Citation Nr: 22016491 Decision Date: 03/22/22 Archive Date: 03/22/22 DOCKET NO. 16-35 791A DATE: March 22, 2022 ORDER Entitlement to an increased evaluation in excess of 50 percent from September 25, 2008 to April 5, 2016 for an acquired psychiatric disorder, to include bipolar disorder and other specified anxiety disorder (psychiatric disorder) is denied. Entitlement to an increased evaluation of 70 percent, but no higher is granted for a psychiatric disorder effective May 2, 2016 to November 10, 2020. Entitlement to a total disability evaluation based on individual unemployability (TDIU) prior to May 2, 2016 is denied. Entitlement to a total disability evaluation based on individual unemployability (TDIU) on/after May 2, 2016 to August 5, 2019 is granted. FINDING OF FACT 1. From September 25, 2008 to May 1, 2016 the severity, frequency, and duration of the Veteran's psychiatric disorders symptoms did not more closely approximate occupational and social impairment with deficiencies in most areas. 2. From May 2, 2016 to November 10, 2020 the severity, frequency, and duration of the Veteran's psychiatric disorders symptoms did more closely approximate occupational and social impairment with deficiencies in most areas. 3. Prior to May 2, 2016, the Veteran's service connected disabilities did not prevent him from securing or following substantially gainful employment. 4. On/after May 2, 2016 to August 5, 2019, the Veteran's service connected disabilities did prevent him from securing or following substantially gainful employment. CONCLUSION OF LAW 1. The criteria for an increased evaluation in excess of 50 percent from September 25, 2008 to May 1, 2016 for a psychiatric disorder 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 9432. 2. With resolution of reasonable doubt in the Veteran's favor, the criteria for an increased evaluation of 70 percent, but no higher for a psychiatric disorder effective May 2, 2016 to November 10, 2020 are met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9432. 3. The criteria for a total disability rating based on individual unemployability prior to May 2, 2016 are not met. 38 U.S.C. §§ 7104, 7105; 38 C.F.R. §§ 4.14, 4.16. 4. On/after May 2, 2016 to August 5, 2019, the criteria for a total disability rating based on individual unemployability prior to May 2, 2016 are met. 38 U.S.C. §§ 7104, 7105; 38 C.F.R. §§ 4.14, 4.16. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1979 to October 1983. This matter comes to the Board of Veterans' Appeals (BVA or Board) on appeal from a February 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In the February 2016 rating decision on appeal, the Regional Office (RO) granted service connection for the Veteran's psychiatric disorder and assigned a 50 percent evaluation effective September 25, 2008. The Veteran filed a March 2016 Notice of Disagreement. The RO issued a June 2016 Statement of the Case continuing the Veteran's 50 percent evaluation. The Veteran filed a July 2016 Form 9 Appeal to the Board. In a November 2020 rating decision, the RO assigned a total evaluation for the Veteran's psychiatric disorder effective November 11, 2020. In a May 2021 informal hearing presentation, the Veteran requested an increased evaluation in excess of 50 percent prior to November 11, 2020. In an August 2020 rating decision, the RO granted a TDIU effective August 5, 2019. The Veteran as not raised any additional arguments as it pertains to the assignment of TDIU after August 5, 2019. Nothing here shall interfere with that award. In a May 2021 brief, the Veteran reported that his PTSD symptoms worsened to the point where he was no longer able to work and requested a TDIU prior to August 5, 2019. A request for a TDIU (whether expressly raised or implied by the record) is not a separate claim for benefits, but rather an attempt to obtain an appropriate rating, either as part of the initial adjudication of a claim or as part of a claim for an increased rating. Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). Once the issue of entitlement to a TDIU is raised, it is "part of the claim for benefits for the underlying disability." Id. Once entitlement to a TDIU is at issue as part of a claim for an increased rating, a claimant need not appeal a denial by the agency of original jurisdiction (AOJ) for the issue to remain in appellate status. Payne v. Wilkie, 31 Vet. App. 373 (2019); Harper v. Wilkie, 30 Vet. App. 356 (2018). As such, the Board's decision will address the Veteran's TDIU claim below prior to August 5, 2019. 1. Entitlement to an increased evaluation in excess of 50 percent from September 25, 2008 to April 5, 2016 for a psychiatric disorder The Veteran contends that he is entitled to an increased evaluation prior to November 11, 2020 for his psychiatric disorder, to include bipolar disorder. 