perform occupational tasks in environments that are loud, unfamiliar, or unpredictable. The examiner opined that the Veteran's PTSD resulted in occupational and social impairment with reduced reliability and productivity. On March 2016 VA treatment, the Veteran reported feeling well, enjoying the warmer weather, and being happy to see some progress with his grandson who was currently in alternative education classes due to previous behavior problems. He reported that he felt more relaxed, less worried, and trying to take things just as they come. His depression/anxiety was stable. On mental status examination, his sleep and energy were good/improved, and his stress tolerance and anger control were fair/improved. His interest and appetite were good, and his irritability was decreased. His motivation and grooming were good. His attitude was within normal limits, eye contact was normal, mood was within normal limits, and affect was baseline and euthymic. His thought form and content were logical. His concentration was intact, speech and psychomotor activity were within normal limits, and he was fully alert and oriented. He denied suicidal or homicidal ideation, and his insight and judgment were intact. Based on this evidence, an August 2016 rating decision granted a 30 percent initial rating for PTSD effective November 26, 2012, and a 50 percent rating effective July 15, 2015. On September 2017 VA treatment, the Veteran reported that his wife had died of an opiate overdose in July 2017, when she had been out of jail for about 2 weeks. He reported that he did not think it would bother him that much, but was sorry that she had to end up like that; he felt he did what he could and did not have guilt about it. He reported having less anxiety, and was calm and focused on evaluation. He reported that he was busy around his house and continued to enjoy his grandchildren. He reported drinking 2 to 3 beers on a weekend while watching a race on TV but did not use alcohol otherwise. He continued taking medication for anxiety, sleep, and pain management. His depression/anxiety was stable. On mental status examination, his sleep and energy was good, and his stress tolerance, anger control, and interest were good/improved. His appetite and motivation were good, and irritability was decreased. His grooming was good and eye contact was normal. His attitude was within normal limits. He was alert and fully oriented. His mood was within normal limits/baseline, and his affect was appropriate. His thought form was linear and thought content was logical. His concentration was intact. His speech and psychomotor activity were within normal limits, and he denied suicidal and homicidal ideation. He had no psychotic symptoms. His insight and judgment were intact. On March 2018 VA treatment, it was noted that the Veteran was having some financial difficulties due to his mortgage having increased. He reported having work to do that afternoon on his rental property. He reported feeling overall that he was handling day to day stressors. He had stopped taking Zoloft and did not feel any increase in anxiety without it. He reported feeling much less stressed since his drug-addicted wife was no longer in his life. He continued taking Trazodone, Clonazepam, and Gabapentin for sleep, anxiety, and pain management. His depression/anxiety was stable. On mental status examination, his sleep, energy, appetite, and compliance were good. His stress tolerance, anger control, and interest were good/improved. His irritability was decreased, and motivation and grooming were good. His attitude was within normal limits, eye contact was normal, mood was within normal limits/baseline, and affect was appropriate. His thought form was linear, thought content was logical, concentration was intact, and speech and psychomotor activity were within normal limits. He was fully oriented. He denied suicidal or homicidal ideation. He did not have psychotic symptoms. His insight and judgment were intact. On February 2019 VA treatment, the Veteran was calm and focused. He lived in an RV on his property and his daughter's family lived in the house. He felt he was coping as well as he could, though he had periods of anxiety and panic. He took Trazodone and Gabapentin, with Clonazepam available as needed, and he would try taking Trazodone again as well. On mental status examination, his sleep, energy, appetite, and compliance were good. His stress tolerance, anger control, and interest were good/improved. His irritability was decreased, he denied crying, and his motivation and grooming were good. His attitude was within normal limits, eye contact was normal, mood was within normal limits/baseline, and affect was appropriate. His thought form was linear, thought content was logical, concentration was intact, and speech and psychomotor activity were within normal limits. He was fully oriented. He denied suicidal or homicidal ideation and psychotic symptoms. His insight and judgment were intact. At the March 2019 Board hearing, the Veteran testified that he has sleep disturbance, anxiety, nervousness, loss of appetite, failure to communicate well with people, confusion, and depression due to his PTSD. He testified that he has crying spells about once per month and suicidal thoughts at least once a month, and that when things do