Citation Nr: 21039905 Decision Date: 07/01/21 Archive Date: 07/01/21 DOCKET NO. 17-25 320 DATE: July 1, 2021 ORDER Entitlement to a rating in excess of 50 percent disabling for service-connected posttraumatic stress disorder (PTSD) is denied. REMANDED Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. FINDING OF FACT The Veteran's PTSD is manifested by occupational and social impairment with reduced reliability and productivity as a result of psychiatric symptomatology, to include hypervigilance with exaggerated startle response, depression, anxiety, chronic sleep disturbance and nightmares, difficulty concentrating, irritability, outbursts of anger, suspiciousness, panic attacks more than once a week, near-continuous panic or depression affecting the ability to function independently, appropriately and effectively, mild memory loss, impairment of short and long term memory, flattened affect, difficulty in understanding complex commands, impaired judgment, disturbances of mood and motivation, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances including work or a work like setting, inability to establish and maintain effective relationships, and impaired impulse control such as unprovoked irritability with periods of violence, without more severe manifestations that more nearly approximate occupational and social impairment with deficiencies in most areas, or total occupational and social impairment. CONCLUSION OF LAW The criteria for a rating in excess of 50 percent disabling for service-connected PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1-4.14, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from February 2004 to March 2013. In May 2021 the Veteran testified before the undersigned Veterans Law Judge at a Board hearing. A transcript of the hearing is of record. Entitlement to a rating in excess of 50 percent disabling for service-connected PTSD is denied. The Veteran is currently in receipt of a 50 percent rating for service-connected PTSD effective March 22, 2013. He contends that such disability is more severe than the currently assigned rating, and as such, an increased rating is warranted. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise the lower rating will be assigned. 38 C.F.R. § 4.7. All benefit of the doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. 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). Where the appeal arises from the original assignment of a disability evaluation following an award of service connection, the severity of the disability at issue is to be considered during the entire period from the initial assignment of the disability rating to the present time. See Fenderson v. West, 12 Vet. App. 119 (1999). While the Veteran's entire history is reviewed when making a disability determination, where service connection has already been established and an increase in the disability rating is at issue, it is a present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). The Court has held that, in determining the present level of a disability for any increased evaluation claim, the Board must consider the application of staged ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). In other words, where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibited diverse symptoms meeting the criteria for different ratings during the course of the appeal, the assignment of staged ratings would be necessary. The Veteran's service-connected PTSD is evaluated under the criteria of Diagnostic Code 9411, which provides evaluations pursuant to VA's General Rating Formula for Mental Disorders. Under the formula, a 50 percent 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 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 irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships. A 100 percent rating is warranted when 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. As the United States Court of Appeals for the Federal Circuit recently explained, evaluation under 38 C.F.R. § 4.130 is "symptom-driven," meaning that "symptomatology should be the fact-finder's primary focus when deciding entitlement to a given disability rating" under that regulation. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed.Cir.2013). The symptoms listed are not exhaustive, but rather "serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating." Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). In the context of determining whether a higher disability evaluation is warranted, the analysis requires considering "not only the presence of certain symptoms[,] but also that those symptoms have caused occupational and social impairment in most of the referenced areas" - i.e., "the regulation... requires an ultimate factual conclusion as to the Veteran's level of impairment in 'most areas.'" Vazquez-Claudio, 713 F.3d at 117-18; 38 C.F.R. § 4.130, Diagnostic Code 9411. Furthermore, when evaluating a mental disorder, the Board must consider the "frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission," and must also "assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination." 