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 70 percent or higher. The Board concludes that the Veteran's symptoms did not cause the level of impairment required for a disability rating of 70 percent or higher. 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. 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. In a November 2007 VA treatment note, the Veteran presented with complaints of stress. The Veteran also complained of depression and anger problems, but denies any suicide ideation. The clinician diagnosed the Veteran with anxiety. In a January 2009 private treatment record, the Veteran presented with anxiety attacks. He reported symptoms of depression, sadness, decreased interest in life, poor energy, and poor concentration. The Veteran denied manic symptoms and suicidal ideation. The Veteran reported the use of alcohol and marijuana daily for the past twenty years, but has since ceased the use of either. The Veteran did not endorse any PTSD symptoms or psychotic features. In a January private treatment records reveal that the Veteran presented with complaints of a panic attack. The clinician noted no thoughts of harm to self or others. The clinician noted that the Veteran was alert, well maintained with a normal mood and affect. Speech and cognition was noted as normal with no evidence of hallucinations or delusions diagnosed. The clinician diagnosed the Veteran with major depressive disorder and panic disorder with agoraphobia, alcohol abuse, and marijuana abuse. In a February 2009 private treatment record, the Veteran presented with a panic attack. He did not endorse any ideas of self-harm or harm to others. The clinician noted that the Veteran was alert, with normal mood, and appropriate affect. The clinician also noted continuous, coherent, and relevant thoughts. Speech was noted as normal with intact cognition and no evidence of hallucinations or delusions noted. In a May 2009 private treatment record the Veteran presented with a panic attack. He did not endorse any ideas of self-harm or harm to others. The clinician noted that the Veteran was alert, with normal mood, and appropriate affect. The clinician also noted continuous, coherent, and relevant thoughts. Speech was noted as normal with intact cognition and no evidence of hallucinations or delusions noted. In an August 2009 private treatment record the Veteran reported that he is still depressed. He did not endorse any ideas of self-harm or harm to others. The clinician noted that the Veteran was alert, with normal mood, and appropriate affect. The clinician also noted continuous, coherent, and relevant thoughts. Speech was noted as normal with intact cognition and no evidence of hallucinations or delusions noted. November 2009 private treatment records reveal that the Veteran reported that his depression was much better. The Veteran denied manic symptoms and suicidal ideation. The Veteran reported the use of alcohol and marijuana daily for the past twenty years, but ceased intake. The Veteran did not endorse any PTSD symptoms or psychotic features. November 2009 VA outpatient treatment records note a diagnosis of chronic anxiety. In a December 2009 Mental Residual Functional Capacity Assessment for SSA benefits, the clinician determined that the Veteran's understanding and memory is not significantly limited. Sustained concentration and persistence was not a not significantly limited with the exception of moderate impairment pertaining to the ability to maintain concentration for extended periods of time, perform activities within a schedule, and complete work without psychological based interruptions. Social interactional was noted as not significantly limited with moderate impairment when accepting instructions and responding appropriately to criticism for supervisors. The clinician also noted adaptation was not significantly impaired. The clinician noted that the Veteran is best suited for stable jobs with short routines of moderately detailed instructions with minimal direct supervision. In a February 2010 private treatment note, the clinician diagnosed the Veteran with major depressive disorder and panic disorder. The clinician noted that the Veteran's mood was anxious with an appropriate affect and normal speech with intact cognition, judgment, and insight. In a May 2010 private treatment record, the clinician diagnosed the Veteran with major depressive disorder, panic disorder, alcohol abuse, and marijuana abuse in remission. In an October 2010 VA outpatient treatment note, the clinician noted that the Veteran's anxiety is well controlled. In a December 2010 VA health consultation, the Veteran presented alert and oriented. The clinician noted that the Veteran is cooperative with clear speech. The clinician noted that the Veteran's mood was anxious. The Veteran denied any suicidal