Citation Nr: 22014372 Decision Date: 03/12/22 Archive Date: 03/12/22 DOCKET NO. 15-18 706 DATE: March 12, 2022 ORDER For the period on appeal prior to September 1, 2010, entitlement to an evaluation of 50 percent, but not higher, for a schizophrenia disability, is granted. For the period on appeal between September 1, 2010, and March 8, 2015, entitlement to an evaluation of 70 percent, but not higher, for a schizophrenia disability is granted. For the appeal period from January 2013 entitlement to a total disability rating due to individual unemployability (TDIU), is granted. FINDINGS OF FACT 1. For the period on appeal prior to September 1, 2010, the Veteran's schizophrenia disability has demonstrated occupational and social impairment with reduced reliability and productivity with corresponding symptomatology. 2. For the period on appeal between September 1, 2010, and March 8, 2015, the Veteran's schizophrenia disability has demonstrated occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, with corresponding symptomatology. 3. For the appeal period from January 2013 the Veteran has been precluded from obtaining and maintaining substantially gainful employment by his service-connected disability. CONCLUSIONS OF LAW 1. For the period on appeal prior to September 1, 2010, the criteria for a rating of 50 percent for schizophrenia are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.130, Diagnostic Code 9203. 2. For the period on appeal between September 1, 2010, and March 8, 2015, the criteria for a rating of 70 percent for schizophrenia are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.130, Diagnostic Code 9203. 3. For the appeal period from January 2013 the criteria for entitlement to a TDIU are met. 38 U.S.C. § 1155; 38 C.F.R. § 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from June 1971 to July 1974. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This matter has been previously before the Board in March 2020, and appealed to the Court of Appeals for Veterans Claims (CAVC). The March 2020 decision denied the issue of entitlement to a disability rating in excess of 30 percent for schizophrenia prior to September 1, 2010; however, the Board granted a 50 percent rating effective from September 1, 2010, to March 8, 2015. The Veteran appealed the March 2020 decision to the CAVC. In a July 2021 Memorandum Decision, the CAVC set aside the decision and remanded it. CAVC found the Board provided inadequate reasons and bases. Specifically: The Board failed to identify any individual symptom that contributed to the appellant's level of occupational and social impairment between March 27, 2000, and September 1, 2010, or all the symptoms that contributed to the appellant's level of occupational and social impairment between the September 1, 2010, and March 8, 2015, period. The Board also failed to address the severity, frequency, and duration of all the appellant's symptoms in both periods. Remand is required for the Board to provide an adequate statement of reasons or bases with a holistic analysis that assesses all the appellant's anxiety symptoms, as well as the severity, frequency, and duration of those symptoms. See 38 U.S.C. § 7104(d)(1); see also Bankhead v. Shulkin, 29 Vet. App. 10 (2017). CAVC further found, On remand, the Board should adjudicate whether the appellant is entitled to a total disability rating based on individual unemployability as "part and parcel" of the appellant's increased-rating claims. See Rice v. Shinseki, 22 Vet. App. 447, 453-55 (2009). The record appears to contain potentially "cogent" evidence of unemployability, see id., specifically a May 2012 private vocational report in which the examiner concluded that the appellant has only been able to maintain supported employment and that his schizophrenia "may continue to keep him from being able to secure competitive employment," R. at 1523, or "it might make be difficult or impossible for him to obtain and maintain employment outside of a supported situation." As such the Board will proceed with the merits of this appeal providing a holistic analysis for the increased rating and TDIU claim. Increased Rating Disability ratings 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. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran. See 38 C.F.R. § 4.3. The evaluation of the same disability under various diagnoses, and the evaluation of the same manifestation under different diagnoses, are to be avoided. 38 C.F.R. § 4.14. The Veteran's entire history is to be considered when making disability evaluations. See 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. For the period on appeal prior to September 1, 2010, entitlement to an evaluation in excess of 30 percent for a schizophrenia disability 2. For the period on appeal between September 1, 2010, and March 8, 2015, entitlement to an evaluation in excess of 50 percent for a schizophrenia disability The Veteran contends for the rating period prior to September 2010 a rating in excess of 30 percent is warranted and for the appeal period from September 2010 to March 2015 a rating in excess of 50 percent is warranted. The Board agrees as discussed below. In a December 2011 rating decision, the RO granted the Veteran service connection for a schizophrenia disability with a 30 percent evaluation under Diagnostic Code (DC) 9203, effective March 27, 2000. See 38 C.F.R. § 4.130. Later, in a March 2015 