Citation Nr: 23044094 Decision Date: 08/08/23 Archive Date: 08/08/23 DOCKET NO. 14-23 453 DATE: August 8, 2023 ORDER Prior to May 8, 2020, entitlement to a disability rating in excess of 30 percent for the Veteran's service-connected posttraumatic stress disorder (PTSD) is denied. From August 13, 2012 to May 7, 2020, entitlement to a total disability rating based on individual unemployability (TDIU) is granted. Since May 8, 2020, entitlement to a TDIU is denied as moot. Effective August 13, 2012, and no earlier, entitlement to basic eligibility to Dependents' Educational Assistance (DEA) benefits based on permanent and total disability status is granted. FINDINGS OF FACT 1. Prior to May 8, 2020, the Veteran's service-connected PTSD most closely approximated occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. 2. From August 13, 2012 to May 7, 2020, the most probative evidence of record establishes that the Veteran's service-connected disabilities precluded the Veteran from securing and following substantially gainful employment based on his occupational history and educational attainment. 3. Since May 8, 2020 (and excluding the period of July 22, 2020 to September 1, 2020 when the Veteran was awarded special monthly compensation (SMC) based on statutory housebound status) the Veteran was in receipt of a 100 percent schedular rating as a result of his service-connected PTSD, and during this time period, the evidence does not support the award of a TDIU for any single disability sufficient to establish entitlement to SMC based on the statutory housebound criteria. 4. Effective August 13, 2012, and no earlier, the Veteran became permanently and totally disabled for the purposes of entitlement to basic eligibility to DEA benefits. CONCLUSIONS OF LAW 1. Prior to May 8, 2020, the criteria for entitlement to a disability rating in excess of 30 percent for the Veteran's service-connected PTSD have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.130, Diagnostic Code 9411. 2. From August 13, 2012 to May 7, 2020, the criteria for entitlement to a TDIU on an extraschedular basis have been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.16. 3. Since May 8, 2020, the Veteran's TDIU claim is denied as moot. 38 U.S.C. §§ 1155, 1114(s); 38 C.F.R. §§ 3.350, 3.351, 4.16. 4. Effective August 13, 2012, and no earlier, the criteria for entitlement to basic eligibility to DEA benefits based on permanent and total disability status have been met. 38 U.S.C. §§ 3510, 5110, 5113; 38 C.F.R. §§ 3.807, 21.3021. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1991 to November 1991 and from October 2008 to August 2012, with additional periods of National Guard service. These matters come before the Board of Veterans' Appeals (Board) on appeal from an August 2012 rating decision issued by a Regional Office (RO) of the United States Department of Veterans Affairs (VA). In July 2019, the Veteran and his spouse provided sworn testimony before the undersigned Veterans Law Judge at a Travel Board hearing. A copy of the hearing transcript has been associated with the Veteran's electronic claims file. The Veteran has not requested an additional Board hearing following the return of this appeal from the United States Court of Appeals for Veterans Claims (Court). See Cook v. Wilkie, 908 F.3d 813 (Fed. Cir. 2018). In January 2020, the Board adjudicated several claims, including entitlement to a disability rating in excess of 30 percent for the Veteran's service-connected PTSD. The Veteran filed a Motion for Reconsideration in May 2020 that was denied by the Board in June 2021. The Veteran subsequently filed an appeal at the Court. In December 2022, the Court issued a memorandum decision. The Court dismissed the appeal of the portion of the Board's January 2020 decision denying increased ratings for left and right knee disabilities, hypogonadism, left and right lower extremity radiculopathy, and a right foot disability. The Court affirmed the Board's decision denying a rating higher than 20 percent for the Veteran's low back disability. The Court vacated the Board's decision denying a rating in excess of 30 percent for the Veteran's service-connected PTSD. The Court determined that the Board erred because it did not address a favorable piece of evidence-the May 2019 VA examiner's opinion that as a result of the Veteran's PTSD, he needed a job position with limited interaction with others and a flexible schedule. The Court concluded that this evidence suggested that the Veteran's PTSD may have impacted his ability to establish and maintain effective work and social relationships, which is a symptom contemplated by a higher 50 percent rating under Diagnostic Code 9411. The Court acknowledged the Board's analysis regarding the Veteran's ability to socialize with family and friends, but concluded that the Board did not address the Veteran's ability to socialize in a workplace setting. Accordingly, the Board's decision denying a rating in excess of 30 percent for the Veteran's PTSD was vacated, and the claim was remanded to the Board for additional consideration in accordance with the memorandum decision. While the increased rating claim for PTSD was pending the Board's action on the May 2020 Motion for Reconsideration, the RO issued a rating decision in August 2020 awarding a higher 100 percent rating for the Veteran's service-connected PTSD, effective May 8, 2020. The matter has now returned to the Board for further agency consideration. In July 2023, the Veteran's attorney waived initial RO review of all VA-generated evidence received since the last consideration of the matter by the RO. Accordingly, the Board may proceed with its appellate review. Under 38 U.S.C. § 7104, Board decisions must be based on the entire record, with consideration of all the evidence. The law requires only that the Board address its reasons for rejecting evidence favorable to the Veteran. Timberlake v. Gober, 14 Vet. App. 122, 128-29 (2000). The Board must review the entire record but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1381 (Fed. Cir. 2000). The analysis below focuses on the most salient and relevant evidence within the period on appeal and on what this evidence shows, or fails to show, on the claims. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake, supra. 