or homicidal thoughts. The clinician diagnosed the Veteran with dysthymic disorder. In an August 2012 VA mental health note, the clinician diagnosed the Veteran with adjustment reaction with mixed emotional features. The Veteran presented as friendly with a euthymic mood. The clinician noted clear speech with no memory problems. The Veteran's attention and judgment was noted as age appropriate with normal impulse control and logical thoughts. The clinician noted that the Veteran denied suicidal or homicidal thoughts. In an October 2012 VA mental health note, the clinician diagnosed the Veteran with adjustment reaction with mixed emotional features. The Veteran presented cooperative with a euthymic mood. The clinician noted clear speech with no memory problems. The Veteran's attention and judgment was noted as age appropriate with normal impulse control and logical thoughts. The clinician noted that the Veteran denies suicidal or homicidal thoughts. In a March 2013 VA mental health consultation, the Veteran present alert and oriented. His speech was noted as clear, logical, and organized. The clinician noted his insight and judgment as normal. The Veteran's memory and thoughts were noted as intact. The Veteran's mood and affect were noted as irritable and anxious with no indication of hallucinations or delusions. The clinician noted that the Veteran is hypersensitive and feel overwhelmed. The clinician diagnosed the Veteran with generalized anxiety disorder with panic attacks and adjustment disorder with depressive features. In an April 2013 VA mental health consultation, the Veteran reported that his anxiety has improved. The Veteran presented alert with coherent thoughts and adjusted speech. The Veteran denied any hallucinations. delusions, or suicidal ideations. The clinician noted that the Veteran's cognition and memory were intact. with some disruption processing when anxiety was heightened. In a July 2013 VA mental health consultation, the Veteran presented with a euthymic mood and appropriate affect. The clinician noted that the Veteran was cooperative with clear speech, logical thoughts, and no memory problems. The clinician noted that the Veteran's attention and judgment was age appropriate with normal impulse control. The Veteran denied suicidal or homicidal thoughts. In a September 2013 VA mental health note, the clinician diagnosed the Veteran with anxiety disorder and adjustment disorder. The clinician noted that the Veteran's speech is coherent and relevant with a nervous and depressed mood. The clinician noted that the Veteran's cognition and memory are intact with some short memory lapses. The clinician noted that the Veteran's judgment and reasoning was intact. The Veteran denied suicidal ideation or intent. The clinician noted that the Veteran's impulse control is age appropriate. In an October 2013 VA mental health note, the clinician noted that the Veteran presented friendly with clear speech and no memory problems. The clinician noted that the Veteran's attention and judgment was age appropriate with impulse control noted as normal. The clinician also noted that the Veteran's thoughts were logical, and he denied suicidal or homicidal thoughts. The clinician diagnosed the Veteran with adjustment reaction with mixed emotional features. In a November 2013 VA mental health note, the clinician diagnosed the Veteran with panic disorder and generalized anxiety. The clinician noted that the Veteran presented alert, cooperative and pleasant. The clinician noted normal speech with an anxious mood. The Veteran reported feelings of irritability with low patience and tolerance for frustration. The Veteran reported feelings of fidgety gestures and restlessness during periods of stress. The clinician noted normal judgment and reasoning, but noted that the Veteran's cognitive function is interrupted by his psychiatric symptoms. In an April 2014 VA mental health note, the clinician noted the Veterans speech as clear and memory as normal. The Veteran's mood was noted as friendly and his judgment was noted as age appropriate with normal impulse control and no memory problems. The clinician noted in the negative for suicidal ideation. The clinician diagnosed the Veteran with adjustment disorder. In a June 2014 VA mental health consultation, the clinician diagnosed the Veteran with moderate to severe major depressive disorder and panic disorder. The Veteran presented alert with clear speech. The clinician noted varying mood swings. In an August 2014 Board hearing, the Veteran reported symptoms of being anxious, aggravated, quick to anger, depression, and self-isolation. In a September 2014 VA mental health note the Veteran presented with anxiety and depression. The Veteran's mood and speech was noted as normal. The clinician also noted that the Veteran was alert and