Citation Nr: 25004574 Decision Date: 04/03/25 Archive Date: 04/03/25 DOCKET NO. 13-00 582 DATE: April 3, 2025 ORDER A total disability rating based upon individual unemployability due to service-connected disabilities from April 24, 2013, but no earlier, is granted. Prior to April 24, 2013, entitlement to a TDIU on an extraschedular basis is denied. FINDINGS OF FACT 1. The Veteran was engaged in substantially gainful employment until December 11, 2011. 2. The evidence dated from December 11, 2011, to April 24, 2013 persuasively weighs against a finding that the Veteran's service-connected disabilities, alone, prevented him from obtaining and maintaining substantially gainful employment consistent with his educational and vocational experience. 3. Effective April 24, 2013, the evidence supports a finding that the Veteran's service-connected disabilities prevented him from obtaining and maintaining substantially gainful employment consistent with his educational and vocational experience. CONCLUSIONS OF LAW 1. From December 11, 2011, to April 24, 2013, the criteria for entitlement to a TDIU on an extraschedular basis have not been met. 38 U.S.C. §§ 1151, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. 2. The criteria for entitlement to a TDIU have been met, effective April 24, 2013. 38U.S.C. §§ 1151, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The issue of entitlement to a TDIU was raised in conjunction with increased rating claims for posttraumatic stress disorder (PTSD), hearing loss, and tinnitus that had been pending since October 2007 and September 2008. During the pendency of the appeal for those issues, the Veteran testified before a Veterans Law Judge (VLJ) who is no longer employed by the Board. See October 2015 hearing transcript. After receiving appropriate notice as to the Veteran's right to have another hearing, the Veteran's representative indicated that he did not wish to have another hearing. See statements dated April 2021 and January 2022. As such, all due process has been provided to the Veteran with respect to his right to a hearing. This appeal has an extensive procedural history that includes numerous remands by the Board, three Joints Motions for Partial Remand (JMRs) granted by the U.S. Court of Appeals (Court), and a Memorandum Decision issued by the Court in October 2024. In this regard, the record reflects that, in March 2022, the Board denied entitlement to a rating in excess of 50 percent for the Veteran's service-connected PTSD, depression, panic, and generalized anxiety disorder prior to April 24, 2013, as well as entitlement to a TDIU, including on an extraschedular basis, prior to April 24, 2013, and entitlement to a TDIU from April 24, 2013 to May 20, 2015 (the date from which TDIU is already granted). The Veteran appealed the March 2022 Board decision to the Court, and, in the October 2022 JMR, the parties agreed that the portion of the March 2022 decision that denied entitlement to a TDIU prior to April 24, 2013 and from April 24, 2013 to May 20, 2015 should be vacated and remanded to the Board for readjudication. The Veteran did not appeal the portion of the decision that denied entitlement to a rating in excess of 50 percent for service-connected PTSD, depression, panic, and generalized anxiety disorder prior to April 24, 2013. Therefore, that issue is no longer before the Board. In February 2023, the Board granted entitlement to a TDIU from July 7, 2016 but denied entitlement to a TDIU, to include on an extraschedular basis, prior to that date. The Veteran appealed the February 2023 decision to the Court and, in October 2024, the Court issued a single judge Memorandum Decision that vacated the portion of the decision that denied entitlement to a TDIU prior to July 7, 2016 and remanded the claim for further readjudication consistent with the Memorandum Decision. The appeal now returns to the Board for further consideration. 1. Entitlement to a total disability rating based upon individual unemployability, to include on an extraschedular basis, prior to July 7, 2016 As noted, the issue of entitlement to a TDIU was raised in conjunction with claims that have been pending since October 2007. Therefore, the Board must consider whether entitlement to a TDIU is warranted from October 26, 2007, the date of receipt of the Veteran's initial claim seeking entitlement to service connection for PTSD (and the date from which service connection for PTSD is granted). See Rice v. Shinseki, 22 Vet. App. 447, 455 (2009). The Veteran has been awarded entitlement to TDIU due to his service-connected PTSD, depression, panic, and generalized anxiety disorder from July 7, 2016. See February 2023 Board and rating decision. However, the Veteran has asserted that he is entitled to a TDIU from the last day he was employed on a full-time basis and performed substantially gainful employment, i.e., December 11, 2011. See December 2022 and February 2025 brief. In this case, the evidence persuasively establishes that the Veteran earned and maintained more than marginal income and full-time employment from approximately February 1979 to December 11, 2011. See July 2018 VA Form 21-8940; earnings statement from the Social Security Administration (SSA). As such, actual employability is established for that period. See Foust v. West, 13 Vet. App. 342 (2000). Further, the Veteran and his representative attorney do not argue that the Veteran was employed in a protected environment. Based on this evidence, along with the arguments made by the Veteran's attorney, this decision will address the Veteran's entitlement to a TDIU from December 11, 2011. VA will grant a total rating for compensation purposes based on unemployability when the evidence shows a 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. In reaching such a determination, 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 (1993). Neither nonservice-connected disabilities nor advancing age may be considered in the determination. 