1. Prior to May 8, 2020, entitlement to a disability rating in excess of 30 percent for the Veteran's service-connected PTSD is denied. The Veteran is currently receiving a 30 percent disability rating for his service-connected PTSD for the period prior to May 8, 2020 under Diagnostic Code 9411, 38 C.F.R. § 4.130. He seeks a higher initial disability rating on appeal, and has specifically argued for a 50 percent rating. See Veteran's Court brief, p. 5. The Veteran was awarded a maximum 100 percent rating for his PTSD, effective May 8, 2020 in an August 2020 rating decision. Consequently, the Veteran's increased rating claim is moot for the period since May 8, 2020, as the Veteran is in receipt of the highest schedular rating available. The issue in this appeal is whether the symptoms associated with the Veteran's service-connected PTSD have caused the level of impairment required for a disability rating of 50 percent or higher during the period prior to May 8, 2020. Under Diagnostic Code 9411, 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 higher 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 total 100 percent rating is assigned when symptoms such 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 cause total occupational and social impairment. Following a complete review of the appellate record, the Board finds that the Veteran's psychiatric symptoms did not cause the level of impairment required for a disability rating of 50 percent or higher during the period under consideration. Having reviewed the VA treatment records, the private treatment records, the November 2011 VA examination, the October 2014 VA examination, the May 2019 VA examination, and the Veteran's lay statements, the most probative evidence establishes that the Veteran's service-connected PTSD was most closely approximated by symptoms associated with a 30 percent rating under Diagnostic Code 9411, 38 C.F.R. § 4.130, and resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks during the period prior to May 8, 2020. At the November 2011 VA examination, the Veteran reported experiencing periodic nightmares, irritability/anger, intrusive thoughts, lack of interest in leisure activities, avoidance symptoms, physiological reactivity, and hypervigilance. The Veteran also reported chronic sleep impairment manifested by insomnia and intermittent wakefulness in sleep during the evening and morning hours. The Veteran did not have a history of violent behavior or a history of suicidal attempts. Upon mental status examination, the Veteran was found to be oriented; his appearance, hygiene, and behavior were appropriate; his affect and mood were reflective of anxiety and depression; communication and speech were within normal limits; focus, concentration, and attention were impaired; panic attacks were present and reported as occurring less than once per week; the Veteran was positive for suspiciousness; there were no delusions or hallucinations; obsessive-compulsive behavior was absent; thought processes were appropriate (he could understand directions and did not have slowness of thoughts or confusion); his memory was mildly impaired; and suicidal/homicidal ideations were absent. The November 2011 VA examiner stated that the Veteran did not have mental difficulty performing activities of daily living. The VA examiner stated that the Veteran's psychiatric symptoms most closely approximated occupational and social impairment with occasional decrease in work efficiency and intermittent ability to perform occupational tasks, although he functioned satisfactorily with routine behavior, self-care, and normal conversation. The examiner remarked that the Veteran had difficulty maintaining effective family role functioning, but the fact remains that he was happily married and had meaningful relationships with his children at the time of the examination. The examiner concluded that the Veteran had no difficulty understanding commands, and did not pose any threat of danger or injury to himself or others. The Veteran appeared at a July 2012 psychological examination relevant to his claim for Social Security disability benefits. He was assessed as experiencing anxiety, irritability, anger management problems, nightmares, intrusive memories, and exaggerated startle response. The examiner stated that the Veteran "did not appear to have sufficient resources to manage the relationships necessary to employment or tolerate the stress or usual work environments." By using the phrase "did not appear," the examiner's opinion is inconclusive and speculative. Accordingly, the Board affords little weight to this opinion. The Veteran attended another VA examination in October 2014 to assess the symptoms of his service-connected PTSD. Mental status examination showed that the Veteran was alert and fully oriented; he was neatly groomed, cleanly dressed, cooperative, and polite; his speech had a normal rate, rhythm, and volume; his thought processes were logical, linear, and goal-directed; his mood was depressed, with a congruent affect; he denied hallucinations and suicidal/homicidal intent or ideations; he had no observable impairment in attention, concentration, or memory; and his insight, judgment, and impulse control were intact. The VA examiner determined that the Veteran's primary psychiatric symptoms were suspiciousness, chronic sleep impairment, nightmares, and road rage. The examiner noted that the Veteran's psychiatric symptoms resulted in 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 medication. The Veteran was afforded a final VA examination in May 2019 to assess the severity of his service-connected PTSD. The Veteran reported his inpatient psychiatric hospitalization in January 2019 following a single incident of violence directed towards someone who disrespected his wife. See discussion, infra. The VA examiner charted that the Veteran was depressed, anxious, and worried about his finances and the effect of his actions on his family. The Veteran was noted to be irritable and easily angered. The Veteran reported intrusive memories from his deployment, but denied avoidance behaviors. He denied suicidal ideations. Mental status examination results showed that the Veteran was punctual and cooperative with objective testing. He was clean, well-groomed, and casually dressed. He was alert and oriented to all spheres; he maintained good eye contact; his speech was normal for rate, prosody, tone, volume, and content; his comprehension appeared intact; his thought processes were linear and goal-directed; thought content was unremarkable; memory and cognition were grossly intact; there was no evidence of auditory or visual hallucinations; and insight and impulse control were intact. The VA examiner determined that the Veteran's primary psychiatric