Citation Nr: 21042268 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 19-38 146 DATE: July 12, 2021 ORDER Entitlement to service connection for diabetes mellitus is denied. Entitlement to service connection for glaucoma is denied. Entitlement to service connection for a left hip disorder is denied. Entitlement to service connection for a left leg disorder is denied. Entitlement to a compensable rating for ulceration of the right septum is denied. Entitlement to a rating in excess of 10 percent for residuals, fracture of left navicular bone, is denied. Entitlement to a rating in excess of 70 percent for posttraumatic stress disorder (PTSD) is denied. Entitlement to a total rating based on individual employability due to service-connected disabilities (TDIU) is granted. Entitlement to an effective date earlier than September 13, 2017, for the grant of a 70 percent rating for PTSD is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that diabetes mellitus began during active service, or is otherwise related to an in-service injury or disease. 2. The preponderance of the evidence is against finding that glaucoma began during active service, or is otherwise related to an in-service injury or disease. 3. The preponderance of the evidence of record is against finding that the Veteran has had a left hip disorder or any related disorder at any time during or approximate to the pendency of the claim. 4. The preponderance of the evidence of record is against finding that the Veteran has had a left leg disorder or any related disorder at any time during or approximate to the pendency of the claim. 5. The Veteran's ulceration of the right septum is manifested by resolved ulcerations of nasal cavity, with no residuals and recurrent epistaxis; there is no obstruction of the nasal passage on both sides or complete obstruction on one side. 6. The Veteran's residuals, fracture of left navicular bone, is manifested by painful motion; there is no ankylosis. 7. The severity, frequency, and duration of the Veteran's PTSD symptoms did not more closely approximate total occupational and social impairment. 8. The Veteran is service-connected for psychiatric, left knee, left wrist, nose, and hemorrhoid disabilities; he meets the schedular criteria for consideration for TDIU. 9. The Veteran last worked in 1989 as a laborer; his service-connected disabilities preclude substantially gainful employment consistent with his educational background and occupational experience. 10. A July 2015 rating decision granted service connection for PTSD; the Veteran did not appeal the rating assigned, and that decision is final. 11. An intent to file an increased rating claim for PTSD was received on September 13, 2017. CONCLUSIONS OF LAW 1. The criteria for service connection for diabetes mellitus are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for glaucoma are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for a left hip disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for left leg disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for a compensable rating for ulceration of the right septum are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.97, Diagnostic Code 6599-6502. 6. The criteria for a rating in excess of 10 percent for residuals, fracture of left navicular bone, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5215. 7. The criteria for a disability rating in excess of 70 percent for PTSD are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. 8. The criteria for TDIU are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16. 9. The criteria for an effective date earlier than September 13, 2017, for the grant of a 70 percent rating for PTSD are not met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.151, 3.155, 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had a period of active duty for training (ACDUTRA) from October 1967 to March 1968, and active military service from September 1970 to March 1972. This matter is on appeal from an April 2018 rating decision. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). 1. Entitlement to service connection for diabetes mellitus The Veteran contends that his diabetes mellitus is related to service. March 2018 claim. The Veteran has a current diagnosis of diabetes mellitus as evidenced by an April 2018 VA treatment record. Diabetes mellitus is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. However, the disability was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. VA treatment records show the Veteran was not diagnosed with diabetes mellitus until May 2017, decades after his separation from service, and decades outside of the applicable presumptive period. The Veteran has not reported experiencing symptoms associated with diabetes mellitus during service or since service. Further, he is not competent to determine the onset date of diagnosis as he has not demonstrated the necessary medical expertise. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). None of the Veteran's medical records have indicated that his diabetes mellitus had its onset in service or is otherwise directly related to service. No medical professional has provided any opinion otherwise relating diabetes mellitus to the Veteran's military service. Absent such evidence, there is no reasonable likelihood that a VA examination would result in findings favorable to the Veteran; a VA examination is therefore not warranted. 38 C.F.R. § 3.159(c)(4). While the Veteran believes his diabetes mellitus is related to an in-service injury, event, or disease, he is not competent to provide a nexus opinion in this case as he has not demonstrated the necessary medical expertise. Jandreau, 492 F.3d at 1377 n.4. Consequently, the Board of Veterans' Appeals (Board) gives more probative weight to the competent medical evidence failing to show that diabetes mellitus is related to the Veteran's military service. 