Citation Nr: 21031691 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 16-35 915A DATE: May 24, 2021 ORDER Entitlement to a rating in excess of 70 percent for posttraumatic stress disorder (PTSD) is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities prior to January 12, 2015, is granted. FINDING OF FACTS 1. Throughout the appeal period, the Veteran's PTSD symptoms and overall impairment more nearly approximate deficiencies in most areas but do not more nearly approximate total occupational and social impairment. 2. From July 15, 2013, the Veteran was unable to secure or follow a substantially gainful occupation due to his service-connected disabilities. CONCLUSION OF LAW 1. The criteria for a rating in excess of 70 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.130; Diagnostic Code (DC) 9411 (2019). 2. The criteria for entitlement to a TDIU from July 15, 2013, to January 11, 2015, have been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.16, 3.400(o)(2). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably on active duty from October 1966 to September 1968. This matter comes before the Board of Veteran's Appeals (Board) on appeal from an August 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). By way of background, the Veteran sought an evaluation in excess of 70 percent for his service-connected PTSD in June 2012. In an August 2013 rating decision, the RO declined to grant a rating in excess of 70 percent for the Veteran's service-connected PTSD. Subsequently, in October 2013, the Veteran filed a Notice of Disagreement (NOD) as to the evaluation of his service-connected PTSD. In a February 2017 rating decision, the Veteran was granted a TDIU effective November 29, 2016. In a subsequent September 2019 rating decision, the Veteran was granted an earlier effective date of January 12, 2015, for entitlement to a TDIU. Both the February 2017 and September 2019 rating decisions clearly state the Veteran's PTSD is among his service-connected disabilities which contribute to his TDIU. When evidence of unemployability is submitted during the course of an appeal from an assigned disability rating, a claim for a TDIU will be considered part of the claim for benefits for the underlying disability. Rice v. Shinseki, 22 Vet. App. 447 (2009). Therefore, the Board finds the Veteran's claim for a TDIU was part and parcel of his claim for an increased rating for his PTSD. Because the Veteran has not been awarded a TDIU for the full period in this appeal, the relevant period on appeal for the Veteran's TDIU is from June 13, 2013, to January 11, 2015. Additionally, the Veteran requested a videoconference hearing, which was scheduled for October 2019. He did not report at the scheduled time and his request for a hearing is deemed withdrawn. See 38 C.F.R. § 20.704 (2019). Increased Rating Disability ratings are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran. See 38 C.F.R. § 4.3. A disability rating may require re-evaluation in accordance with changes in a veteran's condition. Thus, it is essential that the disability be considered in the context of the entire recorded history when determining the level of current impairment. See 38 C.F.R. § 4.1. See also Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Nevertheless, where a veteran is appealing the rating for an already established service-connected condition, the present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Staged ratings are appropriate for an increased-rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). Psychiatric disabilities other than eating disorders are rated pursuant to the criteria of a General Rating Formula. See 38 C.F.R. § 4.130. Under the General Rating Formula, a 70 percent rating contemplates 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; intermittently illogical, obscure, or irrelevant speech; 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); inability to establish and maintain effective relationships. Id. A 100 percent rating is warranted for 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. As the United States Court of Appeals for the Federal Circuit has explained, evaluation under 38 C.F.R. § 4.130 is "symptom-driven," meaning that "symptomatology should be the fact-finder's primary focus when deciding entitlement to a given disability rating" under that regulation. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). The symptoms listed are not exhaustive, but rather "serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating." Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). In the context of determining whether a higher disability evaluation is warranted, the analysis requires considering "not only the presence of certain symptoms[,] but also that those symptoms have caused occupational and social impairment in most of the referenced areas" - i.e., "the regulation... requires an ultimate factual conclusion as to the Veteran's level of impairment in 'most areas.' "Vazquez-Claudio, 713 F.3d at 117-18; 38 C.F.R. § 4.130. When evaluating a mental disorder, the Board must consider the "frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission," and must also "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." 38 C.F.R. § 4.126(a). Entitlement to a rating in excess of 70 percent for PTSD The Veteran contends that the severity of his psychiatric disorder warrants a rating in excess of 70 percent. He contends that his condition has gotten much worse, and he is experiencing increased agitation, isolation, and anxiety. See June 2012 Statement in Support of Claim. The Veteran's service-connected PTSD is currently rated at 70 percent under diagnostic code 9411 and has been effective since July 2006 pursuant to a February 2007 rating decision. The current appeal period before the Board begins on June 13, 2012, the date the VA received the Veteran's claim for an increased rating, plus the one-year "look back" period. Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). In June 2013, the Veteran was afforded a VA Examination for PTSD. The examiner revealed that the Veteran's PTSD is productive of 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. The examiner noted that the Veteran exhibits symptoms of reliving, avoidance, and hyperarousal. Additionally, the examiner noted that the Veteran takes medications to help him with sleep and depression. For psychosocial and environmental problems, the examiner noted "the effects of anxiety, depression, recollections and hyperarousal, and avoidance symptoms on limiting his social and personal relationships." The examiner notes that the Veteran was never married and has no children, he states "this is how I like it, to be by myself." The Veteran's symptoms were noted to include depressed mood, anxiety, chronic sleep impairment, disturbances in motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and difficulty in adapting to stressful circumstances, including work or a worklike setting. A September 2013 Correspondence from the Chicago Heights Veteran Center, which was completed by a readjustment counseling therapist, notes that the Veteran attends weekly group and individual therapy sessions at the Veteran Center. The counseling therapist documented the Veteran's issues as the following: Chronic PTSD, medical problems, never married, and being unemployable. The counseling therapist noted that the Veteran's combat nightmares continue to be realistic, and even with medication the Veteran only sleeps 3 to 5 hours per night. It is noted that the Veteran sleeps separately from others for fear of acting out his nightmares. He experiences excessive worry, and continues to have unexplainable outbursts of anger, panic and anxiety attacks. The counseling therapist concluded that the Veteran's symptoms results in: impairment of thought processes, difficulty concentrating and decision making with regards to activities of daily living, low tolerance for conflict, inability to express thoughts and feelings to others, and short term memory loss. The counseling therapist's opined that these symptoms render the Veteran unemployable. Additionally, the counseling therapist concluded that in his professional opinion, he believes that these symptoms have been present since the Veteran left Vietnam, and that the Veteran will need weekly therapy session to help with his PTSD symptoms. An October 2013 Correspondence from Dr. P.D. notes that he has treated the Veteran since July 7, 2011. Additionally, the letter states that the Veteran was treated with standard medication. However, Dr. P.D. concluded that "in spite of medications and psychotherapy [the Veteran] continues to suffer from severe PTSD and it has severely impacted his social and occupational function." Various VA treatment documents his mental status and the progress of his PTSD symptoms. Mental status examinations from February 2012 through November 2016 describe the Veteran as well-groomed, cooperative, oriented to time and place, no acute distress, concentration and memory grossly intact, normal speech, fair insight, and fair judgement. Mental health attending notes from February 2012 through March 2016 indicate that the Veteran continues to have nightmares, flashbacks, hypervigilance, and insomnia. It was noted that the Veteran has no close friendship and doesn't like crowds. The Veteran's concentration and memory are grossly intact. Additionally, although his mood is anxious, his judgement and insight are fair. Mental health attending notes from September 2015 reveal that the Veteran suffers a lot of guilt from Vietnam. Additionally, it was noted that the Veteran does not like walking in forests or crowds. He enjoys solitude and prefers to isolate himself. The Veteran reports avoidance of situations that remind him of Vietnam. He reports that his sister is going to move in with him and feels that she is a soothing influence. The Veteran's concentration was noted as variable. His long-term memory is good; however, his short-term memory is worst. He reports feelings of guilt and worthlessness, and hopelessness. Mental health attending notes from December 2015 reveal that the Veteran's gunshot wound in his leg swelled up which triggered the Veteran's flashbacks. He states that the problems with his leg triggers a lot of anxiety and unpleasant memories from Vietnam. He continues to struggle with his hypervigilance and triggers like the forest behind his house. Mental health attending notes from March 2016 reveal that the Veteran talked to his buddies from the war, however it caused the Veteran distress. Additionally, he notes that the wound on his leg is a reminder every day of his traumas in Vietnam. It is noted that the Veteran's sister helps him at home. The Veteran reported sleeping even less. When he is able to sleep, he sleeps with one eye open. It is noted that the Veteran started doing perimeter checks. He reports feeling depressed due to his leg. The Veteran reports some feelings of guilt and worthlessness. It is reported that the Veteran's short-term memory is worse. In June 2016, the Veteran was afforded a VA Examination for PTSD. The examiner revealed that the Veteran's PTSD are productive of occupational and social impairment with reduced reliability and productivity. In terms of functional impact, the