Citation Nr: 22018965 Decision Date: 03/30/22 Archive Date: 03/30/22 DOCKET NO. 16-51 979 DATE: March 30, 2022 ORDER Entitlement to an initial evaluation of 50 percent, but not higher, for unspecified trauma and stressor related disorder, prior to December 12, 2019, is granted. Entitlement to an evaluation in excess of 70 percent for unspecified trauma and stressor related disorder from December 12, 2019, is denied. Entitlement to total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is granted. FINDINGS OF FACT 1. Prior to December 12, 2019, the Veteran's unspecified trauma and stressor related disorder was productive of a disability picture that more nearly approximates that of occupational and social impairment with reduced reliability and productivity. 2. From December 12, 2019, the Veteran's unspecified trauma and stressor related disorder manifested as occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgement, thinking and/or mood; total occupational and social impairment was not shown. 3. The Veteran's combined service-connected disabilities have rendered him unable to secure and follow a substantially gainful occupation. CONCLUSIONS OF LAW 1. Prior to December 12, 2019, the criteria for an initial evaluation of 50 percent, but no higher, for the Veteran's unspecified trauma and stressor related disorder, have been met. 38 U.S.C.§§1155, 5107; 38 C.F.R. § 4.130, Diagnostic Code 9411. 2. The criteria for entitlement to an initial rating in excess of 70 percent from December 12, 2019, for an unspecified trauma and stressor related disorder, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.130 Diagnostic Code 9411. 3. The criteria for TDIU have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.16, 4.18, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from October 1963 to December 1967. This matter comes before the Board of Veterans Appeals (Board) on appeal from a September 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Board previously remanded the increased rating issue in February 2019 for further development, to include obtaining treatment records and scheduling an examination. The Board also inferred a TDIU claim as part of the increased rating claim for an unspecified trauma and stressor related disorder and remanded the issue for development. See Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). The requested action has been undertaken. Accordingly, there has been substantial compliance with the prior remand instructions. See D'Aries v. Peake, 22 Vet. App. 97 (2008). During the course of the appeal, the RO increased the Veteran's disability rating for his unspecified trauma and stressor related disorder from 10 percent to 70 percent, effective December 12, 2019. However, because this award amounts to less than the maximum benefit available for the Veteran's service-connected unspecified trauma and stressor related disorder, and because he has not indicated that he is satisfied with a 70 percent disability rating, the Veteran's increased rating claim for his service-connected unspecified trauma and stressor related disorder remains on appeal. See AB v. Brown, 6 Vet. App. 35, 39-40 (1993) (holding that a decision awarding a higher rating, but less than the maximum available benefit, does not abrogate the pending appeal). Increased rating Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity caused by the given disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining, including degree of disability, is to be resolved in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. In any claim for an increased rating, "staged" ratings may be warranted where the factual findings show distinct time periods when the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119 (1999). 1. Entitlement to an initial evaluation in excess of 10 percent for an unspecified trauma and stressor related disorder prior to December 12, 2019, and in excess of 70 percent thereafter In a September 2015 rating decision, the Veteran was granted service connection for an unspecified trauma and stressor related disorder rated at 10 percent, effective December 1, 2014, under the provisions of Diagnostic Code 9499-9411. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. Because the Veteran's specific diagnosis is not listed in the Rating Schedule, DC 9499 has been assigned pursuant to 38 C.F.R. § 4.27, which provides that unlisted disabilities requiring rating by analogy will be coded first by the numbers of the most closely related body part and "99." See 38 C.F.R. § 4.20. Here, the most closely analogous diagnostic code is DC 9411, PTSD. The ratings under Codes 9499-9411 are in accordance with the General Rating Formula for Mental Disorders. See 38 C.F.R. § 4.130. As mentioned above, in August 2020, the RO granted an increased rating of 70 percent for an unspecified trauma and stressor related disorder, effective December 12, 2019, under Diagnostic Code 9411. The issue on appeal is whether the Veteran's associated symptoms caused the level of impairment required for an initial disability rating in excess of 10 percent prior to December 12, 2019, and in excess of 70 percent thereafter for his unspecified trauma and stressor related disorder. The Veteran contends that at least 