Citation Nr: 21030032 Decision Date: 05/17/21 Archive Date: 05/17/21 DOCKET NO. 15-11 621 DATE: May 17, 2021 ORDER Entitlement to an increased rating of 70 percent, but no higher, prior to May 7, 2015 for service-connected posttraumatic stress disorder (PTSD) is granted. Entitlement to an increased rating in excess of 70 percent disabling from May 7, 2015 for service-connected PTSD is denied. Entitlement to a compensable disability rating for bilateral hearing loss is denied. Entitlement to a total disability rating for compensation purposes based on individual unemployability (TDIU) from June 3, 2008 to March 18, 2015 is denied. Entitlement to a TDIU from March 19, 2015 to May 6, 2015 is granted. FINDINGS OF FACT 1. The service-connected PTSD from March 22, 2012 to May 6, 2015 more nearly approximates occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking, or mood. 2. From May 7, 2015, the service-connected PTSD does not more nearly approximate the criteria for total occupational and social impairment. 3. Throughout the appeal period, the Veteran's bilateral hearing loss disability has been manifested by hearing acuity no worse than Level II in both ears, with no exceptional pattern of hearing loss in either ear. 4. From June 3, 2008 to March 18, 2015, the Veteran's service-connected disabilities did not prevent him from securing or following gainful employment. 5. Resolving doubt in the Veteran's favor, the Veteran is unable to secure and maintain substantially gainful employment as a result of his service-connected disabilities from March 19, 2015 to May 6, 2015. CONCLUSIONS OF LAW 1. The criteria for an initial 70 percent rating for PTSD from March 22, 2012 to May 6, 2015 have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.3, 4.7, 4.130, Diagnostic Code 9411. 2. The criteria for rating in excess of 70 percent from May 7, 2015 for PTSD have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.3, 4.7, 4.130, Diagnostic Code 9411. 3. The criteria for a compensable disability rating for bilateral hearing loss are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 4.85, 4.86, Diagnostic Code 6100. 4. From June 3, 2008 to March 18, 2015 the criteria for TDIU are not met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.340, 4.16(b). 5. From March 19, 2015 to May 6, 2015 the criteria for TDIU due to service-connected disabilities have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.340, 4.15, 4.16(b). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from March 1966 to August 1966, May 1968 to June 1974, and from July 1983 to December 1983. His decorations include the Air Medal and Bronze Star Medal. In an April 2019 Board decision, these issues were remanded to obtain new VA examinations to assess the Veteran's current severity for his disabilities. The Board finds that VA substantially complied with the remand instructions and the issues are properly before the Board for adjudication. Increased Ratings A disability rating is determined by the application of VA's 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. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. VA has a duty to acknowledge and consider all regulations that are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusions. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). 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 for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings," whether it is an initial rating case or not. Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. Entitlement to an increased rating of 70 percent, but no higher, prior to May 7, 2015 for service-connected PTSD. 2. Entitlement to an increased rating in excess of 70 percent disabling from May 7, 2015 for service-connected PTSD. By way of history, the Veteran was granted service connection for PTSD and assigned an initial evaluation of 30 percent, effective March 22, 2012, the date of claim. Thereafter, in a May 2015 rating decision, the RO increased the rating to 70 percent disabling, effective May 7, 2015. The Veteran asserts that his PTSD is more disabling than reflected by the assigned ratings. The Veteran's PTSD has been rated under Diagnostic Code 9411, which is rated under the General Rating Formula for Mental Disorders. 38C.F.R. §4.130, Diagnostic Code 9411. Under the General Rating Formula for Mental Disorders, a 30 percent evaluation is assigned when a veteran's mental disability causes 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, mild memory loss (such as forgetting names, directions, recent events). 