Citation Nr: 21032716 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 19-35 525 DATE: May 27, 2021 ORDER 1. An effective date of September 20, 1979, but no earlier, for the award of service connection for Post-Traumatic Stress Disorder (PTSD) to include major depressive disorder (MDD) and insomnia disorder is granted. 2. An initial disability rating in excess of 70 percent for PTSD, to include MDD, and insomnia disorder is denied. 3. Entitlement to total disability based on individual unemployability due to service-connected disabilities (TDIU) is granted. FINDINGS OF FACT 1. Prior to the September 20, 1979 congressional inquiry, the record contains no informal, formal claim, or any written intent to file a claim for entitlement to service connection for PTSD after June 29, 1976, when 38 C.F.R. 3.6(c)(3) was amended entitling Veterans in the National Guard who served prior to January 1959 to benefits. 2. For the entire initial rating period on appeal, the Veteran's PTSD has manifested as occupational and social impairment with deficiencies in most areas due to such symptoms as anxiety, nightmares, sleep impairment, night sweats, difficulty controlling emotions, and isolation. 3. The competent and probative evidence is, at the very least, in relative equipoise as to whether the Veteran is entitled to a TDIU. CONCLUSIONS OF LAW 1. The criteria to establish an effective date of September 10, 1979, but no earlier, for the award of service connection for PTSD have been met. 38 U.S.C. §§ 5103, 5103A, 5107, 5110; 38 C.F.R. §§ 3.102, 3.156, 3.159, 3.400. 2. The criteria for an evaluation in excess of 70 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.130, Diagnostic Code 9411. 3. The criteria for a TDIU have been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the Army National Guard from June 1955 to November 1957 with period of active duty for training (ACDUTRA) from June 19, 1955 to July 2, 1955, June16, 1956 to June 30, 1956, and June 15, 1957 to June 29, 1957. These matters come before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in April 2018 when the RO granted service connection for PTSD, rated at 70 percent, effective January 13, 2006. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c). The Board notes that the Court of Appeals for Veterans Claims (Court), has held that a claim for TDIU is part and parcel of any increased rating claim when it is raised by the record. See Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). As the issue of the rating assigned for PTSD is on appeal, and the Veteran has raised the issue of TDIU during the pendency of this appeal, the Board finds that TDIU is part and parcel of this appeal and therefore has been added to the issues listed on appeal above. 1. An effective date of September 10, 1979, but no earlier, for the award of service connection for Post-Traumatic Stress Disorder (PTSD) to include major depressive disorder (MDD) and insomnia disorder is granted. Unless specifically provided otherwise, the effective date of an award based on an original claim shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of the application. 38 U.S.C. § 5110 (a). The statutory provision is implemented by regulation, which provides that the effective date for an evaluation and award of compensation based on an original claim will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400. A specific claim in the form prescribed by the Secretary must be filed in order for benefits to be paid or furnished to any individual under the laws administered by VA. 38 U.S.C. § 5101 (a); 38 C.F.R. § 3.151 (a). The term "claim" or "application" means a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1 (p). Any communication or action indicating intent to apply for one or more benefits under the laws administered by VA, from a Veteran or his representative, may be considered an informal claim. Such informal claim must identify the benefit sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. If received within one year from the date it was sent to the Veteran, it will be considered filed as of the date of receipt of the informal claim. 38 C.F.R. § 3.155. The Veteran essentially contends that his claim for service connection for PTSD should be granted back to July 22, 1976, the date he reports submitting an informal claim showing his psychiatric symptoms began during his military service. Historically, the Veteran applied for service connection for a nervous condition in May 1974. He was denied service connection due to having, at the time, no qualifying service. In April 1975, the Veteran again applied for entitlement to service connection for heat exhaustion problems which resulted in an acquired psychological condition resulting from heat exhaustion in service. He was again denied and informed that under the law, at that time, National Guard members with service prior to January 1, 1959, do not meet the eligibility requirements to claim VA disability benefits based on disabilities incurred while on ACDUTRA. See 38 C.F.R. § 36(c)(3) (1975). In December 1975, the Veteran submitted medical records from his National Guard service detailing his psychiatric symptoms as noted during service. In June 1976, the exclusionary date was taken out of the law, entitling Veterans who served prior to January 1959 to benefits. See 41 FR 26881, June 29, 1976. The