symptoms were depressed mood, anxiety, suspiciousness, and chronic sleep impairment . The examiner noted that the Veteran's psychiatric symptoms resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. In the November 2022 memorandum decision, the Board was ordered to address the portion of the May 2019 VA examination report opining that "as a result of [his] PTSD, [the Veteran] needed a job with limited interaction with others and a flexible schedule." The Veteran argued that this finding by the examiner was more consistent with a 50 percent rating under Diagnostic 9411; however, the Board disagrees. The symptoms used to support the VA examiner's employability statement, as set forth in section 4 of the examination report, are symptoms that are directly contemplated by the 30 percent criteria under the Rating Schedule, to include depressed mood, anxiety, suspiciousness, and chronic sleep impairment. When assessing the DSM-5 criteria for a PTSD diagnosis, the examiner check marked findings such as feelings of detachment and estrangement from others; irritable behavior and angry outbursts expressed as verbal or physical aggression; reckless or self-destructive behavior; and recurrent distressing memories. However, when asked to identify the relevant symptoms for rating purposes, the VA examiner identified depressed mood, anxiety, suspiciousness, and chronic sleep impairment. Thus, the Board is left with the distinct impression that the PTSD symptoms identified in section 4 of the examination report were the Veteran's predominant PTSD symptoms for rating purposes, and the other symptoms check marked in section 3 of the report, in relation to assessing a DSM-5 diagnosis of PTSD, occurred less frequently and with a shorter duration than those documented in section 4. This is supported by the fact that the Veteran's VA treatment records prior to the May 2019 VA examination (with the exclusion of his brief period of exacerbation in December 2018 to January 2019, discussed infra) did not show violent tendencies, aggression, emotional detachment, or intrusive memories significantly impacting the Veteran's ability to function under the ordinary conditions of life. Moreover, at the examination, the Veteran was found to be alert and oriented; cooperative and sincere; and with intact impulse control and insight. While the examiner found that the Veteran would be best suited in employment with a flexible schedule, decreased stress, and limited interactions with others, the totality of the evidence, including the Veteran's VA treatment records, does not demonstrate occupational and social impairment with reduced reliability and productivity during the period under consideration. In the November 2022 memorandum decision, the Court noted that the Board adequately analyzed the social impairment element of a 50 percent rating, but criticized the Board for failing to engage in a more in-depth analysis of the occupational impairment element. The Board is perplexed by this analysis, as a 50 percent rating requires both social AND occupational impairment resulting in reduced reliability and productivity before the higher rating can be assigned. See Camacho v. Nicholson, 21 Vet. App. 360, 366 (2007) (stating that the inclusion of the conjunctive word "and" in a regulation clearly indicates that all listed criteria must be demonstrated, or it would render the wording meaningless); see Melson v. Derwinski, 1 Vet. App. 334 (1991) (noting that use of the conjunctive "and" in a statutory provision meant that all of the conditions listed in the provision must be met). Nevertheless, consistent with the analysis in this decision, the evidence does not show that the Veteran has experienced social and occupational impairment consistent with a 50 percent rating or higher during the period under consideration. The Board finds the VA examinations of record to be thoughtfully performed, comprehensive, and entitled to significant probative value in this appeal. They do not support a rating higher than 30 percent under Diagnostic Code 9411 during the period under consideration. At the July 2019 Travel Board hearing, the Veteran testified that his primary psychiatric symptoms consisted of nightmares/chronic sleep impairment, irritability/anger, avoidance of crowds and closed spaces, impaired concentration, impaired memory, and use of alcohol to self-medicate. The Board finds the Veteran's testimony to be competent, credible, and consistent with his VA treatment records, which document continuous psychiatric treatment throughout the appeal period. The Veteran's VA treatment records document frequent complaints regarding nightmares, suspiciousness, chronic sleep impairment, anxiety, depression, episodic road rage, flashbacks of deployment, avoidance of crowds, hypervigilance, and poor concentration. Review of the correlating mental status examination findings throughout the course of the Veteran's VA psychiatric treatment establishes that the Veteran consistently had a normal appearance, with appropriate dress and hygiene; he exhibited a cooperative attitude and behavior; his mood and affect were depressed, anxious, or irritable; his speech was normal rate, rhythm, and tone; his thought processes were logical and goal-directed; he was without delusions/hallucinations and suicidal/homicidal ideations; he was always oriented to time, person, and place; and his insight, judgment, and cognition were fair and grossly intact. The administrative record reveals that the Veteran was briefly admitted to inpatient psychiatric hospitalization for two weeks in January 2019 secondary to an acute exacerbation of his service-connected PTSD symptoms following an incident of violence triggered by a man who bragged about sexually assaulting his spouse as a teenager. Following this episode of violence, the Veteran briefly entered a deep depression until his hospitalization. He reported to the emergency room in a disheveled and unhygienic state. He reported brief suicidal desires without intent in the week prior to hospitalization. He reported having lost 10 pounds after not eating for 5 days. Three weeks prior to admission, the Veteran appeared at the man's house with the intent to shoot him, and when the man did not answer the door, the Veteran shot his gun in the air. This episode triggered a worsening of the Veteran's depression. The Veteran was admitted for homicidal ideations towards the man who abused his wife as a teenager. At hospital discharge, the Veteran's condition had stabilized, and he denied thoughts of self-harm and intentions to carry out harm against others. The Board is tasked with interpreting reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of the disability present. 