38 C.F.R. § 4.130, Diagnostic Code 9411. A 50 percent rating requires occupational and social impairment, but with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, 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 task); 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 for even greater occupational and social impairment with deficiencies in most areas, such as work, school, family relationships, judgment, thinking or mood, due to such symptoms as: suicidal ideation; obsessional rituals that interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting 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 if 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. Id. When rating a mental disorder, VA must consider the frequency, severity, and duration of the Veteran's psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission. The rating agency must assign a rating 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. When rating the level of disability from a mental disorder, the rating agency must consider the extent of social impairment but cannot assign a rating solely on the basis of social impairment. 38 C.F.R. § 4.126. The Veteran's actual symptomatology, and resulting social and occupational impairment, will be the primary focus when assigning a disability rating for a mental disorder, and the Veteran may qualify for a particular rating by demonstrating the particular symptoms associated with that percentage, or other symptoms of similar severity, frequency, and duration. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). Medical treatment record throughout the period on appeal reflect that the Veteran attended individual therapy sessions regularly and group therapy periodically. He was also treated with medication with no reported side effects. In April 2012, the Veteran reported that he lacked motivation and that he continued to struggle with hypervigilance and anger management. The attending clinician noted that he exhibited limited to fair ability of coping skills dealing with his daily triggers and frustrations. The clinician noted that he appeared appropriately groomed, had good eye contact, his affect was within normal range, and thought process and content were within normal limit. He denied any type of delusions or hallucinations and did not have suicidal or homicidal ideation. He was alert and oriented to person, time, place, and situation and had limited to fair insight and judgment. From May 2012 to March 2015, the Veteran was alert, oriented, and neatly groomed. He did not show any psychosis or mania and did not have suicidal or homicidal ideation. In a May 2012 psychiatric report completed by the Veteran's VA psychiatrist, the psychiatrist indicated that the Veteran had severe PTSD symptoms. He explained that the Veteran experienced chronic anxiety, panic attacks more than once a week, chronic episodes of anger management problems which lead to impaired impulse control such as unprovoked irritable behavior. He furthered that the Veteran had poor sleep due to nightmares and re-experienced the trauma he experienced during his time in the military when he was around people, watching the news or war movies, and loud voices. The psychiatrist explained that the Veteran exhibited difficulty in maintaining and engaging in social and effective work relationships. He also reported that he Veteran had difficulty concentrating and completing tasks. The Veteran reported that he had to sleep separately from his wife since he would start to fight during his sleep. The psychiatrist noted that even though the Veteran was on psychotropic medications, he continued to exhibit disturbances of motivation, anger, and had severe anxiety at times. In the June 2012 VA examination, the examiner opined that the Veteran experienced occupational and social impairment with reduced reliability and productivity. The Veteran reported that he was happily married to his wife for 41 years and that he has a great relationship with his family. He reported that his hobbies included gardening and playing golf with fellow veterans. The Veteran reported symptoms of nightmares, bouts of anger on a daily basis, and weekly depression. He furthered that he has to sleep separately from his wife since he gets combative in his sleep. He added that he gets startled when he hears loud noises and is hypervigilant. The examiner indicated that the Veteran experienced depressed mood, anxiety, and chronic sleep impairment. The examiner noted that the Veteran was dress appropriately and was alert, coherent, polite, and maintained good eye contact. The examiner furthered that the Veteran had full and appropriate affect. There was no evidence of hallucinations or delusions nor did the Veteran have any suicidal or homicidal ideation. There was no gross impairment of memory and insight and judgment were adequate. In an October 2013 psychiatric report, the psychiatrist indicated that the Veteran dealt with nightmares, hypervigilance, and easy startle response. The psychiatrist indicated that while the Veteran had good judgment and had reasonably good control over his behavior, he had difficulty feeling and expressing emotions and experienced distress at reminders of traumatic military events. In a March 2015 report, the VA psychiatrist indicated that the Veteran still had severe PTSD symptoms. The psychiatrist noted that the