Veteran is frequently disrupted by psychologically based symptoms. He often has trouble developing close relationships with other people and prefers to keep to himself. He is socially withdrawn. The Veteran experiences panic attacks that frequently increase his avoidance behaviors, however he can maintain a normal daily routine. He maintains good self-care and hygiene, and he exhibits no significant impairments in communications. The Veteran receives help from his sister and brother-in-law who lives with him. He participates in household responsibilities such as cleaning, maintaining his home, and managing finances. The Veteran reports enjoying reading history and learning gardening from his sister. The examiner noted that the Veteran was appropriately dressed and well groomed. He was calm and cooperative, although anxious and tearful discussing his experiences in Vietnam. His speech and articulation were clear and easily understandable. The Veteran's thought processes were logical and coherent. A June 2016 Buddy Statement was provided by the Veteran's sister. She notes that she has lived with the Veteran since August 2014. Further, the Veteran's sister notes that she noticed a decline in the Veteran's mental state due to his PTSD. She states that she rarely sees him sleep more than 4 hours at a time and most nights he has nightmares. She states that she became so concerned with him, that she and her husband sold her house to move in with him and ensure his wellbeing. A June 2016 Correspondence from the Chicago Heights Veteran Center notes that Veteran has participated in Readjustment Counseling Services since 1996. The team leader notes that the Veteran suffers from severe PTSD. He experiences depression, nervousness, and uncertainty. Additionally, he struggles "making the right decisions" and is suspicious of others. He has never married, nor does he have children. His PTSD overwhelms him with guilt and has denied him a fulfilled life. He often has nightmares, uncontrollable anger, intrusive thoughts, and frequent flashbacks including hearing bullets. He also experiences suicidal ideations but denied plan and intent. The team leader concluded her correspondence by noting that the Veteran's PTSD affects every aspect of his life. A July 2016 Correspondence from Dr. K.D. states that the Veteran has struggled from his PTSD symptoms since his deployment to Vietnam. Dr. K.D. notes that the Veteran struggles with nightmares, flashbacks, particularly when triggered to talk about his experiences. He endures hypervigilance and anxiety, with prominent checking behavior. Additionally, he cannot handle crowds and practices avoidance and isolation to deal with his symptoms. He struggles with irritability and has chronic feelings of guilt and worthlessness. Dr. K.D. concluded that the Veteran's PTSD symptoms are severe and have led to significant impairment in the Veteran's personal and professional life. A January 2017 VA Examination for PTSD notes that the Veteran exhibits moderate limitations in the areas of social interaction. He has trouble responding to real and perceived criticism, interacting with others at work or in the community. He has trouble with responding appropriately to changes and stress in his environment, as well as interacting with others at work or in the community. The examiner noted the Veteran was socially withdrawn, preferring to be left alone and easily stress by his environment. Additionally, he would have trouble completing a workday or week without extreme forms of behavior around coworkers or staff. The Veteran has mild limitations in the areas of concentration and completing work without being disrupted by psychologically based symptoms. The examiner revealed that the Veteran's PTSD are productive of occupational and social impairment with reduced reliability and productivity. The examiner noted symptoms including depressed mood, feeling fatigue and worthlessness, anxiety, suspiciousness, near-continuous panic or depression, chronic sleep impairment, neglect of personal appearance and hygiene, and disturbances of motivation and mood. The Board has engaged in a holistic analysis of the severity, frequency, and duration of the signs and symptoms of the Veteran's PTSD but finds that his symptoms do not more nearly approximate a 100 percent rating. The Veteran's symptoms of depressed mood, anxiety, chronic sleep impairment, panic attacks, irritability, flashbacks, impaired short-term memory, disturbances of motivation and mood, vigilance, near-continuous panic or depression, suicidal ideation, difficulty in establishing and maintaining effective work and social relationships, and difficulty in adapting to stressful circumstances, including work or a worklike setting are expressly contemplated under the rating for a 70 percent (or lower) evaluation. See 38 C.F.R. § 4.130. In finding that the weight of the competent evidence does not support a finding of total occupational and social impairment, the Board has also considered as a factor that the evidence does not indicate gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; disorientation to time or place; or memory loss for names of close relatives, own occupation, or own name. See 38 C.F.R. § 4.130. The Board acknowledges the Veteran's report of symptoms, such as flashbacks, but finds that the totality of the Veteran's symptoms throughout the period on appeal does not demonstrate total occupational and social impairment to warrant a 100 percent rating. The relevant evidence shows that the Veteran has linear thought process and is able to communicate clearly. He can perform activities of daily living and generally