2. Entitlement to service connection for glaucoma The Veteran contends that his glaucoma is related to his service. March 2018 claim. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a diagnosis of glaucoma, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. The first indication of glaucoma in the Veteran's private treatment records is in October 1998, when a past medical history of glaucoma was noted, decades after his separation from service. The Veteran has not reported experiencing symptoms associated with glaucoma during service or since service. Further, he is not competent to determine the onset date of diagnosis as he has not demonstrated the necessary medical expertise. Jandreau, 492 F.3d at 1377 n.4. None of the Veteran's medical records have indicated that his glaucoma had its onset in service or is otherwise directly related to service. No medical professional has provided any opinion otherwise relating glaucoma to the Veteran's military service. Absent such evidence, there is no reasonable likelihood that a VA examination would result in findings favorable to the Veteran; a VA examination is therefore not warranted. 38 C.F.R. § 3.159(c)(4). While the Veteran believes his glaucoma is related to an in-service injury, event, or disease, he is not competent to provide a nexus opinion in this case as he has not demonstrated the necessary medical expertise. Jandreau, 492 F.3d at 1377 n.4. Consequently, the Board gives more probative weight to the competent medical evidence failing to show that glaucoma is related to the Veteran's military service. 3. Entitlement to service connection for a left hip disorder The Veteran contends that he has a left hip disorder related to his service. March 2018 claim. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of a left hip disorder and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The April 2018 VA examiner evaluated the Veteran and determined that, while he experienced subjective symptoms of pain, he did not have a diagnosis of a left hip disorder. Further, despite consistent treatment since 2001, VA treatment records do not contain a diagnosis of a left hip disorder. While the Veteran believes that he has a diagnosis of a left hip disorder, he does not have the training or credentials to provide a competent opinion as to a diagnosis or the onset date of such diagnosis. Jandreau, 492 F.3d at 1377 n.4. Moreover, there is insufficient lay or medical evidence to suggest that any left hip symptoms reach the level of functional impairment of earning capacity. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). In the absence of proof of a disability, there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Consequently, the Board gives more probative weight to the competent medical evidence failing to show a diagnosis of a left hip disorder, and the appeal must be denied. 4. Entitlement to service connection for a left leg disorder The Veteran contends that he has a left leg disorder related to his service. March 2018 claim. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of a left leg disorder and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky, 26 Vet. App. at 294; McClain, 21 Vet. App. at 321. The April 2018 VA examiner evaluated the Veteran and determined that, while he experienced subjective symptoms of pain, he did not have a diagnosis of a left leg disorder. Further, despite consistent treatment since 2001, VA treatment records do not contain a diagnosis of a left leg disorder. In finding no current diagnosis, the Board acknowledges that private treatment records reflect complaints of left leg pain associated with a back disorder. See, e.g., July 1993 progress note. The Veteran currently has an appeal pending in the modernized review system, also known as the Appeals Modernization Act (AMA), for service connection for a lumbar spine disorder with left lumbar radiculopathy, which will be the subject of a future and separate Board decision. While the Veteran believes that he has a diagnosis of a left leg disorder, he does not have the training or credentials to provide a competent opinion as to a diagnosis or the onset date of such diagnosis. Jandreau, 492 F.3d at 1377 n.4. Moreover, there is insufficient lay or medical evidence to suggest that any left leg symptoms, including his reported pain, reach the level of functional impairment of earning capacity. See Saunders, 886 F.3d 1356. In the absence of proof of a disability, there can be no valid claim for service connection. Brammer, 3 Vet. App. at 225. Consequently, the Board gives more probative weight to the competent medical evidence failing to show a diagnosis of a left leg disorder, and the appeal must be denied. Increased Rating Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. Ratings are based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where entitlement to compensation has already been established, and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, the regulations do not give past medical reports precedence over current findings. See Francisco v. Brown, 7 Vet. App. 55 (1994); 38 C.F.R. § 4.2. Staged ratings are, however, appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. The relevant focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. See generally Hart v. Mansfield, 21 Vet. App. 505 (2007). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. 