logical. In an October 2014 VA Mental Health Questionnaire, the clinician reported treating the Veteran two to four times a week for his anxiety affective disorder. The clinician noted the Veteran's diagnosis as a panic disorder. In an October 2014 VA mental health note, the clinician diagnosed the Veteran with mild anxiety and depressive disorder. The clinician also diagnosed the Veteran with panic disorder. The clinician noted that the Veteran was cooperative with an anxious mood. The clinician also noted that the Veteran denied homicidal or suicidal thoughts. In a November 2014 VA mental health note, the clinician diagnosed the Veteran with moderate to severe depressive disorder and anxiety. The clinician noted that the Veteran was cooperative with normal speech and a depressed mood. The clinician also noted that the Veteran was logical with good insight and judgment. In a December 2014 VA mental health outpatient note, the clinician diagnosed the Veteran with anxiety. The Veteran presented friendly, and his affect was noted as normal with clear speech. The Veteran's memory, thoughts, and judgment was also noted as normal. The Veteran denied any suicidal thoughts. In a February 2015 VA mental health note, the clinician diagnosed the Veteran with anxiety disorder and depressive disorder. The clinician noted that the Veteran was cooperative with clear speech and anxious mood. The clinician also noted that the Veteran was alert and logical with fair judgment with an anxious mood. In an April 2015 VA mental health note, the clinician diagnosed the Veteran with anxiety disorder and major depressive disorder moderate to severe. The clinician noted that the Veteran was cooperative, but anxious with congruent speech, a depressed mood, and logical thoughts. The clinician noted that the Veteran's insight and judgment was fair. In a June 2015 VA mental health note, the clinician noted major depressive disorder, moderate to severe with anxiety. The clinician noted that the Veteran presented cooperative with congruent speech and an anxious mood. The clinician also noted symptoms of the Veteran being moderately depressed, guarded, irritable, and withdrawn. The clinician diagnosed the Veteran's thought process as being easily overwhelmed, distorted, and showing some capacity for the practical with evidence of some self-awareness and trigger avoidance. In a March 2015 VA mental health note, the clinician diagnosed the Veteran with generalized anxiety disorder and major depressive disorder. The Veteran was noted as cooperative, with clear speech, and his mood was noted as negative. In an August 2015 VA mental health note, the clinician diagnosed the Veteran with anxiety disorder and major depressive disorder moderate to severe. The clinician noted that the Veteran was cooperative, but anxious with congruent speech, a depressed mood, and logical thoughts. The clinician noted that the Veteran's insight and judgment was fair. In a September 2015 VA mental health note, the clinician noted a diagnosis of recurrent major depressive and anxiety disorder. The clinician noted that the Veteran presented cooperative with an anxious mood and appropriate affect. The Veteran's speech was noted as clear and his judgment was age appropriate with normal impulse control. The Veteran's thoughts were noted as logical and coherent with no evidence of suicidal or homicidal thoughts. In an October 2015 VA mental health note, the clinician noted a diagnosis of major depression disorder and anxiety disorder. The clinician noted that the Veteran presented cooperative with congruent speech and a depressed mood. The clinician noted that the Veteran was alert and logical with fair insight and judgment. In a November 2015 VA mental disorder examination, the examiner diagnosed the Veteran with bipolar disorder and anxiety disorder. The examiner noted occupational and social impairment with reduced reliability and productivity. The examiner noted the following symptoms: depressed mood; anxiety; suspiciousness; circumstantial, circumlocutory or stereotyped speech; difficulty establishing and maintaining relationships; and difficult adapting to stressful circumstances, including work or worklike setting. The examiner also noted that the Veteran is stressed by arguing, fussing, or excessive sensory stimulation. The examiner noted no evidence of suicidal or delusional ideation. In a February 2016 VA mental health note, the clinician noted a diagnosis of generalized anxiety disorder with episodic panic attacks, major depressive disorder with episodic panic attacks, and an acute stress history. The Veteran presented cooperative with clear speech and a mood defined by depression, social isolation, anger, and irritability and anxiousness. The clinician diagnosed the Veteran's thought process as logical with fair insight and judgment. In an April 2016 VA mental health note, the clinician noted a diagnosis of bipolar disorder and panic disorder. The Veteran presented cooperative with clear speech and an anxious mood. The clinician diagnosed the Veteran's thought process as logical with fair insight and judgment. The Board also reviewed the relevant evidence during the period on appeal noted in the Veteran's lay statements, statements of support, and informal hearing presentation. The Veteran is competent to report issues such as symptomology related to his disability. See Jandreau v. Nicholson, 492 F. 3d at 1377. However overall disability findings require expertise. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Additionally, the Board is constrained in that it may not consider evidence outside the appeal period, although the history of the disability is for consideration under 38 C.F.R. § 4.2. After a thorough review of the record, the Board concludes that the severity, frequency, and duration of the Veteran's psychiatric disability symptoms from September 25, 2008 to April 5, 2016 warrant the sustaining of the 50 percent assigned evaluation. The examiner findings in the November 2015 VA mental disorder examination reflects occupational and social impairment with reduced reliability and productivity. An examination of the record reveals that during the period on appeal the Veteran experienced the following symptoms: depression; sadness; poor energy; poor concentration; panic attacks; anxious mood; irritability; self-isolation; guarded suspiciousness; and anxiety. The Veteran's representative has stated the Board should adopt conclusions of the Social Security Administration (SSA); however, the Board is not bound by conclusions or rules of that separate process. See, e.g., Rouse v. McDonough, 34 Vet. App. 43 (2021) (VA is not required to adopt SSA's definition of "sedentary work" or "sedentary employment."). The Board did consider findings and evidence associated with the SSA file as pertinent here. The Board considered a 70 percent evaluation and found that it was not warranted as the severity, frequency, and duration of the Veteran's symptoms did not more closely approximate occupational and social impairment with deficiencies in most areas to warrant the assignment of a 70 percent evaluation. In coming to this conclusion, the Board finds the November 2015 VA examination report to be the most probative piece of evidence as the Veteran was clinically interviewed, the file was reviewed and an opinion supported by accurate facts was provided. The Veteran was found competent to manage his financial affairs during the appeal period. Signs of suicide ideation or impaired impulse control are not apparent during the period on appeal. See Vazquez-Claudio, 713 F.3d at 114 (holding 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"). Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). The Board finds that based on the evidence of the claims file, the 50 percent evaluation currently assigned prior to September 25, 2008 to May 1, 2016 better approximates the trajectory of the Veteran's psychiatric disorder. As the Board reviewed the Veteran's records and determined that they do not support an increased disability rating in excess of 50 percent prior to September 25, 2008 to May 1, 2016 for this disorder, reasonable doubt provisions are inapplicable. 38 C.F.R. § 3.102. 2. Entitlement to an increased evaluation in excess of 50 percent for a psychiatric disorder from May 2, 2016 to November 10, 2020 In a May 2, 2016 VA mental health note, the clinician noted a diagnosis of bipolar disorder and anxiety disorder. The Veteran present polite and conversant with clear speech and mood defined by depressed mood swings, social isolation, anger, and irritability. The Veteran's thought process was noted as normal with fair judgment and insight noted. The clinician noted that the Veteran's bipolar disorder and anxiety impairs his consistent functioning. In a November 2016 VA outpatient mental status examination, the Licensed Clinical Social Worker (LCSW) noted symptoms of dysphoria, social withdrawal, irritability, low frustration tolerance, and suspicious thoughts. The LCSW also noted the following: depressed mood; mood swings; perceptual distortions; guarded suspiciousness; avoidant behavior; anxiety; loss of concentration; memory impairment; and fair insight and judgment. The LCSW noted periods of functioning within normal limits; however, mood cycles interfere with consistent functioning. In an August 2020 VA mental health note, the Veteran underwent a telephonic psychiatric evaluation, the clinician noted that the Veteran was cooperative with normal tone. The Veteran's thought process was noted as logical with fair judgment. The Veteran verbalized insight to his problems and wanted help. He also