Veteran had chronic anxiety, occasional panic attacks, episodes of anger management problems that lead to impaired impulse control such as unprovoked irritable behavior. The psychiatrist further indicated that the Veteran exhibited difficulty maintaining and engaging in social relationships and effective work and had difficulties concentrating and completing tasks. In the May 2015 VA examination, the examiner indicated that the Veteran experienced occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. The Veteran reported that anger management was his most concerning symptom. He explained that he experienced significant irritability due to lack of sleep, nightmares, and situational stressors which contribute to verbal aggression. Physical aggression occurred when the Veteran perceived that hew as in imminent danger. He furthered that with medication he is able to sleep two hours per night, but that he generally experienced difficulty falling and staying asleep, would wake up early morning, and had nightmares. He experienced intrusive thoughts about two to three times a week. He furthered that he experienced constant anxiety, including hypervigilance. He explained that he had about a dozen panic attacks in the last 20 years. The examiner noted that the Veteran's depressed mood occurs three times per week and lasts for four days. The Veteran denied having suicidal or homicidal ideation or any hallucinations and delusions. The examiner indicated that the Veteran experienced symptoms of depressed mood, anxiety, suspiciousness, panic attacks that occur less than weekly, near-continuous depression affecting the ability to function independently, appropriately and effectively, chronic sleep impairment, mild memory loss, impairment of short- and long-term memory, speech intermittently illogical, obscure, or irrelevant; difficulty in understanding complex commands; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, including work or a work like setting, impaired impulse control, and neglect of personal appearance and hygiene. The examiner noted that the Veteran was well-oriented in all spheres, had adequate hygiene, had restricted affect, was mildly irritable, thought processes were logical and coherent, insight was adequate, and judgement was poor. The Veteran denied any suicidal or homicidal ideation. The examiner noted that the Veteran is not able to work due to severe anger outbursts, uncontrollable verbal aggression, and physical aggression that occurs when he feels threatened. A February 2017 VA treatment record reported that the Veteran continued to struggle with anxiety, hypervigilance, insomnia, anger management, and irritability. In the November 2019 VA examination, the examiner claimed that the Veteran had occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood. The Veteran reported escalated symptoms of anger with unexplained outburst. He also reported that his sleep pattern varies and that once his sleep is disrupted, he is unable to sleep. He also reported that he felt isolated and that there are days that he is unable to get out of bed due to his depression. The examiner indicated that the Veteran experienced symptoms of depressed mood; anxiety; panic attacks that occur weekly or less often; chronic sleep impairment; mild memory loss; impairment of short and long term memory; flattened affect; speech intermittently illogical, obscure, or irrelevant; gross impairment in thought processes or communication; disturbances of motivation and mood; impaired impulse control; and neglect of personal appearance and hygiene. The examiner indicated that the Veteran was oriented to person, place, time, and situation. The Veteran denied any suicidal or homicidal ideation and of any hallucinations or delusions. Based on the evidence of record, the overall symptomatology during the appeal period prior to May 7, 2015 met the criteria for both a 50 percent rating and a 70 percent rating. As such and affording the benefit of the doubt in the Veteran's favor, the Board finds that a 70 percent rating for this appeal period is warranted. Here, although the Veteran did not experience suicidal ideation, obsessional rituals, illogical or irrelevant speech, spatial disorientation, or neglect of personal appearance and hygiene, the Veteran did consistently experience near-continuous depression or anxiety and had impaired impulse control which often led to unprovoked irritability with periods of violence. The Veteran in fact had to sleep separately from his wife because he would get violent during his sleep. While the Veteran had a good relationship with his wife and his family, he would easily get irritated by others if they did not properly follow directions. Moreover, when he was around people and large crowds with loud noises, it would keep him hypervigilant and he would have exaggerated startle response. Moreover, clinicians have indicated that the Veteran's PTSD symptoms are severe, despite compliance with treatment