38 C.F.R. §§ 3.341, 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). In arriving at a conclusion, consideration may be given to the veteran's level of education, special training, and previous work experience, but not to his age or the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. The United States Court of Appeals for Veterans Claims (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 U.S. 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, auditory and visual, 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. Ray v. Wilkie, 31 Vet. App. 58 (2019). As sedentary is defined as "doing or requiring much sitting" the Board finds that sedentary employment is a job where the worker primarily sits down. MERRIAM-WEBSTER'S COLLEGEIATE DICTIONARY 1123 (2003). If there is only one service-connected disability, it must be rated at least 60 percent disabling to qualify for TDIU benefits; if there are two or more such disabilities, there shall 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. 38 C.F.R. § 4.16 (a). VA's policy is to grant TDIU in all cases where a service-connected disability causes unemployability regardless of the percentage evaluations. 38 C.F.R. § 4.16 (b). In situations where the percentage evaluations do not allow TDIU under § 4.16 (a), an extraschedular TDIU may be awarded under § 4.16 (b). The Board is precluded by regulation from assigning an extraschedular rating under 38 C.F.R. § 4.16 in the first instance. The Board, however, is not precluded from considering whether the case should be referred to the Director of VA's Compensation Service for consideration of an extraschedular TDIU rating. A decision by the Director of the Compensation Service is not evidence. Rather it is a decision or adjudication that is adopted by the RO and reviewed de novo by the Board. Wages v. McDonald, 27 Vet. App. 233 (2015). The determination of whether a case should be referred for an extraschedular TDIU determination under 38 C.F.R. § 4.16 (b) is a lower standard than a determination on whether TDIU is warranted. See Snider v. McDonough, 35 Vet. App. 1 (2021). In determining whether a referral is warranted, the Board must address whether there is sufficient evidence to substantiate a reasonable possibility that a veteran is unemployable because of service-connected disabilities. See Ray, supra. If the Board concludes that this lesser standard has not been met, i.e., there is no reasonable possibility that the veteran is unemployable because of service-connected disabilities, then it necessarily follows that the higher, on the merits standard has also not been met. The Veteran has been awarded service connection for the following disabilities: PTSD, depression, panic and generalized anxiety disorder (hereinafter referred to as "PTSD"), which is rated 50 percent disabling from October 26, 2007 to April 23, 2013 and 70 percent disabling from April 24, 2013; tinnitus, which is rated 10 percent disabling from September 26, 2008; right ear hearing loss, which is rated noncompensable (zero percent) from September 26, 2008, and bilateral hearing loss, which is rated noncompensable from January 12, 2011. The foregoing results in a combined rating of 60 percent from September 26, 2008, to April 24, 2013 and a combined rating of 70 percent from April 24, 2013. See 38 C.F.R. § 4.25. As shown above, the Veteran does not meet the percentage standards set forth in 38 C.F.R. § 4.16 (a) until April 24, 2013, as he has one disability rated at 40 percent or more and sufficient additional disability to bring his combined rating to 70 percent or more from that date but not earlier. Accordingly, the Board may consider the claim for a TDIU on a schedular basis from April 24, 2013. 38 C.F.R. § 4.16 (a). In April 2019, the Board referred the issue of entitlement to a TDIU prior to May 21, 2018, for extra-schedular consideration, after which the Director provided a written determination in July 2019. In this regard, the Board notes that, at the time of the April 2019 referral, the Veteran's service-connected PTSD was assigned an initial 50 percent rating until May 21, 2018, at which point a 70 percent rating was assigned. Therefore, at that time, the issue was properly characterized as entitlement to a TDIU on an extraschedular basis prior to May 21, 2018, as the Veteran did not meet the schedular criteria for TDIU until that date. However, the Board subsequently granted a 70 percent rating for PTSD from April 24, 2013 to May 20, 2018 and, thus, the issue is now correctly characterized as entitlement to a TDIU on an extraschedular basis prior to April 24, 2013. Because the Director's July 2019 determination included consideration of the period prior to April 24, 2013, the Board finds no prejudice to the Veteran in this regard. In fact, the Board notes that the decision of the Director of Compensation Service is not evidence, but rather simply a decision that is adopted by the Regional Office and reviewed de novo by the Board. Wages v. McDonald, 27 Vet. App. 233, 239 (2015). In the July 2019 decision, the Director denied entitlement to a TDIU on an extra-schedular basis prior to April 24, 