rating decision, the RO increased the Veteran's evaluation for a schizophrenia disability to 70 percent, effective March 8, 2015. Under DC 9203 and the General Rating Formula for Mental Disorders, a non-compensable (0 percent) evaluation is warranted where a mental condition has been formally diagnosed but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication. A 10 percent evaluation is warranted where there is occupational and social impairment due to mild or transient symptoms that decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication. See 38 C.F.R. § 4.130. A 30 percent evaluation is warranted where there is occupational 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) due to symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events). Id. A 50 percent evaluation is warranted where there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short-and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent evaluation is warranted where there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech that is intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. Id. A 100 percent evaluation requires total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name. Id. Symptoms listed in the VA's general rating formula for mental disorders serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating, and are not intended to constitute an exhaustive list. See Mauerhan v. Principi, 16 Vet. App. 436, 442-44 (2002). The U.S. Court of Appeals for the Federal Circuit (Federal Circuit) has emphasized that the list of symptoms under a given rating is a non-exhaustive list, as indicated by the words "such as" that precede each list of symptoms. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 115 (Fed. Cir. 2013). In Vazquez-Claudio, the Federal Circuit held "that a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage or others of similar severity, frequency, and duration." Id. at 117. Other language in the decision indicates that the phrase "others of similar severity, frequency, and duration," can be thought of as symptoms of like kind to those listed in the regulation for a given disability rating. Id. at 116. Per applicable rating criteria, when evaluating a mental disorder, the frequency, severity, duration of psychiatric symptoms, length of remissions, and the Veteran's capacity for adjustment during periods of remission must be considered. See 38 C.F.R. § 4.126(a). In addition, the evaluation must be based on all the evidence of record that bears on occupational and social impairment, not solely on the examiner's assessment of the level of disability at the moment of the examination. Id. Further, when evaluating the level of disability from a mental disorder, the extent of social impairment is considered, but the rating cannot be assigned solely on the basis of social impairment. See 38 C.F.R. § 4.126(b). Turning to the evidence, in a March 2000 letter, the Veteran's physician, Dr. A.L., noted that the Veteran suffered from schizophrenia, but he was doing very well and compliant with his medication. At the time, he was also employed and doing well at his job. In July 2001 VA treatment records, the Veteran reported that he had been diagnosed with schizophrenia, and for the past 12 years he had treated the condition with monthly Haldol Decanoate injections. He also indicated he had been hospitalized in July 1997 for this condition. He reported that when he did not take his medication, he felt as if he were "falling off a cliff" and having a nightmare. He was reported to live with his mother and work full-time as a government mail clerk. He Veteran indicated that his psychiatric symptoms were under control with medication. The psychologist found the Veteran to be clear, calm, alert, and oriented with his memory intact. In an April 2002 VA Psychiatric Note, the Veteran was reported to be psychiatrically stable. The Veteran denied any difficulty with hallucinations or anhedonia. His mood was ok. He noted being depressed at times, as his life had not been where he feels it should have been. The Veteran had a girlfriend, and he was taking a computer class, which he enjoyed. In April 2004 VA treatment records the Veteran reported that he did not socialize much and "is now out of touch with his 27-year-old daughter and her six children." In an April 2004 Psychiatric Note, the Veteran denied ongoing psychotic symptoms. He also denied depression or suicidal ideation. He described his mood as good. His sleep and appetite were adequate. The Veteran reported that he did not socialize much, but things were going well at home with no problems. The examiner found that the Veteran had no thought disorder, and he described the Veteran as pleasant and cooperative. The Veteran was unshaven, but his affect had full range. His mood was euthymic. He had no abnormal movements, and his speech was within normal limits. In a related letter, the examiner noted that the Veteran was stable and free of major symptoms of schizophrenia. In a February 2005 Psychiatric Note, the Veteran stated that he was getting along well at home and work, and he denied interpersonal conflict problems. He denied depressive or manic symptoms, and his sleep and appetite were satisfactory. The Veteran also denied psychotic problems, hallucinations, and delusions. The examiner found the Veteran to be calm, pleasant, and cooperative without overt disorganization or negative