Citation Nr: 21031722 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 17-44 202 DATE: May 24, 2021 ORDER Entitlement to a disability rating in excess of 60 percent for Hepatitis C, from March 27, 2014 is denied. Entitlement to a disability rating of 50 percent, but no higher, for an acquired psychiatric disorder, from February 17, 2015 to June 25, 2020, is granted. Entitlement to a disability rating of 70 percent, but no higher, for an acquired psychiatric disorder, from June 25, 2020, is granted. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU), from December 3, 2016, is granted. FINDINGS OF FACT 1. From March 27, 2014, the Veteran's Hepatitis C did not manifest as near-constant debilitating symptoms (such as malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain). 2. From February 17, 2015 to June 25, 2020, the Veteran's acquired psychiatric disorder manifested as symptoms no more severe than occupational and social impairment with reduced reliability and productivity, difficulty in establishing and maintaining effective work and social relationships, and impaired judgement. 3. From June 25, 2020, the Veteran's acquired psychiatric manifested in symptoms and impairment that more nearly approximate occupational and social impairment with deficiencies in most areas and impaired impulse control such as unprovoked irritability with periods of violence. 4. Resolving reasonable doubt in the Veteran's favor, from December 3, 2016, the evidence of record is in relative equipoise as to whether the Veteran's service-connected disabilities have rendered him unable to secure and follow a substantially gainful occupation. CONCLUSIONS OF LAW 1. The criteria for entitlement to a disability rating in excess of 60 percent for Hepatitis C, from March 27, 2014 are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.114, Diagnostic Code 7354. 2. The criteria for a disability rating of 50 percent, but no higher, for an acquired psychiatric disorder, from February 17, 2015 to June 25, 2020, are met. 38 U.S.C. § 1155; 38 C.F.R. § 4.130, Diagnostic Code 9434. 3. The criteria for a disability rating of 70 percent, but no higher, for an acquired psychiatric disorder, from June 25, 2020, are met. 38 U.S.C. § 1155; 38 C.F.R. § 4.130, Diagnostic Code 9434. 4. The criteria for TDIU from December 3, 2016 are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.15, 4.16, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1975 to January 1977. This appeal is before the Board of Veterans' Appeals (Board) from multiple rating decisions from a Department of Veterans Affairs (VA) Regional Office. The procedural history for this case is as follows: In a November 2013 rating decision the RO granted entitlement to service connection for Hepatitis C at 10 percent disabling and for Depression at 30 percent disabling, both effective June 4, 2010. On March 27, 2014 the Veteran filed a VA 21-526EZ for his Hepatitis C disability which functioned as a Notice of Disagreement (NOD) to the November 2013 rating decision. In November 2014, the RO granted the Veteran a 60 percent disability rating for Hepatitis C from March 27, 2014. In February 2015, the Veteran submitted a VA 21-8940 Application for Increased Compensation Based on Unemployability. In turn, the RO operated as though the February 2015 form functioned as: (1) a NOD to the November 2014 rating decision, (2) as a claim for an increased rating for his Depression, and (3) a claim for TDIU. Accordingly, in July 2015, the RO issued a rating decision that denied the Veteran his increased rating claims and his claim for TDIU. Further development followed, including a May 2020 Board hearing, and in July 2020 the Board remanded the Veteran's claims for further development. The Veteran's claims have since returned to the Board and for the reasons set forth below, the Board finds substantial compliance with the remand directives. Stegall v. West, 11 Vet. App. 268 (1998). Lastly, the Board notes in March 2021 the Veteran submitted a Board hearing request. However, that request was withdrawn in May 2021 and the Board may proceed with adjudication of the Veteran's claims. 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; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Nevertheless, where a veteran is appealing the rating for an already established service-connected condition, his present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, when an appeal is based on the assignment of an initial rating for a disability, following an initial award of service connection for this disability, the rule articulated in Francisco does not apply. Fenderson v. West, 12 Vet. App. 119 (1999). Instead, the evaluation must be based on the overall recorded history of a disability, giving equal weight to past and present medical reports. Id. 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). 1. Hepatitis C from March 27, 2014 The Veteran contends he is entitled to a disability rating in excess of 60 percent from March 27, 2014 for his Hepatitis C disability. Under Diagnostic Code 7354, a 60 percent rating is warranted for daily fatigue, malaise and anorexia, with substantial weight loss and hepatomegaly, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least 6 weeks during the past 12- month period, but not occurring constantly. 