Citation Nr: 21032543 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 13-34 231 DATE: May 27, 2021 ORDER For the rating period from August 28, 2009 through August 10, 2014, a higher initial disability rating of 70 percent for service-connected PTSD is granted; a higher initial disability rating in excess of 70 percent at any point during the initial rating period on appeal, from August 28, 2009, is denied. From August 28, 2009 through August 10, 2014, a total disability rating for compensation purposes based on individual unemployability due to service connected disabilities (TDIU) is granted. FINDINGS OF FACT 1. From August 28, 2009 through August 10, 2014, the severity, frequency, and duration of the symptoms of the service connected PTSD more nearly approximated occupational and social impairment with deficiencies in most areas. 2. During the entire initial rating period on appeal, from August 28, 2009, the severity, frequency, and duration of the symptoms of the service connected PTSD did not manifest as total occupational or social impairment. 3. From August 28, 2009 through August 10, 2014, the Veteran was unable to maintain substantially gainful employment as a result of service connected disabilities. CONCLUSIONS OF LAW 1. Resolving reasonable doubt in the Veteran's favor, from August 28, 2009 through August 10, 2014, the criteria for an increased disability rating of 70 percent for the service connected PTSD have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.3, 4.7, 4.130, Diagnostic Code 9411. 2. For the entire initial rating period on appeal, from August 28, 2009, the criteria for a higher initial disability rating in excess of 70 percent for service connected PTSD have not been met or more nearly approximated. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.3, 4.7, 4.130, Diagnostic Code 9411. 3. Resolving reasonable doubt in the Veteran's favor, from August 28, 2009 through August 10, 2014, the criteria for a TDIU have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.340, 3.341, 4.15, 4.16, 4.18, 4.19, 4.25. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant, had active service from October 1966 to October 1968. This matter came before the Board of Veterans' Appeals (Board) on appeal from a November 2009 Department of Veterans Affairs (VA) Regional Office (RO) rating decision that granted service connection for PTSD and assigned an initial 10 percent disability rating. Upon the Veteran appealing the initial rating assigned, in a May 2011 rating decision, the Agency of Original Jurisdiction (AOJ) granted a higher initial disability rating of 30 percent. In July 2014, the Board found that during the course of the appeal the Veteran had withdrawn the issue of a higher initial disability rating for PTSD, but that the Veteran's actions had raised the issue of an increased disability rating for the service-connected PTSD. Despite the Board's findings, in a subsequent September 2014 rating decision, the AOJ granted a higher initial disability rating of 50 percent for the service connected PTSD from August 28, 2009, the date of grant of service connection for PTSD, and also granted a staged higher initial disability rating of 70 percent from August 11, 2014. Considering the record as a whole and the actions taken by the AOJ in September 2014, the Board finds that, even assuming that the higher initial rating issue had previously been withdrawn by the Veteran, actions taken by the AOJ, Board, and Veteran have revived the appeal for a higher initial disability rating for PTSD. The instant matter has been before the Board on three prior occasions. In each instance the issue on appeal was remanded for additional development. Review of the record supports that all prior directed development has been satisfied to the extent possible. As such, the Board finds the instant matter ripe for adjudication. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.159, 3.326(a). As the PTSD rating issue arises from the Veteran's disagreement with the initial rating assigned following the grant of service connection, no additional notice is required regarding this downstream element of the service connection claim. Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007); Dunlap v. Nicholson, 21 Vet. App. 112 (2007); 38 C.F.R. § 3.159(b)(3). Regarding the duty to assist, the record reflects that VA obtained all relevant documentation to the extent possible and provided the Veteran with adequate VA mental health examinations. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). As such, the Board finds that the duties to notify and assist the Veteran in this case have been fulfilled. 1. Higher Initial Disability Rating for PTSD Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) found in 38 C.F.R. Part 4. 38 U.S.C. § 1155. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. Where there is a question as to which of two disability ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. The Veteran has appealed from the initial rating assigned for the service connected PTSD. In Fenderson v. West, 12 Vet. App. 119, 125 26 (1999), the United States Court of Appeals for Veterans Claims (Court) addressed a similar appeal and directed that such appeal of the initial rating assigned following a grant of service connection was specifically not a claim for an increased disability rating. The Court also directed that separate ratings may be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. Under Diagnostic Code 9411, a 50 percent rating will be assigned for a mental disability which is productive of occupational and social impairment with reduced reliability and productivity due to symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks occurring 