denied suicidal ideation or homicidal thoughts. The Veteran reported that he was depressed most of the day and he had no wife, relationships, or friends. The clinician diagnosed the Veteran with major depressive disorder. August 2020 VA outpatient mental health note reveals that the Veteran reported daily irritability and anger. In a November 2020 VA mental disorder examination, the examiner diagnosed the Veteran with bipolar disorder and noted that the current episode is hypomaniac. The examiner also diagnosed the Veteran with anxiety disorder. The examiner noted occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. However, the examiner determined that the Veteran is capable of managing his financial affairs. The examiner noted that the Veteran was last employed in 2008 at a boat company. The examiner also noted that the Veteran was awarded SSA disability benefits in 2012. The Board also reviewed the relevant evidence during the period on appeal noted in the Veteran's lay statements, statements of support, and informal hearing presentation. The Veteran is competent to report issues such as symptomology related to his disability. See Jandreau v. Nicholson, 492 F. 3d at 1377. However overall disability findings require expertise. Woehlaert, 21 Vet. App. 456. Additionally, the Board is constrained in that it may not consider evidence outside the appeal period, although the history of the disability is for consideration under 38 C.F.R. § 4.2. After a thorough review of the record, the Board concludes that the severity, frequency, and duration of the Veteran's psychiatric disability symptoms from May 2, 2016 to November 10, 2020 warrant the assignment of an evaluation of 70 percent, but no higher. It was in May 2016 that the reports of inconsistent functioning became apparent in the record. Additionally, the examiner findings in the October 2020 VA psychiatric examination reflect occupational and social impairment with deficiencies in most areas. An examination of the record during the period on appeal reveals that the Veteran suffered from the following diagnosed symptoms: depressed mood; mood swings; perceptual distortions; guarded suspiciousness; avoidant behavior; anxiety; loss of concentration; memory impairment; social isolation; anger; and daily irritability. The Board considered a total evaluation and found that it was not warrant as the severity, frequency, and duration of the Veteran's symptoms did not more closely reflect total occupational and social impairment to warrant a 100 percent evaluation. Although the Veteran has reported experiencing symptoms of daily irritability, social isolationism, and anxiety impairing his consistent functioning, there is no evidence in the record of suicide ideation, hallucinations, or gross impairment in thought processes or communication. As indicated by the November 2020 VA examiner, the Veteran is capable of managing his financial affairs and did not diagnose gross impairment in thought processes or communication or total social or occupational impairment. See Vazquez-Claudio, 713 F.3d at 114 (holding 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"). Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Therefore, resolving all doubt in the Veteran's favor, the Board finds that the level of severity of the Veteran's psychiatric disorder satisfies the criteria for a higher disability evaluation under DC 9432 and the Veteran's claim for an increased 70 percent rating is granted effective May 2, 2016 to November 10, 2020. 3. Entitlement to a total disability evaluation (TDIU) based on individual unemployability prior to August 6, 2016 As noted above, in a May 2021 informal hearing presentation, the Veteran requested TDIU prior to August 5, 2019. As indicated above, the Veteran was awarded an increased evaluation of 70 percent effective May 2, 2016 to November 10, 2020. As such the Board will consider TDIU from September 25, 2008, the effective date of the Veteran's 50 percent psychiatric disorder award. The Veteran filed a March 2018 VA Form 21-8940 Veteran's Application for Increased Compensation Based on Unemployability. The Veteran reports he was last employed full-time in the manufacturing industry in February 2010 and earned a salary of $29,000 a year when his service connected back disorder rendered him too disabled to work. On the form, the Veteran also reports the following prior employment: local government from 2008 to 2010; C.B. from 2005 to 2005; and F.P. from 2008 to 2008. SSA employment records in connection with SSA disability benefits reveal the following prior employment history: supervisor at a plastic company from 1987 to 1991; assembler from 1990 to 1991; batcher at a chemical company from 1991 to 1992; saw operator from February 1992 to August 1998; security guard from March 1999 to March 1999; charcoal