not go his way, he gets angry and isolates himself. He testified that he has panic attacks at least once per week, triggered by loud noises or crowds, and that he gets up 3 or 4 times a night, and has nightmares once every week to two weeks. He testified that he has difficulty with attention and concentration. He testified that his daughter essentially lives with him and assists him with activities of daily living such as reminding him to pay bills and take medication. He testified that he no longer feels motivated to attend recreational events with his family. He testified that he gets along with his three grandchildren. He testified that he cannot go to church because he gets too nervous and upset. He testified that he does not want to be around anyone, and eels humiliated due to not being able to sit and talk with people normally. He testified that he had problems getting along with his supervisors at his last jobs. On May 31, 2019 private psychological examination, the Veteran reported that he had various difficulties at his last job due to his perception and belief that his supervisors were being condescending toward him. He reported that he struggled to maintain adequate control over his psychiatric problems during that 6 year employment, until he finally retired at age 62. He reported currently having significant emotional distress with general anxiety and tension, unstable mood swings, and flashbacks. He appeared guarded, highly anxious, and tense. His abstract thinking ability appeared intact. His affect was somewhat increased. His speech was clear and comprehensible, though rambling and tangential. His attention and concentration were adequate, but he was somewhat distractible. His speech was somewhat pressured, of a rapid rate with normal volume, and presented in a highly emotional tone and quality. He spoke spontaneously and in a hyper-garrulous manner in a rambling fashion, and his stream of speech was consistent, with considerable anxiety and ruminations/worry. He was fully oriented, and there was no evidence of formal thought disorder, hallucinations, delusions, or any florid or major underlying psychopathology. His thought processes were tangential and manifested flight of ideas. He described and manifested clinically significant depression and anxiety. He denied suicidal ideation or plans. He demonstrated questionable insight into his symptoms and situational problems. His affect was odd and inappropriate, and he had disorganized concentration and attention. He reported decreased productivity at home, poor interpersonal relations, social isolation, and intrusive memories. His symptoms included deficiencies in family relations and mood, persistent irrational fears, difficulty in adapting to stressful circumstances, intrusive recollections of a traumatic experience, and unprovoked hostility and irritability. The examiner opined that the Veteran had moderate psychopathology, currently controlled and contained by a low-stress environment. The examiner opined that, due to the nature and level of his psychological impairment, the Veteran cannot function in a competitive employment environment; his ability to deal with the stresses of work is moderately impaired, and any attempts to engage in employment is likely to result in an acute deterioration in psychological functioning, with at least some potential for eliciting suicidal ideation or behavior. The examiner opined that, if he were to attempt a return to the work force, the types of work he might eventually be capable of sustaining are likely to be low-paying (such as sheltered workshops for the mentally compromised) with little by way of employee benefits. The examiner opined that even if he did seek and manage to obtain employment, he would not be able to sustain it in a responsible and competent manner without interference from his psychological symptoms. The examiner opined that, with psychological care and appropriate psychoactive medications, the Veteran would be capable of limited, low-stress work placement in a supported/sheltered supervised work setting and, even in such conditions, he would be an unreliable and unproductive employee due to his moderate psychological disabilities. The examiner opined that the Veteran's psychological condition and the high likelihood of workplace stress causing severe depressive deterioration and possible suicidal risk, combined, would preclude employment, and he should be considered as being moderately disabled from performing full-time competitive work in a normal competitive work setting. On December 10, 2020 VA examination, the Veteran reported that he had discontinued all psychiatric medications, stating that he did not feel they were helpful. He denied any counseling for PTSD since the previous VA exam. His reported symptoms included depressed mood, anxiety, suspiciousness, chronic sleep impairment, mild memory loss, 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 suicidal ideation. On mental status examination, the Veteran's appearance, behavior, and speech were within normal limits. His mood and affect were congruent, and a good level of rapport was established. He reported chronic passive suicidal/nihilistic thoughts but no history of suicide attempts and no plan or intent to harm himself. The examiner opined that the Veteran's PTSD