5. Entitlement to a compensable rating for ulceration, right septum The Veteran contends that his nose disability is entitled to a higher rating. The Veteran's nose disability is rated under 38 C.F.R. § 4.97, Diagnostic Code 6502, for deviation of nasal septum. Under Diagnostic Code 6502, 50-percent obstruction of the nasal passage on both sides or complete obstruction on one side warrants a 10 percent rating. 38 C.F.R. § 4.97, Diagnostic Code 6502. There are no other ratings available under Diagnostic Code 6502. The Board finds that the preponderance of the evidence is against a compensable rating for the Veteran's nose disability. An April 2018 VA examination reveals that the Veteran did not have at least 50 percent obstruction of the nasal passage on both sides, or complete obstruction on either side. Treatment records during this appeal similarly do not show at least 50 percent obstruction of the nasal passage on both sides, or complete obstruction on either side. The Board has considered whether any other Diagnostic Codes related to disabilities of the nose would provide for a higher disability rating. However, the evidence does not reflect that the symptoms would warrant a higher rating under a different Diagnostic Code. See 38 C.F.R. § 4.97. The April 2018 examination shows that there was no evidence of septal deviation, recent nosebleed, or ulceration. He was diagnosed with resolved ulcerations of nasal cavity, with no residuals and recurrent epistaxis. The examination and treatment records do not reflect symptoms warranting a compensable rating under other Diagnostic Codes. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's appeal for a compensable rating for his nose disability. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 6. Entitlement to a rating in excess of 10 percent for residuals, fracture of left navicular bone The Veteran contends that he is entitled to a higher rating for his left wrist disability. The Veteran's left wrist disability is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5215, for limitation of motion of the wrist. Under Diagnostic Code 5215, dorsiflexion less than 15 degrees or palmar flexion limited in line with forearm warrants a 10 percent rating for both the major and minor arms. There is no other rating available under Diagnostic Code 5215. 38 C.F.R. § 4.71a, Diagnostic Code 5215. Diagnostic Code 5214, which evaluates ankylosis of the wrist, provides ratings higher than 10 percent. Under Diagnostic Code 5214, favorable ankylosis in 20 degrees to 30 degrees dorsiflexion warrants a 20 percent rating for the minor arm. Ankylosis in any other position, except favorable, warrants a 30 percent rating for the minor arm. Unfavorable ankylosis in any degree of palmar flexion, or with ulnar or radial deviation, warrants a 40 percent rating for the minor arm. 38 C.F.R. § 4.71a, Diagnostic Code 5214. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint." In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. The Board finds that the preponderance of the evidence is against a rating in excess of 10 percent for the left wrist disability. The evidence of record shows that the Veteran is right-handed as reported to the April 2018 VA examiner. The Board acknowledges the Veteran's lay reports of symptoms, and that there was functional loss due to swelling with limitations in lifting, pushing, and pulling. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements that the Veteran experienced flare-ups with cold weather causing a lot of pain, would not result in symptoms more nearly approximating favorable ankylosis in 20 degrees to 30 degrees dorsiflexion. The April 2018 VA examination reveals that the Veteran had palmar flexion to 60 degrees, dorsiflexion to 50 degrees, ulnar deviation to 40 degrees, and radial deviation to 20 degrees. He had pain with palmar flexion and dorsiflexion, which did not result in functional loss. There was no change in palmar flexion, ulnar deviation, or ulnar deviation following repetition, but dorsiflexion was reduced to 40 degrees. The Veteran reported developing pain if he lifted greater than 50 pounds, and that he had limitations in pushing and pulling weight. The examiner was unable to opine as to the Veteran's limitation of motion during flare-ups as the Veteran was not being observed during a flare-up. The examiner reported that he would have to observe and measure range of motion both during flares and at baseline in the same visit in order to reliably provide additional range of motion loss during flares. No ankylosis was shown at the examination or in any treatment records. The Board has considered whether any other Diagnostic Codes related to disabilities of the wrist would provide for a higher disability rating. As already noted above, higher ratings are available for ankylosis, which has not been shown. The evidence does not reflect that the symptoms would warrant a higher rating under a different Diagnostic Code. See 38 C.F.R. § 4.71a. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's appeal for a rating in excess of 20 percent for his left wrist disability. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 7. Entitlement to a rating in excess of 70 percent for PTSD The Veteran contends that he is entitled to a higher rating for his PTSD. Under the General Formula for Mental Disorders (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). The issue in this appeal is whether the Veteran's associated symptoms caused the level of impairment required for a disability rating of 100 percent. The Board concludes that the Veteran's symptoms did not cause the level of impairment required for a disability rating of 100 percent. The Veteran's symptoms more closely approximated the symptoms associated with a 70 percent rating and resulted in a level of impairment that most closely approximated the level of impairment associated with a 70 percent rating. A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name. VA treatment records, the April 2018 VA examination, and the Veteran's lay statements show that his PTSD was manifested by symptoms associated with a 70 percent rating of impaired impulse control and difficulty in adapting to stressful circumstances. No symptoms associated with a 100 percent rating have been shown. He also had symptoms that are not listed with a specific rating, such as irritability. The Board finds the severity, frequency, and duration of the Veteran's unlisted symptoms more closely approximate the symptoms contemplated by a 70 percent rating, which are less severe, less frequent, and shorter in duration than those contemplated by a 100 percent rating. See 38 C.F.R. § 4.126. No flare-ups in severity were reported by the Veteran. Further, irritability is similar to difficulty in adapting to stressful circumstances, which is contemplated by the assigned 70 percent rating. The Board also finds the level of impairment caused by the Veteran's symptoms more closely approximates the level associated with a 70 percent rating. The Veteran experienced occupational and social impairment with reduced reliability and productivity with deficiencies in most areas. Mental status examinations in VA treatment records and the April 2018 VA examination indicate that the Veteran had normal speech; depressed, occasionally irritable, euthymic, and stable moods; congruent affect; logical thought processes; fair insight and judgment; and intact memory. During the April 2018 VA examination, the Veteran reported that he had no occupational or social endeavors. The evidence overall does not demonstrate the level of impairment associated with a 100 percent rating. As noted above, the Veteran's other remaining symptoms were either contemplated by or more consistent with a 70 percent rating. Further, while the Veteran is being granted a TDIU, he was not totally socially impaired. The April 2018 examination shows that, while he had limited social activity outside of his church, he functioned as a Deacon in his church. He remained married to his wife of 44 years and reported a generally good marital relationship. He also reported good relationships with all of his children. In short, the preponderance of the evidence weighs against finding that the severity, frequency, and duration of the Veteran's symptoms resulted in the level of impairment required for a 100 percent rating. The criteria for a 100 percent or higher rating are not met and the appeal must be denied. 8. Entitlement to TDIU The Veteran seeks a TDIU. He contends that his service-connected disabilities render him unemployable. A TDIU may be assigned, where the schedular rating is less than total, where a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16(a). To qualify for schedular consideration of a TDIU, if there is only one such disability, this disability shall be ratable at 60 percent or more, and, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. Id. The phrase "unable to secure and follow a substantially gainful occupation" contains both economic and noneconomic components. See Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). The economic component refers to an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. Id. The noneconomic component requires a determination as to a veteran's ability to secure and follow such employment. Id. Attention should be given to the veteran's history, education, skills, and training; whether the veteran has the physical ability (both exertional and non-exertional) to perform the types of activities required by the occupation at issue (e.g., lifting, bending, sitting, standing, walking, climbing, as well as auditory and visual limitations); and whether the veteran has the mental ability to perform the activities required by the occupation at issue (e.g., memory, concentration, ability to adapt to change, handle work place stress, get along with coworkers, and demonstrate reliability and productivity). Id. An award of TDIU is an individualized determination, specific to a veteran's particular circumstances, e.g., their history, education, skills, and training. See Todd v. McDonald, 27 Vet. App. 79, 85 (2014). It does not require a showing of 100 percent unemployability. Roberson v. Principi, 251 F.3d 1378, 1385 (Fed. Cir. 2001). The ultimate question is whether they are capable of performing the physical and mental acts required by employment, not whether they can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). The Veteran has the following disabilities that are service-connected: PTSD rated 70 percent disabling; internal derangement of left knee rated 20 percent disabling; limitation of extension of left knee rated 20 percent disabling; residuals, fracture of left navicular bone rated 10 percent disabling; ulceration of right septum rated zero percent disabling; and hemorrhoidectomy rated zero percent disabling. Based on the forgoing, the Veteran has one disability rated 60 percent or more. Accordingly, the Board may consider the claim for a TDIU on a schedular basis. 