grill manufacturer for 1999 to 2000; and retail store assembler from December 2000 to December 2000; teacher from February 2001 to February 2001; drafting from 2003 to 2003; tech school from 2001 to 2004; welder from September 2004 to November 2004; construction equipment operator from January 2004 to March 2004; construction concrete laborer from March 2004 to June 2004; boat cabinet helper from November 2004 to January 2008 and from August 2007 to June 2008; steel detailer from August 2007 to December 2007. Total disability ratings are authorized for any disability or combination of disabilities for which the Schedule for Rating Disabilities prescribes a 100 percent disability evaluation, or, with less disability, if certain criteria are met. Id. Where the schedular rating is less than total, a total disability rating for compensation purposes may be assigned when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service connected disabilities, provided that, if there is only one such disability, this disability shall be ratable at 60 percent or more, or if there are two or more disabilities, there shall be at least one ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). In exceptional circumstances, where a Veteran does not meet the aforementioned percentage requirements, a total rating may nonetheless be assigned upon a showing that the individual is unable to obtain or retain substantially gainful employment. 38 C.F.R. § 4.16(b). This cannot be awarded by the Board in the first instance, but only considered after a preliminary referral to the Director of the Compensation service. In reaching a determination regarding TDIU, the central inquiry is "whether the Veteran's service connected disabilities alone are of sufficient severity to produce unemployability." Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Consideration may not be given to the impairment caused by nonservice connected disabilities. See 38 C.F.R. §§ 3.34, 4.16, 4.19. Although all the evidence has been reviewed, only the most relevant and salient evidence is discussed below. See Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence). Substantially gainful employment is defined as an occupation that provides an annual income that exceeds the poverty threshold for one person, irrespective of the number of hours or days that a Veteran actually works and without regard to a Veteran's earned annual income. See Faust v. West, 13 Vet. App. 342 (2000). The determination as to whether TDIU is appropriate should not be based solely upon demonstrated difficulty in obtaining employment in one particular field, which could also potentially be due to external bases such as economic factors, but rather to all reasonably available sources of employment under the circumstances. See Ferraro v. Derwinski, 1 Vet. App. 326, 331-32 (1991). As "sedentary" is defined as "[r]equiring or marked by much sitting " the Board finds that sedentary employment is a job where the worker primarily sits down. Webster's II New College Dictionary 999 (1999). TDIU prior to May 2, 2016 Prior to May 2, 2016, the Veteran is service connected for an acquired psychiatric disorder, to include bipolar disorder and anxiety disorder at 50 percent. As the Veteran does not have a single service-connected disability ratable at 60 percent or more, or there are not more than two or more disabilities with one at least ratable at 40 percent or more, and a sufficient additional disability to bring the combined rating to 70 percent or more, the Veteran did not meet the schedular requirements for consideration of individual unemployability. As noted, the Veteran reported being regularly employed until 2008, when the appeal period starts. January private treatment records reveal the Veteran was alert, well maintained with a normal mood and affect. Speech and cognition was noted as normal. In a December 2009 Mental Residual Functional Capacity Assessment for SSA benefits, the clinician determined that the Veteran's understanding and memory is not significantly limited. Sustained concentration and persistence was not significantly limited with the exception of moderate impairment pertaining to the ability to maintain concentration for extended periods of time, perform activities within a schedule, and complete work without psychological based interruptions. Social interactional was noted as not significantly limited with moderate impairment when accepting instructions and responding appropriately to criticism for supervisors. The clinician also noted adaptation was not significantly impaired. The clinician noted that the Veteran is best suited for stable jobs with short routines of moderately detailed instructions with minimal direct supervision. In a November 2015 VA mental disorder examination, the examiner diagnosed the Veteran with bipolar