2013, finding that the available evidence did not support the contention that the Veteran's service-connected disabilities prevented him from obtaining or maintaining substantially gainful employment in his usual occupation prior to May 21, 2018. In Ray v. Wilkie, 31 Vet. App. 58 (2019), the Court held that, after the Director performs his or her duties and if the Director denies an extraschedular rating, the Board, then, reviewing that decision without deference and bearing in mind the benefit of the doubt standard, decides whether the evidence shows the Veteran is unemployable by reason of his or her service-connected disabilities. The Board has considered the Veteran's educational and employment background. The evidence reflects that the Veteran graduated high school, completed one year of college, and also received vocational training in auto maintenance. The evidence also reflects that the Veteran's work history included working as a maintenance mechanic from approximately February 1979 to December 11, 2011. See July 2018VA Form 21-8940. Over the course of the appeal, the Veteran reported that his job required that he remain standing for most of his shift, climb ladders, and perform heavy lifting while repairing machines. See e.g., VA examination reports dated May and December 2011; VA treatment records dated April 2009 and February 2010. At this juncture, the Board notes that, despite two attempts, VA has been unable to secure employment information from the Veteran's employer. The record reflects that, in October 2018, the Veteran's representative requested an extension of time to allow them to obtain the requested information from the Veteran's employer; however, in December 2018, the representative requested that the Board move forward with adjudicating the claim if a response had not been received from the employer. As such, the record does not contain any information or evidence from the Veteran's former employer documenting the time lost from work, whether he was provided concessions due to his disability, or the reason(s) why his employment was terminated. On his July 2018 TDIU claim, the Veteran reported that he lost one to three days a month due to his service-connected disabilities and that he left his last job because of his disabilities. The Veteran also reported that he tried to obtain employment since he became too disabled to work in December 2011, which he stated occurred briefly between 2012 and 2013. In this regard, the Veteran has explained that, after retiring in 2011, his previous employer asked him to return a few times to repair machines with which he was familiar. See e.g., December 2013 VA PTSD examination report; April 2018 Veteran statement. Despite the evidence showing that the Veteran performed part-time employment in 2012 and 2013, the record reflects that the income he received in 2012 and 2013 was below the poverty threshold. See SSA earnings record. Therefore, his employment after 2011 was marginal and, thus, not substantially gainful employment. As the evidence does not show the Veteran has engaged in substantially gainful employment since December 2011, the economic component of a TDIU is not at issue during the time period in question. Instead, the Board will focus its discussion on the non-economic component of a TDIU, i.e., whether he is able to secure and follow substantially gainful employment given his history, education, skill, and training, in addition to his physical and mental ability. As discussed above, the Board has considered the Veteran's education and training history, as well as the evidence that describes the nature of the Veteran's usual occupation. In this regard, the evidence shows that the Veteran's employment as a maintenance mechanic was highly skilled work that required a heavy physical demand level, including climbing, bending, balancing, stooping, crawling, reaching and handling. The evidence also shows this particular occupation required occasional hearing in conditions with a loud noise intensity level, as well as interaction with co-workers, interaction with others, and also required other work abilities, such as oral comprehension and selective attention. See June 2020 vocational assessment. With respect to the Veteran's physical ability, the Board notes that the evidence shows his service-connected bilateral hearing loss impacts his daily conditions of life, including his ability to work, as he has reported difficulty hearing speech in background noise. See VA audio examinations dated December 2013 and Februaryand April 2016. The clinicians who performed the VA examinations conducted during the appeal period did not indicate that the Veteran's service-connected tinnitus impacts his ability to work, but the Veteran has consistently reported that the constant ringing in his ears resulted in persistent sleep disturbances which, in turn, caused fatigue and tiredness that contributed to problems at work. See January 2011 Veteran statement; May 2011 VA PTSD examination report. With respect to the Veteran's mental ability, the evidence reflects that his service-connected PTSD has increased in severity during the course of the appeal period, as reflected by the staged rating assigned. As noted, the Veteran's psychiatric disability is rated 50 percent disabling prior to April 24, 2013 and 70 percent thereafter, which reflects that he has experienced moderately severe to serious symptoms and functional impairment throughout the appeal period. The question that remains is if, since December 2011, the Veteran had the ability to perform the