Citation Nr: 21042209 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 19-21 334 DATE: July 12, 2021 ORDER 1. Entitlement to an initial disability rating in excess of 70 percent for posttraumatic stress disorder (PTSD) with major depressive disorder is denied. 2. Entitlement to a total disability rating for compensation based upon individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. For the entire period on appeal, the Veteran's PTSD with major depressive disorder has not been manifested by total occupational and social impairment. 2. For the entire period on appeal, the Veteran was not precluded from securing or following a substantially gainful occupation due to his service-connected disabilities. CONCLUSIONS OF LAW 1. The criteria for an initial disability rating in excess of 70 percent for PTSD with major depressive disorder have not been met for any period on appeal. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.126, 4.130, Diagnostic Code (DC) 9411. 2. The criteria for a TDIU rating have not been met for any period on appeal. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from October 2000 to October 2004. These matters come to the Board of Veterans' Appeals (Board) from a March 2017 rating decision, which granted service connection for PTSD and assigned a 70 percent rating, effective October 16, 2009, and a subsequent August 2017 rating decision which denied a TDIU rating. The Veteran testified before the undersigned Veterans Law Judge at an October 2020 virtual hearing and a transcript of that hearing has been associated with the claims file. 1. Entitlement to an initial disability rating in excess of 70 percent for PTSD with major depressive disorder. Disability evaluations are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran. Whether the issue is one of an initial rating or an increased rating, separate ratings can be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. Regarding the Veteran's initial rating claim for PTSD with major depressive disorder, the Board has considered the claim from the currently assigned effective date, as well as whether any staged ratings periods are warranted. The Veteran's service-connected other specified trauma and stressor-related disorder is currently rated as 70 percent disabling from April 29, 2009 under Diagnostic Code (DC) 9499-9411 of the General Rating Formula for Mental Disorders. Under the applicable rating criteria, a 70 percent disability rating is warranted for 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 maximum schedular 100 percent disability 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. When determining the appropriate disability evaluation to assign, the Board's primary consideration is a veteran's symptoms, but it must also make findings as to how those symptoms impact the veteran's occupational and social impairment. The use of the term "such as" in the rating criteria demonstrates that the symptoms after that phrase 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. Thus, the Board need not find the presence of all, most, or even some, of the enumerated symptoms to award a specific rating. Nevertheless, 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 rating by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. In Golden v. Shulkin, 29 Vet. App. 221 (2017), the U.S. Court of Appeals for Veterans Claims held that, given that the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) abandoned the Global Assessment of Functioning (GAF) scale and that VA has formally adopted the DSM-5, GAF scores are inapplicable to assign a psychiatric rating in cases where the DSM-5 applies when the appeal was certified after August 4, 2014. Because the current appeal was certified to the Board after August 4, 2014, the Board will not rely on GAF scores when analyzing the merits of the Veteran's psychiatric increased rating claim on appeal. Following a careful review of the evidence of record, and as discussed further below, the Board finds that the preponderance of the evidence is against the Veteran's claim of entitlement to an initial disability rating in excess of 70 percent for PTSD with major depressive disorder for the entire period on appeal. Significantly, the most probative evidence of record does not document psychiatric symptomatology which more closely approximates total occupational and social impairment for any period on appeal. Indeed, the probative evidence during the appeal period does not document total occupational and social impairment manifested by 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; or other symptoms of this level of severity. In order to be entitled to 100 percent disability rating, the Veteran must have both total social and total occupational impairment. The Veteran has consistently been found to have no worse than occupational and social impairment with deficiencies in most areas (or symptomatology which was found to result in less severe impairment, such as reduced reliability and productivity) but without total impairment in either area of functioning. Additionally, the Board has also considered the severity, frequency, and duration of the mental health symptoms displayed by the Veteran during the period on appeal; however, the Board finds that the Veteran's mental health symptoms, as discussed in the lay and medical evidence of record, were not of such severity, frequency, and/or duration to more nearly approximate total occupational and social impairment for any period on appeal. Turning to the evidence of record, VA treatment records from August 2009 document that the Veteran first sought mental health treatment at that time, when he reported nightmares since he returned from Iraq. At that time of his October 2009 claim, the Veteran reported that he was treated for his claimed psychiatric disability in 2009. During a November 2009 VA neuropsychological evaluation, the Veteran reported a history of TBI and complaints of memory deficits and problems learning new information. The examiner stressed "significant concerns" as to whether the Veteran was putting forth his best effort in testing, as certain aspects of his performance called his motivation and effort into question. His test scores were significantly worse than expected given the nature of the reported accident and his overall functioning since the time of the accident. The examiner stated that it is unlikely that someone with scores as low as the Veteran's, which taken in isolation would suggest fairly severe cognitive deficits at a moderate to severe level, would be able to function at the level that the Veteran had been able to do so, including completing academic endeavors on a college level. Based on the Veteran's presentation in the interview, the examiner stated it is likely that he would qualify for academic endeavors and would likely benefit from referral to vocational rehabilitation. However, given the severity of his currently obtained test scores, the examiner was unable to make any specific recommendations or provide much information for doing so. Upon VA psychiatric examination in July 2010, a VA examiner diagnosed PTSD, chronic depressive disorder, and amnestic disorder and found that the Veteran was able to function independently. The examiner believed that the Veteran's mood symptoms and cognitive deficits significantly impact his ability to recall and follow instructions, and that his mood symptoms affected, but did not preclude, his ability to attend to tasks for at least two consecutive hours and to interact with coworkers, customers, and supervisors. The