30 percent rating is warranted because he has been hospitalized for his psychiatric disorder. See December 2015 Notice of Disagreement. During his September 2015 VA examination he denied ever being hospitalized for psychiatric reasons. He told the December 2019 VA examiner that he had "several brief hospital visits" for anxiety symptoms. He sought emergency treatment for an anxiety attack related to pain from a tooth extraction in December 2018 and a trauma fall in August 2017. The evidence in the file does not reflect any psychiatric hospitalizations. When rating a mental disorder, VA must consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the claimant's capacity for adjustment during periods of remission. VA shall assign a rating based on all the evidence of record that bears on occupational and social impairment, rather than solely on the examiner's assessment of the level of disability at the moment of the examination. 38 C.F.R. § 4.126 (a). When rating the level of disability from a mental disorder, VA will consider the extent of social impairment, but shall not assign a rating solely on the basis of social impairment. 38 C.F.R. § 4.126 (b). Under the General Rating Formula for Mental Disorders at 38 C.F.R. § 4.130, a 10 percent rating is assigned for occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication. 38 C.F.R. § 4.130, Code 9411. A 30 percent evaluation is warranted where there is 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). This may be due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). Id. A 50 percent evaluation is warranted where there is occupational and social impairment with reduced reliability and productivity. This may be 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). This may be due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. Id. A 100 percent evaluation is warranted for total occupational and social impairment. This may be due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. The list of symptoms in the General Formula is not intended to constitute an exhaustive list but provides examples of the type and degree of symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). In Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (2013), the U.S. Court of Appeals for the Federal Circuit (Federal Circuit) held that VA "intended the General Rating Formula to provide a regulatory framework for placing veterans on a disability spectrum based upon their objectively observable symptoms." The Federal Circuit stated 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." It was further noted that "§ 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas." Effective August 4, 2014, VA amended the regulations regarding the evaluation of mental disorders by removing outdated references to DSM-IV. The amendments replace those references with references to the recently updated "DSM-5." As the Veteran's claim was certified to the Board after August 4, 2014, the DSM-5 is applicable to this case. As such, the use of global assessment of functioning scores is inappropriate. Golden v. Shulkin, No. 16-1208 (Feb. 23, 2018). Period of appeal prior to December 12, 2019 After careful review, the evidence shows that for this period of appeal, the Veteran's unspecified trauma and stressor related disorder most closely approximates the criteria for a 50 percent rating under Diagnostic Code 9411. The evidence does not more closely approximate the schedular criteria for the assignment of disability rating in excess of 50 percent. In September 2015, the Veteran was afforded a VA examination. The Veteran endorsed symptoms of anxiety, panic attacks that occur weekly or less often, and chronic sleep impairment. The examiner noted that the Veteran had occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress. During the evaluation, the examiner observed that the Veteran was neatly dressed, cooperative, and had fair eye-contact, denied suicidal and homicidal thoughts, plans or intent; that his conversation was logical, coherent and goal directed; his affect was variable and congruent to the conversation; his mood was fair; there was no indication of any psychotic manifestations or bizarre behaviors; his judgment and insight were considered fair; and that he was stable and in adequate control. The Veteran endorsed getting along with family members, to include his wife and daughter. He maintains his house and yard, and enjoys walking, remodeling, decorating, playing cards, and watching television. He had retired from his job in 2008. He worked part-time for another 5-6 years, but had not worked since 2014 due to "bad knees." The examiner noted he was prescribed Clonazepam and Citalopram Hydrobromide for his anxiety. The Board finds that this level of occupational and social impairment more closely approximates the criteria for a 10 percent rating under Diagnostic Code 9411 when considering all of the symptoms due to the unspecified trauma and stressor related disorder. However, the VA mental health treatment records for the time period in question show a more severe impairment that more closely approximates the criteria for a 50 percent rating. A July 2015 VA primary care note indicates that the Veteran reported his anxiety symptoms are not well