Court has held that when there is an intervening change in the law or regulation creating a new basis for entitlement to benefits, a claim under the liberalizing regulation is a claim separate and distinct from the claim previously and finally denied and may be reviewed on a de novo basis. See Spencer v Brown, 4 Vet. App. 283, 288-89 (1993) aff'd, 17 F 3d 368 (Fed Cir 1994), cert denied 513 US 810 (1994). On September 10, 1979, the RO received a Congressional Inquiry which inquired whether the Veteran was entitled to VA benefits for injuries incurred while in the Reserves. Attached was the Veteran's letter requesting assistance obtaining service connection for his acquired psychiatric symptoms which be believed began in July 1957, while on ACDUTRA in the National Guard. The RO denied service connection for PTSD in November 2006. In January 2007, the Veteran submitted a Notice of Disagreement (NOD) disagreeing with the denial of his service connection claim for PTSD. A statement of the Case (SOC) was provided in November 2007, continuing the denial for service connection for PTSD, and a December 2007 VA Form 9 requested a Board hearing. Here, the earliest date that the Board can construe VA receipt of an informal claim is the September 10, 1979 Congressional Inquiry. Although the Board acknowledges that the Veteran submitted medical records detailing his hospitalization due to psychiatric symptoms during ACDUTRA in December 1975, this date is prior to the June 1976 change in law which entitled the Veteran to benefits based on his service in the Reserves. There is no indication of an intent to claim service connection for PTSD prior to September 10, 1979, and after June 1976. Accordingly, the Veteran is entitled to an effective date of September 10, 1979, for the grant of service connection for PTSD. 38 U.S.C. § 5110 (b)(1); 38 C.F.R. § 3.400 (b)(2)(i). 2. An initial disability rating in excess of 70 percent for PTSD, to include MDD, and insomnia disorder is denied. The Veteran contends that he is entitled to an initial disability rating in excess of 70 percent for his PTSD. He has been awarded service connection, with a 70 percent initial rating, initially effective January 13, 2006, for posttraumatic stress disorder (PTSD). However, as explained in detail above, this decision has granted an earlier effective date of September 29, 1979. He contends the impairment resulting from this disability is more severe than is rated by VA, and an increased rating is warranted. Disability evaluations are based upon the average impairment of earning capacity as contemplated by the schedule for rating disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). In adjudicating increased rating claims, the level of disability in all periods since the effective date of the grant of service connection must be taken into account, to include the possibility that a staged rating may be assigned. See Fenderson v. West, 12 Vet. App. 119 (1998); Hart v. Mansfield, 21 Vet. App. 505 (2007). As such, the Board will consider whether staged ratings are appropriate to the pending appeals. In cases in which a reasonable doubt arises as to the appropriate degree of disability to be assigned, such doubt shall be resolved in favor of the Veteran. 38 C.F.R. § 4.3. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. 38 C.F.R. § 4.7. Preliminarily, the Board notes the applicable Diagnostic Code (DC) is DC 9411, which is evaluated under the General Rating Formula for Mental Disorders. See 38 C.F.R. §§ 4.27, 4.130. Under the General Rating Formula for Mental Disorders, a 70 percent disability rating is warranted for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgement, 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, inability to establish and maintain effective relationships. A 100 percent evaluation for a psychiatric disability 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. 38 C.F.R. § 4.130, Diagnostic Code 9411. In evaluating psychiatric disorders, the Board is mindful that the use of the term "such as" in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve only as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). In Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (2013), the U.S. Court of Appeals for the Federal Circuit (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." Clinical evaluations reflect assignment of various Global Assessment of Functioning (GAF) scores. The Global Assessment of Functioning is a scale reflecting the subject's psychological, social, and occupational functioning. Richard v. Brown, 9 Vet. App. 266, 267 (1997). A GAF of 51-60 indicates moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (few friends, conflicts with peers or co-workers). A GAF score of 41-50 is indicative of serious symptoms (e.g., suicidal ideation, severe obsessive rituals, frequent shoplifting), or any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job). See American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (DSM- IV) (4th Ed.). The schedular criteria incorporate the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). 