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 or forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating will be assigned for occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking, or mood due to symptoms such 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); and an inability to establish and maintain effective relationships. A 100 percent rating will be assigned for total occupational and social impairment due to symptoms such as gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, a persistent danger of hurting herself or others, an intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene), disorientation to time or place, and memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130. The Secretary of VA, acting within the authority to adopt and apply a schedule of ratings, chose to create one general rating formula for mental disorders. 38 U.S.C. § 1155; see 38 U.S.C. § 501 (2012); 38 C.F.R. § 4.130. By establishing one general formula to be used in rating more than 30 psychiatric disorders, there can be no doubt that the Secretary of VA anticipated that any list of symptoms justifying a particular rating would in many situations be either under- or over inclusive. The Secretary's use of the phrase "such symptoms as," followed by a list of examples, provides guidance as to the severity of symptoms contemplated for each rating, in addition to permitting consideration of other symptoms, particular to each veteran and disorder, and the effect of those symptoms on the claimant's social and work situation. This construction is not inconsistent with Cohen v. Brown, 10 Vet. App. 128 (1997). See Mauerhan v. Principi, 16 Vet. App. 436, 442 (1992). The evidence considered in determining the level of impairment under 38 C.F.R. § 4.130 is not restricted to the symptoms provided in the diagnostic code. Instead, the rating specialist is to consider all symptoms of a claimant's condition that affect the level of occupational and social impairment, including, if applicable, those identified in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). See 38 C.F.R. § 4.126. If the evidence demonstrates that a claimant suffers symptoms or effects that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the diagnostic code, the appropriate, equivalent rating will be assigned. The schedular rating criteria rate by analogy psychiatric symptoms that are "like or similar to" those explicitly listed in the schedular rating criteria. Mauerhan, 16 Vet. App. at 443. The Federal Circuit has embraced the Mauerhan interpretation of the criteria for rating psychiatric disabilities. Sellers v. Principi, 372 F.3d 1318, 1326 (Fed. Cir. 2004). In Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (2013), the Federal Circuit held that VA "intended the General Rating Formula to provide a regulatory framework for placing veterans on a disability spectrum based upon their objectively observable symptoms." The Federal Circuit stated that "a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration." It was further noted that "§ 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas." See also Bankhead v. Shulkin, 29 Vet. App. 10 (2017) (indicating that the Board should consider the severity, frequency, and duration of the signs and symptoms of a mental disorder when determining the appropriate rating). 70 Percent Rating for Period from August 28, 2009 through August 10, 2014 is Granted Having reviewed the evidence of record, lay and medical, the Board finds that, from August 28, 2009 through August 10, 2014, the severity, frequency, and duration of the symptoms of the service connected PTSD more nearly approximated occupational and social impairment with deficiencies in most areas, to warrant the grant of an increased 70 percent disability rating for this period on appeal. The Veteran received a VA mental health examination in August 2014. At that time, the VA examiner noted a number of significant mental health symptoms commonly associated with the 50, 70, and 100 percent mental health rating criteria. Such symptoms included impairment of short- and long-term memory, 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 worklike setting, and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. Subsequently, in a September 2014 rating decision, the AOJ found that the severity, frequency, and duration of the symptoms noted at the time of the August 2014 VA mental health examination warranted a staged initial disability rating of 70 percent from August 11, 2014, the date of examination. As such, the Board will now consider whether the Veteran had symptoms of similar severity, frequency, and/or duration during the initial rating period from August 28, 2009 through August 10, 2014. VA received a September 2014 private psychological evaluation. Significantly, per the evaluation report, the Veteran conveyed retiring from work as a car salesman in 2008 due to engaging in multiple confrontations with customers. The Veteran's statements are supported by a VA Form 21-4192, Request for Employment Information in Connection with Claim for Disability Benefits, submitted by the Veteran's previous employer in October 2014. Per the Form, the Veteran had essentially been forced to retire in May 2008 due to PTSD symptoms, to include lack of memory and "attitude problems." Such evidence supports that the Veteran had difficulty in adapting to stressful circumstances, including work or a worklike setting, a mental health symptom commonly associated with the 70 percent rating criteria, throughout the entire initial rating period from August 28, 2009 through August 10, 2014. In a November 2013 lay statement, the Veteran advanced having symptoms of irritability, anger, and