38 C.F.R. § 4.114. A 100 percent rating is assigned for near-constant debilitating symptoms (such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain). The schedule indicates at Note (1): Evaluate sequelae, such as cirrhosis or malignancy of the liver, under an appropriate diagnostic code, but do not use the same signs and symptoms as the basis for evaluation under Diagnostic Code 7354 and under a diagnostic code for sequelae. 38 C.F.R. §§ 4.14, 4.115, Diagnostic Code 7354. The schedule further indicates at Note (2): For purposes of evaluating conditions under diagnostic code 7354, "incapacitating episode" means a period of acute signs and symptoms severe enough to require bed rest and treatment by a physician. Id. For purposes of evaluating conditions, the term "substantial weight loss" means a loss of greater than 20 percent of the individual's baseline weight, sustained for three months or longer. The term "minor weight loss" means a weight loss of 10 to 20 percent of the individual's baseline weight, sustained for three months or longer. In addition, the term "inability to gain weight" means that there has been substantial weight loss with an inability to regain it despite appropriate therapy, and "baseline weight" means the average weight for the two-year period preceding onset of the disease. 38 C.F.R. § 4.112. Turning to the evidence of record, in November 2014, a VA Hepatitis, Cirrhosis, and Other Liver Conditions examination report included a review of the claims file, a recitation of complaints and medical history, and physical examination results. The Veteran subjectively reported his condition recently improved, but that he has experienced increased fatigue. The report determined he suffered from near constant and debilitating fatigue and intermittent right upper quadrant pain. The report also noted he was diagnosed with an incapacitating episode over the past 12 months that lasted 6 weeks or more. Lastly, the examiner noted he experienced chronic fatigue that interfered with his ability to work. In March 2015 a VA Hepatitis, Cirrhosis and Other Liver Conditions examination report included a review of the claims file, a recitation of complaints and medical history, and physical examination results. The report noted he suffered from the following symptoms: intermittent fatigue, malaise, nausea, daily arthralgia, and right upper quadrant pain. The report also noted he did not have any incapacitating episodes due to his Hepatitis C in the last 12 months. The report determined the following symptoms were due to cirrhosis of the liver, biliary cirrhosis, or cirrhotic phase of sclerosing cholangitis: intermittent weakness and malaise and daily abdominal pain. During the Veteran's March 2020 Board hearing the Veteran alleged he experienced near constant abdominal pain and that occasionally it can be "debilitating," lasting up to several days, and requiring him to lay down. He also alleged that he experiences chronic fatigue that can be "severe at times." A VA treatment record from August 2020 indicates he "feels fatigued and low energy." After a review of the claims file in conjunction with the applicable laws and regulations, the Board finds the preponderance of the evidence is against finding the Veteran's hypothyroidism warrants a disability rating in excess of 60 percent from March 27, 2014. Here, the Board acknowledges the November 2014 VA examination's finding that he suffered from near constant debilitating fatigue; however, by his March 2015 VA examination his fatigue was determined to be intermittent. Moreover, the November 2014 VA examination did not mention other symptoms such as nausea, malaise, vomiting, and arthralgia, and his right upper quadrant pain was determined to be intermittent and the March 2015 VA examination determined he did not experience any near constant debilitating symptoms. The Board further acknowledges the examination's finding that he experienced an incapacitating episode that lasted 6 weeks or more; however, that symptom is contemplated by his current 60 percent rating. Lastly, the Board acknowledges his March 2020 Board testimony of near constant abdominal pain that can be "occasionally debilitating" and chronic fatigue; however, once again, these symptoms are contemplated by his current 60 percent rating. Moreover, during this time period the evidence of record does not contain any competent or credible evidence the he experienced near constant and debilitating symptoms. Indeed, the evidence of record does not contain any indication at any point that he suffered from malaise, nausea, vomiting, anorexia, or arthralgia. As such, the evidence of record does not contain any indication his Hepatitis C symptoms manifested to the degree contemplated by a 100 percent disability rating. In sum, the preponderance of the evidence is against finding the Veteran's Hepatitis C disability warrants a disability rating in excess of 60 percent from March 27, 2014. To the extent that any higher rating is sought, the preponderance of the evidence is against the claim. Hence the benefit of the doubt rule does not apply. Gilbert, 1 Vet. App. 49; 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7. Therefore, the Veteran's claim for a disability rating in excess of 60 percent from March 27, 2014 for his Hepatitis C disability, is denied. Increased Rating for an Acquired Psychiatric Disorder The Veteran's acquired psychiatric disorder is evaluated as 30 percent disabling under 38 C.F.R. § 