Citation Nr: 22013151 Decision Date: 03/08/22 Archive Date: 03/08/22 DOCKET NO. 11-23 231 DATE: March 8, 2022 ORDER Prior to June 22, 2021, an initial rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is denied. Effective June 22, 2021, a 70 percent rating, but no higher, for PTSD is granted. Prior to December 16, 2020, entitlement to a total disability rating due to individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. Prior to June 22, 2021, the severity, frequency, and duration of the Veteran's PTSD symptoms did not more closely approximate occupational and social impairment with deficiencies in most areas. 2. Effective June 22, 2021, a 70 percent rating, but no higher, for PTSD. The severity, frequency, and duration of the Veteran's PTSD symptoms more closely approximated occupational and social impairment with deficiencies in most areas; they did not more closely approximate total occupational and social impairment. 3. Prior to December 16, 2020, the Veteran's service-connected disabilities do not preclude him from spersecuring and following substantially gainful employment. CONCLUSIONS OF LAW 1. Prior to June 22, 2021, the criteria for a disability rating in excess of 50 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. 2. Effective June 22, 2021, the criteria for a disability rating of 70 percent, but no higher, for PTSD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. 3. Prior to December 16, 2020, the criteria for a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from June 1966 to June 1968. For his meritorious service, the Veteran was awarded (among other decorations) the Vietnam Service Medal with Bronze Star and Fleet Marine Combat Insignia. This matter comes before the Board of Veterans' Appeals (Board) from a June 2009 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). In September 2011, the Veteran withdrew his request to testify at a hearing before a Veterans Law Judge. 38 C.F.R. § 20.704(e). In February 2019, the Board denied an initial rating in excess of 50 percent for PTSD and a TDIU. The Veteran appealed this decision to the United States Court of Appeals for Veterans Claims (Court). In December 2019, pursuant to a Joint Motion for Remand (JMR), the Court vacated the Board's denial and remanded the matter to the Board for additional proceedings. The Board remanded the claims in November 2020 to obtain updated VA examinations and further development regarding entitlement to a TDIU. The Board finds substantial compliance with the remand directives and therefore another remand is not necessary. Stegall v. West, 11 Vet. App. 268 (1998). 1. Increased rating for PTSD The Veteran contends he is entitled to a rating in excess of 50 percent for 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). A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. 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. Here, the Board concludes that the Veteran's symptoms did not cause the level of impairment required for a disability rating greater than 50 percent prior to June 22, 2021. The Veteran's symptoms more closely approximated the symptoms associated with a 50 percent rating and resulted in a level of impairment that most closely approximated the level of impairment associated with a 50 percent rating. The Board further concludes that, effective June 22, 2021, 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. However, his symptoms did not more nearly approximate the symptoms associated with a 100 percent rating or cause the level of impairment required for a disability rating of 100 percent. Prior to the June 2021 VA examination, VA and private treatment records, the May 2009 and December 2015 VA examinations, and the Veteran's lay statements show that the Veteran's PTSD was manifested by symptoms associated with a 50 percent rating (impaired judgment, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships), and symptoms associated with a 70 percent rating (difficulty in adapting to stressful circumstances (including work or a worklike setting) and suicidal ideation). He also had symptoms that are not listed with a specific rating, such as constricted affect, hypervigilance, easy startling, nightmares, and intrusive memories. The Veteran first presented for psychiatric treatment in May 2008. He reported that he retired because the pressure from his job caused him to lose his temper. His mood was reported as dreary and down, but he interacted in a pleasant manner. Affect was constricted and inappropriate to content of speech. The Veteran presented with disrupted sleep, fair appetite, and limited judgment and insight. The Veteran denied thoughts of hurting himself or others. Throughout 2008 and 2009 the Veteran tried medication without success and attended a 12-week PTSD group. He reported symptoms of depressed mood, occasional nightmares, impaired sleep, and intrusive memories. In September 2008 he was noted to have mild to moderate avoidance symptoms, hyperarousal symptoms, depression, and overall mild symptoms of PTSD. However, the Veteran also reported passive suicidal ideation within the past two weeks without