impaired impulse control, which negatively affected employability. The Board notes that impaired impulse control is commonly associated with the 70 percent mental health rating criteria. The record also includes a July 2011 private psychological evaluation. Significantly, per the evaluation report, the Veteran was noted to have impaired impulse control that manifested as irritability and angry outbursts that substantially negatively impacted employability. The Board notes that impaired impulse control and difficulty adapting to stressful circumstances, including work or a worklike setting, are symptoms commonly associated with the 70 percent rating criteria. Further, the private examiner found that the Veteran had an overall severe mental health symptom picture. Such evidence supports that the severity, frequency, and duration of the Veteran's mental health symptoms more nearly approximated the 70 percent rating criteria at that time. The Veteran testified at a March 2011 hearing before a Decision Review Officer (DRO). At that time, the Veteran credibly testified to having symptoms similar to those discussed above since at least May 2008 when the Veteran was forced to retire from work as a car salesman due to PTSD symptoms. The Veteran also received a new VA mental health examination in March 2011. A review of the VA examination report indicates that the severity, frequency, and duration of the Veteran's symptoms at that time were in line with the symptoms identified by the private examiner in July 2011. VA received a Vet Center mental health treatment letter in October 2009. Per the treatment letter, the Veteran had been experiencing symptoms including anxiety, depression, fear and helplessness, social isolation, and hopeless feelings about the future. Such evidence supports that the Veteran was experiencing symptoms consistent with difficulty adapting to stressful circumstances at that time. Finally, the Board notes that the Veteran also received a VA mental health examination in October 2009. The Board notes that the symptoms reported at that time were not consistent with the severity, frequency, and duration of the symptomatology commonly associated with a 70 percent disability rating; however, per the examination report, the VA examiner specifically noted that it was difficult to render an opinion about the Veteran's level of disability at that time. As such, the Board finds the October 2009 VA examination report to be outweighed by the other evidence of record discussed above. After a review of all the evidence, lay and medical, the Board finds that, from August 28, 2009 through August 10, 2014, the severity, frequency, and duration of the symptoms of the service connected PTSD more nearly approximated occupational and social impairment with deficiencies in most areas, as required for a disability rating of 70 percent under Diagnostic Code 9411. A review of the lay and medical evidence of record supports that from August 28, 2009 through August 10, 2014, the Veteran regularly manifested symptoms consistent with difficulty adapting to stressful circumstances, including work or a worklike setting, and impaired impulse control, which are contemplated by the 70 percent rating criteria. For these reasons, resolving all reasonable doubt in favor of the Veteran, the Board finds that the lay and medical evidence shows that a higher initial disability rating of 70 percent is warranted for the service connected PTSD for the rating period from August 28, 2009 through August 10, 2014. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7, 4.130, Diagnostic Code 9411. Initial Disability Rating in Excess of 70 Percent is Denied Having reviewed the evidence of record, lay and medical, the Board finds that, for the entire initial rating period on appeal, from August 28, 2009, the severity, frequency, and duration of the symptoms of the service connected PTSD did not manifest as total occupational or social impairment. The Board acknowledges that during the course of this appeal there were some symptoms commonly associated with the total 100 percent mental health rating criteria; however, for the reasons discussed below, the Board does not find that the severity, frequency, and duration of these symptoms warrant the grant of a staged 100 percent total disability rating at any point during the initial rating period on appeal. These symptoms did not manifest in total social occupational and social impairment. Per the report from the August 2014 VA mental health examination, the Veteran was found to have intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene, which is associated with the 100 percent mental health rating criteria; however, per the examination report, after examining the Veteran and reviewing the evidence of record, the VA examiner explicitly opined that the Veteran was not totally occupationally and socially impaired. In other words, the severity, frequency, and duration of the Veteran's intermittent inability to perform activities of daily living was not so severe as to result in total occupational and social impairment. Significantly, per the examination report, at that time the Veteran was living with his daughter and it was noted that the living arrangement was going well. Further, the Veteran conveyed that his family knew about the mental health symptoms and gave him time and space to be alone; however, there was no indication that the Veteran was completely isolated from his family. Such evidence weighs against a finding that the Veteran had total social impairment. Further, at the time of a January 2015 VA metal health examination, the Veteran was noted to have symptoms of intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene, and