4.130, Diagnostic Code 9434 of the General Rating Formula for Mental Disorders. A 30 percent disability rating is warranted when there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). A 50 percent disability rating is warranted when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped, speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is warranted where there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked inability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. A 100 percent rating is warranted where 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. The United States Court of Appeals for the Federal Circuit held that an 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." Vasquez-Claudio v. Shinseki, 713 F3d 112, 11617 (Fed. Cir. 2013). The symptoms listed are not exhaustive, but rather, "serve as examples of the type and degree of symptom, 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.'" Vasquez-Claudio, 713 F.3d at 11718; 38 C.F.R. § 4.130, DC 9411. Further, 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." 38 C.F.R. § 4.126(a). The Board 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 examination." Id. 2. Increased Rating from February 17, 2015 to June 25, 2020 Turning to the evidence of record, in May 2015, the Veteran underwent a VA mental disorders examination report which included a review of the claims file, a recitation of complaints and medical history, and physical examination results. The report determined he had 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 report noted he experienced the following symptoms: depressed mood, anxiety, and a chronic sleep impairment. The examiner noted the following behavioral observations: "The Veteran was alert and oriented, his mood and affect were appropriate. Initially, he would only respond with nods and gestures but became talkative and cooperative towards the end of the evaluation." A May 2015 VA mental status examination objectively indicates that the Veteran was negative for suicidal and homicidal ideation, it was reported that the Veteran stated, "I'm homicidal... if you cross the line, I'll put you back behind it." The examination also indicated his appearance was neatly shaved, groomed and dressed, had no abnormal movements, his speech was appropriate in volume, rate, tone, and articulation. Also, his thought process was generally linear, he had no reported or observed overt delusions, and his cognition, incite, and judgement were grossly intact and/or "fair-good." A June 2015 VA record indicates he was an "imminent risk of becoming homeless" and has been "homeless for 2 years." A July 2015 VA treatment record indicates he was away from home and "staying with a friend in Houston." A March 8, 2016 VA psychiatrist follow up note indicates he subjectively reported that he was frustrated and has increased anxiety in crowds, and prefers to stay home and isolate. A June 2018 private mental status examination report for the purpose of Social Security Disability Benefits, included a review of the Veteran's medical history and psychiatric examination results. The examiner noted the Veteran was dressed appropriately and his hygiene and grooming habits were "adequate." The Veteran subjectively reported irritability, anxiety, depressed mood, difficulty with memory, concentration, focus and attention, and that he "feels like the walls are closing in on him." The interviewer noted he seemed "visibly agitated, anxious and irritable, [and] he could not sit still during the interview." The interviewer also determined his interactions were "considered appropriate for the situation," his thought process was within normal limits, showed no evidence of delusions or highly irrelevant loose associations or derailment, and was oriented to time, place, person, and situation. Additionally, the interviewer determined his remote memory was average, his immediate memory was poor as he was unable to repeat a 7-digit number, and his delayed memory was "good/fair/poor" as he was able to recall "xx or 3 words after a 5-minute delay." Moreover, the interviewer determined his judgement was questionable as "he would go knock on the door to alert his neighbor of the fire if he saw smoke coming from his neighbor's window." Lastly, the Veteran subjectively reported that he receives assistance from friends, maintains relationships and hobbies including a weekly dance class, but that he has difficulty completing tasks due to his depressive and anxious symptoms and that the recent loss of his brother has "made him more reclusive." After a review of the claims file in conjunction with the applicable laws and regulations, the Board finds the evidence of record indicates a distinct period of worsening and the Veteran's acquired psychiatric disorder warrants a 50 percent rating, but no higher, from February 17, 2015 to June 25, 2020. Here, the evidence of record indicates a distinct period of worsening in the Veteran's acquired psychiatric disorder. The Board acknowledges the May 2015 VA examination determined he met the schedular criteria for a 30 percent rating with occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. However, a VA record one month later indicated the Veteran was in "imminent" risk of homelessness. Moreover, in March 2016 he stated he experienced increased anxiety in crowds and a preference to self-isolate due to the passing of his