38 C.F.R. § 4.126 (a). In addition to evidence regarding the Veteran's symptomatology and its impact on his social and occupational functioning, a Global Assessment of Functioning (GAF) score is another component considered to determine the entire disability picture for the Veteran. The GAF score is a scale reflecting the "psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness" from 0 to 100, with 100 representing superior functioning in a wide range of activities and no psychiatric symptoms. Carpenter v. Brown, 8 Vet. App. 240, 242 (1995) (quoting DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS 32 (4th ed. 1994)). The Board notes that VA recently updated references in its regulations to the Fifth Edition of the DSM (DSM-5), which has removed the use of GAF scores due to their inconsistency and subjective nature. The changes only apply to claims that were certified for appeal to the Board after August 4, 2014. See 80 Fed. Reg. 14,308 (March 19, 2015) (Applicability Date). Inasmuch as the Veteran's appeal was certified to the Board in May 2017, the amendments are applicable. Therefore, while the Board will note the GAF scores assigned to the Veteran, and consider such in light of the other evidence of record, they are not definitive. The Veteran's post-service treatment records reflect that the Veteran underwent psychiatric treatment to include individual therapy. Treatment records in 2014 reflect that the Veteran was alert and oriented, but visibly tense and anxious. The Veteran's immediate attention was adequate but he had difficulty concentrating. His processing speed and verbal abstractions were adequate. The examiner noted occasional slow rhythmic rocking, jiggling of his legs, and pulling on his fingers. The Veteran reported sleep problems and nightmares. Treatment records in 2015 and 2016 reflect that the Veteran suffered from chronic anxiety which ranged from moderate to severe with occasional depression as well as difficulty sleeping and nightmares. Mental status evaluations repeatedly noted that the Veteran was appropriately groomed with a neat appearance. His mood was anxious and his affect was congruent with his mood. His speech was spontaneous, organized, fluent and non-pressured. Furthermore, it had a normal rate, rhythm, and volume. He maintained good eye contact and his thought process was logical, linear and goal directed. His thought content was coherent with no signs of psychosis. His psychomotor activity showed no involuntary movement and his cognition, memory and concentration were intact. Additional treatment records in 2016 and 2017 reflect the Veteran's reports of moderate anxiety and persistent sleep problems and nightmares. Mental status examinations revealed that the Veteran was oriented and alert. His mood ranged from depressed to euthymic and his functional status was intact, his affect was appropriate and he was interactive during sessions. Treatment records in 2019, 2020 and 2021 reflect the Veteran's reports of moderate anxiety and sleep problems. He routinely denied suicidal and homicidal ideation, intent or plans and noted that he mostly stayed at home and did not engage in social relationships or activities. Rather the Veteran noted that he relied on his service dog and avoided social situations. During mental status examinations it was repeatedly noted that the Veteran's general appearance and dress were appropriate, his motor activity was unremarkable and his insight and judgment were good. His affect was appropriate and his mood was euthymic. He was routinely oriented to person, place, and time. His memory was intact and his attention and concentration were good. His thought content was appropriate and his perception and flow of thought were unremarkable. The Veteran was interactive during sessions. In August 2012, prior to the Veteran's discharge from service, he underwent VA examinations. During a general examination, the examiner conducted a mental status evaluation and noted that the Veteran was alert and oriented. His behavior was normal and his affect and mood were appropriate. The Veteran's comprehension of commands was normal and his memory was intact. There were no signs of anxiety and he answered questions appropriately. Finally, the examiner noted no obvious signs of hallucinations or delusions. During the PTSD examination, the examiner noted that the Veteran's mood was dysphoric with congruent affect. The examiner found no obvious signs of suicidal or homicidal ideation. The Veteran reported feeling anxious and depressed as well as hypervigilant. He also noted that he avoided social situations, and had difficulty falling and staying asleep. The examiner noted that the Veteran was married with children and had great relationships with his family. Upon examination, the Veteran was found to be oriented and his appearance, hygiene and behavior were appropriate. He maintained good eye contact. His affect and mood revealed mood swings, anxiety, and depression. The examiner noted irritability and anger outbursts as well. The Veteran's communication, speech, and concentration were within normal limits. He did not suffer from panic attacks or suspiciousness. The examiner found no evidence of delusions, hallucinations, or obsessive-compulsive behavior. His thought process was appropriate and his judgement was not impaired. The Veteran's abstract thinking and memory were within normal limits. Finally, the examiner found no evidence of and the Veteran denied suicidal and homicidal ideation. The examiner assigned a GAF score of 60. In April 2014 the Veteran underwent a VA Mental Health examination with an accompanying disability benefits questionnaire (DBQ). The examiner noted that the Veteran suffered from PTSD and that such caused occupational and social impairment with reduced reliability and productivity. The Veteran reported that he had been married for five years and that they had two-year-old twins. He further noted that they lived with his parents. He reported that while he got along with his family, he did not socialize. The Veteran also