maintain personal hygiene. The evidence has not shown the Veteran to be disoriented with time or place. Although the record notes that the Veteran struggles with short term memory, he does not forget names of close relatives nor his own name. The Board notes that the Veteran suffers from frequent flashbacks, at times noting that he can hear bullets. These types of flashbacks are consistent with hallucinations; however, the evidence of record does not show these types of flashbacks to be persistent. Alternatively, even if these flashbacks were found to be persistent, a holistic view of the relevant evidence does not warrant a 100 percent rating, because the evidence more nearly shows occupational and social impairment with deficiencies in most area. The Veteran maintains social relationships with his sister and brother-in-law and other Veterans. The evidence does not indicate he is a peristent danger to himself or others. Therefore, the evidence does not show a total inability to function socially and occupationally pursuant to 38 C.F.R. § 4.130. The Board is sympathetic to the Veteran's condition and acknowledges the severe symptoms demonstrated throughout the rating period on appeal, however, the Board finds that the assigned 70 percent rating has contemplated and compensated those symptoms. The Board finds that a 100 percent rating is not warranted for PTSD because the weight of the competent and probative evidence is against finding that the Veteran's PTSD results in total social and occupational impairment. See 38 C.F.R. § 4.130. TDIU 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 in unable to secure or follow a substantially gainful occupation due to their service-connected disabilities. Substantially gainful employment is defined as work which is more than marginal, and which permits the individual to earn a living wage. Moore v. Derwinski, 1 Vet. App. 356 (1991). 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). VA may consider the level of education, special training, and previous work experience in making this determination, but may not consider the Veteran's age or the impairment caused by any nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19; see also Ferraro v. Derwinski, 1 Vet. App. (1991). In 2019, the U.S. Court of Appeals for Veterans Claims (CAVC) held that substantially gainful employment, in the TDIU context, contains economic and noneconomic components; the economic component means an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person, while the noneconomic component requires consideration of a veteran's ability to secure or follow that type of employment. Ray v. Wilkie, 31 Vet. App. 58 (2019). The CAVC also provided guidance as to the meaning of a veteran's ability to secure and follow such employment, noting that attention must be given to: the veteran's occupational history, education, skill and training; whether the veteran has the physical ability to perform occupational activities; and whether the veteran has the mental ability to perform occupational activities. Medical evidence describing the effect of each disorder on the Veteran's occupational functioning is crucial to permit the Board to arrive at an assessment of employability. 38 C.F.R. § 4.1. However, the question of whether the Veteran's service-connected disabilities are of sufficient severity to produce unemployability is ultimately the Board's determination to make. See Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013) (citing 38 C.F.R. § 4.16(a) as support for the conclusion that the applicable statutory and regulatory provisions "place responsibility for the ultimate TDIU determination on the VA, not a medical examiner"). A threshold requirement for eligibility for a TDIU under 38 C.F.R. § 4.16(a) is that, if there is only one such disability, it must be rated at 60 percent or more; if there are two or more disabilities, at least one disability must be rated at 40 percent or more, with sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). For the above purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable, (2) disabilities resulting from common etiology or a single accident, (3) disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric, (4) multiple injuries incurred in action, or (5) multiple disabilities incurred as a prisoner of war. 38 C.F.R. § 4.16(a). Entitlement to a TDIU prior to January 12, 2015. As noted above, the Veteran was granted TDIU effective January 12, 2015, the date he submitted a VA Form 21-8940, Veteran's Application for Increased Compensation Based on Unemployability. However, since TDIU was reasonably raised during the appeal period of the increased rating claim for PTSD, the Board will determine whether the Veteran is entitled to TDIU during the remaining period on appeal. The current appeal period before the Board begins on June 13, 2012, the date the VA received the Veteran's claim for an increased rating, plus the one-year "look back" period. Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). The Board notes that at all times during the period on appeal prior to January 1, 2015, the Veteran met the schedular criteria for a TDIU. See 38 C.F.R. §§ 4.16(a), 4.24, 4.26. From July 2006, the Veteran was service connected for PTSD at a 70 percent rating and a gunshot wound of the left calf with atrophy and achilles tendonitis with left lower extremity peripheral neuropathy (left calf) at 20 percent, for a combined rating of 80 percent. Beginning October 22, 2013, the Veteran's left calf disability rating was increased to 30 percent, and he was also service connected for bilateral tinnitus at 10 percent and lower extremity peripheral neuropathy at 10 percent; his combined disability rating was 90 percent. The Veteran indicated on his VA Forms 21-8940 that he last worked on July 1, 2012, and the date his disabilities affected full-time employment was October 22, 2013. See VA Forms 21-8940 received January 2015 and November 2015. In a March 2015 Correspondence, the Veteran's last employer states that he was a dedicated and loyal employee at the company until July 15, 2013, when the business closed. The letter also notes that the Veteran was respected for his leadership and ability to work in his sometimes painful physical condition; and the company established a flexible work scheduled which allowed the Veteran to sometimes end his working day early. W-2 and Earnings Statements indicate the Veteran earned wages of over $51,000 and over $29,000 in 2012 and 2013, respectively. The June 2013 VA PTSD Examination touched on the Veteran's employability and work background. The examiner revealed that the Veteran's PTSD are productive of 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. Relevant educational history notes that the Veteran finished high school and one year of college. Relevant occupational history notes that the Veteran worked in the chemical industry for most of his adult working career. The diagnostic criteria reveal that the Veteran's PTSD symptoms described causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. The examiner noted that the Veteran has difficulty establishing and maintaining effective work and social relationships. Additionally, the Veteran has difficulty adapting to stressful circumstances, including work or a worklike setting. A September 2013 Correspondence from the Chicago Heights Veteran Center, which was completed by a readjustment counseling therapist, notes that the Veteran attends weekly group and individual therapy sessions at the Veteran Center. The counseling therapist documents the Veterans issues as the following: Chronic PTSD, medical problems, never married, and being unemployable. The counseling therapist noted that the Veteran's combat nightmares continue to be realistic, and even with medication the Veteran only sleeps 3 to 5 hours per night. It is noted that the Veteran sleeps separately from others for fear of acting out his nightmares. He experiences excessive worry, and continues to have unexplainable outbursts of anger, panic, and anxiety attacks. The counseling therapist concludes that the Veteran's symptoms results in: impairment of thought processes, difficulty concentrating and decision making with regards to activities of daily living, low tolerance for conflict, inability to express thoughts and feelings to others, and short term memory loss. The counseling therapist's opined that these symptoms renders the Veteran unemployable. Additionally, the counseling therapist concluded that in his professional opinion, he believes that these symptoms have been present since the Veteran left Vietnam, and that the Veteran will need weekly therapy session for to help with his PTSD symptoms. An October 2013 Correspondence from Dr. P.D. notes that the Veteran has been treated by the doctor since July 7, 2011. Additionally, the letter states that the Veteran was treated with standard medication. However, Dr. P.D. notes that "in spite of medications and psychotherapy [the Veteran] continues to suffer from severe PTSD and it has severely impacted his social and occupational function." VA examinations in September 2014 note that the Veteran's left calf and peripheral neuropathy do not impact his ability to work. An October VA examination determined the Veteran's tinnitus interferes with communication. When considering the Veteran's employment and educational background, as well as the medical evidence of record, in addition to affording the Veteran the benefit of the doubt, the Board finds that the evidence supports a grant of a TDIU prior to January 12, 2015. When looking at the effects of the Veteran's service-connected disabilities in the aggregate, and considering the Veteran's past education and work experience as a foreman in a chemical plant, the Board finds that the severity of the Veteran's symptoms and his limitations of his combined service-connected disabilities prevent him from obtaining and maintaining substantially gainful employment. Although the VA examinations in 2014 note few impacts to the Veteran's ability to work from his left calf and peripheral neuropathy conditions, the Board finds the letter from the Veteran's last employer highly persuasive as to the impacts of these physical disabilities and assigns it greater probative weight. The Veteran stated on his VA Form 21-8940 received November 2016 that his service-connected disabilities affected his full-time employment on October 22, 2013, but he last worked July 1, 2012 . Other evidence in the record, including the statement from the Veteran's last employer and a 2013 W-2, indicate the Veteran was employed until July 15, 2013, when the business closed. In view of the totality of the evidence, the Board finds the Veteran's service-connected disabilities rendered him unable to secure and follow substantially gainful employment effective July 15, 2013, the date it was factually ascertainable he last worked within the one-year period prior to the date of the Veteran's increased rating claim for PTSD. 38 C.F.R. § 3.400(o)(2). (Continued on the next page) As such, the Board concludes that TDIU is warranted from July 15, 2013. Tiffany Dawson Veterans Law Judge Board of Veterans' Appeals Law Clerk for the Board N. Jamordee 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.