brother; and in a June 2018 private examination stated he felt like "the walls are closing in on him." Indeed, the examiner noted visible agitation and anxiousness on behalf of the Veteran during the interview. The Board is reminded that the symptoms listed are not exhaustive, but rather, "serve as examples of the type and degree of symptom, or their effects, that would justify a particular rating." Mauerhan, 16 Vet. App. at 442 (2002). Moreover, that the "regulation... requires an ultimate factual conclusion as to the Veteran's level of impairment in 'most areas.'" Vasquez-Claudio, 713 F.3d at 11718; 38 C.F.R. § 4.130, DC 9411. Here, the Board finds the Veteran's acquired psychiatric disorder manifested as difficulty establishing and maintaining work and social relationships as evidenced by the severity of his impaired judgment. Moreover, there was an increasing tendency to self-isolate and have increased anxiety in crowds, indicating disturbances in his mood and further difficulty establishing and maintaining social relationships. Accordingly, the Board finds it is at least as likely as not the Veteran's acquired psychiatric disability manifested at a 50 percent rating during this time period. However, the Board finds the Veteran's acquired psychiatric disorder does not warrant a disability rating in excess of 50 percent for this period. Specifically, the June 2018 private examination determined the Veteran may still be employable in some areas of work. Moreover, the evidence does not contain evidence of obsessive rituals or intermittently illogical speech. Indeed, the June 2018 examination indicated his speech was of "appropriate tone and articulation" and his psychomotor "activity was within normal limits." Furthermore, during this period there was no evidence of impaired impulse control such as unprovoked irritability with periods of violence or any issues with personal appearance or hygiene. Indeed, the evidence of record continually reflects the Veteran's appearance to be "neat" or "appropriate." While the Board acknowledges the Veteran's struggles with depression, anxiety and an associated sleep impairment, these symptoms are contemplated by the assigned 50 percent rating for this period of time. During this time period, there are no other psychiatric records or other evidence that demonstrate symptoms commensurate with the next higher rating or above. As such, the Board finds the evidence of record reflects a distinct period of worsening of the Veteran's acquired psychiatric disorder and thus warrants a 50 percent disability rating, but no higher, from February 17, 2015 to June 25, 2020. To the extent that any higher rating is sought from February 17, 2015 to June 25, 2020, the preponderance of the evidence is against the claim and the benefit of the doubt rule does not apply. Gilbert, 1 Vet. App. 49; 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7. Therefore, the Veteran's claim for a disability rating of 50 percent, but no higher, from February 17, 2015 to June 25, 2020 for an acquired psychiatric disorder, is granted. 3. Increased Rating from June 25, 2020 Turning to the evidence of record, VA treatment records indicate on June 25, 2020 that the Veteran was arrested at a VA hospital for "assaultive behavior" toward an ER nurse. An August 13, 2020 VA mental status examination record contains the following notes: He describes his mood as lower but does not appear to be in a major depressive episode... He endorses chronic [homicidal ideation] without current desire/intent/planning, which appears to be more related to personality and coping suite as opposed to an acutely reversible psychiatric condition. His risk of harm to self is low. Although his risk of harm to others is baseline elevated, at this time it appears his imminent risk is low as well. An August 25, 2020 VA treatment record indicates his daughter passed away. An October 2020 VA record indicates he stated that he is "very upset with the incident in the ER" and that "he has felt increasingly angry since that time." After a review of the claims file in conjunction with the applicable laws and regulations, the Board finds the evidence of record indicates a distinct period of worsening of the Veteran's acquired psychiatric disorder and thus warrants a 70 percent rating, but no higher, from June 25, 2020. Here, on June 25, 2020, the Veteran was arrested at a VA hospital for "assaultive behavior" toward a nurse indicating unprovoked irritability with periods of violence. Moreover, an August 2020 mental status examination indicated the Veteran reflected homicidal ideation and that his "risk of harm to others is baseline elevated" once again indicating unprovoked irritability with possible periods of violence and a likely inability to establish and maintain effective relationships. Lastly, the Veteran reported that after the ER incident he has felt "increasingly angry." However, while the Board acknowledges an increased level of danger to others, the August 2020 VA note is not repeated in any treatment records prior to or after that date indicating this increased level is not a persistent danger. Moreover, the evidence during this time period does not indicate the Veteran has an intermittent inability to perform daily tasks, persistent delusions or hallucinations, disorientation to place or time, or memory loss. See 38 C.F.R. § 4.130. In view of this evidence, the