symptoms. The Veteran's schizophrenia was reported to be stable and under control with medication. In a February 2010 Psychiatric Note, the Veteran was found to be alert, oriented, and cooperative. His speech was clear, coherent, and normal; and his thought process was goal-directed. He endorsed auditory verbal hallucinations. He denied paranoia, suicidal ideation, or homicidal ideation. His judgement and insight were fair. An August 2010 VA examination report indicated review of the Veteran's claims file, recounted the Veteran's history, and recited his complaints. He was diagnosed with schizophrenia, paranoid type. The Veteran reported that he was receiving outpatient psychiatric treatment at the VAMC, where he presented monthly for a medication injection. He also took risperidone daily, and he met with a psychiatrist every three months. He stated that his medication regimen worked fine with no adverse side effects. The VA examiner observed that the Veteran's behavior in the session was appropriate. He was pleasant, cooperative, and forthcoming. He was adequately groomed with appropriate attire, and there was no evidence of psychomotor abnormalities. He was able to maintain personal hygiene and basic activities of daily living. He had orientation to person, place, and time; and his rate and flow of speech were normal. He reported vague paranoid ideation and difficulty with social skills. His appetite and energy level were appropriate. It was noted there was some disorganized reasoning and vague thought content. Thought process was tangential and at times it was difficult to understand his line of reasoning. Past medical records indicated ongoing vague speech, likely due to low grade thought disorder rather than intentional vagueness. He denied present perceptual disturbances, however he expressed vague thoughts of paranoia that were not well-focused but was without overt delusional content. He denied suicidal or homicidal ideation. The examiner described the Veteran's psychiatric symptoms as moderate, chronic, and continuous, and stated that these symptoms mildly affected his employment and severely affected his relationships. The August 2010 VA examiner observed that the Veteran has been functioning well in the community and had been able to maintain employment. His general work history was good, and he had not missed work over the past year. The Veteran noted that he had won an Outstanding Employee Award 4 times over a 16-year period. The Veteran was a widower, having been married between 2005 and 2007. He had one adult daughter whom he saw once or twice a month, as well as grandchildren. He lived with his mother and grandniece. He appropriately interacted with others, and he was capable of basic activities of daily living. He was able to meet work demands and responsibilities, as well as family responsibilities. However, the Veteran tended to isolate himself, and he reported that he did not socialize with coworkers. He had one female friend whom he saw every weekend; he had known her for two years. The Veteran also reported difficulty with social skills, specifically with introductions and greeting other people. Additionally, the August 2010 VA examiner found that the Veteran displayed deficits in communication, presumably due to a low-grade thought disorder. The Veteran additionally reported mild short-term memory impairment. In an April 2012 Vocational assessment, it was noted, the Veteran was extremely conscientious about completing all paperwork, however seemed easily confused about instructions. In some cases, he had difficulty understanding directions and completing sample problems on the testing. He worked slowly on the testing but was able to complete the identifying information. It was further noted that he was not a good historian as he had difficulty reporting his work, incarceration, and medical histories. He reported trouble communicating and was confused about the career path he should take. The vocational counselor indicated although medication controls the worst of his symptoms, he still has impaired thought process that is chronic and not likely to improve in the foreseeable future. His condition was otherwise found to be stable and controlled with medication. An August 2012 VA examination report indicated review of the Veteran's claims file, recounted the Veteran's history, and recited his complaints. He was diagnosed with schizophrenia, paranoid type. The examiner noted that the Veteran was generally functioning pretty well, and he was able to maintain employment. The Veteran had only some mild symptoms, at times more persistent and durable than transient and expectable reactions to psychosocial stressors. The symptoms were not always linked to clear and brief/ temporary stressor. There was only some difficulty in social, occupational, or school functioning, not always clearly tied to a brief and temporary stressor. The Veteran's level of occupational and social impairment was described as "mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication. The Veteran's behavior at this session was appropriate, and he was alert and cooperative. He was able to maintain personal hygiene and basic activities of daily living; and he was oriented to person, place and time. His rate and flow of speech were normal, and he did not have impaired impulse control. He denied having hallucinations, delusions, suicidal ideation, and homicidal ideation. He