disorientation to time or place, which are symptoms commonly associated with the 100 percent mental health rating criteria. Again, however, the VA examiner explicitly opined that the diagnosed symptoms were not of such severity, frequency, or duration to result in total occupational and social impairment. At the time of the January 2015 VA mental health examination, the Veteran was living alone; however, it was noted that the Veteran had four children that he visited a few times per year. Further, the Veteran was attending daily AA meetings and conveyed having made friends at the meetings. Again, such evidence weighs against a finding that the Veteran had total social impairment. No evidence received during the course of this appeal supports that the Veteran had total social impairment at any point during the initial rating period on appeal from August 28, 2009. The Board has reviewed all the evidence of record, lay and medical, and acknowledges that the PTSD symptoms have resulted in significant social and occupational impairment, hence, is assigning a 70 percent disability rating in the instant decision for the relevant periods on appeal that recognizes serious symptoms and serious occupational and social impairment that affects various aspects of the Veteran's life; however, the evidence of record does not reflect that during the relevant periods on appeal the symptoms were so severe, or frequent, or of such duration to cause total occupational and social impairment to warrant a 100 percent total schedular disability rating. Again, the evidence received during the course of this appeal does not support that the Veteran had total social impairment at any time from August 28, 2009 to the present. As such, the Board finds that a total 100 percent disability rating is not warranted at any point during the initial rating period from August 28, 2009. 38 C.F.R. §§ 4.3, 4.7. Extraschedular Claim Not Raised The Board finds that neither the Veteran nor the record has raised a claim for extraschedular rating under 38 C.F.R. § 3.321(b) for any period for the initial PTSD rating issue on appeal. See Thun v. Peake, 22 Vet. App. 111 (2008); Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record); Yancy v. McDonald, 27 Vet. App. 484, 494 (2016), citing Dingess v. Nicholson, 19 Vet. App. 473, 499 (2006), aff'd, 226 Fed. Appx. 1004 (Fed. Cir. 2007) (holding that when 38 C.F.R. § 3.321(b)(1) is not "specifically sought by the claimant nor reasonably raised by the facts found by the Board, the Board is not required to discuss whether referral is warranted"). 2. TDIU from August 28, 2009 through August 10, 2014 Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities (Rating Schedule), which is based on the average impairment of earning capacity. 38 U.S.C. § 1155. Total disability is considered to exist when there is any impairment which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. Total disability may or may not be permanent. 38 C.F.R. § 3.340(a)(1). Total ratings are authorized for any disability or combination of disabilities for which the Rating Schedule prescribes a 100 percent evaluation. 38 C.F.R. § 3.340(a)(2). TDIU may be assigned when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. The service-connected disabilities, employment history, educational and vocational attainment, and all other factors having a bearing on the issue will be addressed in both instances. 38 C.F.R. § 4.16(a),(b). 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). If a veteran's disabilities do not meet the objective combined rating percentage criteria of 38 C.F.R. § 4.16(a), it then becomes necessary to consider whether the criteria for referral for extraschedular consideration are met under § 4.16(b) criteria. It is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. Submission to the Director, Compensation and Pension Service, for extraschedular consideration is warranted in all cases of veterans who are unemployable by reason of service-connected disabilities, but who fail to meet the percentage standards set forth in § 4.16(a). 38 C.F.R. § 4.16(b). Individual unemployability must be determined without regard to any non service connected disabilities or a veteran's advancing age. 38 C.F.R. §§ 3.341(a), 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). The sole fact that a veteran 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 or keep employment, but the ultimate question is whether a veteran is capable of performing the physical and mental acts required by employment, not whether a veteran can find employment. Id. at 361. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in a veteran's favor. 38 C.F.R. § 4.3. In Faust v. West, 13 Vet. App. 342 (2000), the United States Court of Appeals for Veterans Claims (Court) defined "substantially gainful employment" as an occupation that provides an annual income that exceeds the poverty threshold for one person, irrespective of the number of hours or days that a veteran actually works and without regard to a veteran's earned annual income. In Hatlestad v. Derwinski, 5 Vet. App. 524, 529 (1993), the Court held that the central inquiry in determining whether a veteran is entitled to a TDIU is whether a veteran's service connected disabilities alone are of sufficient severity to produce unemployability. The determination as to whether a total disability is appropriate should not be based solely upon demonstrated difficulty in obtaining employment in one particular field, which could also potentially be due to external bases such as economic factors, but rather to all reasonably available sources of employment under the circumstances. See Ferraro v. Derwinski, 1 Vet. App. 326, 331-332 (1991). In evaluating a veteran's employability, consideration may be given to the level of education, special training, and previous work experience in arriving at a conclusion, but not to age or impairment caused by non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. Marginal employment is not considered substantially gainful employment and generally is deemed to exist when a veteran's earned income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. Marginal employment may also be held to exist in certain cases when earned annual income exceeds the poverty threshold on a facts-found basis. Consideration shall be given in all claims to the nature of the employment and the reason for termination. 