Citation Nr: 21028715 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 13-15 252 DATE: May 11, 2021 ORDER A rating in excess of 50 percent for posttraumatic stress disorder (PTSD) prior to February 7, 2013, is denied. A total disability rating based on individual unemployability (TDIU) prior to February 7, 2013, is denied FINDINGS OF FACT 1. Prior to February 7, 2013, the Veteran's PTSD did not manifest as occupational and social impairment with deficiencies in most areas. 2. Prior to February 2, 2013, the evidence of record does not show that the Veteran was unable to secure or follow substantially gainful employment as a result of his service-connected disabilities. CONCLUSIONS OF LAW 1. Prior to February 7, 2013, the criteria for a disability rating in excess of 50 percent for PTSD have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.130, Diagnostic Code 9411. 2. Prior to February 7, 2013, the criteria for entitlement to a TDIU have not been met. 38 U.S.C. §§ 1155, 5103, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1966 to March 1969, to include service in the Republic of Vietnam. These matters comes before the Board of Veterans' Appeals (Board) on appeal from a January 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). Initial Consideration The Board remanded these matters in January 2017 and October 2020. In both remands, the Board requested that the RO obtain copies of the Veteran's psychotherapeutic treatment records from the Charleston, South Carolina Vet Center and associate them with the claims file. The Veteran indicated that he received psychotherapeutic treatment for PTSD from 2009. To obtain these records, the RO sent correspondence to the Veteran in October 2020. This correspondence included a copy of a VA Form 21-2142 (Authorization to Disclose Information to VA) and a copy of a VA Form 21-4142a (General Release for Medical Provider Information to VA). The RO requested that the Veteran complete both forms so that VA could obtain copies of the treatment records from the Charleston Vet Center. To date, the Veteran has not returned executed copies of either of the forms. Consequently, the VA psychologist who prepared a December 2020 retrospective opinion addressing the severity of the Veteran's service-connected prior to February 7, 2013, did not have the Charleston Vet Center psychotherapeutic treatment records to consider within the calculus of the retrospective opinion. Applicants for benefits, such as the Veteran, are obligated to cooperate and assist VA in developing evidence. See Wamhoff v. Brown, 8 Vet. App. 517, 522 (1996). Consequently, the Board proceeds with adjudication of these claims based upon the extant evidence of record and additional VA retrospective examinations are not in order. Increased Disability Ratings The Veteran asserted that the severity of his PTSD warranted a disability rating in excess of 50 percent prior to February 7, 2013. Ratings for service-connected disabilities are determined by comparing the veteran's symptoms with criteria listed in VA's Schedule for Rating Disabilities, which is based, as far as practically can be determined, on average impairment in earning capacity. Separate diagnostic codes identify the various disabilities. 38 C.F.R. Part 4. When rating a service-connected disability, the entire history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Hart v. Mansfield, 21 Vet. App. 505 (2007). PTSD is evaluated under the General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130, Diagnostic Codes 9201-9440. Pertinent to this appeal, the General Rating Formula for Mental Disorders are as follows: A 50 percent disability rating is assigned 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 abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. A 70 percent disability rating is assigned 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 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 inability to establish and maintain effective relationships. A 100 percent disability rating is assigned 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, for the veteran's own occupation, or own name. When determining the appropriate disability evaluation to assign, the Board's primary consideration is the Veteran's symptoms, but it must also make findings as to how those symptoms impact the Veteran's occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F. 3d 112, 118 (Fed. Cir. 2013); Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). When adjudicating psychiatric claims, the Board has an obligation under Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017) to conduct a three-part "holistic" analysis. The first step of the analysis is to assess the "severity, frequency, and duration of the signs and symptoms" of the Veteran's condition. The second step is to quantify "the level of occupational and social impairment caused by those signs and symptoms." The third step is to assign an "evaluation that most closely approximates that level of occupational and social impairment." See also Mauerhan, 16 Vet. App. 436 (holding that the list of symptoms in the disability rating schedule for psychiatric disabilities is not exhaustive); and see Vazquez-Claudio, 713 F. 3d 112 (holding that the disability rating schedule for psychiatric disabilities reflects "objectively-observable symptomatology," and "it is the severity of the effects of the symptoms as described by the examiner that determines the rating."). As all ratings in the general rating formula are also associated with objectively observable symptomatology and the plain language of the regulation makes it clear that the Veteran's impairment must