results in occupational and social impairment with reduced reliability and productivity. The examiner opined that the Veteran's PTSD and level of impairment remained virtually unchanged since the previous exam, though the severity of his symptoms and impairment may fluctuate in response to life stressors. The examiner opined that the Veteran's poor sleep would affect his ability to perform job duties safely in some work environments; his re-experiencing symptoms would affect his ability to complete tasks in most job settings; and his irritability and anxiety would interfere with his ability to interact effectively with coworkers, supervisors, and the public in most job settings. Based on this evidence, a December 2020 rating decision granted a 70 percent rating for PTSD effective December 10, 2020. Additional treatment records throughout show symptoms for the most part similar to those noted on contemporaneous examinations and treatment visits described above. The Veteran has also submitted lay statements describing his difficulties due to psychiatric disability. Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. With the initial rating assigned upon a grant of service connection, separate (staged) ratings may be assigned for separate periods of time, based on the facts found. Fenderson v. West, 12 Vet. App. 119, 126 (1999). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Reasonable doubt as to the degree of disability will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. Under Code 9411 and the General Rating Formula for Mental Disorders, a 30 percent rating is warranted for PTSD when there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss (such as forgetting names, directions, recent events. A 50 percent rating is warranted when there is 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 (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. 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 worklike setting); inability to establish and maintain effective relationships. 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; memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130, Code 9411. The use of the phrase "such symptoms as", followed by a list of examples, provides guidance as to the severity of symptoms contemplated for each rating, in addition to permitting consideration of other symptoms, particular to each veteran and disorder, and the effect of those symptoms on the claimant's social and work situation. Mauerhan v. Principi, 16 Vet. App. 436, 443 (2002). Because "[a]ll nonzero disability levels [in § 4.130] are also associated with objectively observable symptomatology," and the plain language of this regulation makes it clear that "the veteran's impairment must be 'due to' those symptoms," "a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration." Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). "[I]n the context of a 70[%] rating, § 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas." Id. at 117. Although a veteran's symptoms are the "primary consideration" in assigning a rating under § 4.130, the determination as to whether the veteran is entitled to a 70% disability evaluation "also requires an ultimate factual conclusion as to the veteran's level of impairment in 'most areas.'" Id. at 118. When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remissions. 38 C.F.R. § 4.126(a). The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. Id. However, when evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation on the basis of social impairment. 38 C.F.R. § 4.126(b). The Board finds that, from November 26, 2012 to July 15, 2015, the reports of VA examinations, treatment records, medical statements, hearing testimony, and lay statements, overall, do not show that prior to July 15, 2015 symptoms of the Veteran's PTSD resulted in occupational and social impairment with reduced reliability and productivity, so as to meet the criteria for the next higher (50 percent) rating. While he reported feeling anxious in crowds and avoiding large crowds, he consistently maintained relations with close family (his wife, adult daughter, three grandchildren, and four siblings), he enjoyed playing golf weekly with one friend, suggesting regular leisure activity, and had several other friends, and he enjoyed fishing and hunting with his grandson. There was no evidence of a cognitive or thought disorder or impaired insight or judgment, and he consistently denied having suicidal ideation. The August 2013 and April 2014 VA examiners opined that the Veteran's PTSD symptoms were mild in severity. This disability picture does not reflect that due to PTSD he had occupational and social impairment with reduced reliability and productivity prior to July 15, 2015; instead, it reflects a reasonably well-functioning individual, with no deficiency in daily-activity functioning, thinking, or judgment, and with the ability to maintain familial relationships, several friendships, and regular leisure outings. Continuing the analysis, the Board finds that from [the earlier effective date of] July 15, 2015, the Veteran, his treating and evaluating mental health personnel, and the VA examiners have reported symptoms that reflect occupational and social impairment with deficiencies in most areas, consistent with a 70 percent rating. On