intention or plan. The physician determined he was not a risk to himself or others. At the May 2009 VA examination, the Veteran reported problems with memory and concentration, impaired sleep resulting in daytime fatigue, hypervigilance, intrusive memories, ruminating thoughts, once monthly nightmares, easy startling, and a poor outlook on his future. Mental status examination showed euthymic mood and mildly constricted affect, though the Veteran reported his mood was somewhat depressed. Additionally, while the Veteran described some forgetfulness and concentration difficulties, none were noted on examination and memory functions appeared relatively intact regarding recent remote recall. Thought content was mildly concrete but within normal limits. The Veteran trialed different medications from 2010 to 2012 with improvement of his symptoms. In October 2012, the Veteran reported he was doing well with better appetite, sleep, coping mechanisms, and frustration tolerance. He was noted to be stable with his current medications with no side effects. Mental status examination was normal. The Veteran consistently denied suicidal thoughts throughout this period, citing his religious beliefs and friends as protective factors. April 2013 VA treatment records show he stopped taking his medication but continued to report he was doing well until March 2014 when PTSD and depression screens showed mild to moderate symptoms of nightmares, avoidance, hypervigilance, disturbing memories, loss of interest, feeling distant and cut off from others, feeling emotionally numb, trouble sleeping, difficulty concentrating, and hypervigilance. The Veteran also reported that he felt jumpy and had irritable or angry outbursts quite a bit. At the December 2015 VA examination the Veteran reported poor sleep, flashbacks three to four times per week, poor relationships, avoidance of crowds, and moderate symptoms of depression. He further reported no mental health treatment since 2012, and side effects from psychiatric medications. Mental status examination was normal. The examiner described his current symptoms as depressed mood, anxiety, chronic sleep impairment, and difficulty in establishing and maintaining effective work and social relationships. Subsequently, VA treatment records contain no reports of psychiatric symptoms, treatment, or medication until May 2019 despite the Veteran receiving regular treatment at VA for other conditions. In May 2019 a screen for PTSD was negative, though he reported that over the past month he had nightmares, avoided thinking of traumatic events and reminders thereof, and was constantly on guard, watchful, or easily startled. He denied suicidal thoughts. In February 2021 the Veteran's mood and affect were appropriate, and he had good insight and memory. He was not on any psychiatric medication. In summary, the Board finds the severity, frequency, and duration of the Veteran's listed and unlisted symptoms prior to June 2021 more closely approximate the symptoms contemplated by a 50 percent rating. See 38 C.F.R. § 4.126. The weight of the competent medical evidence suggests that while the Veteran was always hypervigilant and easily startled, symptoms of nightmares, intrusive memories, and constricted affect were not present daily, but would increase in severity with additional stressors or changes in medication. Further, these symptoms are similar to panic attacks more than once a week, impaired abstract thinking, disturbances of motivation and mood, and flattened affect, which are contemplated by the assigned 50 percent rating. However, the weight of the evidence indicates a worsening of the severity, frequency, and duration of the Veteran's symptoms effective June 22, 2021. Accordingly, as of June 22, 2021, the Board concludes that the Veteran's symptoms caused the level of impairment required for a disability rating of 70 percent. At the June 2021 VA examination the Veteran reported that he does not sleep well, has road range and anxiety, and is hypervigilant and easily startled. The Veteran reported that he walks around the house and the yard to check the perimeter and that he struggles with concentration while reading. The Veteran appeared anxious on examination. The examiner described the Veteran's symptoms as follows: disturbances of motivation and mood; suspiciousness; panic attacks that occur weekly or less often; chronic sleep impairment; mild memory loss, such as forgetting names, directions or recent events; flattened affect; difficulty in establishing and maintaining effective work and social relationships; and difficulty adapting to stressful circumstances, including work or a work like setting. At that examination, while his PTSD was manifested primarily by symptoms associated with a 50 percent rating, as above, the examination showed additional symptoms that are associated with a 70 percent rating (difficulty adapting to stressful circumstances, including work or a work like setting, and near-continuous depression). The Board further notes that the Veteran expressed suicidal ideation, which is similar to persistent danger of self-harm, which