examiner concluded that the Veteran's PTSD signs and symptoms resulted in deficiencies in the areas of thinking, family relations, work, mood, and school. Upon evaluation in October 2010, the Veteran reported a history of PTSD, with problems with decreased memory, irritability, and sleep impairment. In March 2011, the same VA examiner who conducted the previous July 2010 VA examination wrote that since he last examined the Veteran, he maintained more doubts regarding the Veteran's symptom reports than were present during the last C&P review in July 2010. As such, the examiner no longer found adequate support for diagnoses of PTSD and/or Amnestic Disorder, but stated that a diagnosis of depressive disorder, not otherwise specified, was most appropriate. Notably, the examiner was unable to assert that the Veteran's depressive disorder was as likely as not caused by or a result of military service; however, the examiner concluded that the Veteran's psychiatric symptoms resulted in reduced reliability and productivity. Upon subsequent VA PTSD examination in November 2016, a VA examiner diagnosed PTSD and major depressive disorder, with distinguished symptoms of PTSD identified as intrusion symptoms, avoidance behaviors, and increased arousal response (startle, hypervigilance, irritability) and symptoms of major depressive disorder identified as social withdrawal, lowered motivation, and helplessness. The examiner noted that some symptoms overlapped, including depressed mood, loss of interest, and sleep disturbance. The examiner concluded that the Veteran had occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood, and noted that based on the Veteran's report, it appears that his impairment is primarily due to his PTSD symptoms, with secondary depressive symptoms. Regarding the Veteran's social history, the examiner noted that there were no changes in his family/marital status since his previous evaluation in 2011. The Veteran reported a good relationship with his sons, who lived with him approximately 50 percent of the time. Regarding his occupational and educational history since his last evaluation in 2011, the examiner noted that the Veteran had held a number of positions. The Veteran left his automotive position after getting an offer to be a maintenance manager at Elgin, Alabama, but he was let go after approximately one year for not attending all of his meetings (he reported that he often would forget his meeting times). The Veteran denied any problems with his job performance and noted that he had sleeping difficulties that made it difficult to get to work by 7:00am. Following that position, the Veteran was employed at an insulation company in Phoenix City, Alabama, for a short-time as a maintenance manager, but reported that he was let go again due to time-management problems, which he reported was the inability to get to work on time due to sleep. He reported that he began working at Green Island Country Club as the maintenance director in January 2016 and stated that "it was going good" because they were more flexible, although the past two months had been "rough" because of a new director. He reported that he typically gets to work approximately 30 minutes to an hour after his start time (at least two days per week, though "some weeks are worse than others"). He noted that he was previously paid an annual salary, but as of last week he was switched to hourly pay due to his time management issues. Concerning the Veteran's education, the examiner noted that the Veteran received his bachelor's degree in business administration from Bryant & Stratton College in 2015. The Veteran took his classes online and was full-time most of the time (in addition to working full-time). Regarding his mental health history, the Veteran was receiving medication management with a psychiatrist for the past six months to a year. He noted that he tried to attend group treatment, but found it difficult to participate in groups. He also followed up with a VA social worker through the Montgomery VA to discuss his anxiety and depressive symptoms. He reported current symptoms including sleep disturbance with nightmares, occasional intrusive thoughts during the day, avoidance behaviors, increased startle response, increased hypervigilance: he is uneasy in crowds and with his back to other people, he feels as though he has to always protect himself from others. He repeatedly checks the locks to ensure his safety. Veteran noted that his symptoms become worse when his children are home because he becomes very protective and on-guard (he reports staying up all night at time when they are present). He noted that he used to be fearful of the dark, though he is becoming more comfortable in the dark. Reports that he is "short-tempered," but has been working on his anger management strategies. Veteran endorsed depressive symptoms. He endorsed daily depressed mood, sleep disturbance, irregular appetite and weight loss/gain, lowered motivation, social withdrawal, loneliness, and helplessness. The Veteran denied suicidal or homicidal ideation, plan, or intent. He reported occasional and infrequent nocturnal panic attacks one to two times per month with chest pressure, shortness of breath, disorientation/dizziness, and increased heart rate. He further reported memory deficits (forgets bills, appointments, and when things are due), time management issues, and difficulty managing finances (though he is able to manage his own finances). The examiner identified the Veteran's psychiatric symptoms as depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, chronic sleep impairment, mild memory loss (such as forgetting names, directions or recent events), impairment of short and long-term memory (for example, retention of only highly learned material, while forgetting to complete tasks), flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and difficulty in adapting to stressful circumstances including work or a work like setting. Upon mental status examination, the Veteran appeared appropriately dressed and casually groomed. He was polite, cooperative, and oriented, with dysthymic mood, blunted affect, and unremarkable speech. His thought processes were generally logical and organized, though tangential at times, with intact judgment, insight, and decision-making. An additional VA PTSD examination in August 2017 documents a VA examiner's conclusion that the Veteran's PTSD resulted in occupational and social impairment with reduced reliability and productivity. Regarding his social history, the Veteran retained shared custody of his two sons, ages 10 and 14, and continued to see them at least three or four days a week and to attend their school football games, go out to the movies, and dine out with them. The Veteran also reported that he enjoyed taking care of his dogs. Regarding his occupational and educational history, the Veteran currently worked as a maintenance supervisor at an apartment complex and has had this job for a month. He had previously worked at Boyd Corporation in management. As such, the examiner stated that it does not appear that the Veteran's PTSD symptoms result in significant vocational impairment. The Veteran was able to understand directions, take instructions, interact with coworkers, and respond to supervision. Regarding his mental health history, the Veteran had continued treatment for the diagnosis of PTSD and is prescribed bupropion, prazosin, and trazodone; however, the examiner noted that these medications were last filled on March 10, 2017 with a 90-day supply and, if taken as