Citation Nr: 21040928 Decision Date: 07/07/21 Archive Date: 07/07/21 DOCKET NO. 16-52 211 DATE: July 7, 2021 ORDER Entitlement to an increased rating of 70 percent prior to October 29, 2019, but no higher, for posttraumatic stress disorder (PTSD) is granted, subject to the laws and regulations controlling the award of monetary benefits. Entitlement to a disability rating higher than 70 percent, from October 29, 2019, for PTSD is denied. Entitlement to a total disability rating based on individual unemployability (TDIU), due to service-connected disabilities, is denied. FINDINGS OF FACT 1. Prior to October 29, 2019, the Veteran's PTSD symptoms and impairment approximated occupational and social impairment with deficiencies in most areas, but at no time during the appeal period did they more nearly approximate total occupational and social impairment. 2. The evidence of record does not show that the Veteran was unable to secure or follow substantially gainful employment, as a result of her service-connected disabilities, at any time throughout the pendency of the appeal. CONCLUSIONS OF LAW 1. Prior August 29, 2019, the criteria for a disability rating of 70 percent, but no higher, for PTSD, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9411. 2. From August 29, 2019, the criteria for a disability rating higher than 70 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9411. 3. The criteria for a TDIU have not been met at any time during the appeal period. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U. S. Army from June 2010 to July 2011. This case comes before the Board of Veterans' Appeals (Board) from an appeal of an October 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office, which continued the 50 percent evaluation of the Veteran's service-connected PTSD. The Veteran filed a Notice of Disagreement in July 2016. A Statement of the Case was issued in September 2016 continuing the denial of an initial rating higher than 50 percent for PTSD and denying the Veteran's claim for TDIU. The Veteran perfected her appeal in October 2016. In December 2018, the Board remanded the Veteran's claims for additional evidentiary development on the issues of an increased rating for the Veteran's service-connected PTSD and her claim for TDIU. The Board instructed that updated VA treatment records be obtained and a new VA examination as to the severity of PTSD be conducted. The updated treatment records were obtained and the examination conducted. For the reasons below, the examination was adequate and therefore the agency of original jurisdiction complied with the remand instructions. Stegall v. West, 11 Vet. App. 268, 271 (1998). In an August 2020 rating decision, the RO assigned a 70 percent rating to the Veteran's PTSD, effective October 29, 2019. This created a staged rating. The RO also indicated in a contemporaneous supplemental statement of the case that it denied TDIU. As the increased benefits do not constitute a full grant of the benefits sought, the issues remain in appellate status. See A.B. v. Brown, 6 Vet. App. 35, 39 (1993). Increased Disability Ratings The Veteran's PTSD is currently rated at 50 percent prior to October 29, 2019 and at 70 percent from October 29, 2019. The Veteran asserts that the respective disability ratings assigned to her service-connected PTSD do not adequately contemplate the severity of her symptoms and that higher disability ratings should be assigned. Ratings for service-connected disabilities are determined by comparing the Veteran's symptoms with criteria listed in VA's Schedule for Rating Disabilities, which is based, as far as practically can be determined, on average impairment in earning capacity. Separate diagnostic codes identify the various disabilities. 38 C.F.R. Part 4. The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Hart v. Mansfield, 21 Vet. App. 505 (2007). Where there is a question as to which of two 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. PTSD is evaluated under the General Rating Formula for Mental Disorders (General Rating Formula). The Veteran's service-connected PTSD is rated under 38 C.F.R. § 4.130, Diagnostic Code 9411. A 50 percent disability rating is assigned when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. A 70 percent disability rating is assigned when 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 that is 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); and inability to establish and maintain effective relationships. And, a 100 percent disability rating is assigned 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; and memory loss for names of close relatives, for the veteran's own occupation, or own name. 38 C.F.R. § 4.130, Diagnostic Code 9411. When determining the appropriate disability evaluation to assign, the Board's primary consideration is the Veteran's symptoms, but it must also make findings as to how those symptoms impact the Veteran's occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F. 3d 112, 118 (Fed. Cir. 2013); Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). When adjudicating psychiatric claims, the Board has an obligation under Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017) to conduct a three-part "holistic" analysis. The first step of the analysis is to assess the "severity, frequency, and duration of the signs and symptoms" of the Veteran's condition. The second step is to quantify "the level of occupational and social impairment caused by those signs and symptoms." The third step is to assign an "evaluation that most closely approximates that level of occupational and social impairment." See also Mauerhan, 16 Vet. App. 436 (holding that the list of symptoms in the disability rating schedule for psychiatric disabilities is not exhaustive); and see Vazquez-Claudio, 713 F. 3d 112 (holding that the disability rating schedule for psychiatric