38 C.F.R. § 4.2. Thus, viewing the evidence holistically, the record shows that the Veteran's episode of severe depression, suicidality, and homicidally following his altercation with his wife's alleged attacker was an acute exacerbation of his PTSD symptoms, and as soon as he presented for medical treatment, initiated psychiatric care, and had his medications managed, the Veteran's heightened psychiatric symptoms subsided. The Board does not find the Veteran's brief period of exacerbated psychiatric symptoms to be reflective of his overall PTSD symptomatology during the period under consideration. The Board has considered whether the Veteran is eligible for a staged rating during this period, but the Board does not find the Veteran's episodic exacerbation to be of the frequency or duration sufficient to warrant a staged rating. Since the Veteran's psychiatric exacerbation from December 2018 to early January 2019 was an isolated episode, especially when compared to the remainder of the Veteran's psychiatric treatment during the relevant period prior to May 8, 2020, the Board finds this period to be an outlier in assessing the Veteran's symptomatology, and as such, it is afforded minimal probative value in this appeal. The Board's conclusion in this regard is further supported by the VA mental health records dated in the months after the Veteran's inpatient psychiatric hospitalization, as well as the results of the May 2019 VA examination, all of which showed that the Veteran's psychiatric symptoms quickly returned to the baseline level that was in existence for the majority of the period under consideration. Having fully considered the evidence, the Board finds that the Veteran's psychiatric symptoms are adequately contemplated by his current 30 percent disability rating for the entire period prior to May 8, 2020. His primary complaints of depressed mood, anxiety, suspiciousness, mild memory loss, less than weekly panic attacks, and chronic sleep impairment are fully contemplated by the 30 percent rating criteria under Diagnostic Code 9411, 38 C.F.R. § 4.130. To the extent that the Veteran experienced any unlisted symptoms-and aside from the challenges to the interpretation of the May 2019 VA examination report, discussed supra-neither the Veteran nor his attorney has articulated how these symptoms were of the severity, frequency, or duration that they resulted in social and occupational impairment worse than reflected by a 30 percent rating during the period under consideration. See Vazquez v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). With respect to a 50 percent rating, the record does not indicate that the Veteran experienced a flattened affect, as nearly all mental status examinations showed affect congruent to the Veteran's mood. He never exhibited circumstantial, circulatory, or stereotyped speech, as nearly all mental status examinations showed clear, coherent, spontaneous, and responsive speech. There is no objective evidence that the Veteran has experienced panic attacks occurring more than once a week. Likewise, there is no indication of difficulty understanding complex commands or impairment of long-or-short-term memory, as the Veteran was shown to consistently exhibit only mild memory impairment, and normal cognition. There was also no evidence of impaired judgment or impaired abstract thinking, as all mental status examinations showed fair and grossly intact judgment and reasonable insight. While the Veteran exhibited disturbances of motivation and mood, the frequency and severity of this symptomatology more closely approximated a 30 percent rating during the period under consideration. This conclusion is supported by the fact that the Veteran engaged in hobbies such as hunting and fishing, raising and taking care of animals (rabbits, chickens, dogs, and cats), vegetable gardening, and aquaponics; and his psychiatric symptoms did not result in reduced reliability or productivity. Thus, while he exhibited disturbances of motivation and mood, he remained capable of engaging in hobbies and activities of daily living that produced episodes of enjoyment. Similarly, while he reported avoidance behavior; the Veteran maintained a strong familial relationship with his wife, his children, his brother, and a neighbor-friend who he occasionally talked with and worked with on projects. See October 2014 VA examination. While the May 2019 VA examiner estimated that the Veteran's PTSD would require employment with a flexible schedule and limited interactions with others, this was caused by symptoms predominantly contemplated by the 30 percent rating criteria, and the record is without probative evidence that the Veteran's PTSD resulted in both social AND occupational impairment with reduced reliability and productivity. The Veteran's psychiatric symptoms were not of a severity or frequency to warrant a higher 50 percent evaluation during the period under consideration. With respect to the 70 percent criteria, the record does not support a finding that the Veteran had occupational or social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood during the period under consideration. Excluding the nonprobative psychiatric exacerbation from December 2018 to early January 2019, the Veteran consistently denied suicidal/homicidal ideations throughout the period under consideration. There were no signs of obsessive ritual behavior in his treatment records. The Veteran's speech was always normal upon examination. There was no evidence of near-continuous panic during the relevant period prior to May 8, 2020, and while the Veteran maintained a consistent degree of depression throughout the appellate period under consideration, it did not negatively impact his ability to function independently, appropriately, and effectively. At nearly all mental status examinations, the Veteran's behavior and attitude were cooperative and appropriate, and he was persistently noted as casually dressed and with appropriate hygiene. There was no evidence of impaired impulse control, such as violent tendencies or public outbursts. He was always oriented to time, person, and place. His PTSD symptoms were described as manageable despite the stress that came along with his physical orthopedic impairments. He also maintained successful relationships with immediate relatives. The Veteran's psychiatric symptoms were not of