prescribed, would have run out by now. The examiner identified the Veteran's relevant psychiatric symptoms as anxiety, suspiciousness, chronic sleep impairment, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. Upon mental status examination, the Veteran was alert and oriented, maintained good eye contact, and was in no acute distress. Most recently, upon VA PTSD examination in August 2018, a VA examiner concluded that the Veteran's PTSD resulted in occupational and social impairment with reduced reliability and productivity. Regarding his social history, the Veteran reported that he lived with his two sons when they are in his custody. He reported a positive relationship with his sons, and was clearly involved in their care. He reported limited friendships and social relationships, and reported that he feels safer when he is alone. He reported that he often feels "on guard" when in crowds and social situations, which leads to elevated anxiety when in the community and some avoidance. He reported that he forces himself to take his sons out for their benefit, but it is difficult for him to do so. The Veteran stated he relies on his mom and dad to help him maintain his work schedule, budget, and other details. Regarding his occupational and educational history, the Veteran reported that he had worked "off and on" in various maintenance positions over the past year. He reported that he was unemployed from August 2017 to November 2017 and stated that he had worked various positions through a temporary agency since then. He reported that he has had a difficult time maintaining employment, reportedly due to various PTSD symptoms. He reported that he often has difficulty remembering his work schedule, which often changes day to day. Thus, he often arrives at work too early or late. He also reported that on the job he often forgets to complete tasks and has a difficult time following instructions. He reported that he has a difficult time feeling safe due to difficulties trusting people and more general hypervigilance. He reported that he has been re-assigned to different positions by the temporary agency because of difficulties on the job. Thus, while he has been able to maintain some level of employment, it also appears to be the case that his PTSD symptoms impair his occupational functioning. Regarding his mental health history, to include prescribed medications and family mental health, the Veteran reported that he has had a difficult time maintaining regular follow-up appointments with his VA psychiatrist. He reported that he has had appointments cancelled and been asked to reschedule appointments, and he has a hard time remembering to make appointments or fitting them into his work schedule. He reported that he has taken his medications but with only limited impact. He also stated that he is not always sure he can fully trust the VA, and that they may not be giving him the best medications given that he has been unable to see a psychiatrist on a regular schedule. The VA examiner identified the Veteran's psychiatric symptoms as depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, chronic sleep impairment, mild memory loss (such as forgetting names, directions or recent events), impairment of short- and long-term memory (for example, retention of only highly learned material, while forgetting to complete tasks), disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances (including work or a worklike setting) and suicidal ideation. The Board notes that the VA examination reports reviewed in detail above document the finding of several VA examiners that the Veteran's psychiatric disorder resulted in either occupational and social impairment with reduced reliability and productivity, or with deficiencies in most areas, which is consistent with the criteria for a 50 percent and 70 percent disability rating, respectively. While the adjudicator is responsible in determining which disability rating is warranted, the VA examiners' conclusions that the Veteran's impairment resulting from his service-connected psychiatric disorder was best described as meeting the 50 percent or 70 percent disability rating criteria is probative evidence against a finding that the Veteran's service-connected psychiatric disability has resulted in total occupational and social impairment for the appeal period. Additional VA treatment records throughout the appeal period likewise do not document total occupational and social impairment that would warrant an increased 100 percent disability rating for any period on appeal. The Board has also considered a July 2017 private psychological evaluation completed by Dr. Quinn Austin-Small, Ph.D. Therein, Dr. Austin-Small documented that upon mental status examination, the Veteran appeared alert and oriented, and presented as friendly but considerably slowed in response time and processing time in relation to questioning. The Veteran reported having little structure and spending the day inside, with difficulty motivating himself to complete even minor daily living tasks. His mood was numb and disconnected, sleep was poor, and he reported a history of suicidal ideation, but cited his children as a protective factor. He denied a history of homicidal ideation and reported difficulty concentrating. Dr. Austin-Small stated that the Veteran continued to describe considerable PTSD symptoms (61/85 on PCL-M screening test), with the strongest symptoms of feeling distant, cut off from others, feeling emotionally numb, and chronically super-alert or on guard. He also reported significant startle reflex, difficulty with concentration, sleep difficulties, nightmares, and flashbacks. His interpersonal functioning was poor, and he reported only two friends and these are people he has known a long time. His marriage had disintegrated and he was estranged from his ex-wife and his sister. He separated himself from most other people in order to avoid outbursts and disagreements, and reported considerable difficulty throughout his civilian working life with verbal confrontations with superiors and coworkers, and feeling chronically on edge and irritable, and was utterly unable to tolerate working cooperatively with others. Dr. Austin-Small noted that no psychosis or thought disorder was seen during his evaluation and the Veteran's thought processes were clearly slowed and concrete, but were linear and clear. There was no history of auditory or visual hallucinations, but some difficulty with memory (timelines and remembering details), with limited judgment and fair impulse control. Dr. Austin-Small concluded that the Veteran was further precluded from work. He stated that the Veteran has difficulties with all areas of living, with difficulty completing activities of daily living (ADLs), and an inability to structure his time effectively. Dr. Austin-Small stated that the Veteran had "near-total social impairment" and that he is not able to tolerate even brief and superficial social contact in the workplace or in most community interactions, such as waiting in line or eating a meal at a restaurant. His ongoing social relationships have disintegrated precipitously. He has persistent difficulties with severe PTSD and depression, and these in turn cause at least some of his concentration and cognitive difficulties. His depression and PTSD are primary limiters as they result in significant cognitive impairments, interpersonal difficulties, and ongoing mood difficulties to the degree that even his activities of daily living are substantially impaired. While the Board has considered the July 2017 