activities required to perform substantially gainful employment consistent with this education and employment history. The Veteran has submitted two private opinions in support of his claim. In July 2018, the Veteran submitted a private psychiatric evaluation conducted by Dr. Morris who, following review of the claims file and telephone interview of the Veteran, stated that the Veteran has been unable to secure and follow substantially gainful employment due to his service-connected psychiatric disability since 2011. Dr. Morris noted the Veteran's education and employment history and specifically noted the Veteran's report that he retired in 2011 because of problems he had working around other people and his panic attacks. After performing a number of tests, Dr. Morris opined that the Veteran's psychiatric disability has caused occupational and social impairment with deficiencies in most areas since at least October 2007, as evidenced by his persistent withdrawal from others, self-isolation, and inability to establish and maintain effective work and social relationships. In this regard, the examiner also noted the Veteran's continuous depression, suicidal ideation, panic attacks, difficulty with concentration, irritability, and adapting to stressful circumstances. Dr. Morris noted that the Veteran was able to understand and follow simple instructions and perform simple math but stated that the Veteran is significantly psychologically impaired and would not be able to respond favorably to supervision or interact cooperatively with co-workers on a sustained basis. In this regard, the examiner noted that, when the Veteran was working, he did his best to avoid customers and co-workers whenever possible. He also noted that the Veteran's concentration and attention are markedly affected when he experiences a panic attack and that he would have great difficulty completing tasks in a timely and acceptable manner on a sustained basis, while further noting his occasional explosive outbursts and crying spells. As noted, in June 2020, the Veteran submitted a vocational assessment from P. Thal who, after review of the claims file and telephone interview, opined that the Veteran's service-connected PTSD, tinnitus, and hearing loss disabilities precluded his ability to secure and follow substantially gainful employment, including unskilled sedentary employment, from at least December 2011. In this regard, P. Thal noted the Veteran's employment history which he reportedly left in 2011 due to his service-connected disabilities. P. Thal noted the Veteran's report that his PTSD affected his employment, noting that he typically did not attend work between one to three days a month due to his disability. She also noted the Veteran's report that he tried to avoid customers and co-workers as much as possible and experienced panic attacks when around others, almost daily, with episodes in which he blacked out. He also reported having memory issues at work, frequently forgetting co-workers' names and his job responsibilities, in addition to difficulty concentrating and focusing on his job. P. Thal also noted that the Veteran's hearing loss and tinnitus further impacted his abilities at work, as he had difficulty communicating with and understanding supervisors, co-workers, and customers. P. Thal specifically noted that the Veteran's description of what transpired while employed indicates difficulty in establishing and maintaining appropriate work relations and behaviors and dealing with job responsibilities effectively, while his inability to hear others impacted his overall work performance. P. Thal stated that, in her vocational experience, all employment requires some degree of interaction with others that is expected to be appropriate and effective and, based upon the evidence of record, the Veteran would be unable to meet these requirements due to his well-documented psychiatric symptoms of hypervigilance, concentration and focus difficulties, frequent panic attacks, difficulty establishing and maintaining relationships, isolative tendencies, and memory impairment. P. Thal also noted that all employment requires the lack of excessive absences and tardiness, the production of a minimum amount of accurate work on a regular and reliable basis, and the ability to sustain concentration for at least two consecutive hours, all of which is precluded by the service-connected psychiatric disability. P. Thal also opined that the Veteran's hearing loss and tinnitus contributes to his inability to sustain adequate pace and productivity, as well as preclude him from all substantially gainful employment, to include sedentary unskilled work, due to his inability to consistently understand oral work instruction and difficulty staying focused on work tasks for more than two hours without distraction from tinnitus. In this regard, P. Thal noted that the Veteran would be prone to making errors due to inability to hear instructions correctly which would slow down his pace and productivity. Finally, P. Thal noted the Veteran does not possess any skills that are readily transferable to other occupations, including those with a sedentary physical demand level, given his work history and the fact that he does not possess any computer skills that are typically required for sedentary occupations. As discussed above, both of the foregoing opinions are based upon review of the Veteran's claims file, but it appears that the opinions are largely based upon the Veteran's report of the nature and severity of his symptoms when he retired in 