was capable of managing his financial affairs. The Veteran exhibited symptoms of flattened effect and impaired abstract thinking; as well as circumstantial, circumlocutory, or stereotyped speech. He was noted to have problems with social isolation. The Veteran also reported mild short-term memory impairment. It was noted the Veteran's thought process or communication consisted of some vague, circumstantial speech, but he was able to clarify his intent when questioned. In a July 2013 VA Mental Health Note, the Veteran's thought process was reported to be tangential at times with derailment. He reported doing well as he was hopeful and wanted to start working again. He denied depression and paranoia. In a November 2013 VA treatment record a mental status examination indicated the Veteran had good grooming and hygiene. He was pleasant and cooperative. He denied suicidal and homicidal ideation. Although his thought processes were slightly disorganized at times, they were logical and linear goal directed. His judgement and insight were fair. In a May 2014 Mental Health Note, the Veteran reported that he had been misinterpreting his family members, and he felt that they could not accept him with his illness. He also felt at times that people were plotting against him, but he stated this did not bother him because he was taking care of himself. Even so, he denied altercations or conflicts, and reported he was getting along with the family members he lived with. In another May 2014 VA Mental Health Note, the Veteran's thought process was noted too often be circumferential and at times tangential. In November 2014 VA treatment records the Veteran reported he has been feeling well overall. He denied psychotic symptoms and indicated his mood was good. He denied depressive or manic symptoms. He indicated he spends time watching the news and reading. He continues to live with his mother and sister, and claims they are getting along with no problems. A March 2015 VA examination report indicated review of the Veteran's claims file, recounted the Veteran's history, and recited his complaints. The VA examiner found that the Veteran had occupational and social impairment with reduced reliability and productivity. The Veteran exhibited symptoms of suspiciousness; chronic sleep impairment; mild memory loss (such as forgetting names, directions, or recent events); flattened affect; circumstantial, circumlocutory, or stereotyped speech; speech that was intermittently illogical, obscure, or irrelevant; and difficulty in adapting to stressful circumstances (including work or a work-like setting). The VA examiner reported that the Veteran was tangential during the examination. He had a hard time answering questions directly and was nonsensical at times. When asked if he lived with family members, the Veteran responded that, "That's a good question. That's what I'm wondering." No psychotic symptoms were reported, but the Veteran appeared somewhat disorganized during examination. His sleep, appetite, and energy level were reported to be fair. He described his mood as "in between." The Veteran denied having current auditory or visual hallucinations, and he denied suicidal or homicidal ideation. The Veteran was capable of managing his financial affairs. During the March 2015 VA examination he reported that, in August 2014, he had obtained a position as a janitor through the VAMC Compensated Work Therapy Program; and he worked in the position briefly. However, it did not work out, and he quit the position. When asked why he quit, he stated that he did not like riding the bus with co-workers because he could hear them talking, even though they were not talking about him. He also did not like that other worker's in the building might interact with him; and he reported that a co-worker talked a lot while they worked. For the appeal period prior to September 2010 the Board has reviewed all of the lay and medical evidence of record in conjunction with the applicable laws and regulations and finds the Veteran's psychiatric disability, based on a holistic analysis, warrants a 50 percent disability rating. In this regard, for the appeal period prior to September 2010, the Board finds the treatment records and August 2010 VA examinations probative. There is evidence of occupational and social impairment with reduced reliability and productivity warranting a 50 percent evaluation. Specifically, there was evidence of disturbance in his motivation and mood as demonstrated in the April 2002 treatment records where he reported being depressed at times, as his life had not been where he feels it should have been. There's evidence of difficulty in establishing and maintaining effective work and social relationships as demonstrated in the April 2004 VA treatment records where the Veteran reported that he did not socialize much and "is now out of touch with his 27-year-old daughter and her six children." Also, in the August 2010 VA examination he reported tending to isolate himself, as he did not socialize with coworkers. He also reported having only one female friend and difficulty with social skills. Furthermore, the examiner described the Veteran's psychiatric symptoms as moderate, chronic, and continuous, and stated that these symptoms mildly affected his employment however, they severely affected his relationships. There is evidence of memory loss as demonstrated in the August 2010 VA