a severity or frequency to warrant a higher 70 percent evaluation during the period prior to May 8, 2020. With respect to a 100 percent disability rating, the Veteran never exhibited gross impairment in thought processes or communication or persistent delusions or hallucinations (nearly all mental status examinations showed thought processes were linear, coherent, and without hallucinations or delusions and his speech was normal). The Veteran never exhibited grossly inappropriate behavior (behavior was nearly always noted as cooperative or appropriate upon mental status examination) or persistent danger of hurting self or others (excluding the period from December 2018 to early January 2019, the Veteran denied suicidal and homicidal ideations on all occasions and exhibited no dangerous tendencies). The Veteran remained fully capable of performing activities of daily living. The Veteran was never disoriented to time or place, as all mental status examinations showed orientation to all spheres. The Veteran's psychiatric symptoms were not of a severity or frequency to warrant a higher 100 percent evaluation during the period under consideration. For the reasons stated above, the Veteran's request for a rating in excess of his currently assessed 30 percent rating for service-connected PTSD is denied for the entire appellate period prior to May 8, 2020. In an August 2020 rating decision, the RO increased the Veteran's rating for his service-connected PTSD to 100 percent, effective May 8, 2020. The RO assigned this effective date because May 8, 2020 was the date of a private examination showing a stark increase in the Veteran's PTSD symptoms. May 8, 2020 was the first date that the increase in the Veteran's symptoms were factually ascertainable under the record, and the Board finds no error in the RO's determination to use this date as the effective date for the increased 100 percent evaluation. Swain v. McDonald, 27 Vet. App. 219, 224 (2015). [Continued on Next Page] 2. From August 13, 2012 to May 7, 2020, entitlement to a TDIU is granted. The Veteran has alleged that he is entitled to a TDIU. See June 2014 and March 2019 VA forms 21-8940, Veteran's Application for Increased Compensation Based on Unemployability. The Veteran has not been employed since he was released from active duty in August 2012. The Veteran was denied entitlement to a TDIU in an unappealed and final October 2014 rating decision. However, the Board has jurisdiction over an inferred claim of TDIU, as such a claim is part and parcel with the increased rating claim on appeal. See Rice v. Shinseki, 22 Vet. App. 447 (2009). The undersigned agreed to take jurisdiction over an inferred TDIU claim at the July 2019 Travel Board hearing. In the January 2020 Board decision, the Veteran's claim seeking entitlement to a TDIU was remanded for referral to the Director of Compensation Service for extraschedular consideration. The Director considered the matter in April 2020 and denied the request. In an August 2020 rating decision, the RO increased the Veteran's rating for his PTSD to 100 percent, effective May 8, 2020, and stated that "this grant of a total evaluation satisfies the issue of individual unemployability on appeal." However, such a conclusion is not legally accurate, as a grant of a100 percent disability rating does not always render the issue of TDIU moot, particularly when the increased evaluation does not span the entire appellate period for the underlying increased rating claim. VA will grant a TDIU when the evidence shows that the Veteran is precluded, by reason of his service-connected disabilities, from securing and following all forms of substantially gainful employment, consistent with his education and occupational experience. 38 C.F.R. § 4.16. The Court has held that the term "unable to secure and follow a substantially gainful occupation" in 38 C.F.R. § 4.16 has two components. First, there is an economic component which essentially contemplates an occupation earning more than marginal income (outside of a protected environment) as determined by the United States Department of Commerce as the poverty threshold for one person. Second, there is a non-economic component dealing with the individual veteran's ability to "follow and secure" employment. For the second component, attention must be given to: (a) the Veteran's history, education, skill, and training; (b) the Veteran's physical ability (both exertional and non-exertional) to perform the type of activities (e.g., sedentary, light, medium, heavy, or very heavy) required by the occupation at issue, with relevant factors such as lifting, bending, sitting, standing, walking, climbing, grasping, typing, reaching, and auditory/visual limitations; and (c) whether the Veteran has the mental ability to perform the type of activities required by the occupation at issue, with relevant factors such as memory, concentration, and ability to adapt to change, handle work place stress, get along with coworkers, and demonstrate reliability and productivity. See Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). The economic component of a TDIU claim is not in dispute, as the record sufficiently indicates that the Veteran has not earned an annual income greater than the poverty threshold during the period under consideration, as he has been unemployed. The Veteran has not been substantially gainfully employed since he left active duty service on August 12, 2012. Thus, the remainder of this analysis shall focus on the non-economic component of a TDIU claim. Under 38 C.F.R. § 4.16(a), if there is only one service-connected disability, the disability must be rated at 60 percent or more to qualify for schedular TDIU consideration. If there are two or more service-connected disabilities, there must be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more, to allow for schedular TDIU consideration. 38 C.F.R. § 4.16(a). For the time period under consideration-August 13, 2012, (the day following the Veteran's separation from active duty service) through May 7, 2020, the Veteran was service-connected for PTSD (30 percent); low back disability (20 percent); left knee (10 percent); right knee (10 percent); tinnitus (10 percent); right foot (noncompensable); hypogonadism (noncompensable); left lower extremity radiculopathy (noncompensable); and right lower extremity radiculopathy (noncompensable). His total combined disability rating was 60 percent, but his disabilities could not be combined as a "single disability" under any of the enumerated circumstances set forth in 38 C.F.R. § 4.16(a). Therefore, the Veteran did not meet the schedular criteria for a TDIU during the period under consideration. The relevant regulation provides that, if the required percentage requirements for TDIU are not met on a scheduler basis, but the Veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities, then the Director, Compensation Service, should consider whether TDIU may be awarded on an extraschedular basis. 