2011. However, the Board's review of the evidence shows that the Veteran's description of the impact of his service-connected PTSD, hearing loss, and tinnitus disabilities during and shortly after he was employed and of the reasons he retired in 2011 are not consistent with the statements he subsequently made to Dr. Morris and P. Thal or in support of his claim of entitlement to a TDIU. In making this determination, the Board notes that a discussion of the historical background of the Veteran's service-connected PTSD and other disabilities is necessary. The evidence historically shows the Veteran experienced myriad symptoms as a result of his PTSD disability, including sleep impairment due to nightmares, tinnitus, and physical pain, as well as depressed mood, anxiety, panic attacks, memory problems, concentration and attention problems, irritability, exaggerated startle response, and hypervigilance. The evidence dated in 2009 shows that the Veteran reported that he got nervous and experienced panic attacks three to four times a week and he also endorsed problems with decreased short and long term memory, worsened mood swings, and trouble maintaining work and social relationships. See e.g., April 2009 Veteran statement. The medical evidence reflects that he reported having tinnitus 75 percent of the time, which affected communication, concentration, sleep, work, and quiet resting activities. See February 2009 VA treatment record. The medical evidence also reflects that he endorsed having symptoms of anxiety but, otherwise, his thought process and content were normal, his memory, concentration, and attention were intact, and his insight and judgement were good. At that time, the Veteran reported working as a mechanic during the second shift and stated that he experienced pain and swelling that was worse after working. He stated that he wanted to work two more years but, notably, did not report any occupational limitations as a result of his PTSD. See e.g., VA treatment records dated April and May 2009. Indeed, in August 2009, the Veteran reported concern about if he would continue to have a job and, in this regard, indicated that he wanted to try and work until 62 but described having a great deal of neuropathic pain in his legs, which he stated kept him awake at night. At that time, he also reported waking at night with nightmares, but his mental status examination was normal although the clinician noted he exhibited paranoia and that his memory, concentration, and attention were impaired due to difficulty recalling incidents and attending the diagnostic interview. Nevertheless, the Veteran exhibited average intelligence and ability to understand instructions. The evidence dated in 2010 shows the Veteran stated that ringing in his ears, nightmares, and pain kept him awake a great deal. He also reported missing two nights of work due to sore muscles but did not, otherwise, report any occupational limitations as a result of his PTSD. See February 2010 VA treatment record. In fact, during the August 2010 VA PTSD examination, he reported that he took the medication Darvocet to enable him to do his job at work and, in this regard, endorsed having muscle and bone pain in his knees and hips that occurred daily such that he could barely walk in the morning and sometimes woke him at night. The Veteran reported having dreams three to four days a week that sometimes woke him up along with the joint pain that resulted in poor sleep, which the examiner noted interfered with his concentration to a minor extent. He reported avoiding talking about his military experiences and hyperarousal symptoms, such as irritability, that had begun to bother him after starting PTSD classes in September 2009. He stated that, when he was irritable, he would keep to himself and withdraw. As for other PTSD symptoms, the Veteran endorsed having anxiety most days and a tendency to ruminate about things, and he also endorsed hypervigilance and exaggerated startle response. However, his mental status examination was normal, with normal memory, good impulse control, and no episodes of violence noted. The Veteran also reported that his motivation was as good as ever and that he was happy most of the time. As for social relationships, he reported having a good relationship with his kids, fishing with his son, and playing with his grandchildren. He reported seeing his family every Sunday, as they went to church and had lunch and also talked on the phone every day. The Veteran described himself as a loner but stated that he had more friends and had come out of his shell a little. In this regard, he reported socializing with people from work and church and going out to eat. The August 2010 VA examiner noted the Veteran's report of losing four weeks in the last 12 months due to his physical problems and noted that increased absenteeism would impact his occupational functioning. In this regard, the VA examiner noted the Veteran did not directly link his PTSD symptoms to his job performance but opined that, as much as his PTSD symptoms contributed to poor sleep and, in turn, to physical pain, his PTSD symptoms could be linked to increased absenteeism at work. In 2011, the Veteran reported that he may have to retire early because his hearing was such that he was afraid he would cause harm to himself and his co-workers. He also reported that his tinnitus kept him awake at night and stated that, if he could not sleep, he could not work. In October, he stated that he was no longer able to work a full 40 hour week, as his memory had worsened such that he could