examination. Other than the symptoms specifically addressed above, the record for this appeal period has consistently indicated the Veteran's schizophrenia was reported to be stable and under control with medication as demonstrated in the March 2000 letter, July 2001 VA treatment records, April 2002 VA Psychiatric Note, April 2004 VA treatment records, February 2005 Psychiatric Note, and August 2010 VA examination. As such, the Board finds a rating in excess of 50 percent for this appeal period is not warranted. In this regard, the Board acknowledges that the August 2010 VA examiner indicated there was some disorganized reasoning and vague thought content as thought process was tangential and at times it was difficult to understand his line of reasoning. The examiner noted past medical records indicated ongoing vague speech, likely due to low grade thought disorder rather than intentional vagueness. However, engaging in a holistic analysis of the severity, frequency, and duration of the Veteran's symptoms, the Board finds there is no evidence of gross impairment in thought processes or communication. Specifically, the record has consistently indicated the Veteran's speech was clear, coherent, and normal; and his thought process was goal-directed, as demonstrated in the April 2004 VA treatment records, and February 2010 Psychiatric Note. Also, the Board acknowledges that during the August 2010 VA examination the Veteran expressed vague thoughts of paranoia, However, he indicated they were not well-focused and was without overt delusional content. The Board also acknowledges the February 2010 Psychiatry Note where the Veteran endorsed auditory verbal hallucinations. However, the record does not demonstrate persistent delusions or hallucinations. The Veteran has consistently denied delusions and hallucinations as demonstrated in the April 2002 VA Psychiatric Note and February 2005 Psychiatric Note. During the August 2010 VA examination the Veteran specifically denied present perceptual disturbances. Furthermore, the record has consistently indicated the Veteran has denied suicidal ideation, or homicidal ideation. Also, his judgement and insight have been fair for this appeal period. Summarily the Board finds a 50 percent rating, but not higher, is warranted for the appeal period prior to September 2010. Appeal period from September 2010 to March 2015 For the appeal period from September 2010 to March 2015 the Board has reviewed all of the lay and medical evidence of record in conjunction with the applicable laws and regulations and finds the Veteran's psychiatric disability, based on a holistic analysis, warrants a 70 percent disability rating. In this regard, for the appeal period from September 2010 to March 2015, the Board finds the treatment records, April 2012 Vocational assessment, and August 2012 VA examination probative. There is evidence of occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. Specifically, in the April 2012 Vocational assessment it was noted, the Veteran was extremely conscientious about completing all paperwork, however seemed easily confused about instructions. He had difficulty understanding directions and completing sample problems on the testing. Also, he was not a good historian as he had difficulty reporting his work, incarceration, and medical histories. He reported trouble communicating and was confused about the career path he should take. The vocational counselor indicated although medication controls the worst of his symptoms, he still has impaired thought process that is chronic and not likely to improve in the foreseeable future. Likewise, the August 2012 VA examiner indicated the Veteran exhibited symptoms of flattened effect and impaired abstract thinking; as well as circumstantial, circumlocutory, or stereotyped speech. The Veteran was noted to have problems with social isolation, and he again reported mild short-term memory impairment. The treatment records consistently demonstrated impaired abstract thinking as noted in the August 2012 vocational assessment, August 2013 VA examination, July 2013 VA Mental Health Note, November 2013 VA treatment records, and May 2014 VA Mental Health Note. The Board finds the severity, frequency, and duration of his impaired thinking coupled with the circumstantial, circumlocutory, or stereotyped speech, warrants a 70 percent evaluation. However, a rating in excess of 70 percent is not warranted. The evidence has not demonstrated total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name. Although the record has consistently demonstrated impaired abstract thinking and communication issues, the record does not reflect gross impairment in thought processes or communication. Specifically, the April 2012 vocational assessment indicated the Veteran seemed easily confused about instructions and had difficulty understanding directions and completing sample problems on the testing. However, he worked slowly on the testing but was able to complete the identifying information. Furthermore, the August 2012 VA examiner indicated, there was some vague, circumstantial speech, however, the Veteran was able to clarify his intent when questioned. As such, taking a holistic approach, the Board finds the record does not demonstrate gross impairment in thought processes or communication. In this case the record has consistently demonstrated the Veteran was able to maintain personal hygiene and basic activities of daily living; as well as orientation to person, place and time as noted in the August 2012 VA examination, November 2013 VA treatment records, and May 2014 treatment records. Summarily the Board finds a 70 percent rating, but not higher, is warranted for the appeal period from September 2010 to March 2015. 