38 C.F.R. § 4.16(b). The Board may not award a TDIU on an extraschedular basis in the first instance. Bowling v. Principi, 15 Vet. App. 1 (2001). Pursuant to the January 2020 Board remand order, the matter was referred to the Director of Compensation Service. On April 23, 2020, the RO Veterans Service Center Manager (VSCM) completed an administrative review of the claims file and issued a recommendation to the Director of Compensation Service that the Veteran should be awarded an extraschedular TDIU, effective June 2, 2014, the date VA received the Veteran's formal TDIU application. The VSCM stated, in pertinent part: The Veteran has orthopedic and mental conditions that when taken as a whole, would preclude his ability to perform his normal occupation of commercial truck driver. His knee and back conditions render it difficult to remain seated for periods of time. His use of prescribed medications for his service-connected conditions renders him unable to remain awake and alert creating a danger to himself and others. The Veteran has a GED. The Veteran is 52 years old...In this instance[,] an unusual disability pattern has indeed been demonstrated that would render application of the regular rating criteria impractical. The evidence shows the Veteran's occupation as a truck driver has been precluded. His inability to sit due to his service-connected orthopedic disabilities would render his ability to perform sedentary work unlikely as well. On April 28, 2020, the Director of Compensation Service issued a decision denying the Veteran's request for an extraschedular TDIU. The Director stated, in pertinent part: In this case, it is noted that the Veteran has multiple orthopedic disabilities which could impair him with prolonged physical demands. Further, the Veteran has PTSD which has caused some impairment. As noted above, a high rating in itself recognizes that the impairment makes it difficult to obtain and keep employment. Further, the ultimate question is whether the Veteran, because of service-connected disabilities, is incapable of performing the physical and mental acts required by employment, not whether or not he can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). It is well known that the American workplace has had a dramatic shift in the labor force over the last several decades. It has long been known that Americans generally have less strenuous jobs compared to those of years ago. The decline is due in part to the increasing reliance on computers, the Internet, and e-mail. There are many jobs in today's workplace that require only light activity and for which a person with a high school education would be capable of performing. That is, a person need not be college educated or highly skilled to be productive in today's work environment. Although the Director of Compensation Service found that entitlement to a TDIU on an extraschedular basis was not warranted, the Board still has the authority to assign an extraschedular total disability rating for compensation purposes based on individual unemployability after referral to the Director of Compensation Service. See Anderson v. Shinseki, 22 Vet. App. 423, 427 (2009) ("[T]here is no restriction on the Board's ability to review the denial of an extraschedular rating on appeal."); Wages v. McDonald, 27 Vet. App. 233, 236 (2015) (per curiam) (finding that the Board erroneously relied upon the determination of the Director of Compensation Service as evidence, rather than merely "the de facto decision of the agency of original jurisdiction," subject to de novo review). The Veteran has been awarded entitlement to Social Security disability benefits based on his service-connected disabilities. While the Board is not bound by administrative determinations rendered by other governmental agencies, applying laws and regulations distinct from those considered by VA, see Collier v. Derwinski, 1 Vet. App. 413 (1991), this evidence from the Social Security Administration nevertheless suggests that the Veteran has experienced difficulty securing and following substantially gainful employment during the period under consideration, as a result of his service-connected disabilities. The record reflects that the Veteran's highest level of education is a GED, and his most recent and relevant work experience is primarily in the field of truck driving. The July 2012 psychological assessment noted a history of construction employment ending in 1999. The Veteran's DD Form 214 from his first period of active duty service lists his military occupational specialty (MOS) as track vehicle repairer. His DD Form 214 from his second period of active duty service lists his MOS as motor transport operator. The Veteran medically retired from the Army in 2012 after approximately 15 years of active and National Guard service, and was immediately awarded Social Security disability benefits. In October 2011, the Veteran attended a VA general examination. The Veteran reported that his job as a truck driver required prolonged sitting and the climbing of stairs, and as a result of his service-connected lumbar spine and bilateral knee disabilities, he was no longer capable of sitting for long periods of time or ascending stairs into a truck cabin. These actions resulted in episodes of pain and weakness in the low back and bilateral knees. At the October 2014 PTSD examination, the Veteran explained that his PTSD made it difficult for him to work as a truck driver. The Veteran feared having road rage while driving a big truck due to his PTSD symptoms and expressed an aversion to working with others. He further stated that his low frustration tolerance, lack of concentration, and limited experience with using computers would prevent him from learning a new career. He stated, "[e]verything is computer driven now and I can barely turn one on to get to [F]acebook." The Board is persuaded that the Veteran's PTSD symptoms could dangerously result in road rage and road safety issues. While the Veteran has asserted a subjective difficulty working with others, the Board finds this to be less probative, as the position of