not remember the names of close relatives, could not do crowds, and was depressed all the time. See lay statements dated January, April, October, and December 2011. The medical evidence dated in 2011 shows the Veteran continued to report that his constant tinnitus resulted in persistent sleep disturbances. See February 2011 VA audio examination. The evidence also shows the Veteran continued to take Lorazepam and Gabapentin for anxiety, mood, and sleep, which he reported was helpful. See May 2011 VA PTSD examination. During the PTSD examination, he reported feeling tired most of the time because of poor sleep due to nightmares and his busy work schedule. He endorsed having panic attacks that occurred out of the blue and stated that the most recent one occurred the previous week while he was in Walmart. In this regard, the examiner noted the Veteran had problems shopping due panic attacks and hypervigilance. The Veteran also reported avoiding crowds and experiencing exaggerated startle response, intrusive thoughts, and flashbacks, while specifically noting he was unable to attend his granddaughter's softball games because someone may have on camouflage which would upset him. Mental status examination was normal except for his tearful affect while describing his experiences in Vietnam. Notably, his memory was normal, and his impulse control was good. The Veteran specifically denied experiencing diminished interest in activities or feelings of detachment and also denied feeling irritable or angry or having concentration problems. As for social relationships, the Veteran reported having a close relationship with his sons, daughter, and six grandchildren and reported seeing them weekly at church. He reported having a female friend who he saw three for four times a week and with whom he would go out to eat every two weeks. He reported getting along well with his co-workers and considered them friends, and he also reported having one close friend who was also a veteran. The Veteran reported having little spare time because of work but stated that, when he did have spare time, he enjoyed fishing with his son, landscaping his house, and attending church with his family every Sunday. As for work, the Veteran reported that he planned to retire in December 2011 when he turned 62. He stated that he had lost less than one week of work in the previous 12 months period and stated that he missed a lot of work (but no more than three days in a row) because of joint pain. In this regard, he explained that he had to remain standing for most of his shift which contributed to his knee pain. The Veteran specifically stated that the major problem with his occupational functioning was having to remain standing for the majority of his shift. However, the Veteran stated that being tired all the time also contributed to problems at his job. The May 2011 VA examiner noted that the Veteran's nightmares (as well as his physical pain) contributed to his sleep problems which resulted in exhaustion and problems with occupational functioning. In a December 2011 statement, the Veteran reported that he was working only parttime because of PTSD and that, after December 2011, he would not work at all because he was afraid he may get hurt because his mind may not be on work, which would make him unemployable. He also stated that he was depressed all the time and his nerves were bad. During the December 2011 VA examination, the Veteran, again, reported that things were worse, as he was not resting well and his joints were hurting due to physical pain. At that time, he stated that he had reduced his days at work to three days a week, as his job required he stand all day and the reduced work schedule would allow him not to stand for such long periods of time. During the December 2011 VA examination, the Veteran continued to report having difficulty sleeping due to physical pain and tinnitus, but he stated he was retiring at the end of December 2011 because of his age and duration of work. When the examiner asked the Veteran what prevented him from working, the Veteran stated that pain in his joints, knees, ankle, and arms prevented work and, in this regard, the examiner noted that, during outpatient treatment in August 2011, the Veteran complained that allergies and physical pain impeded his ability to work. The VA examiner also asked the Veteran if PTSD affected his ability to work, to which he stated that, if he is tired due to not resting with as a result of his nightmares, it is hard to function and do an eight hour day. However, the Veteran reported that he got along well with others and had a good relationship with his kids. He also denied having anger and irritability and, while he reported problems with short-term memory, he stated that his long-term memory is fine. After examining and interviewing the Veteran, the December 2011 VA examiner stated that, based on Veteran's report, PTSD does not prevent him from maintaining or securing substantially gainful employment, as the Veteran described that joint pain, not PTSD, prevented him from working. The examiner also noted, however, that while fatigue due to PTSD may contribute to deficiencies on the job, it did not prevent him from working. In 2012, the Veteran stated that he retired early because his work suffered due to an inability to perform occupational tasks and his memory problems, as he could not remember to do certain jobs. He also endorsed having depression, anxiety, and panic attacks between four to seven times a week. See lay statements dated Januaryand December 2012. The