38 C.F.R. §§ 4.125, 4.130. Since August 4, 2014, VA has required a diagnosis of a mental disorder that conforms with the DSM5. For claims received prior to that date, VA required a diagnosis that conformed with the DSMIV. See Schedule for Rating Disabilities: Mental Disorders and Definition of Psychosis for Certain VA Purposes, 79 Fed. Reg. 45,093, 45,093 94 (Aug. 4, 2014 (amending 38 C.F.R. § 4.125)). The DSM5 eliminated the Global Assessment of Functioning (GAF) scores used in the DSMIV. As the claim on appeal was received in December 2007, the DSM-IV applies, and GAF scores can be considered. Golden v. Shulkin, No 16-1208. As this claim is an appeal of an initial disability rating the evidence to be considered is not limited to the current severity of the disability. Fenderson v. West, 12 Vet. App. 119 (1999); Francisco v. Brown, 7 Vet. App. 55 (1994). In doing so, the Board examines the relevant evidence to determine whether it is possible to grant a higher percentage evaluation for a distinct period; this concept is known as the "staging" of ratings. See Fenderson, 12 Vet. App. at 126-27; Hart v. Mansfield, 21 Vet. App. 505, 510 (2007). In July 1957, while on ACDUTRA with the National Guard, the Veteran reported suffering a heat stroke. He was admitted to several hospital during the course of two weeks, and eventually brought into a hospital on a mental illness commitment. He was given a diagnosis of schizophrenic reaction. Upon examination, he was oriented in all spheres, cooperative and agreeable, with no insight, normally alert facial expression, normal motor activity, and adequate attention and concentration. The Veteran denied delusions and hallucinations. In terms of lay evidence, the Veteran's brother provided a statement reporting personality changes he observed in his brother after returning from ACDUTRA for the United States National Guard. He reported observing a more serious personality, as opposed to his usual gregarious state. He reported observing the Veteran's tendency to isolate and seclude himself for periods of time. He reported remembering the Veteran complaining regularly of headaches, night sweats, nightmares, intermittent fits of rage, and paranoia that he was being talked about. The Veteran underwent his first VA examination In September 1974. During the interview, the Veteran reported suffering from a heat stroke while on active duty with the National Guard. He explained that during this incident he thought he was a prisoner of war in a Russian camp, and recalled being fearful of the corpsmen who were dressed in white. The Veteran stated he continues to have episodes of sweating, nervousness, headaches, and inward fever. Upon examination, the Veteran was noted to be relevant, coherent, and goal directed. Affect, mood, and emotional tone were noted to be appropriate to content and to the interview situation. He denied hallucinations, delusions, ideas of reference and ideas of influence. He was oriented to time and place, with adequate personal insight and judgment. He was deemed competent by the examiner, and found to have no residual neurological issues. The Veteran provided testimony concerning his PTSD symptomology before a Veterans Law Judge (VLJ), other than the undersigned, in January 2011 while seeking entitlement to service connection for PTSD. He testified that since service he has experienced migraine headaches, but other than that he feels normal. He explained that many people have accused him of being short tempered, and overtalkative since leaving the National Guard. The Veteran underwent a PTSD VA examination in October 2011. Regarding the July 1957 incident, the examiner, L.K., an attending VA psychiatrist, diagnosed Brief Psychotic Disorder and deemed the Veteran totally impaired at that time during his ACDUTRA service. The examiner explained that although the Veteran was diagnosed as having schizophrenic reaction in July 1957, the correct diagnosis for a brief psychotic-like event as described in the Veteran's claims file would be brief psychotic reaction, which usually occurs in late teenage years or early twenties and has complete remission of all symptoms, which seems to be the case with the Veteran. He further remarked that since the 1957 incident, the Veteran has recovered from his brief psychotic reaction and has had no further contact with mental health professionals. The Veteran's current symptoms were noted to be chronic sleep impairment and difficulty in adapting to stressful circumstances, including work or a worklike setting. When asked whether the Veteran's current diagnosis affected his usual daily activities, no effects were noted. The Veteran underwent an alcohol screen in July 30, 2013, when asked whether he felt numb or detached from others, activities, or surroundings, he stated that he did not. In April 2014, an addendum opinion for the October 2011 VA examination report was submitted from a clinical psychologist other than the author of the October 2011 report. The report did not mention review of the Veteran's claims file. The private examiner provided a diagnosis of schizophrenia, residual type, with a current Global Assessment of Functioning (GAF) of 45-50. Upon examination, the Veteran was noted to be alert to time, place, purpose and person. He exhibited a depressed and withdrawn mood, with tangential and at times obscure speech. His thought processes were circular, stereotyped, and disorganized. The Veteran reported night sweats, severe migraine headaches, and hypoglycemic reactions. The examiner opined that the Veteran exhibits total social and occupational disability