private evaluation, the Board affords it less probative value regarding the severity of the Veteran's service-connected psychiatric disability than the VA examinations discussed above. Notably, Dr. Austin-Small's opinion is inconsistent with several facts of the case which lower the probative value attributable to the overall opinion. For example, regarding the Veteran's educational history, Dr. Austin-Small noted that the Veteran had obtained his GED and that he had "been attending college for a considerable length of time in pursuit of his bachelor's degree." However, the Veteran has consistently reported that he obtained his bachelor's degree, and the probative evidence, including the November 2016 VA examination report, documents that the Veteran received his bachelor's degree in business administration from Bryant & Stratton College in 2015, which is prior to the July 2017 private evaluation by Dr. Austin-Small. Similarly, regarding the Veteran's occupational history, Dr. Austin-Small stated that the Veteran held his last job in 2008; however, this is also inconsistent with other evidence of record, including the Veteran's own reports that he had continued to work in various supervisory and maintenance positions. Thus, given the inconsistency of the July 2017 private opinion with the additional evidence of record, the Board affords is less probative value generally than the VA examination reports discussed above. The Board has considered the lay statements of the Veteran in support of his appeal, including at the October 2020 virtual hearing. At that time, he testified that his psychiatric symptoms were worse "at times" and that sometimes "it seems like it stays about the same." He noted that it had been more difficult over the past year due to the COVID-19 pandemic, but that he had been doing his best to keep it under control by talking to his VA doctor. He noted that they had recently tried a narcotic-based sleep medicine that had helped his sleep impairment. He testified that he did not have much social interaction outside of caring for his two boys. Given the above lay and medical evidence, and with consideration of the Veteran's current 70 percent disability rating, which already contemplates deficiencies in most areas, the Board finds that the preponderance of the evidence is against a finding that the Veteran has total occupational and total social impairment for any period on appeal, as both must be present for entitlement to an increased 100 percent disability rating. Notably, the Veteran has reported ongoing social relationships with some lifelong friends, ongoing care for his two boys, with whom he has positive relationships, and ongoing relationships with VA therapists and doctors. This is evidence against total social impairment. Concerning occupational impairment, the evidence of record clearly documents that the Veteran has had some occupational impairment resulting in the need to seek several different positions; however, the Board finds it significant that the Veteran has been able to obtain ongoing occupational positions in his areas of study and experience, which is probative evidence against a finding that he has experienced total occupational impairment for any period on appeal. As such, the Board concludes that the most probative evidence of record is against an initial disability rating in excess of 70 percent for the service-connected PTSD with major depressive disorder. for any period on appeal. In sum, as the Veteran's psychiatric symptoms do not more closely approximate total occupational and social impairment, he does not meet the rating criteria for an increased 100 percent disability rating for any period on appeal. Significantly, he has not shown the severity of occupational and social impairment necessary for an increased 100 percent disability rating during the rating period, and his symptoms as a whole are not of similar severity, frequency, and duration as those particular symptoms associated with a 100 percent disability rating. As such, the preponderance of the evidence is against the Veteran's claim of entitlement to an initial disability rating in excess of 70 percent for PTSD with major depressive disorder for any period on appeal, there is no reasonable doubt to be resolved, and the claim for an initial rating in excess of 70 percent is denied. 2. Entitlement to a TDIU rating. The Veteran has also claimed that he is precluded from securing or following a substantially gainful occupation due to his service-connected PTSD, as well as his migraine headaches and TBI. A TDIU rating may be granted upon a showing that the veteran is unable to secure or follow a substantially gainful occupation due solely to impairment resulting from his service-connected disabilities. There are minimum disability rating percentages that must be shown for the service-connected disabilities, alone or in combination, to even qualify for consideration for a TDIU award under the schedular criteria. Indeed, if there is only one such disability, it must be rated at 60 percent or more; if instead there are two or more disabilities, at least one disability must be rated at 40 percent or more, with sufficient additional disability to bring the combined rating to 70 percent or more. In determining whether a veteran is unemployable for VA purposes, consideration may be given to the veteran's level of education, special training, and previous work experience, but not to age or any impairment caused by nonservice-connected disabilities. The central inquiry in determining whether a Veteran is entitled to a TDIU rating is whether service-connected disabilities alone are of sufficient severity to produce unemployability. The sole fact that a veteran is unemployed or has difficulty obtaining employment is not enough; a high disability rating itself is recognition that the impairment makes it difficult to obtain or keep employment. The ultimate question, however, is whether the veteran is capable of performing the physical and mental acts required by employment, not whether he can find employment. The ultimate question of whether a veteran is capable of substantial gainful employment is not a medical one; rather, it is a determination for the adjudicator. In determining whether a veteran can secure and follow a substantially gainful occupation, the Court in Ray v. Wilkie directed the Board to consider the following factors: (1) the veteran's history, education, skill, and training; (2) whether the veteran has the physical ability (both exertional and non-exertional) to perform the type of activities required by the occupation at issue; and (3) whether the veteran has the mental ability to perform the activities required by the occupation at issue. 31 Vet. App. 58, 73 (2019). In determining whether unemployability exists, consideration may be given to the Veteran's level of education, special training, and previous work experience, but not to his age or to any impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. The responsibility for making the ultimate TDIU determination is placed on the adjudicator and not a medical examiner. See Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013). A medical examiner's role is limited to describing the effects of disability upon the person's ordinary activity. See Floore v. Shinseki, 26 Vet. App. 376, 381 (2013). The Veteran is competent to testify as to facts he personally observed or described; this includes recalling what he personally felt, saw, smelled, heard, or tasted. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Veteran is currently service connected for PTSD with major depressive disorder (rated as 70 percent disabling from October 16, 2009), migraine headaches associated with TBI (rated as 30 percent disabling from October 16, 2009 and as 50 percent disabling from November 12, 2018), tinnitus (rated as 10 percent disabling from October 16, 2009), TBI (rated as 10 percent disabling from October 16, 2009, as 40 percent disabling from December 1, 2016, and as 10 percent disabling from November 12, 2018). Based on the above, the Veteran's combined disability rating is 80 percent from October 16, 2009 and 90 percent from December 1, 2016. As such, the Veteran meets the schedular percentage requirements for a TDIU for the entire period on appeal. 38 C.F.R. § 4.16(a). Following a review of the evidence of record, and as discussed further below, the Board finds that the preponderance of the evidence of record weighs against a finding that the Veteran has been precluded from securing or following a substantially gainful occupation due to his service-connected disabilities for any period on appeal. The reasons for this decision follow. VA treatment records from October 2010 document that the Veteran would not be precluded from working in any occupation, including strenuous, light-duty, or sedentary occupations. At that time, the Veteran reported that he was attending junior college and was employed in a part-time occupation. In his initial May 2017 TDIU application, the Veteran asserted that he was prevented from securing or following any substantially gainful occupation due to his service-connected PTSD. He reported that he had been under treatment from 2009 to the present. He stated that the date his disability affected full-time employment and the date he became too disabled to work was in November 2004, but reported that the last date he worked full-time was in April 2017. He noted that the most income he earned in one year was $65,000 in 2014 as a maintenance manager. Regarding his employment history, the Veteran reported past positions at Boyd County in Fairburn, Georgia, a manufacturing position where he worked 60 hours per week from December 2016 to April 2017 and lost one-and-a-half months due to illness; Green Island Country Club in Columbus, Georgia, a hospitality position where he worked 55 hours per week from January 2016 to December 2016 and lost two months due to illness; Johns Manville in Phoenix City, Alabama, a manufacturing position where he worked 55 hours per week from October 2015 to January 2016 and lost one month due to illness; Iljin Alabama, a manufacturing position where he worked 60 hours per week from December 2014 to October 2015 and lost two months from illness; and RAPA in Auburn, Alabama, a manufacturing position where he worked 50 hours per week from June 2014 to December 2014 and lost one month from illness. He reported a total earned income over the past 12 months of $58,000 and stated that he left his last job because of disability. He documented he did not expect to receive disability retirement or workers compensation benefits. He reported that he had tried to obtain employment since he became too disabled to work, including at Lexica, a manufacturing job in May 2017, Walmart, a warehouse job in May 2017, and KMIN, a manufacturing job in June 2017. He reported an educational history including four years of college and additional education/training since he became too disabled to work at Industrial Engineering Business Administration from 2007-2010, and 2013-2015. In July 2017, VA received employment information from several of the Veteran's previous employers. A representative from Rausch (RAPA) reported that the Veteran worked there from August 2014 to December 2014, with no time lost and no concessions. It was noted that the Veteran did not request any accommodations and was able to perform the job, but that he resigned to accept another job offer. A representative from Iljin Global reported that the Veteran worked there from January 2015 to September 2015, with no concessions and no explanation for why the Veteran left the position. A representative from Johns Manville reported that the Veteran worked there from October 2015 to December 2015, with no time lost and no concessions. The Veteran was terminated due to unsatisfactory performance. Finally, a representative from Green Island reported that the Veteran worked there as a facility maintenance director from February 2016 to December 2016, with no time lost and no concessions. It was reported that the Veteran left the job because he took a position with another company. This information provided directly from the Veteran's previously employers weighs against the Veteran's assertion that he was precluded from such positions due to his service-connected disabilities. There were no employers that indicated that the Veteran lost time from his position due to his service-connected symptoms and/or disabilities or that such symptoms required concessions in his work duties. Additionally, aside from the isolated report from Johns Manville that the Veteran was terminated due to unsatisfactory performance (which in itself does not provide specific evidence that such termination was due to a service-connected disability or symptoms thereof), there were no prior employers who reported that the Veteran was terminated or otherwise unable to work due to his service-connected disabilities. Rather, it was consistently reported that the Veteran left one position to pursue another, which is evidence that indicates job mobility, rather than preclusion from substantially gainful employment. Upon VA PTSD examination in November 2016, the Veteran reported that since his previous PTSD evaluation in 2011, he had held a number of positions. He left an automotive position after getting an offer to be a maintenance manager at Elgin, Alabama. He reported that he was let go after approximately one year for not attending all of his meetings, but denied any problems with his job performance. Similarly, upon VA PTSD examination in August 2017, the VA examiner concluded that it did not appear that the Veteran's PTSD symptoms resulted in significant vocational impairment. The examiner stated that the Veteran was "able to understand directions, take instructions, interact with co-workers and respond to supervision." The Board finds that these clinical findings and observations are probative evidence that weigh against the Veteran's TDIU claim. Notably, the Veteran's report in November 2016 that he had held a number of positions could be construed to support his position of an inability to maintain a position, but it could also represent job mobility based upon his increasing skills, experience, and pursuit of advanced educational programs. Additionally, the Board finds it probative that the August 2017 VA examiner found that the Veteran's PTSD symptoms, which is the service-connected disability with the highest rating, did not result in significant vocational impairment. This is also probative evidence that weighs against a finding that the Veteran was precluded from substantially gainful employment due to his psychiatric disability. Regarding the service-connected migraine headaches, VA treatment records from October 2010 document the Veteran's report of daily headaches that may last for 30 seconds, which were alleviated with Tylenol. He denied any nausea, vomiting, photophobia, or numbness or tingling to his face, upper extremities, or lower extremities. Upon VA headaches examination in November 2018, the Veteran reported intermittent headaches