and medications. At no point during this appeal period did the Veteran's overall symptomatology more nearly approximate the criteria for a 100 percent rating as that rating requires evidence of total occupational and social impairment. Neither the lay nor medical evidence of record shows that the Veteran suffered from hallucinations or engaged in grossly inappropriate or dangerous behavior. Throughout the appeal period he was spatially oriented and was able to remember pertinent personal information, such as his name or the names of relatives. He did not have any suicidal ideation and he was able to maintain minimal personal hygiene. Thus, the evidence does not more nearly approximate the criteria for total occupational and social impairment between March 22, 2012 to May 6, 2015. For the period from May 7, 2015, the Board finds that the evidence does not indicate that the Veteran's overall symptomatology more nearly approximated the criteria for a 100 percent rating. The Veteran did not exhibit gross impairment in thought processes or communication, have persistent delusions or hallucinations; was in persistent danger of hurting himself or others, had intermittent inability to perform activities of daily living, disoriented to time or place, of have memory loss of names of close relatives or own name. While the Veteran did exhibit impaired impulse control with unprovoked irritability with periods of violence, it did not rise to the level of grossly inappropriate behavior or persistent danger of hurting others. As such, the disability rating from May 7, 2015 remains at a 70 percent disability rating and is not entitled to a total disability rating. In reaching the above conclusions, the Board has also fully considered the lay statements of record, which are competent insofar as they relate to observable symptoms. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). Notably, however, the lay evidence of record is not competent to provide an expert opinion as to the Veteran's level of functional impairment as a result of his observable PTSD symptoms. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Therefore, it is afforded less probative value than the objective psychiatric medical evidence of record. In conclusion, a schedular rating in excess of 70 percent is warranted prior to May 7, 2015. To this extent, the appeal is granted. However, the preponderance of the evidence is against the assignment of a schedular rating in excess of 70 percent at any point throughout the appeal period. The appeal, to that extent, must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 3. Entitlement to a compensable disability rating for bilateral hearing loss. In an August 2011 rating decision, the Veteran was granted service connection for bilateral hearing loss with a noncompensable disability rating effective December 29, 2009. The Veteran disagreed with the disability rating, but the noncompensable disability rating was continued in the August 2013 rating decision. The Veteran contends that he is entitled to a higher disability rating for his hearing loss. Bilateral hearing loss is rated pursuant to 38 C.F.R. §§ 4.85 and 4.86, Diagnostic Code 6100. Examinations must be conducted by a state licensed audiologist without the use of hearing aids. 38 C.F.R. § 4.85(a). Auditory acuity is measured by a pure tone threshold test in the frequencies of 1000, 2000, 3000 and 4000 cycles per second (hertz) and the Maryland CNC controlled speech discrimination test. 38 C.F.R. § 4.85(a), (d). There are eleven auditory acuity levels of hearing impairment, ranging from level I for essentially normal hearing through level XI for profound deafness. 38 C.F.R. § 4.85(b), (c). Based on the intersection point of the auditory acuity level for each ear, a rating for hearing impairment is derived from Table VII. 38 C.F.R. § 4.85(e). The auditory acuity level for each ear usually is derived from Table VI, which considers the pure tone threshold average and the speech discrimination percentage. 38 C.F.R. § 4.85(b). Table VIa, which considers only pure tone threshold average, is used when use of the speech discrimination percentage is not appropriate. 38 C.F.R. § 4.85(c). For an exceptional pattern of hearing loss, when the pure tone threshold at 1000, 2000, 3000, and 4000 hertz is 55 decibels or more or is 30 decibels or less at 1000 hertz and 70 decibels or more at 2000 hertz, the auditory acuity level for each ear is derived from Table VI or Table VIa depending on which results in the higher level. 38 C.F.R. §§ 4.86(a), (b). This level then is elevated to the next higher level when the pure tone threshold is 30 decibels or less at 1000 hertz and 70 decibels or more at 2000 hertz. 