3. For the appeal period prior to March 2015 entitlement to a TDIU The Veteran seeks a TDIU. He contends that his service-connected disabilities, render him unemployable. The RO has awarded the Veteran with TDIU effective March 8, 2015. Initially, the Board acknowledges this decision granted a 50 percent evaluation for schizophrenia which would have an effective date of March 27, 2000, and a 70 percent evaluation which would have an effective date of September 1, 2010. However, the Board finds remand is not warranted as the Veteran is only service connected for the schizophrenia and schedular has been since September 1, 2010. The Board notes, the appeal period dates back to March 27, 2000, the date the Veteran initially filed the original claim for his psychiatric disability, however, the evidence of record indicates the last time the Veteran worked full-time was in August of 2014 and the date the disability affected his fulltime employment was in January 2015. As such, the Board finds remand is not warranted for the appeal period prior to September 2010. Furthermore, the Board notes the Veteran has a separate appeal stream for entitlement to an earlier effective date for the award of the March 2015 TDIU and entitlement to a TDIU prior to March 2015. Procedurally, in a September 2020 VA Form 10182, the Veteran requested the Board of Veterans' Appeals (Board) complete a direct review of the evidence considered by the RO and a subsequent May 2020 Board decision denied entitlement to TDIU prior to March 8, 2015. In February 2021, pursuant to a Joint Motion for Remand (JMR), the Court of Appeals for Veterans Claims (Court) vacated and remanded the May 2020 Board decision that denied entitlement to TDIU prior to March 8, 2015. More recently, a June 2021 rating decision remanded the entitlement to a TDIU prior to March 2015 for referral to the Director of Compensation to address extraschedular TDIU prior to March 2015. In September 2021 the Director provided an opinion. In January 2022 the Veteran submitted a VA Form 10182 for entitlement to an earlier effective date for TDIU. He did not select a review lane. In February 2022 the VA sent correspondence seeking clarification as to what review lane the Veteran would prefer. To date the Veteran has not submitted a new VA Form 10182 or provided a response to the February 2022 correspondence. In summary, although the Veteran has a separate claim for entitlement to a TDIU prior to March 2015 proceeding under a VA Form 10182 and an unripe claim for entitlement to an earlier effective date for TDIU proceeding under a VA Form 10182, the Board can still review entitlement to a TDIU prior to March 2015 as part and parcel to the increased rating claims for the schizophrenia disability. See Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). Notably the July 2021 Memorandum Decision from the CAVC mandated review of this TDIU claim. As such, the Board will proceed with this claim. Total disability means that there is present any impairment of mind or body sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. §§ 3.340, 4.15. Substantially gainful employment is defined as work which is more than marginal, and which permits the individual to earn a living wage. Moore v. Derwinski, 1 Vet. App. 356 (1991). See also Faust v. West, 13 Vet. App. 342 (2000). In Ray v. Wilkie, 31 Vet. App. 58 (2019), the United States Court of Appeals for Veterans Claims (Court) explained that substantially gainful employment contains economic and noneconomic components. The economic component means "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," while the noneconomic component requires consideration of a veteran's ability to secure or follow that type of employment. Id. A veteran is totally disabled if his service-connected disability or combination of service-connected disabilities is rated at 100 percent pursuant to the Schedule for Rating Disabilities. 38 C.F.R. § 3.340(a)(2). Even if a veteran is less than 100 percent disabled, he still is deemed totally disabled under the Schedule for Rating Disabilities if he satisfies two requirements. 38 C.F.R. § 4.16(a). First, the veteran must meet a minimum percent evaluation. If he has one service-connected disability, it must be evaluated at 60 percent or more. If he has two or more service-connected disabilities, at least one disability must be evaluated at 40 percent or more and the combined evaluation of all the disabilities must be 70 percent or more. The following will be considered as one disability with respect to the minimum percent evaluation: (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. Second, the veteran must be found to be unable to secure and follow a substantially gainful occupation as a result of his service-connected disability or disabilities. Id. As noted above the Veteran is service-connected for schizophrenia evaluated at 50 percent effective March 27, 2000, and 70 percent effective September 1, 2010. He does not have any other service-connected disabilities. He was awarded TDIU effective March 8, 2015, the date he filed a TDIU claim. In this case, for the appeal period beginning September 1, 2010, the Veteran has a single disability evaluated above 60 percent. Therefore, schedular has been met since September 1, 2010. 