one to two times per week and lasting less than one day, with photophobia and phonophobia, which required him to go into a dark room to rest and to take Tylenol as needed. Based upon his reports, the examiner stated that the Veteran had characteristic prostrating attacks of migraine headache pain more frequently than once per month, including very prostrating and prolonged attacks of migraine pain productive of severe economic inadaptability, and that his headache condition impacted his ability to work in that he had at least two prostrating attacks of headaches per month and needed a dark room to rest. Notably, the examiner's finding that the Veteran's reported headache pain was productive of severe economic inadaptability was based largely on the Veteran's own lay report during the examination. However, the Veteran did not elsewhere report that his headaches caused problems with his various occupations or his workplace. Additionally, the July 2017 employment information provided by the Veteran's previous employers does not document any concessions made by reason of disability, such as allowing the Veteran to take breaks or to go home due to his reported characteristic prostrating attacks of migraine headache pain, and each of them documented that the Veteran did not lose time from work due to disability. These documents cover 2014, 2015, and 2016, and they do not show the Veteran losing time from work due to headaches. As such, the Board finds that the November 2018 examination report does not weigh in favor of the Veteran's TDIU claim, as it is inconsistent with additional probative evidence of record regarding the functional impact upon the Veteran's ability to work. Regarding the service-connected TBI, VA treatment records from November 2009 document the Veteran's report of a history of TBI symptoms, with complaints of memory deficits and problems learning new information. The examiner at that time had "significant concerns" as to whether the Veteran was putting forth his best effort in testing, as his test scores were significantly worse than expected given the nature of the reported accident and his overall functioning since the time of the accident, and he stated it was unlikely that someone with such severe cognitive impairment would be able to complete academic endeavors on a college level as the Veteran had. A December 2016 TBI examination documents the Veteran's complaint of mild memory loss without objective evidence on testing. The Veteran stated that he often forgets the details of his children's activities and has difficulty with planning and time management while traveling with his kids. Regarding social interaction, the Veteran reported that he has had difficulty processing everything that is going on around him in social settings. He also stated that he was occasionally disoriented and consistently loses track of time concerning appointments or other engagements. He also reported subjective symptoms that do not interfere with work; instrumental activities of daily living; or work, family, or other close relationships, including mild or occasional headaches, and mild anxiety. He also reported one or more neurobehavioral effects that occasionally interfere with workplace interaction, social interaction, or both but do not preclude them. Specifically, he stated that his friends have commented to him that he is often very moody and very prolonged and direct. The examiner concluded that none of the Veteran's residual symptoms attributable to the TBI impact the Veteran's ability to work. Moreover, the examiner stated that the Veteran did not meet VA documentation criteria to assert a diagnosis of TBI based on the current claims file. This last finding is consistent with August 2017 and August 2018 VA PTSD examinations which also found that the Veteran did not have a diagnosed TBI. A subsequent November 2018 VA TBI examination documents the Veteran's report of problems with forgetfulness and intermittent headaches. Regarding functional impact of any residual conditions attributable to a TBI upon the Veteran's ability to work, the examiner noted that the Veteran needed to write things down as reminders for appointments and to complete tasks. Given the above, the Board finds that the preponderance of evidence is against a finding that the Veteran's service-connected TBI precludes substantially gainful employment consistent with the Veteran's education, training, and prior work history. Initially, the Board notes that the evidence of record is inconsistent as to whether the Veteran experienced a TBI in service. However, given that he is service-connected for such residuals, the Board further finds that the resulting impairment reported by the Veteran, including forgetfulness and headaches, may affect his occupation abilities; however, there is no probative evidence that such residuals preclude employment, which is consistent with the Veteran's ability to obtain several different positions, including with supervisory responsibility, and to complete a college degree. Regarding the service-connected tinnitus, a review of the claims file does not document probative evidence that the Veteran experiences functional impact upon his ability to work due to his tinnitus. Additionally, the Veteran does not assert any such functional impact in the context of his TDIU claim. The Board acknowledges the private opinion evidence of record, including an August 2017 private opinion by Dr. Austin-Small, wherein he concluded that the Veteran was 100 percent disabled and precluded from work. However, as discussed above, Dr. Austin-Small's opinion includes consideration of facts that are inconsistent with other evidence, which lowers the probative value of the overall opinion. For example, regarding the Veteran's educational history, Dr. Austin-Small noted that the Veteran had obtained his GED and that he had "been attending college for a considerable length of time in pursuit of his bachelor's degree." However, the Veteran has consistently reported that he obtained his bachelor's degree, and the probative evidence, including the November 2016 VA examination report, documents that the Veteran received his bachelor's degree in business administration from Bryant & Stratton College in 2015, which is prior to the July 2017 private evaluation by Dr. Austin-Small. Similarly, regarding the Veteran's occupational history, Dr. Austin-Small stated that the Veteran held his last job in 2008; however, this is also inconsistent with the additional evidence of record, including the Veteran's own reports that he had continued to work in various supervisory and maintenance positions and documentation from employers of the Veteran's employment in 2014, 2015, and 2016. Thus, given the inconsistency of the July 2017 private opinion with the additional evidence of record, the Board affords is less probative value generally than the additional evidence of record concerning the Veteran's TDIU claim. The Board has also considered a June 2019 private employability evaluation by Susan McCarron, wherein she reported that the Veteran's employment issues are "quite unique." It was noted that the Veteran had a bachelor's degree in business administration as well as an associate degree in industrial engineering, and although he failed 10 classes along the way, he persevered to earn these degrees. She stated that this self-determination is also apparent when considering the number of jobs that the Veteran has obtained, but failed to maintain. Ms. McCarron wrote that given the VA's definition of employability, which includes the