38 C.F.R. § 4.86(b). Applying these regulations here, the Board finds that the criteria for a compensable disability rating are not met. A December 2010 VA examination shows pure tone thresholds in decibels for the Veteran's right ear at 1000, 2000, 3000, and 4000 Hz were: 15, 20, 60, 65, for an average of 40, and for his left ear, at those same frequencies, were: 20, 25, 35, 55, for an average of 34. Speech discrimination for the right ear was 96 percent and for the left ear it was 88 percent. Using Table VI, these examination results revealed Level I impairment in the right ear and Level II impairment in the left ear resulting in a noncompensable (zero percent) evaluation. 38 C.F.R. § 4.85, Table VII. These audiological results also do not satisfy the criteria for a compensable rating due to an exceptional hearing loss pattern. 38 C.F.R. § 4.86. The June 2012 VA examination shows pure tone thresholds in decibels for the Veteran's right ear at 1000, 2000, 3000, and 4000 Hz were: 20, 30, 65, 65, for an average of 45, and for his left ear, at those same frequencies, were: 25, 25, 45, 60, for an average of 39. Speech discrimination was not evaluated because the speech discrimination score was not appropriate for the Veteran because of language difficulties, cognitive problems, or inconsistent speech discrimination scores. Using Table VIA, these examination results revealed Level II impairment in the right ear and Level I impairment in the left ear resulting in a noncompensable evaluation. 38 C.F.R. § 4.85, Table VII. These audiological results also do not satisfy the criteria for a compensable rating due to an exceptional hearing loss pattern. 38 C.F.R. § 4.86. The November 2019 VA examination shows pure tone thresholds in decibels for the Veteran's right ear at 1000, 2000, 3000, and 4000 Hz were: 10, 30, 65, 70, for an average of 43.75, and for the left ear, at those same frequencies, were: 20, 35, 65, 65, for an average of 46.25. The speech discrimination score for the right ear was 92 percent and 88 percent for the left ear. Using Table VI, these examination results revealed Level I impairment in the right ear and Level II impairment in the left ear resulting in a noncompensable evaluation. 38 C.F.R. § 4.85, Table VII. These audiological results also do not satisfy the criteria for a compensable rating due to an exceptional hearing loss pattern. 38 C.F.R. § 4.86. There are no other audiometric findings included in the treatment records during the appeal period that would warrant a higher rating. In light of the foregoing, it is the Board's conclusion that the preponderance of the evidence is against the assignment of any higher ratings throughout the period on appeal. As set forth above, none of the available audiometric reports pertinent to the period on appeal demonstrate entitlement to anything more than a zero percent rating. In arriving at this conclusion, the Board has considered the Veteran's lay assertions regarding the functional effects of his bilateral hearing loss. Despite any general quality of life problems that he may experience, hearing loss disability is evaluated on the objective findings demonstrated during audiological examination. Just because the Veteran's hearing acuity may be less than optimal does not, by itself, establish entitlement to a higher disability rating. In fact, the assignment of disability ratings for hearing impairment is derived by a mechanical application of the Rating Schedule to the numeric designations based on audiometric test results. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). The rating criteria for hearing loss contemplate functional effects such as difficulty understanding speech, as this is precisely the type of effect that VA's audiometric tests are designed to measure. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). A higher rating can be awarded only when loss of hearing has reached a specified measurable level. Accordingly, the Veteran's impairment due to his hearing loss is most consistent with a noncompensable evaluation. The appeal of this issue must be denied. 4. Entitlement to TDIU prior to May 7, 2015. The Veteran also contends that his service-connected disorders prevent him from engaging in substantially gainful employment and, therefore, that he is entitled to a total disability rating prior to May 7, 2015. The Board notes that the Veteran was granted entitlement to a TDIU effective May 7, 2015, through a May 2015 rating decision; as such, the period since May 7, 2015 is not on appeal. Total disability will be considered to exist when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that, if there is only one such disability, the disability shall be ratable at 60 percent or more, and that, if there are two or more service-connected disabilities, at least one must be rated at 40 percent or more and the combined rating must be 70 percent or more. 38 C.F.R. § 4.16(a). If, however, the veteran does not meet these required percentage standards set forth in 38 C.F.R. § 4.16(a), he still may receive a TDIU on an extraschedular basis if it is determined that he is unable to secure or follow a substantially gainful occupation by reason of his service-connected disabilities. 