disabilities reflects "objectively-observable symptomatology," and "it is the severity of the effects of the symptoms as described by the examiner that determines the rating."). As all ratings in the general rating formula are also associated with objectively observable symptomatology and the plain language of the regulation makes it clear that the Veteran's impairment must be "due to" those symptoms, a veteran may only qualify for a given disability by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. See Vazquez-Claudio, 713 F. 3d 112. In order to evaluate the level of disability and any changes in the condition, it is necessary to consider the complete medical history of the Veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Entitlement to a disability rating higher than 50 percent for PTSD, prior to October 29, 2019. A review of the Veteran's mental health history and treatment indicates that her symptoms of PTSD resulted in deficiencies in most of the areas needed for a 70 percent rating under the General Rating Formula, prior to October 29, 2019. However, from October 29, 2019, the Veteran's symptoms do not more nearly approximate the total occupational and social impairment required for a 100 percent rating. In September 2014, the Veteran was afforded a VA PTSD examination. The clinician indicated that the Veteran reported MST in April 2011 and was subsequently diagnosed with PTSD at a VA facility in April 2014. The clinician also indicated that the Veteran disclosed having frequent nightmares, which sometimes resulted in violent attacks on her husband as she reacted to her dreams while she slept. The Veteran also reported that she had attempted suicide twice since leaving service. The clinician indicated the Veteran exhibited symptoms of PTSD including hypervigilance; angry outbursts; exaggerated startle response; feelings of estrangement from others; difficulty concentrating; sleep disturbance; anxiety, memory loss; disturbances of motivation and mood and difficulty in establishing and maintaining effective work and social relationships. The clinician found that the Veteran's symptoms would result in occupational and social impairment with reduced reliability and productivity. In June 2015, the Veteran underwent another VA examination in conjunction with a Disability Benefits Questionnaire and the Veteran's claim for a TDIU. Upon evaluation, the clinician found that the Veteran's PTSD symptoms resulted in occupational and social impairment causing reduced reliability and productivity. The clinician also noted that, since a previous September 2014 evaluation, the Veteran reported quitting her job in the spring of 2015, after a male co-worker made inappropriate and flirtatious comments to her. The Veteran also reported multiple external stressors, including her husband leaving the family, financial stressors, and housing insecurity. The Veteran stated she had been applying for jobs but does not know how she could work and take care of her two young children. The clinician indicated that the Veteran reported feelings of anxiety, hypervigilance, sleep disturbances, mild memory loss, flattened affect, disturbances of mood and motivation, difficulty in establishing and maintaining effective work and social relationships, and impaired impulse control, such as provoked irritability, with periods of violence. Behaviorally, the clinician observed that the Veteran's speech was normal, her mood was euthymic, and her affect varied appropriately with the content of the session. The Veteran was appropriately dressed, her speech was found to be normal and her thoughts linear and goal-directed. While the Veteran's cognitive abilities were not formally assessed during this examination, the clinician opined that her cognition appeared within normal limits. The clinician further opined that the Veteran appeared to be stable. The Veteran also underwent a VA PTSD examination in August 2016. The clinician indicated that the Veteran reported that her symptoms have gotten worse since her last VA examination in 2015. The Veteran reported a depressed mood, anxiety, hypervigilance, sleep impairment, and mood disturbances. The Veteran also indicated that she had difficulty adapting to stressful circumstances; establishing and maintaining effective work and social relationships; and difficulty concentrating. The Veteran also reported having anxiety most of the time and occasional memory loss. The clinician indicated the Veteran reported that she got along well with co-workers and supervisors only if they were female. The Veteran denied suicidal ideation or depression and she had not been hospitalized and was not currently taking medication for her symptoms. The clinician indicated that the Veteran appeared at the examination casually dressed and appropriately groomed. The clinician found the Veteran demonstrated congruent affect, and her voice and speech were within normal limits. The Veteran demonstrated logical thought processes with no perceptual disturbances, and her analytical ability was intact, although she had some difficulty with attentional memory. The clinician also indicated that the Veteran reported that she would like to own her own daycare business or work in a bakery with her sister. The clinician opined that the Veteran might experience limitations in vocational functioning. In an October 2016 statement from the Veteran's husband, he indicated that the Veteran is often psychologically triggered, which causes flashbacks when memories are brought to the surface. In May 2017, the Veteran underwent another VA PTSD examination. In the examination report, the clinician indicated that, based on her self-reporting, the Veteran's PTSD was stable, chronic and of moderate severity over time. The clinician indicated that the Veteran reported that she had been going to school full-time, where she is working towards