a truck driver is largely solitary. Additionally, the Board finds the Veteran's lay reports of limited familiarity with computers and technology to be competent, credible, and consistent with his limited education level. At an October 2014 VA back examination, the examiner charted the Veteran's lay reports that he was unable to work as a truck driver because the Veteran's low back was too painful when riding in a car/truck. He noted that some days were worse than others and he would likely miss work during his flare-ups of low back pain. The examiner opined that the Veteran would be capable of light activity, "if he so desires" but stated that the Veteran would benefit from employment that allowed both standing and sitting. This last statement would preclude substantially gainful truck driving, which requires prolonged and extensive sitting. At a May 2019 VA PTSD examination, the examiner estimated that the Veteran's PTSD would not impact the Veteran's ability to engage in physical or sedentary employment, but he would require a flexible schedule, decreased stress and responsibility, and limited interactions with staff and customers. The examiner did not assess the impact of any of the Veteran's service-connected physical disabilities on employability. At a May 2019 VA back examination, the examiner opined that the Veteran had a decreased ability to tolerate prolonged standing and walking as a result of increased pain and decreased mobility attributed to his service-connected lumbar spine disability. The Board acknowledges that the Veteran submitted a PTSD disability benefits questionnaire completed by Dr. J.G.L. in May 2020, which opined that the Veteran was unable "to meet the mental demands of even unskilled sedentary work and has been unemployable since September 2012." The clinician stated that the Veteran was unable to function effectively or without anxiety around others and could only tolerate brief interactions. His depressive symptoms made it difficult for him to sustain sufficient energy and motivation to carry out work assignments or most activities of daily living. The Board finds this opinion to be probative and favorable towards the Veteran's TDIU claim dating back to August 13, 2012. The Veteran's service-connected physical and psychiatric disabilities have precluded him from maintaining his commercial driver's license. See April 2013 VA treatment record. His service-connected low back and bilateral knee disabilities prevent the Veteran from sitting for long periods of time. Additionally, the Veteran's chronic use of prescription medications to treat the pain associated with his service-connected disabilities has resulted in side effects, such as drowsiness, that would render commercial driving unsafe. See July 2019 Board hearing. The record reflects that the Veteran has been prescribed hydrocodone and gabapentin on a prolonged basis for his low back pain. Following a thorough review of the electronic claims file, the Board finds that the noneconomic component of a TDIU claim has been satisfied from August 13, 2012 to May 7, 2020. The Veteran's service-connected low back, bilateral knee, and PTSD disabilities have resulted in physical and psychological symptoms that are incompatible with substantially gainful employment as a truck driver. The Board notes that the Veteran has a limited formal education, and his predominant occupational experience has been in the truck driving field. The evidence demonstrates that the Veteran's service-connected disabilities have severely functionally limited the Veteran from performing the physical activity required of a truck driver. The pain associated with his service-connected low back and bilateral knee disabilities has limited his ability to sit for long periods of time and/or climb into a truck cabin, effectively ending any employment potential as a truck driver. His PTSD symptoms of depression, anxiety, and suspiciousness, combined with the drowsiness he experiences as a side effect from the pain medication used to treat his service-connected low back disability has made it unsafe for the Veteran to operate a truck on a substantially gainful basis. Moreover, the pain resulting from his service-connected disabilities has been shown to impact his concentration; his ability to follow instructions; and his ability to learn new career skills. To the extent that the Veteran has past occupational experience in construction work, the impairments caused by the Veteran's low back, bilateral knee, and PTSD disabilities would similarly preclude such employment or jobs of like duties. During the period under consideration, the Veteran has not had the physical capacity to perform the heavy duty work required by construction employment. The Veteran did not have the capacity to engage in heavy lifting, repetitive stooping/squatting, or climbing stairs or ladders. Given these functional limitations, the evidence is in approximate balance or greater that the Veteran has been precluded from securing or following substantially gainful employment consistent with his occupational history and educational attainment during the period from August 13, 2012 to May 7, 2020. In the April 23, 2020 memorandum, the RO VSCM recommended that the Veteran's extraschedular TDIU should be awarded as of June 2, 2014 because this was the date that the Veteran's formal TDIU application was received. However, the Veteran's TDIU claim is linked to the increased rating claim for PTSD, which dates back to August 13, 2012. There is no difference in the Veteran's unemployability status between August 13, 2012 and June 2, 2014, and thus, resolving reasonable doubt in the Veteran's favor, the Board shall enact the Veteran's TDIU rating as of the earlier date of August 13, 2012. Lastly, while the Director of Compensation Services' opinion does not serve as evidence in this appeal, the Board is compelled to address the rationale she invoked to deny extraschedular TDIU benefits. The Director argued that the workforce has veered towards less strenuous work over the decades, and even high school educated individuals are capable of being productive in today's work environment, which relies on light activity and the use of computers/internet. This argument ignores the Veteran's self-professed limitations regarding the use of the internet/computers, his low frustration tolerance, and his inability to adapt to change and maintain the concentration or focus needed to learn new occupational skills. The Veteran has only worked in the truck driving and construction fields, and the impairments from his service-connected disabilities have made this type of employment no longer feasible. The Veteran lacks the mental capacity to pivot to a new career, and he has an extremely limited education level, where he left high school in the 10th grade and ultimately obtained a GED. These circumstances render the Veteran incompatible with adjusting to other career options in the competitive work environment. Consistent with the above analysis, the Veteran's appeal seeking entitlement to an extraschedular TDIU is granted from August 13, 2012, the day following the Veteran's separation from active service, to May 7, 2020. 