38 C.F.R. § 4.16(b); See also Fanning v. Brown, 4 Vet. App. 225 (1993). Thus, there must be a determination as to whether there are circumstances in this case, apart from any non-service-connected conditions and advancing age, which would justify a total rating based on unemployability. See Hodges v. Brown, 5 Vet. App. 375 (1993); Blackburn v. Brown, 4 Vet. App. 395 (1993). Being unable to maintain substantially gainful employment is not the same as being 100 percent disabled. "While the term 'substantially gainful occupation' may not set a clear numerical standard for determining TDIU, it does indicate an amount less than 100 percent." Roberson v. Principi, 251 F.3d 1378 (Fed Cir. 2001). Assignment of a TDIU evaluation requires that the record reflect some factor that "takes the claimant's case outside the norm" of any other veteran rated at the same level. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993) (citing 38 C.F.R. §§ 4.1, 4.15). The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. A disability rating in itself is recognition that the impairment makes it difficult to obtain or keep employment, but the ultimate question is whether the veteran is capable of performing the physical and mental acts required by employment, not whether he or she can find employment. Id. The Board is precluded from assigning an extraschedular rating in the first instance. See Bagwell v. Brown, 9 Vet. App. 237, 238-9 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996). Although the Board may not assign an extraschedular rating in the first instance, it must specifically adjudicate whether to refer a case for extraschedular evaluation when the issue either is raised by the claimant or is reasonably raised by the evidence of record. Barringer v. Peake, 22 Vet. App. 242 (2008); see also Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran's claim of entitlement to TDIU was received in May 2015. However, as the evidence indicates that the Veteran has been unable to work due to his service-connected disabilities, his claim for TDIU arose as part of his claim for a higher rating for his PTSD. Thus, the Veteran's TDIU claim is on appeal pursuant to Rice v. Shinseki, 22 Vet. App. 447, 453 (2009) since June 3, 2008. The Veteran is service connected for the following disabilities: PTSD rated 70 percent from March 22, 2012; diabetes mellitus type II rated 20 percent from June 3, 2008; tinnitus rated at 10 percent from March 22, 2012; bilateral hearing loss with a noncompensable rating from December 29, 2009; and erectile dysfunction also with a noncompensable rating from December 9, 2019. The combined disability rating is 20 percent from June 3, 2008 and 80 percent from March 22, 2012. TDIU has been granted effective May 7, 2015. Thus, prior to May 7, 2015, the combined rating meets the schedular criteria starting from March 22, 2012 but does not from June 3, 2008 to March 21, 2012. A total rating on an extraschedular basis, may nonetheless be granted in exceptional cases (and pursuant to specifically prescribed procedures) when the Veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities. 38 C.F.R. § 4.16(b). Thus, consideration of whether the Veteran is, in fact, unemployable due to service-connected disabilities between June 3, 2008 to March 21, 2012, is also necessary in this case. In a July 2008 VA treatment record, the examiner indicated that the Veteran worked as a retired federal civil servant for 37 years and he was employed as a state conservation manager for five years. A January 2009 VA treatment record reported that the Veteran was still working. In a February 2009 VA treatment record, the examiner noted that the Veteran retired from the Army and that he was currently working for the state of Hawaii in the Guard as an environmentalist. In an October 2011 VA diabetes examination, the examiner noted that the Veteran's diabetes impacted the Veterans ability to work. The examiner noted that the Veteran had been retired for the past nine years and that the Veteran did not think he could work at this time if he needed to due to not being able to perform greater than mild physical activities. The examiner furthered that the Veteran explained that he would need frequent hourly periods of rest before being able to resume his work activities due to his chronic fatigue. In an April 2012 VA treatment record, the examiner indicated that the Veteran retired in January 2010. The June 2012 VA PTSD examination reported that the Veteran had occupational and social impairment with reduced reliability and productivity. In the examination, the Veteran reported that after a 16-month break after he was discharged from the military, he worked for the state department of defense as an environmental conservation manager for seven years and then retired in 2010. In a May 2013 VA kinesiotherapy consultation regarding his neck pain, the Veteran reported that he could not do his usual work at all. Then in a July 2013 VA kinesiotherapy