38 C.F.R. § 4.16(a). However, for the reasons discussed below, the Board finds TDIU is warranted from January 2013. Turning to the evidence, in March 2012 the Veteran enrolled in VA's VR&E program and completed the America Works Veterans Job Readiness Training Program. The January 2014 VR&E records indicated the Veteran applied for numerous jobs beginning in November 2013 however, he had not been hired and was awaiting the outcome of his applications. The March 2016 VA 21-8940 form (claim for TDIU) indicated his service-connected disability prevented him from working. The Veteran indicated he completed 2 years of high school and 1 year of college. He asserts the first date his disabilities affected his full-time employment was January 2015 and the last time he worked full-time was August 2014. The date he became too disabled to work was August 2014 as well. His prior work included full-time work from October 2004 to January 2013 as a mail clerk for the IRS; and part-time work in August 2013 as a cleaner or janitor. He has training and discovery, concentration, mathematics, and traveling. At an April 2012 vocational assessment, the career counselor noted the Veteran suffered from paranoid schizophrenia, which was "stable and controlled with medication so that he [was] able to function in a somewhat limited capacity" and that the "medications seem to be controlling the worst of his symptoms, but he remains impaired. It was noted that the Veteran was "easily confused about instructions," exhibited "difficulty understanding directions," and found the Veteran had "trouble communicating." The counselor noted the Veteran "has only been able to maintain employment in supported employment situations" and "any [potential] employer is likely to notice" the Veteran's "trouble staying on topic" and "difficulty communicating;" therefore, "it might be difficult or impossible for him to obtain and maintain employment outside of a supported situation." The counselor opined that the Veteran has "struggled with this problem for [all] of his adult life and it is clear that this is a chronic condition that is not likely to improve in the foreseeable future." Vocational testing revealed that the Veteran had an IQ of 78 or borderline intellectual functioning. Regarding the Veteran's employment history, the counselor concluded the Veteran has consistently been employed in supported circumstances. It was noted, records indicate that his mental health problems impaired his performance in the military and have prevented him from being able to obtain or maintain competitive employment. His confusion and lack of clear thinking would be quickly apparent to anyone interviewing him for a job and may continue to keep him from being able to secure competitive employment. The counselor described the Veteran as having "difficulty communicating and tending to drift into unrelated conversational trends" such that "it might be difficult or impossible for him to obtain and maintain employment outside of a supported situation." As noted above, while in the VR&E program, the Veteran obtained a parttime position as a janitor, but stopped working in August 2014. During the March 2015 VA examination he reported that he worked in the position briefly. However, it did not work out, and he quit the position. When asked why he quit, he stated that he did not like riding the bus with co-workers because he could hear them talking, even though they were not talking about him. He also did not like that other worker's in the building might interact with him; and he reported that a co-worker talked a lot while they worked. In a September 2021 advisory opinion, the Director opined entitlement to extraschedular TDIU benefits prior to March 2015 is not warranted. It was reasoned: a review of the file shows the Veteran last worked full time on January 4, 2013 as a mail clerk and retired. The Veteran was found to be disabled by the Social Security Administration due to his schizophrenia and gastrointestinal system. The medical records show mild or transient symptoms including flattened affect, impaired abstract thinking and circumstantial, circumlocutory or stereotyped speech. Although it is conceded that the Veteran's service-connected conditions do cause functional limitations, the preponderance of the evidence does not show that the Veteran is unable to obtain or maintain gainful employment due to his service-connected conditions. The Board has reviewed all of the lay and medical evidence of record in conjunction with the applicable laws and regulations and finds a TDIU is warranted from January 2013, the date he last worked full- time. The record reflects the Veteran unsuccessfully attempted to obtain other positions, but ultimately remained unemployed after his fulltime employment ended January 2013. As noted above the August 2014 employment was brief and appears to have resulted in him quitting due to the social isolation and inability to establish and maintain effective relationships as his reasons for quitting were mainly due to interactions or lack thereof with his co-workers. The April 2012 vocational assessment supports awarding a TDIU prior to March 2015 as the counselor found the Veteran "has only been able