3. Since May 8, 2020, entitlement to a TDIU is denied as moot. Since May 8, 2020, the Veteran has been in receipt of a schedular 100 percent rating for his service-connected PTSD. The Board recognizes that the award of a schedular 100 percent rating does not always render the issue of entitlement to a TDIU as moot. Although no additional disability compensation may be paid when a total schedular disability rating is already in effect, Bradley v. Peake, 22 Vet. App. 280 (2008), recognized that a separate award of a TDIU predicated on a single disability may potentially form the basis for an award of SMC under 38 U.S.C. § 1114 (s), allowing the Veteran's benefits to be maximized. In such circumstances, the TDIU issue is not moot. See Bradley, 22 Vet. App. at 293-94 (noting that although no additional disability compensation may be paid when a total schedular disability rating is already in effect, a separate award of a TDIU predicated on a single disability when considered together with another disability or disabilities rated at 60 percent or more may warrant payment of SMC under 38 U.S.C. § 1114 (s)). However, Bradley also explains that a 100 percent combined evaluation does not qualify as "a service-connected disability rated as total" under the statute. 38 U.S.C. § 1114(s); Bradley, 22 Vet. App. at 290. From July 22, 2020 to September 1, 2020, the Veteran was also in receipt of SMC based on statutory housebound status, and thus, a TDIU is denied as moot during this time period, as the Veteran's disability benefits have been maximized. The forthcoming analysis shall exclude this period of time. The Board must consider whether a single service-connected disability, alone, could provide a basis for award of a TDIU during the relevant period since May 8, 2020 (and excluding the period from July 22, 2020 to September 1, 2020), sufficient to warrant entitlement to SMC and maximize the Veteran's benefits. After reviewing the evidence of record, the Board finds that the Veteran is not individually unemployable due solely to any single service-connected disability during this discrete time period. The Board acknowledges that if a TDIU were to be awarded based solely on the Veteran's service-connected PTSD, the remainder of the Veteran's service-connected disabilities do not total to 60 percent or greater, either individually or combined, for the purpose of satisfying the SMC statutory housebound criteria. Thus, in accordance with Bradley, such a factual circumstance would render entitlement to a TDIU based solely on the Veteran's service-connected PTSD moot. If the Veteran were to be awarded entitlement to a TDIU based solely on any other service-connected disability other than PTSD since May 8, 2020, this could qualify the Veteran for SMC at the housebound rate, as the 100 percent rating in effect by virtue of the TDIU, coupled with the 100 percent schedular rating in effect for the Veteran's PTSD would satisfy the statutory and regulatory requirements for SMC under 38 U.S.C. § 1114(s). However, since May 8, 2020, there is no probative evidence indicating, yet alone establishing, that any of the Veteran's individual service-connected disabilities other than PTSD have rendered the Veteran individually unemployable (excluding the period from July 22, 2020 to September 1, 2020, when the Veteran was in receipt of a total temporary disability for his service-connected low back disability). Additionally, none of the Veteran's service-connected disabilities other than PTSD individually satisfy the schedular TDIU criteria since May 8, 2020, and the record is otherwise without "sufficient evidence to substantiate a reasonable possibility that [the Veteran was] unemployable because of [any individual service-connected disability aside from PTSD since May 8, 2020]" to allow for referral of the matter for extraschedular TDIU consideration. See Snider v. McDonough, 35 Vet. App. 1 (2021). Consistent with the above analysis, the Board finds no plausible basis to award TDIU based on a single disability during the relevant period since May 8, 2020, sufficient to warrant entitlement to SMC and maximize the Veteran's benefits (excluding the time period of July 22, 2020 to September 1, 2020). As such, the Veteran's TDIU claim must be denied as moot during the relevant period since May 8, 2020. 4. Effective August 13, 2012, entitlement to basic eligibility to DEA benefits Basic eligibility for DEA benefits for the child, spouse, or surviving spouse of a veteran is established if: (1) the Veteran was discharged from service under conditions other than dishonorable, or died in service; and (2) the Veteran has a permanent total service-connected disability; or (3) a permanent total service-connected disability was in existence at the date of the Veteran's death; or (4) the Veteran died as a result of a service-connected disability. 38 U.S.C. §§ 3500, 3501, 3510; 38 C.F.R. § 3.807. In an August 2020 rating decision, the Veteran was awarded entitlement to basic eligibility to DEA benefits as of May 8, 2020. However, the issue of entitlement to basic eligibility for DEA benefits earlier than this date is linked with the adjudication of the TDIU issue. Because the Board has awarded entitlement to a TDIU from August 13, 2012, to May 7, 2020, the Veteran is also entitled to basic eligibility to DEA benefits during this time period, by virtue of having been awarded a permanent total service-connected disability, and to this extent, the Veteran's appeal is granted. See 38 C.F.R. §§ 3.807, 21.3021(p). August 13, 2012, is the day following the Veteran's separation from active service, and thus, this is the earliest effective date for which basic eligibility to DEA benefits may be awarded under the law. See 38 C.F.R. § 3.400; 38 U.S.C. § 5113. Cynthia M. Bruce Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Galante, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.