medical note, the Veteran reported that he could do most of his usual work, but no more. In a March 2015 psychiatric evaluation, the examiner reported that the Veteran no longer works and would find working unbearable. The examiner furthered that the Veteran described some decrease in motivation and a decreased interest in activities he once enjoyed. In another March 2015 psychiatric evaluation, the examiner noted that the Veteran exhibited difficulty in maintaining and engaging in social relationships and effective work. The examiner also noted that the Veteran had difficulty concentrating and completing tasks. In a March 19, 2015 VA treatment note, the examiner noted that due to the nature, severity, and worsening of the Veteran's PTSD, it was his professional opinion that the Veteran could no longer maintain gainful employment, nor could he sustain effective social relationships. The examiner noted that now that the Veteran can no longer work and is suffering health problems, his activity levels decreased and as a result he experienced an exacerbation of his PTSD symptomology. The Veteran submitted an application for TDIU in May 2015. He reported that his diabetes, PTSD, tinnitus, and hypertension prevented him from securing or following any substantially gainful occupation. He reported that on My 10, 2002 his disability affected his full-time employment. He furthered that he last worked full-time on August 1, 2009 and that he became too disabled to work on January 1, 2010. He listed that he last worked for the Hawaii Department of Defense from July 1974 to May 2002. He reported that he did not leave his last job because of his disability. The form indicated that the Veteran had a college education and that he was trained as a military or commercial pilot and a test pilot. He also reported that he education in aviation logistics program management, state army aviation resources management, Hawaii Department of Defense Deputy Adjutant General, and Deputy Governor's Cabinet. He explained that his education and specialized training fall in the category of being overqualified for job vacancies in his area of expertise. He explained that PTSD and medical limitations and being 69 years old adversely impact his ability to acquire employment in his field. Upon review of all of the evidence of record, both lay and medical, the Board finds that referral for an extraschedular consideration of a TDIU for the period of June 3, 2008 to March 21, 2012 is not warranted. The Board has acknowledged and considered the Veteran's statements addressing his employability. The Board notes that the Veteran is competent and credible to report the subjective symptoms and functional limitations he experienced regarding his service-connected disabilities. See Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Nonetheless, the Board emphasizes that the Veteran's descriptions of his service-connected disabilities must be considered in conjunction with the clinical evidence of record, as well as the pertinent rating criteria. The evidence reflects that the Veteran completed college and had various education and training in the field he worked in. After retiring from the military in 2002, the Veteran worked as an environmental conservation manager and retired in 2010. The Veteran reported that he did not leave his job due to his disability. The Board reiterates that, for a Veteran to prevail on a claim for TDIU on an extraschedular basis, it is necessary that the record reflect some factor which places the case in a different category than other Veterans with an equal rating of disability. See Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). The pertinent question is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether the Veteran can find employment. Id. This is because a disability rating in itself is recognition that the impairment makes it difficult to obtain or keep employment. The Board does not find that the record demonstrates the Veteran was precluded from securing or following substantially gainful employment solely by reason of his service-connected disabilities or that he is incapable of performing the mental and physical acts required by employment due solely to his service-connected disorders, even when his disabilities are assessed in the context of subjective factors such as his occupational background and level of education. Nor does the evidence show the Veteran's record places his case in a different category than other Veteran's with an equal level of disability. While the Veteran has said that he was unable to continue working, these statements must be weighed against the objective medical evidence of record. The Board notes a TDIU rating is not warranted where a veteran is unable to continue a chosen profession but, as already noted, the determinative question for purposes of TDIU is whether the Veteran's level of disability, given his education, training, and experience, renders it impossible for the average person to obtain or retain substantially gainful employment of some type. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Simply stated, while perhaps the Veteran cannot work in his prior job or even in his prior vocation, the question is whether he can, in fact, work. This finding can, unfortunately, not take into consideration the Veteran's age or his nonservice-connected disabilities. Prior to March 19, 2015, the record does not indicate that the Veteran was unable to work. Rather the evidence indicated that the Veteran retired and chose not to work. Additionally, for part of the period, the Veteran did work and then retired. There is no indication that the Veteran left the job due to any of his service-connected disabilities. Rather the October 2011 opinion noted that the Veteran claimed that he did not think he could work at this time, as opposed to the examiner opining whether or not the Veteran was capable of a gainful occupation. Additionally, the Veteran expressed at this time that he did not think he could work since he could not perform greater than mild physical activities and would require periods of rest before being able to resume his work. There is no indication that the Veteran would not be able to complete work requiring to sit down and be at a desk. The Board finds this opinion to be not be probative evidence that the Veteran was unable to work as a result of his service-connected disabilities. To the extent that the medical evidence of record, including the VA examinations, address functional impairment due to any of the Veteran's service-connected disabilities, the Board notes that there is no probative medical opinion of record indicating that the Veteran was unable to work due to solely his service-connected disabilities and the Board does not find that these limitations would prevent all forms of employment. In this regard, the Board acknowledges that the Veteran's diabetes and psychiatric disorder result in general occupational difficulty. However, the Board finds that these symptoms have been adequately considered under his currently assigned disability ratings. Loss of industrial capacity is the principal factor in assigning schedular disability ratings. See 38 C.F.R. §§ 3.321(a), 4.1. Although the Board recognizes that the Veteran believes that his service-connected disabilities have rendered him unable to work, as noted above, the Veteran's description of his service-connected disabilities must be considered in conjunction with the clinical evidence of record, as well as the pertinent rating criteria. Here, after considering the evidence of record, both lay and medical, the Board finds that the preponderance of the competent and credible evidence does not reflect that the Veteran is unable to secure or follow substantially gainful employment due solely to his service-connected disabilities prior to March 19, 2015. The Board is sympathetic to the Veteran's physical and mental limitations, and acknowledges that the Veteran's service connected disabilities will cause him problems, and may have caused him not to be able to function in some jobs; however, this fact, in and of itself, does not provide the basis to grant this case. Based on the foregoing, the Board finds that the weight of the probative lay and medical evidence does not demonstrate that the Veteran is precluded from securing or following substantially gainful employment solely by reason of his service-connected disabilities or that he is incapable of performing the mental and physical acts required by employment due solely to his service-connected disorders, even when his disability is assessed in the context of subjective factors such as his occupational background and level of education prior to March 19, 2015. As such, the Board finds that referral for consideration of a TDIU on an extraschedular basis between June 3, 2008 to March 21, 2012 under 38 C.F.R. § 4.16(b) is not warranted and that the Veteran is not entitled to a schedular TDIU from March 22, 2012 to March 18, 2015. For the period of March 19, 2015 to May 6, 2015, the Board finds that the evidence is at least in equipoise as to the question of whether TDIU may be assigned. The Board finds the March 19, 2015 VA treatment note to have probative weight as it considers the Veteran's medical history and provides a thorough rationale. Resolving all doubt in the Veteran's favor, the Board finds that the evidence is at least in equipoise to support the grant of entitlement to TDIU on a schedular basis from March 19, 2015, to May 6, 2015. As noted, the Veteran's psychiatric disorder heavily impacted the Veteran's ability to work. Thus, the Board finds that the evidence is in equipoise under 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102 and TDIU is granted on a schedular basis from March 19, 2015 to May 6, 2015. Richard Kettler Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Imam, 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.