July 15, 2015 VA examination, he described worsening symptoms that reflect a disability picture reasonably reflective of occupational and social impairment with deficiencies in most areas. At that time, the Veteran first reported increased stress in his household due to his wife's physical limitations from injuries incurred in a severe car accident a few months prior. He reported having significant depression about 20 out of the previous 30 days, feelings of hopelessness multiple times per week, a lot of anxiety, panic attacks several times per week, chronic sleep disruption despite taking medication, decreased interest in activities, and increased irritability and hypervigilance. Importantly, he reported difficulty concentrating and forgetting things, suggesting cognitive impairment. The Board finds significant the December 10, 2020 VA examiner's opinion that the Veteran's PTSD and level of impairment remained virtually unchanged since the previous exam (emphasis added), though the severity of his symptoms and impairment may fluctuate in response to life stressors. Because the December 10, 2020 VA examination was the basis for the AOJ's grant of a 70 percent rating, the Board finds a 70 percent rating is warranted from July 15, 2015, the date of the previous examination, which showed increased symptomatology. The evidence of record does not show that symptoms that met (or approximated) the criteria for a 100 percent schedular rating were manifested at any time during the appeal period. It is not shown that, at any time, the Veteran had symptoms productive of total occupational and social impairment. While on occasion he self-reported symptoms of greater severity, it is not shown by the record that his symptoms resulted in such total impairment. The record does not show that he required assistance tending to finances, gross impairment in thought processes or communication was not shown, his behavior was not shown as grossly inappropriate, and he was not in persistent danger of hurting himself or others. Furthermore, he maintained relations with his daughter, who lived with her family on his property. The lay statements he submitted in support of this claim detail the types of problems that resulted from his psychiatric symptoms. The levels of functioning impairment described are encompassed by the criteria for the 70 percent rating [now] assigned from July 15, 2015. Accordingly, a 100 percent schedular rating is not warranted at any time. 2. A TDIU rating is granted. In his January 2015 application for a TDIU rating, the Veteran reported that he last worked full time in February 2012 as a carpenter for a construction company, and that his service-connected PTSD affected his full-time employment. He stated that he was retired and had not tried to obtain employment since his retirement. He reported that he never worked at any one job for more than 3 years prior to his last employer, noting that he was very angry and uneasy during his time with that employer. He reported that he has a GED (high school equivalency) degree and no additional education or training. In a July 2015 response to a request for employment information, the Veteran's former employer stated that he was employed full time as a carpenter from March 2006 to February 2012, when he retired; the employer noted that it was a "normal retirement". On July 2015 VA examination, the Veteran reported that he had not worked since he retired from construction in 2012 because he was 62 and hated the people for whom he worked. It was noted that the Veteran reported chronic sleep difficulties, and the examiner opined that this would likely impact his ability to perform occupational tasks that require promptness or alertness. The examiner opined that the reported irritability would likely impact his ability to perform occupational tasks that require interaction with other individuals, and his reported ease of startle would likely impact his ability to perform occupational tasks in environments that are loud, unfamiliar, or unpredictable. The examiner opined that the Veteran's PTSD resulted in occupational and social impairment with reduced reliability and productivity. At the March 2019 Board hearing, the Veteran testified that he had problems getting along with supervisors at his last jobs. He testified that after he got a GED, he attended community college for two semesters and earned a commercial driver's license to drive an 18-wheeler truck. He testified that his problems getting along with supervisors at his last job influenced his decision to take an early retirement. He testified that his nerves, panic attacks, lack of concentration and attention, and poor communication skills would keep him from performing full-time work. On May 2019 private psychological examination, the Veteran reported that he had various difficulties at his last job, due to his perception and belief that supervisors were condescending toward him. He reported that he struggled to maintain adequate control over his psychiatric problems during his employment. The examiner opined that, due to the nature and level of his psychological impairment, the Veteran cannot function in a competitive employment environment, and any attempt to engage in employment is likely to result in an acute deterioration in psychological functioning, with