noted that he had been unemployed since service because "its hard to get out in public-I get really nervous." Upon examination, the examiner noted that the Veteran was alert and fully oriented. His speech was normal in rate, tone, and syntax, and his thought content and process were unremarkable. His mood presented as moderately anxious with full and excessively reactive affect. The examiner found no observable responsiveness to internal stimuli. The Veteran denied any hallucinations and delusions as well as suicidal and homicidal ideation, intent, and planning. The examiner found no observable impairment in attention or memory. The examiner further noted that the Veteran was irritable with angry outbursts, hypervigilant with an exaggerated startle response, and that he had problems concentrating. Finally, the examiner noted that the Veteran suffered from anxiety and chronic sleep impairment. In November 2016 the Veteran underwent an additional VA Mental Health examination with an accompanying DBQ. The examiner found that the Veteran suffered from PTSD and ADHD. The examiner found that the Veteran's PTSD caused occupational and social impairment due to mild or transient symptoms which decreased work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms are controlled by medication. The Veteran reported that he had been married twice and had four children. He noted that he spent his free time at home and that he and his family lived with his parents. He reported that he got along well with his father but not with his mother. He noted that he did not exercise, belong to any clubs or organizations, and did not attend church. The Veteran stated that he did not socialize and that his best friend was his service dog. Upon examination, the examiner found the Veteran to be alert and fully oriented, neatly groomed, and cleanly dressed. The Veteran was cooperative and polite, and his speech was normal in rate, rhythm, and volume. His thought process was logical, linear, and goal directed. The Veteran's mood presented as ok with congruent but constricted affect. The examiner found no evidence of hallucinations or delusions. The Veteran denied suicidal and homicidal ideation, intent, and planning. The examiner found no observable impairment in attention, concentration, or memory. The Veteran's insight, judgment and impulse control were intact. The examiner noted that the Veteran suffered from hypervigilance with exaggerated startle response, depression, anxiety, sleep disturbance and nightmares. Ultimately, the examiner found that the Veteran's symptoms caused him mild impairment. In April 2021 the Veteran submitted a private Mental Health examination with an accompanying DBQ. The private examiner found that the Veteran suffered from PTSD as well as major depressive disorder and panic disorder and that such resulted in total occupational and social impairment. The Veteran reported that he was married to his second wife and that they and their children lived with his parents. He reported limited social interactions as people got on his nerves. The Veteran reported difficulty being around other people and severe concentration deficits due to his PTSD. Upon examination, the examiner noted that the Veteran suffered from irritability with anger outbursts, hypervigilance with exaggerated startle response, difficulty concentrating, depressed mood, anxiety, suspiciousness, panic attacks more than once a week, near-continuous panic or depression affecting the ability to function independently, appropriately and effectively, chronic sleep impairment, mild memory loss, impairment of short and long term memory, flattened affect, difficulty in understanding complex commands, impaired judgment, disturbances of mood and motivation, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances including work or a work like setting, inability to establish and maintain effective relationships, impaired impulse control such as unprovoked irritability with periods of violence. In May 2021 the Veteran testified at a Board hearing. The Veteran reported that his PTSD caused sleep disturbance and nightmares. He testified that he could not maintain a schedule due to his interrupted sleep patterns. Furthermore, he noted panic attacks about once a month and that he avoided social situations as a result. The Veteran stated that he used to attend church but that he was always nervous and searching for exits, so he stopped going. He reported no relationships outside of his family. He also noted that he was hypervigilant which resulted in him making sure windows were closed and doors were locked. He stated that his symptoms had been the same since his discharge from the service in 2013. Following a review of the relevant evidence of record, the Board concludes that the Veteran is not entitled to a rating in excess of 50 percent disabling for his service-connected PTSD. In this regard, the Board finds that such disability is manifested by occupational and social impairment with reduced reliability and productivity as a result of psychiatric symptomatology, to include hypervigilance with exaggerated startle response, depression, anxiety, chronic sleep disturbance and nightmares, difficulty concentrating, irritability, outbursts of anger, suspiciousness, panic attacks more than once a week, near-continuous panic or depression affecting the ability to function independently, appropriately and effectively, mild memory loss, impairment of short and long term memory, flattened affect, difficulty in understanding complex commands, impaired judgment, disturbances of mood