is contemplated by the 100 percent criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017). However, the severity, frequency, and duration of the Veteran's suicidal ideation has not risen to the level contemplated by the 100 percent disability rating. The Veteran regularly denied thoughts, intent, or a plan involving self-harm in existing treatment records, and during the VA examinations of record. The Veteran only reported suicidal thoughts to medical providers once since 2008 and was determined to not be a risk of harm to himself or others at the time. See September 2008 VA treatment record. The Board has considered the lay statements of record regarding his symptoms. Two of the Veteran's friends report that the Veteran experiences moodiness, irritability, and a volatile temper. See March 2009 statement from J.W.; October 2009 Statement from K.H. Moreover, while J.W. indicated in the March 2009 statement that the Veteran will deny suicidal thoughts, but J.W. "knows better," there is no indication from the Veteran's lay statements or the competent medical evidence of record that the Veteran experienced suicidal thoughts other than the one instance noted above. As J.W.'s statement is speculative and unsupported by other evidence in the record, it is given little probative weight. The Veteran reports nearly constant depression, nightmares almost every night, hypervigilance, monthly flashbacks, forgetfulness, distractibility, social isolation, and intermittent periods where he neglects his personal hygiene due to increased depressive symptoms. See, e.g., August 2020 VA Form 21-8940; July 2020 Employability Evaluation by Ms. R.B. While the Board finds these statements to be entitled to some probative weight, the Board finds them to be outweighed by the evidence of record that the Veteran sought no mental health treatment from December 2015 to June 2021 even though he consistently sought treatment for other conditions during that period. Though the absence of significant treatment during this time period is not altogether dispositive of the claim, it is nonetheless probative evidence to be considered in deciding this claim and may be viewed as evidence indicating a lesser severity of illness than contended. See, AZ v. Shinseki, 731 F.3d 1303, 1318 (Fed. Cir. 2013) (recognizing the widely held view that the absence of an entry in a record may be considered evidence that the fact did not occur if it appears that the fact would have been recorded if present). Regarding the level of impairment caused by the Veteran's symptoms, prior to the June 2022 VA examination, the Board finds the level of impairment more closely approximates the level associated with a 50 percent rating. The Veteran experienced occupational and social impairment with reduced reliability and productivity. Mental status examinations in VA treatment records and the VA examinations of record indicate that the Veteran had altered mood and affect intermittently throughout the appeal period but was otherwise within normal limits. While the Veteran has consistently reported social isolation and anger management problems impacting personal and work relationships, the severity of those limitations gradually worsened over the appellate period. For example, in May 2008 he reported that he retired because the pressure from his job caused him to lose his temper. The Veteran reported that he watches his two grandchildren several times per week and spends his time cutting grass, tending his garden and goes bowling once a week. See June 2008 and December 2008 VA treatment records. At the May 2009 VA examination, the Veteran reported social isolation due to aggravation when he is around others and daily anger management problems; however, he also reported that he was close to his siblings and some long-term fishing friends. In April 2013 VA treatment records he reported feeling distant and cut off from others. At the December 2015 VA examination he reported poor relationships and avoidance of crowds. The examiner found his psychiatric symptoms cause occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal). As above, there are no VA treatment records indicating the severity of the Veteran's social or occupational impairment after the December 2015 VA examination until May 2019. The competent evidence prior to the June 2022 VA examination weighs in favor of finding that the level of impairment caused by the Veteran's symptoms more closely approximate the level associated with a 50 percent rating. However, as of the June 2021 VA examination, the Board finds the weight of the evidence indicates that the level of impairment caused by the Veteran's symptoms worsened to more closely approximate the level associated with a 70 percent rating. At that time, the Veteran experienced occupational and social impairment with reduced reliability and productivity with deficiencies in most areas. At the June 2021 VA examination, the Veteran reported that he is only close to his stepdaughter and has one brother who he sees once per month; otherwise, he keeps to himself. The Veteran reported only going to stores when few