a graduate degree in business, and had a small group of good friends. The Veteran also reported that she worked part-time and enjoyed working with her female boss. The Veteran indicated that her PTSD symptoms were stable and that the supportive counseling she received at the Vet Center and the Rape Crisis Center had been beneficial. The clinician indicated the Veteran reported going back to school full-time The Veteran received mental health outpatient treatment at her local VA hospital from January 2018 through May 2018. In VA Mental Health outpatient treatment notes from January 2018, the clinician indicated that the Veteran reported that she experienced anxiety, irritability, restlessness, excessive worrying, depression, sleep disturbance, trouble concentrating and a loss of interest in activities she used to enjoy. The Veteran further stated that these symptoms made it difficult for her to work, get along with other people and take care of her home. The clinician diagnosed the Veteran with chronic PTSD based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). In May 2018, VA mental health outpatient treatment notes disclose that the clinician indicated that the Veteran reported irritability, increased anxiety, depression, a reluctance to leave the house and a lack of patience. The clinician observed that the Veteran had good eye contact, an appropriate affect; normal speech; good insight; and good judgement. The clinician noted that the Veteran was cooperative, engaged, pleasant, appropriately dressed and groomed, with no evidence of psychosis. The clinician also indicated that the Veteran denied suicidal or homicidal ideations. Upon discharge from the mental health outpatient program in November 2018, treatment records indicate the clinician reported that the Veteran's condition was stable. The evidence summarized above reflects that, prior to October 29, 2019, the Veteran's symptoms of PTSD most nearly approximated a 70 percent rating under the General Rating Formula. June 2015 and May 2017 VA examination reports similarly reflect the Veteran's PTSD causes deficiencies in most areas. VA mental health outpatient treatment notes reflect that the Veteran experienced depression, hypervigilance, anxiety and isolationism, including a reluctance to leave the house, which affected her ability to function independently. The Veteran has also expressed suicidal ideations. During the May 2017 VA examination, the Veteran said she has daily thoughts of suicide. See Bankhead v. Shulkin, 29 Vet. App. 10, 20 (2017) (the language of the general rating formula indicates that the presence of suicidal ideation alone, that is, a veteran's thoughts of his or her own death or thoughts of engaging in suicide-related behavior, may cause occupational and social impairment with deficiencies in most areas). The Veteran's mental health symptoms also include problems with irritability and mood. In the June 2015 examination report, the clinician indicated that the Veteran suffered from irritability; a depressed mood; has difficulty being around others; and has a short fuse marked by angry outbursts. The clinician noted that the Veteran was hypervigilant and reported exaggerated startle responses. The clinician further indicated that the Veteran's depressive mood lead to a markedly diminished interest in participating in significant activities and feelings of detachment or estrangement from others. During the May 2017 VA examination, the Veteran reported that she prefers working with children because she often gets angry and annoyed around adults. The Veteran experienced occupational and social impairments in most areas caused by her symptoms of PTSD, including expressed suicidal ideations, impaired impulse control, near-continuous panic, and depression affecting her ability to function independently. The symptoms and overall impairment caused by the Veteran's PTSD closely approximates the criteria for a 70 percent rating. Therefore, a rating of 70 percent for the Veteran's service-connected PTSD, prior to October 29, 2019, is warranted. As noted above, to receive an increased disability rating for acquired psychiatric disorder prior to October 29, 2019, there would need to be symptoms and impairment more nearly approximating 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; and memory loss for names of close relatives, for the veteran's own occupation, or own name. 38 C.F.R. § 4.130, Diagnostic Code 9411. Prior to October 29, 2019, the evidence of record shows that the Veteran maintained close relationships with her mother, siblings and a small group of friends. She also worked full-time in a childcare facility and took care of her two small children. Moreover, she enrolled in a full-time graduate program in business administration and stated that her goal was to open her own daycare facility. Thus, while the Veteran may have experienced significant limitations as to vocational functioning during this period, her symptoms and impairment did not more nearly approximate total social and occupational impairment. Therefore, prior to October 29, 2019, a rating higher than 70 percent is not warranted. As the preponderance of the evidence is against granting a rating higher than 70 percent disabling for the Veteran's PTSD prior to October 29, 2019, the benefit of the doubt doctrine is not for application in this regard. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. Entitlement to a rating higher than 70 percent from October 29, 2019. On October 29, 2019, the Veteran underwent a VA PTSD examination. The psychologist indicated that the Veteran reported worsening symptoms of PTSD, including feelings of isolation, a lack of motivation, irritability, anger outbursts, and sleep difficulty. The clinician further indicated that the Veteran described feelings of hypervigilance, anxiety, lack of concentration, avoidance of males, intermittent neglect of hygiene, and near continuous feelings of panic. The clinician also noted that the Veteran reported only an intermittent ability to perform activities of daily life and experiences suicidal ideations daily. The clinician indicated that the Veteran reported being enrolled in school but on academic probation. Here, the Veteran conveyed that the lack of motivation, sleep disturbances and inability to concentrate affected her schoolwork. Furthermore, the Veteran stated that she had not been employed since March 2019. Upon evaluation, the clinician found that the Veteran's speech was normal and her mood was depressed. The clinician also indicated that the Veteran did not generally demonstrate gross impairment in thought processes or communication and there was no evidence of delusions. The clinician indicated that the Veteran reported that she experienced an exaggerated startle response; difficulty adapting to stressful circumstances; and disturbances of mood. Behaviorally, the clinician noted that the Veteran had been polite and cooperative with treatment providers and did not exhibit any grossly inappropriate behavior. The clinician also found that the Veteran commanded full orientation to time and place. Moreover, there was no evidence that she was unable to perform activities of daily living, including taking care of three small children and managing her own financial affairs. In concluding remarks, the clinician found that the Veteran had occupational and social impairments resulting in reduced reliability and productivity. Specifically, the clinician also found that the Veteran was best suited to working mainly alone, with minimal contact with others. In February 2020 VA mental health treatment notes, A clinician reported that the Veteran indicated that she was capable of completing all activities of daily living independently. The clinician noted that the Veteran conveyed symptoms of irritability; depressed mood, diminished pleasure or interest, insomnia, psychomotor agitation, fatigue, feelings of worthlessness, diminished concentration; and panic attacks. The clinician indicated that the Veteran denied suicidal ideation and risky behaviors. Upon assessment, the clinician noted that the Veteran was casually dressed and fully oriented with a congruent affect. The clinician found the Veteran's mood and speech were normal and her memory was intact with no tangential thinking; flight of ideas; mania; or thought symptoms. As noted above, to receive a higher disability rating, there would need to be symptoms and impairment more nearly approximating 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; and memory loss for names of close relatives, for the veteran's own occupation, or own name. While the Veteran's symptoms indicate that PTSD is productive of deficiencies in most areas, the symptoms and impairment have not more nearly approximated the total occupational and social impairment required for a 100 percent rating at any time from October 29, 2019. The evidence of record shows that the Veteran attended a full-time graduate program in Business Administration, maintaining a 3.0 grade point average, while also working part-time at the Veterans of Foreign Wars organization. The Veteran does not fully isolate herself and maintained a close relationship with her mother and children. During the 2019 VA examination, the Veteran reported to the clinician that she was in good spirits and was looking forward to relocating to Texas where she would be closer to her familial support system. The Board has considered the Veteran's extensive symptoms and based on the foregoing, the Board finds that, from October 29, 2019, the frequency, severity, and duration of the Veteran's PTSD symptomatology and impairment more nearly approximate a finding of occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, rather than approximation of total occupational and social impairment. As the preponderance of the evidence is against granting a rating higher than 70 percent disabling for the Veteran's PTSD from October 29, 2019, the benefit of the doubt doctrine is not for application in this regard. See 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. Entitlement to a TDIU due to the Veteran's service-connected PTSD and headaches. The Veteran asserts that, due to her PTSD symptoms, she has lost her ability to earn income and maintain gainful employment since February 2015, as a result of military sexual trauma (MST) that she experienced while in service. In order to establish entitlement to a TDIU due to service-connected disabilities, there must be 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 reaching such a determination, 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 in arriving at a conclusion, but not to his age or to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). "Substantially gainful employment" is that employment "which is ordinarily followed by the nondisabled to earn their livelihood with earnings common to the particular occupation in the community where the veteran resides." Moore (Robert) v. Derwinski, 1 Vet. App. 356, 358 (1991). "Marginal employment shall not be considered substantially gainful employment." 38 C.F.R. §§ 4.16(a), A TDIU is warranted where the combined schedular evaluation for service-connected disabilities is less than total, or 100 percent. 38 C.F.R. § 4.16 (a). Under 38 C.F.R. § 4.16 (a), if there is only one such disability, it must be rated at 60 percent or more to qualify for benefits based on individual unemployability. If there are two or more such disabilities, there shall be at least one disability rated at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent. 38 C.F.R. § 4.16 (a). It is, however, VA's policy to grant TDIU to any veteran who is unable to unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities. 