controlled, is "pacing every day" and currently takes citalopram and clonazepam. A November 2015 VA treatment note indicates the Veteran reported that his anxiety has worsened and that he has insomnia, anger issues, mood swings, is argumentative with others, and has concerns of been forgetful. A December 2015 care manager behavioral clinic note indicates the Veteran reported history of a tank gun going off over his shoulder, that he will pull over when driving and that his wife does most of the driving now. The examiner noted increased anxiety, a lot of nightmares, and fighting in his sleep. A December 2015 consultation report indicates that the Veteran had been seeing and non-VA provider for the past 6 to 7 years for depression and anxiety, that he was prescribed Celexa 30 mg, and that Klonopin 1 mg p.o. daily was added 6 months earlier by his non-VA provider. The Veteran reported that he was involved in an accident when he was in the military where he hurt his shoulder and had been suffering from shoulder pain and anxiety, since then. His anxiety became worse about 6 or 7 years ago due to unknown stressors and he sought help from his non-VA provider. The Veteran's symptoms of anxiety comprised of feeling very nervous, and tense, as well as an inability to relax, difficulty breathing, tightness in his chest, and a sense of impending doom. The Veteran continued to have anxiety despite medication and reported that he became increasingly anxious when driving and had to pull over and let his wife drive. He denied any significant symptoms of depression, mania, hypomania or psychoses, drug or alcohol issues. The clinician's plan for the Veteran was to slowly taper and discontinue Klonopin over the next 2-3 weeks, taper and discontinue Celexa, switch to Lexapro 10 mg p.o. daily, and start trazodone 50 mg p.o. at bedtime as needed for sleep. A February 2016 care manager behavioral clinic note indicates that the Veteran was still not driving due to anxiety, and felt crushed, like he can't breathe. A February 2016 psychiatry note indicates the Veteran continued to complain of severe problems. He reported that his sleep was disturbed and broken. The clinician increased the dosage of trazodone to 100 mg. A May 2016 psychiatry note indicates that the Veteran still continued to experience some panic symptoms in the form of "things closing in on me" and some chest tightness. The examiner reported that "the sleep is much better with the increased dosage of trazodone. He however continues to be somewhat restless in his sleep and throws the sheets around." A July 2016 psychiatry note indicates that the Veteran thanked the clinician for increasing the Lexapro. He reported that his anxiety was under control, panic attacks were less frequent and less intense, and he felt much better with the increased dosage of medication. In a September 2016 statement, the Veteran stated that he is not supposed to drive due to his mental condition, that he had problems getting along with his wife and people, and was unable to get a parttime job due to his anxiety and depression and would not be able to drive to a job. A November 2016 psychiatry note shows the Veteran continued to be anxious, jittery, and edgy with an inability to relax. He continued to experience PTSD symptoms in the form of intrusive thoughts, bad dreams, disturbed sleep as he throws away his pillows in his sleep and his bed sheets are also disarrayed in the morning. The Veteran was referred to counseling to address the PTSD symptoms and anxiety. A January 2017 consultation clinic evaluation report shows the Veteran endorsed the following symptoms: depressed mood, agitation, intrusive recollection, increased arousal, difficulty in control of anxiety, episodes of intense fear and discomfort, restlessness, difficulty concentrating and sleep disturbance, panic attacks "anywhere anytime." The clinician noted that in the office, the Veteran was tapping his foot and jiggling coins in his pocket simultaneously the entire visit. The Veteran reported panic attacks 2 to 3 times per week. Mood was described as dysthymic/depressed. Affect was blunted. A January 2017 psychiatry note shows that the Veteran started counseling and was practicing relaxation techniques to reduce his anxiety. Some PTSD symptoms were still present in the form of bad dreams which woke him up from his sleep. The Veteran reported going out to his porch for about half hour or so in the middle of the night, and then going back to sleep again. He continued to feel anxious and was trying to deal with his anxiety by keeping himself preoccupied and housework, which seemed to help him. Mood was still somewhat anxious. Sleep was broken at times; appetite is fair. A September 2017 psychiatry note indicates that the Veteran was recovering from an injury and had been hospitalized. During the hospitalization, the Lexapro was discontinued, and he was switched to Celexa 30 mg p.o. daily. He was also started on melatonin for sleep. His wife described him as "being more ugly". The Veteran reported a favorable response to Lexapro with a significant improvement in his PTSD symptoms and anxiety. The clinician noted that due to recent trauma, the Veteran's PTSD symptoms increased and that he was experiencing