disorder and anxiety disorder. The examiner noted occupational and social impairment with reduced reliability and productivity. The examiner noted difficulty adapting to stressful circumstances, including work or worklike setting. After a thorough review of the record, the Board finds that while the Veteran's service connected disabilities render him unable to perform certain types of labor; nonetheless, the evidence of record does not show he is rendered unable to physically or mentally secure or follow substantially gainful employment as a result of his service connected psychiatric disorder alone prior to May 2, 2016. As indicated by the record, although the Veteran's service connected disorders present some functional and occupational limitations which preclude the Veteran from complex job functions, the Board did not find he was precluded from work in stable jobs with short routines. As such, TDIU prior to May 2, 2016 is not warranted. As noted above, the Veteran's TDIU compensation forms shows post-service employment in a variety of occupational fields. His work experience demonstrates that he was capable of learning new skillsets, to include limited work with a diverse population. Furthermore, the Board has determined that nothing suggests symptoms outside the norm for rating the service connected disorder during the period on appeal. TDIU on/after May 2, 2016 to August 5, 2019 On/after May 2, 2016, the Veteran is service connected for the following disorders: acquired psychiatric disorder to include bipolar disorder and anxiety disorder at 70 percent; radiculopathy of the left lower extremity at 10 percent; and IVDS at 10 percent from May 27, 2016 and 20 percent from January 19, 2018. As the Veteran has a single service-connected disability ratable at 60 percent or more, the Veteran meets the schedular requirements for consideration of individual unemployability from May 2, 2016. In a May 2, 2016 VA mental health note, the clinician noted a diagnosis of bipolar disorder and anxiety disorder. The Veteran present polite and conversant with clear speech and mood defined by depressed mood swings, social isolation, anger, and irritability. The Veteran's thought process was noted as normal with fair judgment and insight noted. The examiner noted that the Veteran's bipolar disorder and anxiety impairs his consistent functioning. In a June 2016 VA back examination, the examiner diagnosed the Veteran with left lumbar radiculopathy and IDVS of the lumbar spine. Regarding functional and occupational impairment, the examiner noted that the Veteran's lumbar radiculopathy pain impacts his ability to work. In a November 2016 VA outpatient mental status examination, the examiner noted symptoms of dysphoria, social withdrawal, irritability, low frustration tolerance, and suspicious thoughts. The examiner also noted the following: depressed mood; mood swings; perceptual distortions; guarded suspiciousness; avoidant behavior; anxiety; loss of concentration; memory impairment; and fair insight and judgment. The examiner noted periods of functioning within normal limits; however, mood cycles interfere with consistent functioning. In an August 5, 2019 VA back examination, the examiner diagnosed the Veteran with degenerative arthritis of the spine and IVDS. Regarding functional or occupational limitations, the examiner determined that the Veteran's back disorder does not impact his ability to work. In an August 5, 2019 VA peripheral nerve examination, the examiner diagnosed the Veteran with peripheral neuropathy of the lower extremities bilaterally. Regarding functional or occupational limitations, the examiner determined that the Veteran's back disorder does not impact his ability to work. After a complete review of the record, the Board finds that it is a likely as not that the Veteran's service connected disorders, particularly the debilitating nature of the Veteran's psychiatric disorder renders him unable to secure or following substantially gainful employment. Considering the May 2, 2016 VA mental health note, the examiner noted that the Veteran's bipolar disorder and anxiety impairs his consistent functioning. Further, the November 2016 examiner diagnosed the Veteran with anxiety, loss of concentration, and memory impairment. More importantly, the Veteran was granted an increased evaluation of 70 percent for his acquired psychiatric disorder symptomology prior to this period on appeal which infers unemployability. Lastly, during the period on appeal the Veteran has been unemployed due to his psychiatric disorder and other disabilities. As such, TDIU is granted from May 2, 2016 to August 5, 2019, the date he met the schedular requirement for TDIU. Emily Tamlyn Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Elliot Harris 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.