at least some potential for eliciting suicidal ideation or behavior. The examiner opined that, if he were to attempt a return to the work force, the types of work he might eventually be capable of sustaining are likely to be low-paying with few employee benefits. The examiner opined that the Veteran would not be able to sustain employment in a responsible and competent manner without interference from his psychological symptoms, and even with limited, low-stress work placement in a supported/sheltered supervised work setting, he would be an unreliable and unproductive employee due to his PTSD. On December 2020 VA examination, the examiner opined that the Veteran's poor sleep would affect his ability to perform job duties safely in some work environments; his re-experiencing symptoms would affect ability to complete tasks in most job settings; and his irritability and anxiety would interfere with ability to interact effectively with coworkers, supervisors, and the public in most job settings. A TDIU rating may be assigned when the veteran is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation due to service-connected disabilities. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. If there is only one such disability, it must be rated at 60 percent or more, and if there are two or more disabilities, there shall be at least one disability rated at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent. In evaluating a veteran's employability, consideration may be given to the level of education, special training, and previous work experience, but not to age or impairment caused by non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. 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). The Veteran's sole service-connected disability, PTSD, is [now] rated 70 percent from July 15, 2015. Thus, the schedular rating requirement for a TDIU rating in 38 C.F.R. § 4.16(a) is met. The analysis turns to whether the service-connected disability renders him unemployable. Considering the effects of the service-connected disability on employability, the Board finds significant, in support of the Veteran's claim, the opinions of the VA and private examiners discussed above, each based on a review of the complete record, interview of the Veteran, and mental examination. The Board has no reason to question those opinions, and finds they support, in part, that he would be unable to maintain employment consistent with his education and work experience. Most notable are the 2015 VA examiner's observations that the Veteran's PTSD would likely impact his ability to perform occupational tasks that require promptness or alertness, interaction with other individuals, or take place in environments that are loud, unfamiliar, or unpredictable; the 2019 private examiner's opinion that due to his PTSD the Veteran cannot function in a competitive employment environment, and even with limited, low-stress work placement in a supported/sheltered supervised work setting, he would be an unreliable and unproductive employee; and the 2020 VA examiner's opinion that the Veteran's PTSD symptoms would affect his ability to perform job duties safely in some work environments, his ability to complete tasks in most job settings, and his ability to interact effectively with coworkers, supervisors, and the public in most job settings. In addition, the Board notes that the treatment records, examinations, and statements by the Veteran, discussed above, regarding the limitations caused by his service-connected psychiatric disability support his claim for TDIU. The Board notes that he has a high school equivalency degree with one year of community college and no additional training, and that the vast majority of his occupational experience was as a carpenter or truck driver. On review of the record the Board finds that the overall disability picture presented by the Veteran's service-connected PTSD is one which is reasonably shown to now preclude him from maintaining any regular substantially gainful employment consistent with his education and experience. The Board acknowledges that he has comorbid non-service-connected disabilities (most notably vision problems and degenerative disease of the neck, back, and knees) which also substantially contribute to his unemployability, but finds that even disregarding the effects of such disabilities, he is nonetheless shown to be unemployable due solely to his [service-connected] PTSD. Significant in this regard is that his service-connected psychiatric disability causes memory and executive functioning difficulties, anxiety, suspiciousness, panic attacks several times per week, sleep impairment, and difficulty getting along with others and adapting to stressful circumstances including work (which VA has acknowledged results in deficiencies in most areas). Considering the effect of the functional impairment flowing from the Veteran's service-connected PTSD, the Board finds that such disability is now reasonably shown to be of a nature and severity that preclude him from participating in any regular substantially gainful employment consistent with his education and occupational experience. A TDIU rating is warranted. GEORGE R. SENYK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Schechner, 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.