bad dreams of "being crashed". Sleep is fair with the trazodone and melatonin. A May 2018 psychiatry note indicates the Veteran reported that he was doing better, felt calmer, and rated his anxiety and PTSD at 4/10. Sleep was adequate with the trazodone, and he was taking melatonin over-the-counter. A March 2019 psychiatry note indicates the Veteran reported that his PTSD symptoms were under control. He did not report any increase in the bad dreams. His sleep reportedly was better with the trazodone although he got up a couple of times during the night. He experienced minor episodes of anxiety. He denied any panic attacks. The Veteran stated that he had a new cat as his pet, and this was very therapeutic for him. He got along well with his wife, and she provided them with transportation. Mood was stable. A September 2019 psychiatry note shows the Veteran was prescribed a short supply of Xanax to manage his anxiety. The Veteran reported that his anxiety was becoming less. Mood is stable. For the initial appeal period prior to December 12, 2019, the aforementioned evidence reflects that the Veteran's unspecified trauma and stressor related disorder was manifested by agitation, anxiety, insomnia, anger, mood swings, argumentative with others, forgetfulness, intrusive recollection, increased arousal, restlessness, difficulty concentrating, sleep disturbance, panic attacks 2 or 3 times per week, dysthymia, nightmares, and blunted mood. Because the Veteran's statements and private and VA treatment records reflect that his unspecified trauma and stressor related disorder was generally the same during this appeal period and because such records reflect occupational and social impairment with reduced reliability and productivity, the Board finds a higher 50 percent rating is warranted. The Board will give the Veteran the benefit of the doubt and increase his initial rating to 50 percent disabling but no higher during this period on appeal. The Board also finds that a rating in excess of 50 percent is not warranted at any point during this period of appeal. The Veteran has panic attacks more than once a week and depression, consistent with a 50 percent rating, but the record does not show near continuous panic or depression affecting the ability to function independently. Notably, the Veteran has anger and mood swings that affects his relationship with others, but the record does not show inability to establish and maintain relationships. For example, he reports a good relationship with his wife and daughter. Further, the record shows that the Veteran has reported that his symptoms of an unspecified trauma and stressor related disorder had been well-managed for the past several years with the use of counseling and medication. The record does not reflect suicidal ideation. The September 2015 VA examiner found that his judgement and insight were fair and "adequate to function in the community." His insight and judgment were also noted to be fair in a February 2016 VA treatment record. In sum, the totality of the record reflects the Veteran does not present with the frequency, severity, and duration of symptoms that more nearly approximates deficiencies in most areas at any point during the period of appeal prior to December 12, 2019. Because the Veteran's unspecified trauma and stressor related disorder manifested in occupational and social impairment with reduce reliability and productivity, he is entitled to an initial 50 percent rating, but no higher, during the initial period of appeal, prior to December 12, 2019. Period of appeal beginning December 12, 2019, and thereafter For the appeal period beginning December 12, 2019, and thereafter, the Veteran's unspecified trauma and stressor related disorder more closely approximated the criteria for a 70 percent rating and did not more closely approximate the schedular criteria for the assignment of disability rating in excess of 70 percent under Diagnostic Code 9411. In December 2019, the Veteran was afforded a VA mental disorders examination. The examiner diagnosed the Veteran with an unspecified trauma and stressor related disorder. The Veteran reported difficulties working with people, and preference for working alone. The examiner noted that the Veteran had occupational and social impairment with reduced reliability and productivity. The examiner noted that the Veteran has the following symptoms: depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, difficulty in establishing and maintaining effective work on social relationships, difficulty adapting to stressful circumstances including work or a work like setting, and suicidal ideation. These symptoms are like or similar to those contemplated by the current 70 percent rating. VA treatment records from August 2020 shows the Veteran reported doing well and that his PTSD and anxiety symptoms are under control. The Board finds that for this period of the appeal, the Veteran's symptoms were not of such frequency and severity to result in total occupational and a social impairment to warrant a 100 percent rating under Diagnostic Code 9411. The symptoms endorsed at his most recent December 2019 VA examination more closely approximated the criteria for a 70 percent rating. These symptoms have never been shown to be so frequent or disabling that the rise to the level of total occupational or social impairment, which is a level of severity so disabling that some of the examples of symptoms include not knowing one's own name or posing a persistent threat of danger to self or others. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002) (finding that symptoms contained in rating schedule criteria are "not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating."). He spent his time doing chores or watching television. The Veteran had demonstrated that he has a good relationship with his wife and daughter throughout the appeal period. The examiner found he did not pose any threat of danger or injury to himself or others. As a result, he is not totally socially impaired, and a 100 percent rating is not warranted. The Board has considered, though not exclusively relied upon, the criteria listed in the General Formula. The Veteran never reported hallucinations and was never described as delusional. He was almost always (if not always) described as oriented to time, place, and manner. The Board finds the medical evidence after December 12, 2019, does not show that the Veteran's symptoms increased in frequency and severity to result in total occupational and social impairment to warrant a 100 percent rating. He continued to stay married and had good relationships with members of his immediate family. He reported that his PTSD and anxiety symptoms are under control. Therefore, the evidence persuasively weights against the claim and an increased 100 percent schedular rating for an unspecified trauma and stressor related disorder is denied. 2. Entitlement to a TDIU due to service-connected disabilities A total disability evaluation based on unemployability is warranted when the evidence shows that the veteran is precluded from obtaining or maintaining any gainful employment consistent with his education and occupational experience by reason of his service-connected disabilities. 38 C.F.R. §§ 3.340, 3.341, 4.16. Generally, a total rating for compensation may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 4.16(a). However, a total rating based on individual unemployability may still be assigned to a veteran who fails to meet the percentage standards if he is unemployable by reason of his service-connected disabilities. If a veteran is found to be unemployable solely due to his service-connected disabilities, then the case is to be referred to the Director of the Compensation and Pension Service for extraschedular consideration. 38 C.F.R. § 4.16 (b). In Faust v. West, 13 Vet. App. 342 (2000), the Court defined "substantially gainful employment" 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. In Hatlestad v. Derwinski, 5 Vet. App. 524, 529 (1993), the Court held that the central inquiry in determining whether a veteran is entitled to a TDIU is whether a veteran's service-connected disabilities alone are of sufficient severity to produce unemployability. The determination as to whether a total disability 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, 331-332 (1991). In evaluating a veteran's employability, consideration may be given to the level of education, special training, and previous work experience in arriving at a conclusion, but not to age or impairment caused by non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. The ultimate issue of whether a TDIU should be awarded is not a medical issue, but rather is a determination for the adjudicator. See Moore v. Nicholson, 21 Vet. App. 211, 218 (2007) (ultimate question of whether a veteran is capable of substantially gainful employment is not a medical one; that determination is for the adjudicator), rev'd on other grounds sub nom, Moore v. Shinseki, 555 F.3d 1369 (Fed. Cir. 2009). Although VA must give full consideration, per 38 C.F.R. § 4.15, to "the effect of combinations of disability," VA regulations place responsibility for the ultimate TDIU determination on VA, not a medical examiner's opinion. Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013); 38 C.F.R. § 4.16(a); see also Smith v. Shinseki, 647 F.3d 1380, 1385-86 (Fed. Cir. 2011) (VA is not required to obtain an industrial survey from a vocational expert before making a TDIU determination but may choose to do so in an appropriate case). While medical and lay opinions regarding the extent of functional impairment are evidence to be considered, the ultimate factual determination lies with the adjudicator. As an adjudicator may not substitute his or her own opinion for medical judgment, Colvin v. Derwinski, 1 Vet. App. 171 (1991), a medical opinion cannot subvert the responsibility of the fact finder. Moore, supra. Accordingly, the remaining issue is whether the Veteran's service-connected disabilities precluded him from securing and following a substantially gainful occupation. The fact that a veteran is unemployed or has difficulty finding employment does not alone warrant assignment of a TDIU, as a high rating itself establishes that his disability makes it difficult for him to obtain and maintain employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). VA is to look at the impact that the Veteran's service-connected disabilities have on his