be "due to" those symptoms, a veteran may only qualify for a given disability by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. See Vazquez-Claudio, 713 F. 3d 112. Evidence and Analysis A review of the Veteran's VA treatment records from November 2009 disclose that the Veteran sought consultations and clinical advisement for PTSD. In a November 2009 mental health note, a VA social worker indicated that Veteran reported that his psychotropic medication was working "somewhat." He conveyed that his sleep was problematic, but he was sleeping longer than he had in the past. He reported that group therapy sessions at the Vet Center helped, especially with feelings of isolation. As an assessment, this social worker provided insomnia and characteristic PTSD mood and symptoms. Upon a VA mental health assessment in October 2010, a VA psychiatrist indicated that the Veteran complained of frustration due to tiredness. The psychiatrist took the Veteran off of psychotropic medications. Upon mental status examination, the psychiatrist reported that the Veteran presented as normal, with normal psychomotor activity and good eye contact. His mood and affect were good, hi thought processes were linear and articulated in normal tone and rate, and his insight and judgment were fair-to-good. The psychiatrist indicated a total absence of suicidal ideation, homicidal ideation, auditory hallucinations, visual hallucinations, and indications of psychosis. In February 2011, the Veteran reported for a VA PTSD examination. A psychologist reviewed the claims file; considered the Veteran's lay statements; and conducted an appropriate evaluation (hereinafter "VA exam protocols"). The psychologist indicated that the Veteran arrived punctually and reported that he had retired. Attributable symptoms consisted of anxiety; and depression; nervousness; startle response; hypervigilance; avoidance behavior; sleep disturbances; and intrusive thoughts of experience in Vietnam. The Veteran reported that he avoids crowds, loud noises, and hunting. He stated that he was experiencing increased conflict with his spouse. Upon mental status examination, he presented as clean and neat and his affect was serious and pleasant. He did endorse visual hallucinations; however, he denied both suicidal ideation and homicidal ideation. The psychologist found that the Veteran's communication and comprehension skills were "fine". The Veteran endorsed minimal problems with memory, attention, and concentration. The psychologist indicted that the Veteran's symptoms were at the moderately severe level. The psychologist noted that the Veteran's anxiety/worry and depressive symptoms (attributable to an adjustment disorder) had direct connexity to his hypothyroid condition and retirement. (These symptoms were not related to PTSD.) The Veteran was capable of handling his financial matters. While the psychologist opined that it did not appear that the Veteran could return to work, the psychologist opined that PTSD impacted social functioning in a moderately severe manner. In an April 2011 VA mental health note, a VA clinician indicated that the Veteran conveyed that his mental health status was "all right." The Veteran also indicated that he was sleeping better and was uncertain if his psychotropic medication was working. However, he still complained of trouble with sleep (falling asleep easily but waking to use the bathroom and subsequent inability to fall back to sleep). He characterized his mood as "okay when I'm by myself"; however, he was uncomfortable around unknown people and sometimes prone to a "short temper." Overall, the Veteran indicated that his mood was 6/10, which the VA clinician indicated showed improvement. In May 2011, VA received a letter from the Charleston VA Center. A social worker indicated that the Veteran started PTSD group therapy sessions in September 2009. This social worker conveyed that the Veteran endorsed loss of interest in activities; intrusive memories; poor sleep; social isolation; avoidance behaviors; hypervigilance; and exaggerated startle response. The social worker indicated that the Veteran's mood recently was unstable due to a new medication to treat his hyperthyroidism. Otherwise, the Veteran presented as friendly and cooperative as evinced through good eye contact, linear thinking, good insight, and good judgment. The social worker wrote that there was no evidence that the Veteran had either homicidal or suicidal ideations. The social worker did not report that the Veteran endorsed visual or auditory hallucinations. In a June 2011 VA PTSD addendum, the psychologist, who conducted the February 2011 PTSD examination, indicated that there were no changes in the findings made in February. In August 2012, VA received another letter from the Charleston VA Center. A social worker wrote that the Veteran has participated in weekly therapy (and individual therapy on an "as needed" basis) for the past three years. The social work reported that the Veteran exhibited significant hyperarousal symptoms, to include hypervigilance and insomnia. The Veteran also endorsed re-experiencing stressors, anxiety, and guilt. The social worker indicated a long history of hopelessness and suicidal ideation. The social worker reported that the Veteran's PTSD interfered with major areas of life before the Veteran retired. The Veteran reported social isolation; however, he went to church and cared for his family. He also ministered to the needs of others, but PTSD affected this work (despite the Veteran's commitment). VA treatment records and progress notes disclose that the Veteran sought mental health assessments and consultations on a