and motivation, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances including work or a work like setting, inability to establish and maintain effective relationships, and impaired impulse control such as unprovoked irritability with periods of violence, without more severe manifestations that more nearly approximate occupational and social impairment with deficiencies in most areas, or total occupational and social impairment. In this regard, the Board finds that such symptomatology, to specifically include the Veteran's depression, anxiety, chronic sleep disturbance, irritability, outbursts of anger, suspiciousness, panic attacks more than once a week, mild memory impairment, impairment of short and long term memory, flattened affect, difficulty in understanding complex commands, impaired judgment, disturbance of mood and motivation, difficulty in establishing and maintaining effective work and social relationships, as well as the frequency, severity, and duration of his psychiatric symptoms are contemplated in his current 50 percent rating. As indicated previously, 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 irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships. Based on the evidence of record, the Board finds that the Veteran's PTSD does not result in occupational and social impairment with deficiencies in most areas. With respect to the symptoms noted to be indicative of a 70 percent rating, the Board notes that the Veteran has never endorsed suicidal ideation. Rather the Veteran has routinely denied such. Furthermore, while the Veteran testified at his May 2021 Board hearing that he has some obsessive tendencies, to include checking locks, such do not rise to the level of interfering with his routine activities. Rather the Veteran indicated that it takes him approximately two minutes and likened it to his hypervigilance. The Board further notes that none of the examinations of record have found evidence of obsessional rituals. Finally, the Veteran's speech has never been found to be illogical obscure, or irrelevant. Rather the Veteran's speech has routinely been normal in rate, tone, syntax and volume, and his thought process has been routinely logical, linear, and goal directed. The Board notes that while the April 2021 private examiner found that the Veteran suffered from near continuous panic or depression affecting his ability to function independently, appropriately and effectively, none of the other examiners of record nor the copious amount of treatment notes and evaluations have indicated such. Furthermore, the Veteran at his May 2021 hearing indicated that while he did suffer from panic attacks such occurred once a month. However, the Board notes that the Veteran did indicate that he did not go out into public often because of the possibility of panic attacks. Additionally, while the April 2021 private examiner found that the Veteran suffered from impulse control (such as unprovoked irritability with periods of violence), the VA examiners in August 2012, April 2014, and November 2016 did not indicate such. Rather it was noted that the Veteran was irritable with outbursts of anger, but there was no indication that the Veteran was ever violent. Furthermore, no problems with impulse control or violence were noted throughout the Veteran's concurrent treatment notes. The Veteran has never been noted to have spatial disorientation or be neglectful of his hygiene. In this regard, the Veteran has been found to be consistently alert and oriented during the course of the appeal. Furthermore, there is no indication that the Veteran neglects his personal appearance and hygiene. In this regard, all examination reports, both VA and private, as well as treatment records have consistently shown that the Veteran has been clean and casually dressed and neatly groomed. Pertaining to whether the Veteran has difficulty in adapting to stressful circumstances and in establishing and maintaining effective work and social relationships, the Board notes that again the April 2021 private examination report is inconsistent with the remainder of the record. While the Veteran has not worked since his discharge from the service, he has indicated that such is due to his inability to keep a schedule as a result of sleep disturbances. Furthermore, while the Veteran has reported that he does not socialize outside of his family, he has maintained relationships with his children, wife, parents, and in-laws. Finally, all of the VA examinations of record as well as mental status evaluations reflected in his treatment notes indicate that the Veteran's PTSD symptoms resulted in mild to moderate occupational and social impairment. Therefore, while the Board finds that the Veteran has some difficulty in adapting to stressful circumstances and in establishing and maintaining effective work and social relationships, the severity or frequency of such does not result in occupational and social impairment with deficiencies in most areas. The Board further notes that the evidence of record reflects that the Veteran has additional symptomatology that is not enumerated in the rating criteria, to include hypervigilance with exaggerated startle response, difficulty concentrating and nightmares. See Mauerhan, supra; Vazquez-Claudio, supra. However, the Board finds that such symptoms do not more nearly approximate a rating in excess of 50 percent under the General Rating Formula as they are not of such a severity or frequency to result in occupational and social impairment with deficiencies in most areas, or total occupational and