people are present. The examiner indicated that the Veteran has significant difficulty functioning around other people, has difficulty functioning as a team member, feels uncomfortable around others, and cannot tolerate being around other people in any setting for more than a few minutes. Additionally, the examiner noted that the Veteran is so depressed that he has difficulty sustaining energy and motivation to complete assignments at work. Accordingly, the examiner's remarks indicate social and occupational limitations that more closely approximate occupational and social impairment with reduced reliability and productivity. Additionally, while the Veteran evidence indicates the Veteran was intermittently unable to perform activities of daily living as of June 2021 a symptom contemplated by a 100 percent ratingthe 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 has been granted a total disability rating based on individual unemployability effective December 2020 due to service-connected disability, this grant was based on the combined effects of bilateral hearing loss and tinnitus rather than his PTSD. In short, while the Veteran experienced some symptoms contemplated by a 70 percent rating prior to June 2021 difficulty in adapting to stressful circumstances (including work or a worklike setting) and one instance of suicidal ideationthe evidence overall does not demonstrate the level of impairment associated with a 70 percent rating during. However, as of the June 2021 VA examination, the evidence of record persuasively weighs in favor of finding that the severity, frequency, and duration of the Veteran's symptoms resulted in the level of impairment required for a 70 percent rating. Accordingly, as the evidence of record persuasively weighs against the claim for a rating greater than 50 percent prior to June 22, 2021, and greater than 70 percent thereafter, the benefit-of-the-doubt rule does not apply, and any higher ratings must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, No. 2020-2067, 2021 U.S. App. LEXIS 37307 (Fed. Cir. Dec. 17, 2021). As of the date of the grant, the Veteran will be at 100 percent schedular. The Board does not find that it need further address the effects of this in this decision. 2. Entitlement to a TDIU The Veteran contends has been unable to work since July 2008 due to his service-connected disabilities of diabetes, PTSD, hearing loss, and tinnitus. The Veteran was granted a TDIU effective December 16, 2020; therefore, the Board will address entitlement to a TDIU prior to that date. A total disability rating for compensation may be assigned when a veteran receives less than a total disability rating (i.e., less than a 100 percent combined disability rating) and is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. Regulations provide that if a veteran is service connected for one disability, it must be rated as 60 percent disabling or more. If a veteran is service connected for two or more disabilities, at least one disability must be rated at 40 percent or more, and sufficient additional disability must bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16. In making this determination, the following will be considered one disability: (1) Disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable; (2) disabilities resulting from common etiology or a single accident; (3) disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric; (4) multiple injuries incurred in action; or (5) multiple disabilities incurred as a prisoner of war. 38 C.F.R. § 4.16 (a). The Veteran has the following disabilities that are service connected: bilateral hearing loss (rated 0 percent prior to December 16, 2020, and 80 percent thereafter); PTSD (rated 50 percent prior to June 22, 2021, and 70 percent thereafter); diabetes mellitus, type 2 (rated 20 percent effective May 2006); and tinnitus (rated 10 percent effective July 2008). The Veteran's combined rating is 20 percent effective May 2005, 60 percent effective July 31, 2008, and 90 percent effective December 16, 2020. Based on the forgoing, the Veteran does not meet the percentage standards set forth in § 4.16(a) before December 16, 2020. However, the Veteran argues that his PTSD, hearing loss, and tinnitus disabilities should be considered a single 60 percent disability because they all result from combat in the Republic of Vietnam. For the reasons that follow, the Board finds his service-connected PTSD, tinnitus and hearing loss were all incurred in action, and therefore are considered a single disability rated at 60 percent to satisfy the percentage standards set forth in § 4.16(a) effective July 31, 2008. A review of the record shows that his hearing loss and tinnitus were found to be related to noise exposure from his military occupational specialty (MOS) of Seabee and his service in Vietnam, and his PTSD was related to combat in Vietnam. The August 2010 VA examiner who opined his hearing loss and tinnitus were related to service specifically attributed these conditions to acoustic trauma from exposure to heavy equipment, explosives, and M16 qualification activities. While