38 C.F.R. § 4.16(a). For the reasons that follow, the Board finds that a TDIU is warranted. The Veteran completed one year of college. He last worked in 1989 as a laborer. See August 1993 VA Form 21-8940. The Veteran's ability to secure and follow a substantially gainful occupation is impacted by the physical effects of his left knee and left wrist disabilities. An April 2018 VA examination for the Veteran's left knee shows that he was not able to run, climb, or crawl. He reported difficulty with physical employment due to limitations in his ability to walk secondary from his left knee condition, and nonservice-connected back and feet disorders. The examiner opined that the Veteran would have limitations in physical employment due solely to his left knee diagnosis, but it would not preclude sedentary employment. The same examiner also examined the Veteran's left wrist. They opined that the Veteran might have some functional impairment due to lifting, pushing, and pulling with physical employment. He would not have functional limitations to sedentary employment. The Veteran's ability to secure and follow a substantially gainful occupation is impacted by the mental effects of his PTSD. The April 2018 VA examination shows that his disability resulted in difficulty in establishing and maintaining effective work and social relationships, as well as difficulty in adapting to stressful circumstances, including work or a worklike setting. The assigned 70 percent rating for PTSD specifically contemplates occupational and social impairment with deficiencies in most areas, such as work. Given the forgoing, the Veteran's service-connected left knee, left wrist, and psychiatric disabilities preclude him from the ability to secure and follow a substantially gainful occupation consistent with his education, skills, training, and work history. As discussed above, the Veteran's work history consists of being a laborer. His left knee and left wrist disabilities were opined to impact physical employment. His PTSD symptomatology includes difficulty in establishing and maintaining effective work relationships, and difficulty in adapting to stressful circumstances. He has not been employed during this appeal. Accordingly, a TDIU is warranted. Earlier Effective Date 9. Entitlement to an effective date earlier than September 13, 2017, for the grant of a 70 percent rating for PTSD The Veteran contends that an earlier effective date is warranted. The general rule regarding effective dates is that the effective date of a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 C.F.R. § 3.400. A specific claim in the form prescribed by the Secretary of Veterans Affairs must be filed in order for benefits to be paid to any individual under the laws administered by VA. 38 C.F.R. § 3.151. A "claim" means a written communication requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1 (p). "Date of receipt" generally means the date on which a claim, information, or evidence was received by VA. 38 C.F.R. § 3.1(r). Under 38 C.F.R. § 3.400(o)(2), the effective date of an award of increased disability compensation shall be the earliest date as of which it is factually ascertainable that an increase in disability had occurred, if application is received within one year from such date; otherwise, the effective date will be the date of VA receipt of the claim for increase, or the date entitlement arose, whichever is later. Id.; see also 38 U.S.C. § 5110(a), (b)(3). The Court has held that 38 U.S.C. § 5110(b)(3) and 38 C.F.R. § 3.400(o)(2) are applicable only where an increase in disability precedes a claim for an increased disability rating; otherwise the general rule of 38 C.F.R. § 3.400(o)(1) applies. See Harper v. Brown, 10 Vet. App. 125, 126 (1997). Thus, three possible dates may be assigned depending on the facts of the case: (1) if an increase in disability occurs after the claim is filed, the date that the increase is shown to have occurred (date entitlement arose) (38 C.F.R. § 3.400(o)(1)); (2) if an increase in disability precedes the claim by a year or less, the date that the increase is shown to have occurred (factually ascertainable) (38 C.F.R. § 3.400(o)(2)); (3) if an increase in disability precedes the claim by more than a year, the date that the claim is received (date of claim) (38 C.F.R. § 3.400(o)(2)). Harper, 10 Vet. App. at 126. Thus, determining an appropriate effective date for an increased rating under the effective date regulations involves an analysis of the evidence to determine (1) when a claim for an increased rating was received and, if possible, (2) when the increase in disability actually occurred. 38 C.F.R. §§ 3.155, 3.400(o)(2). Service connection for PTSD was initially granted in a July 2015 rating decision with a 50 percent rating assigned. The Veteran did not appeal, and that decision became final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 20.200, 20.302, 20.1103. No new and material evidence was received prior to the expiration of the appeal period for the July 2015 decision. An intent to file a claim was received on September 13, 2017, followed by a formal claim in March 2018. Treatment records in the one year prior to the claim do not show symptomatology warranting a 70 percent rating for PTSD. Symptoms of suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control; spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances; or inability to establish and maintain effective relationships are not shown in the Veteran's VA treatment records. The April 2018 rating decision on appeal granted a 70 percent rating, effective the date of the intent to file. Based on a review of the evidence, the Board concludes that an effective date earlier than September 13, 2017, is not warranted. In this case, the evidence in the one year prior to his claim does not show symptomatology supporting a 70 percent rating for PTSD. Therefore, the earliest possible effective date assignable in this circumstance is September 13, 2017. Therefore, the claim is denied. J. Komperda Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Barstow, 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.