Veterans symptoms do not rise to the severity commensurate with the criteria for a 100 percent rating. As such, the Board finds the Veteran's acquired psychiatric disorder more closely resembles the criteria contemplated by a 70 percent disability rating from June 25, 2020. In sum, the Board finds the evidence of record indicates the Veteran's acquired psychiatric disorder had a distinct period of worsening and warrants a 70 percent rating, but no higher, from June 25, 2020. To the extent that any higher rating is sought from June 25, 2020, the preponderance of the evidence is against the claim and the benefit of the doubt rule does not apply. Gilbert, 1 Vet. App. 49; 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7. Therefore, the Veteran's claim for a disability rating of 70 percent, but no higher, from June 25, 2020 for an acquired psychiatric disorder, is granted. 4. Entitlement to TDIU TDIU may be assigned when a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that: if the veteran has only one such disability, the disability must be rated at 60 percent or more, or, if the veteran has two or more disabilities, at least one disability is rated at 40 percent or more and additional disabilities bring the veteran's combined disability rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). For the above purpose, disabilities affecting a single system, e.g., nervous, will be considered a single disability. 38 C.F.R. § 4.16(a). VA will grant a TDIU when the evidence shows that the veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. §§ 3.340, 3.341, 4.16. Unlike the regular disability rating schedule, which is based on the average work-related impairment caused by a disability, "entitlement to TDIU is based on an individual's particular circumstances." Rice v. Shinseki, 22 Vet. App. 447, 452 (2009). Therefore, when the Board conducts a TDIU analysis, it must take into account the individual veteran's education, training, and work history. See Hatlestad v. Derwinski, 1 Vet. App. 164, 168 (1991). For a veteran to prevail on a claim for a total compensation rating based on individual unemployability, the record must reflect some factor which takes his case outside of the norm. The sole fact that he is unemployed or has difficulty obtaining employment is not enough. A high rating in itself is recognition that the impairment makes it difficult to obtain and keep employment. The question is whether the veteran is capable of performing the physical and mental acts required by employment, not whether he can find employment. Van Hoose v. Brown, 4 Vet. App. 361 (1993). As to his service-connected disabilities, as of March 27, 2014 the Veteran was rated as 80 percent disabled. Specifically, he was rated for: (1) Hepatitis C, rated at 60 percent disabling; (2) liver cirrhosis, rated at 10 percent disabling; and (3) acquired psychiatric disorder, rated at 30 percent disabling. However, as is discussed above, the Board herein increases the Veteran's acquired psychiatric disorder to 50 percent disabling from February 17, 2015 to June 25, 2020; and to 70 percent disabling thereafter. Thus, in accordance with the combined rating code under 38 C.F.R. § 4.25, as of February 17, 2015 the Veteran's total combined rating remains at 80 percent disabled; and as of June 25, 2020, the total combined rating is 90 percent. As such, the Veteran is eligible for the schedular criteria for TDIU under See 38 C.F.R. § 4.16(a) from March 27, 2014. See 38 C.F.R. §§ 3.340, 3.341, 4.16(a). As to when the Veteran's service-connected disabilities prevented him from working, the Board acknowledges the March 27, 2014 VA determination from a Dr. Y. that reported the following: Vet is not currently reasonably feasible for employment services because Vet is not medically stable, inconsistent on days he can work, and frequent medical appointments, and the severity of his disabilities, all hinder his ability to work. While there is contradictory evidence as to when the Veteran became unemployable, and there is some evidence of employment in 2015 and 2016; in June 2018, the Social Security Administration determined the Veteran to be unemployable as of December 3, 2016. Moreover, the SSA determination included the Veteran's service-connected Hepatitis-C and his acquired psychiatric disorder as disabilities affecting his ability to work. While not dispositive, the Board finds the June 2018 SSA determination to be persuasive evidence as to when the Veteran's service-connected disabilities rendered him unemployable. Indeed, as previously stated, from December 3, 2016 he suffered from daily fatigue, malaise, and intermittent right upper quadrant pain caused by his Hepatitis C disability and increased anxiety in crowds and a tendency to self-isolate with periods of irritability and impaired judgement due to his acquired psychiatric disorder. Accordingly, considering the above evidence and the Veteran's complete disability picture and resolving all reasonable doubt in favor of the Veteran, the Board finds that the evidence is at least in equipoise as to whether his service-connected disabilities rendered him unemployable or unable to secure and follow a substantially gainful occupation, and a TDIU is therefore granted from December 3, 2016. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Law Clerk, Tyler R. Masters 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.