the M16 qualification occurred outside of Vietnam, the Veteran reported noise from explosives, heavy machinery, and rocket and mortar attacks during his service in Hue Phu Bai in Vietnam. Further, the Veteran's PTSD was found to be related to his claimed stressor of combat operations in Hue Phu Bai. The Board thus finds the evidence is in relative equipoise regarding whether his PTSD, hearing loss and tinnitus disabilities were all incurred in action. As these disabilities are considered one disability for purposes of determining whether the Veteran meets the schedular requirements for a TDIU, the Board finds that the Veteran meets the schedular criteria effective July 31, 2008. Accordingly, the Board now turns to the merits of the claim. In determining employability for VA purposes, consideration is given to the level of education, special training, and work experience. 38C.F.R.§3.341, 4.16(a), 4.19; Faust v. West, 13 Vet. App. 342 (2000). The question is whether the Veteran is capable of performing the physical and mental acts required by employment. Van Hoose v. Brown, 4 Vet. App. 361 (1993); 38C.F.R.§4.1, 4.15, 4.16(a). Age or impairments caused by nonservice-connected disabilities may not be considered when determining whether such a total disability rating is warranted. See 38 C.F.R. §§ 3.341, 4.16, 4.19. Under the facts of this case, the Board finds entitlement to a TDIU is not warranted. When considering entitlement to TDIU, the record must demonstrate some factor that takes the Veteran's situation outside the norm since the VA Rating Schedule already is designed to take into consideration impairment that renders it difficult to obtain and keep employment. See Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Under the facts of this case, it cannot be said that the Veteran's service-connected disabilities produce total unemployability. The Veteran contends he retired from work due primarily to difficulties working with colleagues and supervisors because of his PTSD symptoms, and that his symptoms became worse after he retired. The Veteran also reports that his hearing disabilities made it difficult to hear others, especially in noisy environments, and that fluctuating blood sugar levels due to diabetes caused him to feel unwell. See August 2020 VA Form 21-8940. The Veteran has a 10th grade education. His work experience consists of metal fabricator, marine machinist, and foreman. He last worked in February 2008. In a July 2020 Employability Evaluation, the evaluator described his past work as requiring medium strength physical exertion or greater and being skilled work according to the Dictionary of Occupational Titles. The Veteran's prior employer confirmed the Veteran retired before he was fired because he could not get along with others. The Veteran's employer reported that he missed two weeks of work due to disability in the 12 months before he retired in February 2008. See December 2020 VA Form 21-4192. VA treatment records further provide that the Veteran reported that he felt the management put unrealistic expectations on him. The Veteran claimed that he did not like how things were at his job, so he felt it was time for him to retire. See, e.g., May 2008 VA treatment record. The Veteran's ability to secure and follow a substantially gainful occupation is impacted by the physical effects of his service-connected hearing loss, tinnitus, and PTSD. Regarding the Veteran's diabetes, the Board finds no significant occupational limitations as his treatment has been well controlled throughout the appeal period, and by May 2014 his diabetes was so well controlled that his medication was discontinued. See, e.g., June 2010 and August 2015 VA treatment records, May 2021 VA examination. Regarding the Veteran's bilateral hearing loss and tinnitus, the Board finds these conditions result in some difficulty hearing and understanding others. Prior to the May 2021 VA examination, the Veteran was able to understand speech in environments without significant background noise sufficiently well to communicate in most work environments. For example, speech discrimination bilaterally was 80 percent at the August 2010 VA examination, and was the same or better in March 2012 VA treatment records. However, at the August 2020 VA examination the Veteran reported that he cannot understand speech. The examiner opined that the Veteran's tinnitus caused significant occupational effects in his ability to hear, but that there was no impact on his daily activities. Audiometry testing is unavailable until the most recent VA examination in May 2021 where the examiner reported significant occupational impairment from tinnitus and hearing loss. The Veteran's rating for bilateral hearing loss was increased to 80 percent as of the date of that examination. However, to the extent the Veteran claims his hearing became worse prior to May 2021, there is no point at which it is factually ascertainable that the Veteran's hearing impairments were so severe as to produce significant occupational impairment prior to that date. Regarding the Veteran's PTSD, his symptoms and occupational limitations