38 C.F.R. § 4.16(a). Marginal employment, odd-job employment, and employment at half the usual remuneration is not incompatible with a determination of unemployability if the restriction to securing or retaining better employment is due to disability. 38 C.F.R. § 4.17(a). The ultimate issue of whether a TDIU should be awarded is not a medical issue, but rather is a determination for the adjudicator. See Moore v. Nicholson, 21 Vet. App. 211, 218 (2007) (ultimate question of whether a veteran is capable of substantial gainful employment is not a medical one; that determination is for the adjudicator), rev'd on other grounds sub nom, Moore v. Shinseki, 555 F.3d 1369 (Fed. Cir. 2009). Although VA must give full consideration, per 38 C.F.R. § 4.15, to "the effect of combinations of disability," VA regulations place responsibility for the ultimate TDIU determination on VA, not a medical examiner's opinion. Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013); 38 C.F.R. § 4.16(a); see also Smith v. Shinseki, 647 F.3d 1380, 1385-86 (Fed. Cir. 2011) (VA is not required to obtain an industrial survey from a vocational expert before making a TDIU determination but may choose to do so in an appropriate case). In this case, due to the Board's grant of a higher initial disability rating of 70 percent for the service connected PTSD, the disability rating eligibility criteria for a TDIU under 38 C.F.R. § 4.16(a) have been met for the entire rating period on appeal, from August 28, 2009 through August 10, 2014. From August 28, 2009, the Veteran was service connected for the single disability of PTSD, which is now rated as 70 percent disabling since the grant of service connection. As discussed above, per an October 2014 VA Form 21-4192, Request for Employment Information in Connection with Claim for Disability Benefits, the Veteran had essentially been forced to retire from full time employment in May 2008 due to PTSD symptoms, to include lack of memory and "attitude problems." Review of the record reflects that the Veteran has not had substantially gainful employment since that time. In March 2015, the AOJ granted a TDIU from October 8, 2014, which was the date VA received the Veteran's VA Form 21-8940, Veteran's Application for Increased Compensation Based on Unemployability; however, pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009), the appropriate rating period on appeal is from August 28, 2009, the date of grant for service connection for PTSD (the Veteran's sole service connected disability). The Board notes that in a subsequent April 2021 rating decision, the AOJ assigned an earlier effective date of August 11, 2014 for the grant of the TDIU. Per the March 2015 rating decision, the TDIU was granted based upon the findings of the VA examiner in the report from the January 2015 VA mental health examination, and the October 2014 VA Form 21-4192 indicating that the Veteran was forced to retire due to PTSD symptoms. For the reasons discussed above, the Board has found that the symptoms and social and occupational impairment shown at that time of the January 2015 VA examination, at least in part, have been present since service connection was granted on August 28, 2009. Further, per an October 2009 Vet Center treatment letter, the Veteran's mental health symptoms had led to detachment from society, which would include a work environment. The report from a July 2011 private psychological evaluation also found that the Veteran's mental health symptoms substantially negatively impacted employability. Additionally, a VA examiner in August 2014 specifically found that the Veteran's ability to obtain and maintain employment was guarded given the Veteran's past behavioral difficulties in the work place. (Continued on the next page) Having reviewed all the evidence of record, lay and medical, the Board finds that, from August 28, 2009 through August 10, 2014, the Veteran was unable to maintain substantially gainful employment as a result of service connected PTSD symptoms. Per the above, the evidence reflects that the Veteran was forced to retire from selling cars in May 2008 due to PTSD symptoms and impairments. Further, VA and private treatment records from the rating period on appeal support that, from August 28, 2009 through August 10, 2014, the Veteran's PTSD symptoms were of such severity to prevent maintain substantially gainful employment. For the above reasons, and resolving reasonable doubt in favor of the Veteran, the Board finds that the service-connected PTSD prevented the Veteran from maintaining substantially gainful employment for the period from August 28, 2009 through August 10, 2014. As such, the Board finds that a TDIU is warranted from August 28, 2009 (the date of grant of service connection for PTSD, the Veteran's sole service-connected disability) through August 10, 2014 (day prior to the AOJ's grant of a TDIU). 38 C.F.R. §§ 3.340, 3.341, 4.16. J. PARKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Blowers, 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.