need to maintain substantial gainful employment, Ms. McCarron stated that the following factors essentially prevent this: compromised executive functioning skills, especially in relation to memory, planning, and organization, time management, and adjusting to change; time management issues, including consistently showing up for work late at all of his jobs, which is inconsistent with employment protocols universally; failure to adjust quickly and efficiently to changes in routine; low frustration tolerances which can cause him to communicate with others in an unprofessional or offensive manner; impaired ability to retain details or follow instructions well, which can diminish his ability to complete a work task efficiently; impaired attention and concentration; sleep disturbances resulting in fatigue during the day; migraine headaches ranging from light to severe which interfere with his work and an times required him to leave the workplace to rest. Ms. McCarron stated that the Veteran has demonstrated in job after job that he cannot function in many spheres in keeping with employment standards of acceptable work behaviors, and that despite his educational level and his obvious ability to obtain employment, he is not able to maintain employment as a result of his service-connected disabilities. Again, the Board finds that Ms. McCarron's opinion that the Veteran was unable to maintain employment due to his service-connected disabilities to be inconsistent with the additional evidence of record, specifically, the July 2017 employment information provided by several of the Veteran's previous employers, which consistently document that the Veteran had no concessions made due to disability and that, but for one position from which he was terminated due to poor performance, he usually left one job to pursue another. This is probative evidence which weighs against Ms. McCarron's conclusion that the was not able to maintain employment due to his service-connected disabilities. In a subsequent July 2019 TDIU application, the Veteran asserted that he was unable to work due to service-connected PTSD, TBI, and migraine headaches. He reported treatment for his disabilities from 2006-2019 and stated that his disability affected full-time employment and that he became too disabled to work in October 2004. He reported that he last worked full-time in March 2019, and that the most income he had earned in one year was $95,000 in 2018 as a maintenance supervisor. Regarding his employment history, the Veteran reported prior employment at Baxter Inc. in Opelika, Alabama, a maintenance position working 60 hours per week from November 2018 to April 2019; Boyd Corp., a maintenance position working 65 hours per week from November 2016 to May 2017; Green Island, a maintenance position working 55 hours per week from December 2015 to January 2016; and Iljin, working 70 hours per week from December 2013 to June 2015. He reported a total earned income over the last 12 months of $65,000 but stated that he was currently unemployed. He stated that he had tried to obtain employment since he became too disabled to work including at B-way, a maintenance position in March 2019; Tuskegee VA in April 2019; and Ply-Gen in May 2019. The Veteran further reported an educational history including four years of college, with other education/training including EPA Universal Certification from March 2008 to May 2008 and no other education/training since he became too disabled to work. The Veteran stated that he was "still looking for work, but when [he was] employed [he] can't seem to maintain [his] employment due to [his] disabilities." In July 2019, the Veteran reported he was hired at Wal-Mart to fill a supervisory position. An April 2020 notice from Milliken & Company documents that the Veteran was furloughed from his position there. At the October 2020 Board hearing, the Veteran testified that he was not currently working and that he last worked full time when he was furloughed in May 2020 and let go in July. He stated that he was told during his exit interview that he needed to find some way to help himself before he got back into management. He reported that he had been through a lot of struggles with employment and that he had reverted to trying to go to school online, and that he was currently enrolled for an master's degree in business administration (MBA), with a goal to get his doctorate one day. He stated that with his education and experience, he could always find a job but that most of his jobs were in manufacturing, which was not flexible and required a person to work all hours of the night, which was really hard on him. The Veteran testified that he did not want to be unemployed or to give up. When asked about his employment history, the Veteran stated that he took a supervisory position at Walmart in July 2019, after which he had a verbal outburst and was told by his general manager that "it wasn't going to work out," after which he took a job at Milliken in August 2019 until he was furloughed in April or May 2020. He further stated that he had applied for a couple of administrative positions in the government and was not trying to give up. Notably, the dates of previous employment reported by the Veteran in his July 2019 TDIU application are different than the ones he initially reported in his May 2017 TDIU application. Such inconsistencies in his reports lessen the credibility of the Veteran's reported history and the overall probative value of his lay statements generally, including in the context of his TDIU claim. Additionally, the Veteran's own October 2020 hearing testimony indicates that he continues to obtain and seek employment, which is probative evidence that weighs against a finding that he has been precluded from securing or following a substantially gainful occupation. Further, medical professionals have documented concerns regarding the Veteran's credibility on at least two occasions, which further supports the Board's finding that the Veteran's credibility has been called into question. For example, a VA neuropsychologist had performed a neuropsychological evaluation in November 2009 and documented multiple inconsistencies during testing. In the final impression, the neuropsychologist wrote she had "significant concerns" as to whether the Veteran had put forth his best effort in testing and that, "certain aspects of his performance called his motivation into question and effort into question." She added that it would be "very unlikely that someone with scores as low as the patient's would be able to function at the level that he reportedly has been able to do." The VA neuropsychologist wrote that it was unlikely that someone with such severe cognitive impairment would be able to complete academic endeavors on a college level." The Veteran was evaluated by a VA psychologist in July 2010, who acknowledged the findings made by the VA neuropsychologist. The July 2010 VA examiner diagnosed PTSD and added that the Veteran's test results and demeanor during the interview argued for an additional diagnosis of amnesiac disorder, not otherwise specified. VA reached out to the July 2010 examiner and asked him to evaluate the Veteran again to elicit the stressors the Veteran was claiming caused his PTSD. In a March 2011 addendum medical opinion, this same examiner interviewed the Veteran and reviewed the evidence and found that he now doubted the Veteran's symptoms that were reported at the time of the July 2010 examination. For example, he stated that at the time of the July 2010 examination, the Veteran