due to the Veteran being unemployed since 1977 and his difficulty controlling his emotions. An August 2014 psychiatry attending record notes the Veteran's denial of psychotic symptoms or suicidal ideation. In December 2014, PTSD group notes for that day included the Veteran's report of staying busy with things he enjoys, including golfing when he can. In December 2015 group notes, the Veteran discussed his inability to play golf for the past few months due to neck pain, and how difficult not playing golf is for him because he really enjoys the sport. The Veteran's Service Outreach Program (VSOP) evaluated the Veteran to ascertain the etiology of his current psychiatric symptoms. The report noted utilizing DSM-V criteria. The examiner noted severe depression, intrusive thoughts, isolation, emotional avoidance, spontaneous walking, and auditory /visual/olfactory memories of service, anxiety, and a GAF score of 39. The examiner also noted the Veteran was observed to be cognitively responsive. The examiner opined that the Veteran is unemployable due to his major occupational and physical challenges, including limited mobility due to age, and continued erosion of health. See October 2015 Medical Treatment Record. The Veteran underwent another PTSD VA examination in February 2019 in which he was found to have occupational and social impairment with occasional decrease in work efficiency. The Veteran reported flashbacks, awakenings at night, forgetfulness, and cold sweats, and uncontrollable anger impulses. Symptoms include anxiety, and chronic sleep impairment. The Veteran denied current and history of suicidal and homicidal ideation, and self-harming behaviors. Upon examination, the Veteran was oriented to person, place, situation, and time, intact memory, hygiene and grooming appropriate, and flat affect with melancholic mood. Initially, at the beginning of the session, the Veteran was reported to be mildly anxious, but as the examination continued, he appeared more at ease. Psychiatric attending reports from June 2019 and October 2019 note no perceptual disturbance such as hallucinations and illusions. Additional psychiatric reports from December 2019 and April 2020 note no perceptual disturbance such as hallucination and illusion. A November 2020 private opinion from a Dr. M.L.C. was associated with the Veteran's claims file. The examiner acknowledged review of the Veteran's complete claims file, and examination of the Veteran. He found the Veteran to have severe mental illness incapable, by 1976, of functioning in prosocial or occupational activities. In support of this conclusion, the examiner outlined the Veteran's medical chronology, including his personal assessment of the Veteran based on three separate hour-long interviews. The Veteran reported feeling fear, apprehension, bizarre thoughts, and voices in 1957 while on ACDUTRA for the National Guard; he further endorsed current symptomology including headaches, avoidance of militaristic themes in media, nightmares, depression, intrusive thoughts, and dissociative episodes regarding his time in the National Guard. The private report also notes the Veteran's belief that he has been treated in the past for depression, migraine headaches, and ongoing auditory hallucinations, which were noted to be present during the November 2020 private interviews. Socially, since service, the Veteran reported mostly interacting with his wife, until her death, and having few friends or acquaintances with whom he has ever engaged. He further reported diminished interest in previous hobbies, and a lifestyle that consisted of rarely leaving his house, and mostly of going to work and going home, when he was employed. Upon formal examination, the Veteran was noted to be cooperative and appropriate with good impulse control; flat speech; speech latency with the Veteran answering in one or two-word sentences; "okay" mood; no suicidal or homicidal ideation, and no overt delusions or illusions, but often having a disconnect between thought content and questions being asked. The Veteran showed extensive thought blocking, and looseness of associations, and endorsed auditory and visual hallucinations. Ultimately, the examiner opined that while on ACDUTRA in the National Guard, the Veteran experienced psychosis manifested by perceptual alterations, paranoid delusions, anxiety, depression and anger, all which progressed and began to include episodic depression, hopelessness, helplessness, and despair after leaving the National Guard. The examiner further explained that since leaving the National Guard the Veteran continues to have auditory hallucinations as well as paranoia. He determined the Veteran is extraordinarily avoidant, spending most of his life primarily going to work and returning home, when he was employed, without any extracurricular activities, hobbies or interests. He further determined that the Veteran lives in a negative emotional state, does not engage in enjoyable activities, and is estranged from society, especially after the death of this wife. Thus, making him completely impaired from occupational and social functioning due to the symptoms previously discussed along with irritability, chronic insomnia, isolative tendencies, and occasional hallucinations. At the outset, the Board finds the private April 2014 addendum opinion to be, at best, of low probative value, and outweighed by the remaining record. The examiner failed to indicate whether the Veteran's claims file was reviewed, potentially resulting in an opinion of total social and occupational impairment based solely on his personal interview and assessment of the Veteran, without giving due consideration to the several VA records reporting remission of most, if not all, symptoms since his service in the National Guard. See September 1974 Neuropsychiatric Examination; October 2011 VA Examination. While the law does not require that an examiner review the claims file for an opinion to be probative, the examiner must have an accurate and complete understanding of the Veteran's medical history. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Moreover, the Board finds the remaining medical record outweighs the probative value of the November 2020 private opinion, as the private opinion is based on an inaccurate factual basis that the Veteran has experienced auditory hallucinations since leaving the National Guard. In fact, to the contrary, VA treatment records and VA examinations alike note the Veteran's consistent denial of hallucinations, delusions, or perceptual disturbances. See September 1974 VA Examination; see also August 2014, June 2019, and October 2019 Psychiatry Attending Notes. The Board finds that the earlier lay statements, given in the context of contemporaneous medical treatment, are more credible than those provided in this report in support of a claim for compensation. Moreover, the November 2020 private report states that the Veteran is, "extraordinarily avoidant, spending most of his life primarily going to work and returning home, without any extracurricular activities, hobbies or interests." The Board finds this fact is also contradicted by the remaining medical evidence of record. PTSD group attending notes include numerous reports from the Veteran admitting that he stays busy doing the things he loves, including golfing. See December 2014 PTSD Group Notes. Further, in July 2013, when asked whether he felt numb or detached from others, activities, or surroundings, the Veteran selected "no." With that, the Board finds that for the entire period on appeal, the Veteran's PTSD does not more nearly approximate a 100-percent disability evaluation. The service-connected PTSD manifested a range of symptoms, but those most frequently emphasized by the Veteran were depressed mood, headaches, anxiety, sleep impairment, nightmares, night sweats, isolation, and difficulty controlling emotions. While the Veteran contends that symptoms have resulted in total impairment and that a higher disability rating is warranted for the entire initial rating period on appeal, there is no evidence of total social or occupational impairment that more nearly approximates a 100-percent disability rating, including due to symptoms such as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name, based on review of treatment records, VA examination reports, or the Veteran's lay statements. Objective examinations demonstrated he was observed to be relevant, coherent, and goal directed. He had appropriate dress and grooming and his memory was noted to be within normal limits. Additionally, the Veteran has never been described as a danger to himself or others. The Board acknowledges the April 2014 private report which observed the Veteran's circular, stereotyped, and disorganized thought processes. However, the Board finds this does not equate to gross impairment, but rather significant impairment in thought processes, which is contemplated by the 70 percent evaluation. The Board further acknowledges the private April 2014 report assigning a GAF score of 45-50, and the October 2015 VSOP evaluation assigning a GAF score of 39. Under the DSM-IV, these scores are consistent with serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job). However, the score of 45-50, assigned by the April 2014 private examiner, is unreliable due to the examiners failure to review the Veteran's claims file, and address previous opinions which conclude that the Veteran is in complete remission of all symptoms since his service in the National Guard. Moreover, the October 2015 GAF score of 39 is inappropriate as the examiner indicated using the DSM-V criteria and not the DSM-IV criteria. There is no question the Veteran has severe symptoms; however, these symptoms have never been shown to be so frequent or disabling that they rise to the level of total occupational or social impairment, which is a level of severity so disabling that some of the examples of symptoms include not knowing one's own name or posing a persistent threat of danger to self or others. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002) (finding that symptoms contained in rating schedule criteria are "not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating."). The records reflect that the Veteran retained some social functioning as he maintained a marriage until his wife unfortunately passed in 2004, was deemed competent to manage his own affairs in 1974, and has reported engaging in some hobbies, including golfing as frequently as possible. Thus, in consideration of the evidence above, the Board finds that, for the entire period on appeal, the weight of the evidence is against finding that the service-connected PTSD resulted in total occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. Because the preponderance of the evidence is against the appeal for a higher initial rating in excess of 70 percent for PTSD, the benefit-of-the-doubt doctrine does not apply. 