are discussed in detail above. To summarize, the Veteran's PTSD symptoms make it difficult for him to interact and work with others, handle stress, and maintain concentration and attention for prolonged periods. The Veteran submitted an Employability Evaluation completed by certified rehabilitation counselor Ms. R.B. in July 2020. The assessment does not consider the symptoms or limitations related to diabetes. After an interview with the Veteran and review of his claims file, Ms. R.B. opined that the Veteran's PTSD and tinnitus make the Veteran unable to secure and follow substantially gainful employment including unskilled sedentary work since at least July 2008, continuing to present date. Ms. R.B opined that his bilateral hearing loss further precluded him from securing and following substantially gainful employment at even the unskilled sedentary level since at least May 2010 and continuing to present date. Specifically, Ms. R.B. explained that his PTSD symptoms result in the need for frequent unscheduled breaks and an inability to concentrate on work tasks for two-hour periods; difficulty retaining new information or instructions which would in turn require frequent supervision and redirection; and that he would be unable to unable to meet employers' expectations of pace and productivity even in unskilled sedentary work. Due to the Veteran's isolative tendencies, irritability and inability to interact inappropriately with others he would only be able to perform work in total isolation, which is not permitted in any field of employment. The Board notes that the Ms. R.B. is a certified rehabilitation counselor and is therefore competent to opine on what types of occupations would be precluded by the Veteran's physical and psychiatric limitations. However, as she is not a qualified medical provider, she has not been shown to have the experience, education, and training necessary to make a competent opinion regarding the extent of his physical and psychiatric limitations. This is an area outside the scope of the examiner's expertise. LeShore v. Brown, 8 Vet. App. 406, 409 (1995). Therefore, Ms. R.B.'s opinions regarding characterization of his specific symptoms and physical or psychiatric limitations therefrom are of no probative weight. Sklar v. Brown, 5 Vet. App. 140 (1993). Considering the evidence as a whole, the Board finds Ms. R.B.'s conclusion that the Veteran's PTSD resulted in the above limitations from July 2009 onward to be inconsistent with the weight of the evidence. The Board therefore gives her opinion regarding the limitations from PTSD no probative weight and finds it to be outweighed by the other evidence of record. Moreover, while, Ms. R.B. is competent to render an opinion regarding the types of occupations precluded by the Veteran's limitations, her conclusions regarding such are given little weight to the extent the Board has found the underlying assessments of abilities inconsistent with the weight of the evidence, as above. While the Board does not doubt the sincerity of the Veteran's contentions, and that his service-connected disabilities do impair his ability to work, the evidence does not weigh in favor of a finding that he has been unable to engage in substantial gainful employment prior to December 2020 due to his service-connected disabilities. As above, while the Veteran's PTSD caused worsening social and occupational functioning over the appellate period, the evidence persuasively weighs against a finding that it resulted in substantial occupational limitations until after December 2020. The Board emphasizes that the mere fact that a Veteran is unemployed, underemployed, or has difficulty obtaining employment is not enough to warrant a TDIU. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). In other words, the fact that the Veteran was able to maintain employment up until retirement shows that he is capable of performing the physical and mental acts required by employment. In summary, the Board finds the Veteran has no significant exertional limitations to perform the physical demands of most types of work. Further, while his service-connected disabilities cause significant non-exertional limitations as above, the Veteran retains the ability to perform work with limited social interaction and changes to routine. Given the forgoing, the Veteran's service-connected disabilities do not preclude him from the ability to secure and follow a substantially gainful occupation consistent with his education, skills, training, and work history for the time period in question. The Board emphasizes that the rating schedule is intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. To the extent the service-connected disabilities impact employment, the assigned schedular rating compensates the Veteran for such impairment. Further, to the extent the Veteran contends the severity of his PTSD increased after he retired, the staged rating granted herein compensates the Veteran for such worsening. Nathaniel J. Doan Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K.L. Blevins, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.