38 C.F.R. § 4.16 (b). In light of the decision herein, the Veteran is service connected for PTSD rated as 70 percent disabling and headaches rated as noncompensable. Therefore, as the Veteran has two disabilities with a combined rating of at least 70 percent with one rated 40 percent or more disabling, she is eligible for consideration for a TDIU on a schedular basis. See 38 C.F.R. § 4.16 (a). Nonetheless, to grant TDIU it must be found that the Veteran is unable to secure or follow a substantially gainful occupation because of her service-connected disability. On her May 2015 application for a TDIU (Form VA 21-8940), the Veteran indicated that her service-connected PTSD prevented her from securing or following any substantially gainful occupation. The Veteran reported that she most recently worked for a day school from August 2014 through February 2015, when she became too disabled to work. Although the evidence shows that the Veteran subsequently obtained employment in 2019 with a daycare provider, as well as with the VFW. The record shows that the Veteran completed 4 years of college and was enrolled in an MBA program at S.H. University in the summer of 2019. While attending graduate school, the Veteran also worked part-time for the VFW. In light of her educational attainments and occupational history, the Board finds that the Veteran's service-connected disabilities do not preclude her from securing and following substantially gainful employment for which the Veteran would otherwise be qualified. The evidence shows that the Veteran has a Bachelor of Arts Degree and enrolled in a Master of Business program at S. H. University in the Fall of 2019. During a May 2017 VA examination, the clinician indicated that the Veteran reported that she was a hard worker with a good work ethic and planned to finish school and start her own business. While the Veteran asserts that her service-connected disabilities rendered her unable to obtain or retain employment consistent with her education and experience, the evidence of record shows that the Veteran obtained a graduate-level education and professional experience working in the daycare industry during the appeal period. This combination of education and work experiences was sufficient for the Veteran to obtain and maintain substantial employment considering her graduate degree and her prior experience in childcare. See Withers v. Wilkie, 30 Vet. App. 139 (2018). The Veteran also contended in her notice of disagreement that the VA Examiner was never asked to provide an opinion about her employability. However, the "applicable regulations place responsibility for the ultimate TDIU determination on the VA, not a medical examiner." Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013). "Of course, medical examiners may assist VA adjudicators in making that determination by providing detailed descriptions of the veteran's disabilities and any functional limitations that they cause." Arline v. McDonough, __ Vet. App. __, No. 18-0765, slip op. at 16 (quoting Delrio v. Wilkie, 32 Vet. App. 232, 242-43 (2019). In a VA October 2019 PTSD examination report, the clinician indicated that the Veteran reported that her lack of motivation, persistent fatigue, hypervigilance, anxiety, and irritability, all impacted her work productivity and her ability to work with teams, and interact with the public. Upon assessment, the VA clinician opined to the effects of the Veteran's PTSD on her occupational impairments and determined that, while her mental symptoms would cause significant impairment, they did not prevent her from obtaining or maintaining substantially gainful employment. The Veteran has a business degree and continues to seek higher education. The VA clinician concluded that the Veteran would be able to do sedentary work limited to jobs having minimal contact with others. During the November 2019 VA PTSD examination, the clinician indicated that the Veteran reported that her symptoms of PTSD affected her ability to obtain and maintain employment as she had difficulty concentrating, a lack of motivation, and an inability to meet deadlines. The Veteran also stated that she has a hard time working with adults and tries to avoid working with young men. The clinician noted that the Veteran indicated that she had previously worked as a teacher, nanny, and daycare worker. The clinician concluded that the Veteran's PTSD symptoms would likely have an adverse impact on work productivity, working in customer service, and receiving feedback from leadership. The clinician found the Veteran is best suited to sedentary work, working alone with minimal contact with others, preferably in a small company (for familiarity and comfort). Based on the above lay and medical evidence, the Board finds that, while the Veteran's PTSD symptoms cause occupational obstacles, these limitations do not preclude her from securing and following substantially gainful employment based on her educational and occupational experience. By her own report, the Veteran seeks employment in the educational field and the above limitations would not prevent her from working in this field in some capacities. For the above reasons, the preponderance of the evidence reflects that the Veteran is capable of securing and following substantially gainful employment. The benefit of the doubt doctrine is therefore not for application in this regard and the claim for a TDIU must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. The Board has considered the Veteran's claim and decided entitlement based on the evidence. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record, with respect to this claim. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (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) Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. K. Donaldson, Associate 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.