ability to engage in the physical and mental acts required by employment. Ray v. Wilkie, 31 Vet. App. 58, 72 (2019). Factual Background & Analysis As part of the TDIU claim development, AOJ requested the Veteran complete and submit a completed VA Form 21-8940. The Veteran did not submit a completed VA Form 21-8940. The AOJ most recently sent the Veteran a letter requesting him to complete and return an enclosed VA Form 21-8940 in June 2020. The Veteran did not submit the VA Form 21-8940. The September 2020 SSOC was also sent to the Veteran's representative. A claimant bears the burden of presenting and supporting a claim for benefits. See 38 U.S.C. § 5107 (a); see also Fagan v. Shinseki, 573 F.3d 1282 (Fed. Cir. 2009). The duty to assist in the development and adjudication of a claim is not a "one-way street." Wamhoff v. Brown, 8 Vet. App. 517, 522 (1996). A claimant may have information that is essential in obtaining the putative evidence. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Here, potentially relevant evidence that could have been provided by the Veteran through the filing of VA Form 21-8940, such as his full employment history, any training or education undertaken since becoming disabled, and the specific circumstances under which he left prior employment, was not available. As such, the Board will adjudicate the TDIU claim and decide on the Veteran's unemployability, based on the evidence available in the file. Here, the Veteran is service connected for an unspecified trauma and stressor related disorder rated at 50 percent (by virtue of this decision), effective December 1, 2014, and at 70 percent, effective December 19, 2019, tinnitus at 10 percent, effective May 26, 2015, and residuals of acromioclavicular joint separation rated at 10 percent, effective February 11, 2016. His combined disability rating is 80 percent from December 12, 2019. Consequently, the Veteran meets the schedular criteria for a TDIU since December 12, 2019. See 38 C.F.R. § 4.16(a). The record shows that the Veteran worked as a maintenance supervisor for 25 years, retired in 2008 and continued to work part-time in maintenance for 5 or 6 years. In a September 2015 VA examination, the Veteran reported that he has not worked since 2014 due to bad knees. In a September 2015 VA examination for shoulder condition, the examiner noted that the Veteran's shoulder condition impacts his ability to work as he has difficulty lifting, pulling and holding things with his left arm due to shoulder pain. In a March 2016 VA examination for a shoulder condition, the examiner noted that the Veteran's shoulder condition impacted his ability to work as he cannot lift, reach, or do his maintenance job and had to retire. In a September 2016 VA treatment note, the Veteran stated he was unable to get a parttime job due to his anxiety and depression and would not be able to drive to a job. See September 2016 VA Form 9. In December 2016, the Veteran's representative stated that the Veteran's condition "is affecting his ability to work." See also February 2019 Informal Hearing Presentation. In a December 2019 VA examination for an unspecified trauma and stressor related disorder, the examiner noted that the Veteran had occupational and social impairment with reduced reliability and productivity. The examiner noted that the Veteran has symptoms of depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, difficulty in establishing and maintaining effective work on social relationships, difficulty adapting to stressful circumstances including work or a work like setting, and suicidal ideation. The examiner noted that the Veteran is retired for the past four or five years from Lowes. The Veteran reported difficulties working with people and a preference for working alone. After a review of all of the evidence of record, with regard to the economic component of substantially gainful employment, the Board finds that the Veteran has been unemployed since approximately 2014. With regard to the noneconomic component of substantially gainful employment, the Board has considered the Veteran's employment history as maintenance supervisor, and his level of disability due to his service-connected disabilities. The Board emphasizes that his unspecified trauma and stressor related disorder causes him difficulty working with others, as well as his anxiety symptoms and panic attacks prevents him from driving and would reasonably be expected to interfere with his ability to pursue an occupation requiring significant social contact. Furthermore, his shoulder disability would reasonably be expected to interfere with his ability to do a maintenance job because he cannot lift or reach and has difficulty holding things with his left arm. (Continued on the next page) In light of the evidence of record, and resolving reasonable doubt in favor of the Veteran, the Board finds that the Veteran is unable to secure and follow a substantially gainful occupation by reason of his service-connected disabilities. See Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013). Accordingly, the Board concludes that TDIU is warranted. Rebecca N. Poulson Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Romero 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.