had alluded to past fear of enemy attack but that the Veteran's service treatment records showed he denied any history of such a threat on a post-deployment questionnaire. See May 2003 Post-Deployment Health Assessment (documenting the Veteran denied seeing anyone wounded, killed or dead during the deployment and denied ever feeling like he was in great danger of being killed). The examiner wrote that a review of the Veteran's reports during the present interview, historical data included in the referral form (wherein VA asked the examiner to solicit stressors to determine if the Veteran's stressor was related to fear of hostile military or terrorist activity), the results of relatively recent neuropsychological testing, and at least one nursing screen had caused the examiner to have "more doubts regarding the [V]eteran's symptom reports than were present during the last C&P review in July, 2010." The examiner wrote that as a result of these doubts, he no longer found adequate support for the diagnoses of PTSD and/or Amnestic Disorder. Thus, there is support in the record to question the Veteran's credibility. While the evidence of record documents some impairment resulting from the Veteran's service-connected disabilities, in particular his PTSD with major depressive disorder, migraine headaches, and TBI, the preponderance of the evidence of record, as discussed in detail above, is against a finding that the Veteran's service-connected disabilities have precluded him from securing or following a substantially gainful occupation for the entire period on appeal. In making this finding, the Board has considered (1) the Veteran's history, education, skill, and training; (2) whether the veteran has the physical ability (both exertional and non-exertional) to perform the type of activities required by the occupation at issue; and (3) whether the veteran has the mental ability to perform the activities required by the occupation at issue, as discussed by the Court in Ray, 31 Vet. App. at 73. Regarding the Veteran's education, training, skills, and work history, his past occupations include work in manufacturing, warehouse, and hospitality. He has been a maintenance supervisor, a facility maintenance director, and maintenance technician. He has completed a bachelor's degree in business administration and is currently pursuing an MBA. The Veteran's varied job history and educational experience demonstrates a capacity for learning and adaptation that would facilitate the ability to perform substantially gainful employment. As to the Veteran's physical ability to perform substantially gainful employment, the Veteran is service connected for headaches, TBI, and tinnitus. The evidence shows the Veteran experiences headaches, although his former employers did not document that the Veteran lost time from work due to headaches. Additionally, the VA treatment records show the Veteran denying headaches. While the Veteran reports headaches regularly, as noted above, his credibility has been called into question. Although the Veteran's headaches and TBI disabilities caused some difficulty for the Veteran, the preponderance of the evidence is against a finding that these service-connected disabilities restrict the Veteran's ability to perform substantially gainful employment. As to the Veteran's ability to perform the mental requirements of substantially gainful employment, the Veteran has a 70 percent rating for PTSD with major depressive disorder. The Veteran has reported a range of symptoms relating to his psychiatric disorder, including difficulty remembering his work schedule, forgetting to complete tasks, difficulty following instructions, and difficulty trusting others. However, the Veteran's treatment records reflect generally unremarkable findings on mental status examination, including that the Veteran was regularly found to be alert and oriented with normal speech. He has been noted to be anxious, but is generally described as pleasant and cooperative while presenting as well-groomed with appropriate behavior. The Veteran has positive relationships with his sons and has been able to complete an undergraduate college degree and is currently enrolled in an MBA program. The Veteran's psychiatric symptoms could be accommodated by a limitation to jobs that could be performed in a controlled environment, and by restricting the Veteran from occupations in which he would have managerial or supervisory duties and occupations that would require routine interaction with the public, so as to limit excess stress and interpersonal conflict. The Veteran could accommodate his difficulties by writing down his hours at work on a calendar and setting his alarm to go off so that he can get to work on time. Thus, the weight of the evidence shows that the Veteran's service-connected PTSD with major depressive disorder does not preclude him from performing the mental requirements of substantially gainful employment. Based on the above assessment of the Veteran's physical and mental abilities with consideration of his education, training, skills, and work history, the Board finds that the Veteran is capable of work that would result in income at the level of substantially gainful employment. For example, the Veteran's prior job experience and employment history indicates that there are jobs that could be performed for which the Veteran is already qualified, including manufacturing positions. The July 2017 employment information provided by the Veteran's previous employers consistently documents that the Veteran left his prior positions to pursue new ones, which is probative evidence that he retains job mobility, including both the physical and mental ability to perform activities required by such occupations. Additionally, the Veteran's service-connected disabilities would not preclude the Veteran from occupations, such as a warehouse worker, assembly line worker, or other positions that would be repetitive, have structure, and would not necessarily require significant social interaction. These examples are not exhaustive but are merely illustrative of potential occupations that the Veteran could perform. This is evidence against a finding that the Veteran is precluded from all forms of substantially gainful employment. Additionally, the Veteran has reported that he has continued to pursue a higher education, including an MBA, and has the goal to obtain his doctorate. His advanced education is further probative evidence that weighs against a finding that the Veteran is precluded from substantially gainful employment, as he retains the ability to pursue a rigorous course of study and to learn and retain information in an academic environment, which will also benefit his ability to find and secure related employment. While he has reported not doing well in some classes, he was able to obtain a bachelor's degree. In sum, while the evidence documents functional impact upon the Veteran's ability to work based upon his service-connected disabilities, such functional impairment is contemplated by the Veteran's combined disability rating of 80 percent and 90 percent throughout the appeal period. The Board concludes that, for all the reasons laid out above, the preponderance of evidence weighs against the Veteran's claim for entitlement to a TDIU rating for the entire period on appeal. As such, there is no reasonable doubt to be resolved, and the claim for entitlement to a TDIU rating is denied. A. P. SIMPSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Chad Johnson, 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.