social impairment. Therefore, as the Veteran's PTSD symptoms, as detailed previously, are contemplated by his 50 percent rating and, absent more severe symptoms, a higher rating is not warranted. Moreover, the Board finds that the criteria for a 100 percent rating under the General Rating Formula are not met. In this regard, the evidence does not show that the Veteran has 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. In this regard, there is no evidence in the record of gross impairment in thought process or communication, delusions or hallucinations, or significant cognitive impairment. Throughout the appeal, the Veteran's thought process and content have been found unremarkable, or without impairment or delusions. Treatment records showed no perceptual disturbance such as delusions or hallucinations, mania, or psychosis. The Veteran's behavior has never been noted to be grossly inappropriate, rather the Veteran has been noted to be cooperative and interactive. There is no evidence that the Veteran is a persistent danger to himself or others. Rather he has maintained relationships with his wife, children, parents, and in-laws. Furthermore, the record does not reflect that the Veteran is unable to perform activities of daily living (including maintenance of minimal personal hygiene). Rather the Veteran has been routinely found to be appropriately groomed and dressed, and fully alert and oriented. Finally, while it has been noted that the Veteran has had some mild to moderate memory loss, there is no indication that the Veteran has suffered memory loss for names of close relatives, own occupation, or name. Therefore, the Veteran is not entitled to a 100 percent rating under the General Rating Formula. The Board acknowledges that the Veteran, in advancing this appeal, believes that his PTSD is more severe than the assigned disability rating reflects. In this regard, he is competent to report observable symptoms. Layno v. Brown, 6 Vet. App. 465, 469 (1994). In this case, however, the competent medical evidence offering detailed specific specialized determinations pertinent to the rating criteria is the most probative evidence with regard to evaluating the pertinent symptoms for the disability on appeal; the medical evidence also largely contemplates the Veteran's descriptions of symptoms. The lay evidence has been considered together with the probative medical evidence clinically evaluating the severity of the pertinent disability symptoms. The Board has considered whether staged ratings under Hart, supra, are appropriate for the Veteran's PTSD; however, the Board finds that his symptomatology has been stable throughout the appeal period. Therefore, assigning staged ratings for this disability is not warranted. In adjudicating the Veteran's claim herein, the Board has also considered the applicability of the benefit of the doubt doctrine. However, in denying a rating in excess of 50 percent disabling, the preponderance of the evidence is against the award of any higher ratings. Therefore, the benefit of the doubt doctrine is not applicable in the instant appeal, and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. REASONS FOR REMAND Entitlement to a TDIU due to service-connected disabilities is remanded. Although the Board regrets the delay, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the Veteran's claim so that he is afforded every possible consideration. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. The Veteran alleges that he is unable to work due to his service-connected PTSD. However, the Board notes that the Veteran does not meet the disability rating percentage threshold for schedular TDIU consideration. 38 C.F.R. §§ 4.16 (a) (if a veteran is service-connected for more than one disability, at least one must be rated at 40 percent disabling, and the total combined disability rating must be at least 70 percent), 4.25. Nevertheless, even when a veteran does not meet the percentage standards for schedular TDIU, he may be considered for TDIU on an extraschedular basis pursuant to 38 C.F.R. § 4.16 (b). However, the Board does not have the authority to assign extraschedular TDIU in the first instance. 38 C.F.R. § 4.16 (b). Rather, the Board may only consider whether referral for extraschedular TDIU to the Director, Compensation Service is appropriate. The Board notes that all the examinations of record indicate that the Veteran's PTSD would impact his ability to work from mild to severe impairment. Furthermore, the Veteran has reported that he has been unable to work since his discharge from the military due to his PTSD. In addition, the Veteran in his VA Form 21-8940 indicated that while he graduated high school, completed some college and some technical training, he was unable to utilize any of his training or education since leaving the military as a result of his PTSD. Furthermore, the Board finds there is no evidence of record suggesting the Veteran has acquired any transferrable job skills or education and training that could be utilized in a sedentary or solitary position, the Board finds referral to the Director, Compensation Services for extraschedular TDIU consideration is warranted. 38 C.F.R. § 4.16 (b). The matter is REMANDED for the following action: 1. Refer the issue of entitlement to TDIU, to the Director, Compensation Services for extraschedular TDIU consideration. 2. Thereafter, if entitlement to TDIU on an extraschedular basis is denied, readjudicate the appeal. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Unger, 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.