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 4.3, 4.7. 3. Entitlement to total disability based on individual unemployability due to service-connected disabilities (TDIU) is granted. As discussed above, the issue of TDIU was raised by the record. See Rice v. Shinseki, 22 Vet. App. 447 (2009). VA disability ratings are based, as far as practicable, on the average impairment of earning capacity attributable to disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. 38 U.S.C. § 1155 (West 2014); 38 C.F.R. §§ 4.1, 4.10 (2017). Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. Id. Where the schedular rating is less than total, a total disability rating may nonetheless 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 disability; provided that, in pertinent part, if there is only one such disability, the disability shall be rated at 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability rated 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341(a), 4.16(a). The Veteran has two service-connected disabilities; PTSD rated at 70 percent and migraine headaches rated as non-compensable. Accordingly, he meets the percentage threshold set forth under 38 C.F.R. § 4.16 (a). The remaining question is therefore whether the Veteran's service-connected disabilities preclude gainful employment for which his education and occupational experience would otherwise qualify him. Entitlement to a TDIU requires the presence of impairment so severe that it is impossible for the average person to follow a substantially gainful occupation. See 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. In determining the severity of impairment, the central inquiry is "whether the Veteran's service-connected disabilities alone are of sufficient severity to produce unemployability." Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Consideration may be given to the Veteran's level of education, special training, and previous work experience, but not to his age or the impairment caused by non-service-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. The Veteran was last employed in January 1976 where he performed shipyard maintenance. He has two years of post-secondary education, with no other education or training. His employment history includes working at the Post Office as a general mail handler, and a general helper for an aluminum company. See Veteran's Application for Increased Compensation Based on Unemployability, January 2021. As discussed above, the October 2015 letter from VSOP indicates that the Veteran is incapable of sustaining gainful employment because of his major occupational and physical challenges, such as limited mobility due to age, and continued erosion of health due to his physical impairment. The Board finds this opinion to be inadequate to grant TDIU because the examiner admitted that the Veteran was unemployable due to limited mobility because of his age, and erosion of physical health. The Board cannot consider in its analysis occupational restrictions caused by non-service-connected disabilities, such as the Veteran's physical ailments, or age. The Veteran's brother submitted a statement explaining the Veteran's struggle with frequent migraine headaches while working at the post office which caused frequent absences at work. The November 2020 private opinion concluded that the Veteran was unemployable due to his service-connected PTSD. Upon an interview, the Veteran reported suffering a work-related back injury around the time he stopped working, but also explained that he was having issues interacting with supervisors, including anger and irritability, and trouble functioning in an occupational setting. Additionally, the Veteran endorsed issues with focus and concentration, and indicated that his insomnia made it difficult to manage the requirements of his employment. As explained above, the Board found this opinion to be based on an inaccurate factual bases concerning certain reports that were noted to have been made by the Veteran, which were in direct contradiction to previous lay statements provided during treatment. With that said, however, although the Board finds the examiner's determination of the Veteran's impairment to be inadequate, along with specific lay statements which were proven to be in direct contradiction with previous lay statements, the remainder of the examination report is found to be competent, credible, and with significant probative weight concerning whether the Veteran is entitled to TDIU. After a thorough review of the evidentiary record, the Board finds that the competent and probative evidence is, at least, in relative equipoise to support a finding that the Veteran was rendered unable to obtain or maintain substantially gainful employment due to the service-connected disabilities from September 29, 1979. Therefore, the criteria for TDIU have been met since that time. Accordingly, the claim for a TDIU for the appeal period from September 29, 1979 is granted. MARJORIE A. AUER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Russell, Tangela 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.