to maintain employment in supported employment situations" and "any [potential] employer is likely to notice" the Veteran's "trouble staying on topic" and "difficulty communicating;" therefore, "it might be difficult or impossible for him to obtain and maintain employment outside of a supported situation." In January 2022 the Veteran's attorney submitted argument in support of the TDIU claim. It was argued the advisory opinion from the Director is inadequate as the Director provided a conclusory statement without support or discussion as to finding, "the preponderance of the evidence does not show that the Veteran is unable to obtain or maintain gainful employment due to his service-connected conditions." The Board agrees which is why the Board is not relying on that advisory opinion for this decision. The Attorney also argued the Veteran's previous employment has been in supported situations, and as such is marginal. The attorney relied on the August 2012 Vocational assessment, as the counselor concluded that the Veteran has only been able to maintain supported employment and that his schizophrenia "may continue to keep him from being able to secure competitive employment, or it might make it difficult or impossible for him to obtain and maintain employment outside of a supported situation. The attorney also cited to an August 2014 VA treatment note that indicated the Veteran had not worked in several years and would need assistance of the "writer," i.e., vocational rehab specialist, to ensure success with his current placement as a part-time janitor. Marginal employment shall not be considered substantially gainful employment. See 38 C.F.R. § 4.16 (a). For purposes of this section, marginal employment generally shall be deemed to exist when a veteran's earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. Marginal employment may also be held to exist, on a fact found basis (includes but is not limited to employment in a protected environment such as a family business or sheltered workshop), when earned annual income exceeds the poverty threshold. Consideration shall be given in all claims to the nature of the employment and the reason for termination. See 38 C.F.R. § 4.16(a). Although the Board finds TDIU is warranted from January 2013, the last month the Veteran worked full-time, the Board does not find the Veteran was engaged in marginal employment warranting TDIU prior to January 2013. As noted above, the Veteran worked full-time from October 2004 to January 2013 as a mail clerk for the IRS. In the November 2013 VR&E records the Veteran reported a starting salary of $15.32 hourly and an ending salary of $16.24 hourly for his 2004 to 2013 mail clerk position. During the March 2015 VA examination the Veteran reported leaving the job due to some health issues. According to the U.S. Department of Commerce, Bureau of the Census, in 2013 the poverty threshold for one person was $11,490 yearly. For 2004, the year he started, the threshold was $9,310. When evaluating the Veteran's yearly salary for 2004, based on his starting salary, he made $2,451.20 a month or $29,414.40 a year. This amount is well above the poverty threshold. Further, the evidence does not indicate the Veteran worked in a protected environment such as a family business or sheltered workshop. The Veteran has not asserted, and the record does not reflect the Veteran received any special accommodations from his employer. Furthermore, the record does not indicate that the hiring and paying of the Veteran was for altruistic reasons. He worked for a federal agency, not a family business or sheltered workshop. Also, the record has not indicated his supervisor was a member of his family or friend or that he was hired due to a family member or friend. Indeed, a May 2012 vocational exploration worksheet indicated the Veteran has worked as a mail clerk for 20 years and this field provides a suitable career with the Veteran's limitations. Vocational testing revealed that the Veteran had an IQ of 78 or borderline intellectual functioning and he was service-connected for schizophrenia at 70 percent for this appeal period. Thus, it's understandable that he would have some limitations in his work. The April 2012 vocational counselor specifically found the Veteran has "struggled with this problem for [all] of his adult life and it is clear that this is a chronic condition that is not likely to improve in the foreseeable future. As such, the Board finds the Veteran engaged in work suitable to his skills and conditions. While the Veteran may use his family for support, as demonstrated in August 2012 VR&E records, the Veteran reported he can maintain a regular schedule, as he has a friend who provides transportation, and family members provide support; the evidence does not indicate these individuals helped him with his job duties. The Veteran's support from his family and friends or a vocational counselor finding the Veteran has worked in supported situations does not suggest his work is marginal. He has suffered from schizophrenia for a considerable amount of time and support would be plausible. Therefore, the Board does not find the work prior to January 2013 resulted in marginal employment. Accordingly, the Board finds a TDIU is warranted from January 2013 and not earlier. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jackman, Bridget 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.