regular basis. Clinicians followed the Veteran's therapeutic status and his psychotropic medication protocols, to achieve maximum efficacy. In November 2012, the Veteran reported for a VA PTSD examination. The psychologist followed VA exam protocols. The psychologist indicated that the Veteran's degree of social and occupational impairment attributable to PTSD was best represented as indicative of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. The psychologist noted the Veteran had depressed mood, anxiety, and chronic sleep impairment. Additionally, the Veteran endorsed "marked worry," especially with financial matters. The Veteran was competent to handle his financial affairs. He presented as appropriately dressed and groomed; generally euthymic in mood; with a full range of affect; with adequate cognitive functioning, communication, and good orientation; and with an ability to retrieve historical information without difficulty. He endorsed intrusive thoughts; occasional nightmares; and reactivity to material suggestive of war. He reported that he was less interested in going to church and reading. The psychologist noted increased arousal and trouble concentrating, especially in situations where people are not following through with their responsibilities. The psychologist did not report that the Veteran endorsed visual or auditory hallucinations. In a December 2012 letter, a social worker at a VA facility submitted a letter, without any annexed clinical records. In pertinent part, this social worker reported that the Veteran's symptoms have fluctuated from moderate-to-severe throughout his three years of VA social work treatment. She also stated that these symptoms significantly impacted the Veteran's quality of life. Then, she provided a "bald" column of symptoms (without any clinical or historical commentary), to include: 1) flashbacks and intrusive memories; 2) anger outburst (sic); 3) isolation and withdrawal from significant social interaction; 4) mood swings; 5) sleep difficulty (sic) and nightmares; 6) increased anxiety; 7) increased irritability; 8) avoidance behaviors; 9) hyper vigilance (sic); and 10) depressed mood. The Board acknowledges this social worker's letter; however, the Board assigns diminished probative weight to it. As already noted, this letter is bereft of clinical records; also, the Board finds that this social worker has not provided any commentary as to specific facts of the Veteran's mental health history. Indeed, the Board observes that this social worker even failed to articulate whether she derived her column of symptoms through psychometric testing or lay reports. Sklar v. Brown, 5 Vet. App, 140 (2003). In a January 2013 lay statement, the Veteran's ex-spouse reported that the Veteran liked to stay at home; appeared to experience disturbing dreams; was moody; displayed repetitive behaviors like double-checking that doors are locked; and was apathetic when his own mother died. She reported that she divorced the Veteran because she feared for her life. The ex-spouse did not expound upon these threats in any way. In January 2013, a VA clinician rendered an addendum as to the severity of the Veteran's PTSD and adjustment disorder. Based upon a comprehensive review of the evidence of record, this psychologist reported that the Veteran's "marked worry," which the November 2012 reported was attributable to adjustment disorder with depression and anxiety emanated from the Veteran's financial concerns and his family stressors. However, the symptoms of this separate and freestanding mental health disorder, related to the then-recent and then-ongoing financial and family stress, may well overlap with the symptoms and functional impairments of PTSD. A differentiation of symptoms can only be made when one of the diagnosed mental health disorders fully resolves. In January 2021, a psychologist rendered a retrospective VA opinion to assess the clinical severity of the Veteran's PTSD prior to February 7, 2013. This psychologist indicated claims file review. The psychologist opined that prior to February 7, 2013, the clinical evidence of record disclosed that the Veteran experienced symptoms of anger and depression, which fluctuated in severity. The psychologist underscored that the Veteran's PTSD symptomatology was fluid throughout this period, based upon the quite limited extant evidence. As to onset of the Veteran's current 70 percent PTSD symptomatology, the psychologist could not offer an opinion without resort to speculation as the claims file did not contain "robust" treatment records. Mental health symptoms and associated functional impairments are fluid and impacted by many variables. (Again, the Board notes that the Veteran never returned executed VA forms to obtain the Charleston Vet Center psychotherapeutic treatment records.) In April 2021, VA received a brief from the Veteran's representative. In pertinent part, the representative argued that the January 2021 retrospective opinion did not comply with the Board's remand directives. The Board finds the representative's arguments to be somewhat disingenuous, as the representative wholly omits the Veteran's failure to return an executed VA Form 21-2142 and an executed VA Form 21-2142a. As a consequence of this, VA could not obtain the "robust" psychotherapeutic treatment records necessary to render an informed opinion as to onset. Again, the April 2021 psychologist indicated that rendering an onset date as to more severe symptomology would be an exercise in pure speculation in the absence of these necessary "robust" records. This highly trained clinical professional insisted that mental health symptoms and associated functional impairments are fluid and impacted by many variables. The Board reminds this representative that the duty to assist is not wholly the responsibility of VA. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) ("The duty to assist is not always a one-way street. If a veteran wants help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence"). As noted above, to receive a higher disability for PTSD prior to February 7, 2013, there would need to be a showing of 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 inability to establish and maintain effective relationships. Such is not disclosed in the evidence of record. Prior to February 7, 2013, the Veteran's PTSD, at worst, manifested as occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. The Board has considered that December 2012 VA social worker's letter, to include her bald column of symptoms. However, for reasons stated above, this letter warrants diminished probative weight as it was bereft of clinical findings and provided no commentary as to specific facts of the Veteran's mental health history. Sklar, 5 Vet. App, 140. Prior to February 7, 2013, the evidence of record fails to disclose that the Veteran's PTSD included such symptoms as 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 inability to establish and maintain effective relationships. Even factoring the conclusory findings of the December 2012 VA social worker and the Veteran's ex-spouse's "fear for her life," such a repertoire of symptoms cannot be derived. The Board has considered whether the record discloses symptoms analogous to those noted above but finds no evidence of such. See Mauerhan, 16 Vet. App. 436; Vazquez-Claudio, 713 F. 3d 112. Prior to February 7, 2013, the evidence of record shows that the Veteran presented as appropriately dressed and groomed; generally euthymic in mood; with a full range of affect; with adequate cognitive functioning, communication, and good orientation; and with an ability to retrieve historical information without difficulty. The Veteran endorsed that he ministered to those in need even though it caused a degree of dissonance. Additionally, he attended church and read, albeit with reduced interest. Nothing in the evidence of record even suggests that the Veteran was unable to handle his financial matters, "person," or hygiene. Consequently, an holistic Bankhead analysis, discerned though the three steps described above, suggests that the Veteran's degree of occupational and social impairment manifested as reduced reliability and productivity due to such symptoms as disturbances of motivation and mood and difficulty in establishing and maintaining effective work and social relationships. The Board finds that the Veteran is competent to convey discernable symptoms (viz., exhaustion) as well as psycho-medical information conveyed to him by competent clinicians. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, the Veteran lacks the specialized training and clinical psychological expertise to render an opinion as to the severity of PTSD symptomology, especially when one considers the highly technical DSM-5 criteria. 38 C.F.R. § 3.159. Therefore, the body of lay evidence warrants minimal probative weight. Overall, the Board finds that the preponderance of evidence is against granting a disability rating in excess of 50 percent for service-connected PTSD prior to February 7, 2013. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Accordingly, the criteria for a schedular rating in excess of 50 percent for service-connected PTSD prior to February 7, 2013, have not been met. A TDIU Prior to February 7, 2013 The Veteran asserted that the grant of a TDIU prior to February 7, 2013, was warranted. In order to establish entitlement to a TDIU due to service-connected disabilities, there must be impairment so severe that it is impossible for the average person to follow a substantially gainful occupation. See 38 U.S.C. §§ 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. In reaching such a determination, the central inquiry is "whether the veteran's service-connected disabilities alone are of sufficient severity to produce unemployability." Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Consideration may be given to the veteran's level of education, special training, and previous work experience in arriving at a conclusion, but not to his age or to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). "Substantially gainful employment" is that employment "which is ordinarily followed by the nondisabled to earn their livelihood with earnings common to the particular occupation in the community where the veteran resides." Moore (Robert) v. Derwinski, 1 Vet. App. 356, 358 (1991). "Marginal employment shall not be considered substantially gainful employment." 38 C.F.R. §§ 4.16(a), The regulatory scheme for a TDIU provides both objective and subjective criteria. Hatlestad, 5 Vet. App. 524, 529; VAOPGCPREC 75-91 (Dec. 27, 1991) 57 Fed. Reg. 2317 (1992). The objective criteria, set forth at 38 C.F.R. § § 3.340(a)(2), provide for a total rating when there is a single disability or a combination of disabilities that results in a 100 percent schedular evaluation. Subjective criteria, set forth at 38 C.F.R. §§ 4.16(a), provide for a TDIU when, due to service-connected disability, a veteran is unable to secure or follow a substantially gainful occupation, and has a single disability rated 60 percent or more, or at least one disability rated 40 percent or more with additional disability sufficient to bring the combined evaluation to 70 percent. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). In exceptional circumstances, where the veteran does not meet the aforementioned percentage requirements, a total rating may nonetheless be assigned upon a showing that the individual is unable to obtain or retain substantially gainful employment. 38 C.F.R. § 4.16(b). Prior to February 7, 2013, the Veteran had the following service-connected disabilities: 1) PTSD at 30 percent, effective from February 12, 2007 and at 50 percent, effective from July 30, 2009; 2) diabetes mellitus at 20 percent, effective from July 27, 2006; and 3) erectile dysfunction at a noncompensable rating, effective from May 28, 2010. Thus, the Veteran met the schedular requirements for service-connected disabilities from July 30, 2009 to February 7, 2013. Upon the VA mental health assessment in October 2010, the VA psychiatrist did not indicate that the Veteran's PTSD impacted the Veteran's ability to work. Upon the February 2011 VA PTSD examination, the psychologist indicated that the Veteran arrived punctually and reported that he had retired. While the psychologist opined that it did not appear that the Veteran could return to work, the psychologist opined that PTSD impacted social functioning in a moderately severe manner. By his own lay account, the Veteran was "all right" in an April 2011 VA mental health note. The May 2011 Charleston VA Center social worker conveyed that the Veteran endorsed loss of interest in activities; intrusive memories; poor sleep; social isolation; avoidance behaviors; hypervigilance; and exaggerated startle response. Otherwise, the Veteran presented as friendly and cooperative, as evinced through good eye contact, linear thinking, good insight, and good judgment. The social worker wrote that there was no evidence to show that the Veteran had either homicidal or suicidal ideations. The August 2012 Charleston VA Center social worker reported that PTSD interfered with major areas of life before the Veteran retired. The Veteran reported social isolation; however, he went to church and cared for his family. He also ministered to the needs of others even though his PTSD affected this work. Upon the November 2012 VA PTSD examination, the psychologist indicated that the Veteran's degree of social and occupational impairment attributable to PTSD was best represented as indicative of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. While the December 2012 VA social worker stated that the symptoms of PTSD significantly impacted the Veteran's quality of life, she did not indicate that the Veteran's PTSD impacted the Veteran's ability to work. Notably, the January 2013 VA clinician, who rendered the mental health addendum, did not indicate that Veteran's PTSD impacted the Veteran's ability to work. The evidence of record shows that the Veteran completed his high school degree and attended college for two years. The Veteran retired after 17 years of work with a Fortune 500 metallurgy corporation. While in this corporation's employ, the Veteran worked in the field of utilities operations. The Veteran reported that he engaged in pastoral work, ministering to those in need. While the Veteran asserted that his service-connected disabilities rendered him unable to obtain or retain employment consistent with his education and experience prior to February 7, 2013, the evidence of record shows that the Veteran has a high school education, two years of college, and professional experience in the field of utilities for Fortune 500 metallurgy corporation. Moreover, the Veteran had voluntary pastoral experience. Collectively, the Board finds that this combination of education and work experiences, prior to February 7, 2013, were more-than-sufficient for the Veteran to obtain and maintain substantial employment considering his specific education and specific work experience. See Withers v. Wilkie, 30 Vet. App. 139 (2018). The Board recognizes that prior to February 7, 2013, the Veteran experienced PTSD symptoms which caused occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. However, these limitations did not rise to the level of rendering the Veteran totally impaired physically, occupationally, or socially. Indeed, the evidence of record does not reveal that any one of his service-connected disabilities, or the entirety of his three service-connected disabilities, precluded him from obtaining and maintaining gainful employment prior to February 7, 2013. Prior to February 7, 2013, the Veteran's job skills would have lent themselves to employment in any corporate setting where utilities operations are integralas a mentor, safety monitor, or in a training capacity. Indeed, working for a Fortune 500 corporation equipped the Veteran with skills for dealing with the bureaucracy of corporate culture. Here, the Board notes that many employers, prior to October 7, 2013, offered accommodations pursuant to the ADA, to allow for downtime due to disabilities. In the Veteran's case, it would have been feasible for an employer to provide breaks in an isolated quiet area where the Veteran could collect himself during bouts of PTSD symptoms. The rating schedule was created as a guide to evaluating disabilities resulting from all types of diseases and injuries encountered, and the percentage ratings that are assigned represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and their residual conditions in civil occupations. 38 C.F.R. § 4.1. 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. (Continued on the next page) Accordingly, entitlement to a TDIU prior to October 7, 2013, is denied. Timothy Berryman Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. J. Komins, 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.