medical evidence dated in 2012 shows the Veteran continued to take medication, including Lorazepam, without difficulty. He also continued to report being unable to sleep week due to tinnitus and worrying about his health problems, but he stated that retiring in December 2011 removed lots of pressure he had with joint difficulty and being unable to work. The Veteran reported doing good despite chronic pain issues and stated that he tried to stay busy around the house. He stated that he enjoyed spending time with his six grandchildren and fishing and indicated that he felt better when busy. Notably, mental status examination was normal, with his memory, concentration, and attention intact. See VA treatment records dated January, May, and October 2012. The medical evidence dated in 2013 shows the Veteran reported having good and bad days, with his anxiety improved by staying busy. In this regard, the Veteran reported spending time with his grandchildren, mowing the lawn when he was able to, and visiting the nursing home for church. He reported that he was often outside of the home. The evidence reflects that he was encouraged to cut back on Lorazepam, but he was unsuccessful and, when his medication ran out, reported that he was doing poorly and struggling, as he experienced chronic depression, anxiety, feeling on edge, some anhedonia, irritability, continued poor sleep and fleeting thoughts of death. See VA treatment records dated April and December 2013. During the December 2013 VA audio examination, the Veteran continued to report difficulty hearing speech in background noise. During the December 2013 VA PTSD examination, he endorsed sleep disruption due to urinary frequency but not PTSD symptoms. The Veteran reported that his medication did not help as much as he would like but that he was less hyper, and the medication helped him stay stable. The Veteran's symptoms included chronic sleep impairment and mild memory impairment. In this regard, he stated that he felt his concentration was poor and, as a result, he could be forgetful, but he stated this was a new issue that developed over the last year. As for social relationships, the Veteran reported dating occasionally and taking people out to eat and he specifically reported seeing someone off and on for five to six who he described as his girlfriend. The Veteran reported that he did not have any problems with her and also stated that he got along well with his kids. He also stated that he would occasionally go to his grandchildren's games and grandparents' day, but he also stated that he was nervous in crowds. Nevertheless, he reported that his grandchildren came over a lot during summer and that he hoped to go fishing soon, which the examiner noted he had done in October 2012. The Veteran stated that he heard from old co-workers and was friendly when he saw them at the store and post office, but he stated that he rarely socialized outside of the family. He explained that he hung out with his brothers to pitch horseshoes and would sometimes go to the VFW to shoot pool during the day when there are fewer people. He also stated that he went to stores when there were fewer people. The Veteran stated that he would speak to people but did not feel close with them. He also reported going to the flea market most Saturdays and continued to go to church. In fact, he stated that he often drove the van to pick up the elderly and homebound. He also stated that he sang in the choir and would lead a song sometimes, and otherwise stated that he liked to stay busy, including going out to eat occasionally and to the flea market with his girlfriend with whom he had taken a trip previously. He also reported having dinner with family on Sundays after church which was either at a restaurant or at one of their houses. The Veteran reported that, when working as a mechanic, he was asked to be a supervisor but declined it because he did not want the responsibility. He also stated that his former employer asked him to return to work despite being retired and indicated that he retired because of his age. Notably, the Veteran stated that he wanted to find a parttime job where he could deliver parts or drive a truck rather than work with the public. After examining the Veteran, the VA examiner noted that, with respect to work, the Veteran's ability to understand and follow instructions and ability to respond well to changes in the work setting were not impaired. However, the examiner noted a mild impairment in his ability to retain instructions and sustain concentration to perform simple tasks, ability to sustain concentration to ask persistence and pace, ability to respond appropriately to co- workers, supervisors, or the general public. Despite the foregoing, the examiner noted the Veteran did well at work in the past. The evidence in 2014 show the Veteran reported that, without Lorazepam, he became extremely anxious and was unable to sit still or sleep. Otherwise, he reported getting along okay with good concentration. He variously reported having panic attacks but also consistently reported having poor energy, continued nightmares, flashbacks, hypervigilance, and hyper startle response. See VA treatment records dated March and September 2014. In 2015, the Veteran took a trip with his significant other and subsequently got married. He indicated that his wife was good support. The Veteran continued to report having panic attacks, but his concentration was good and his mental status was otherwise normal. The evidence dated in early 2016 shows the Veteran denied having suicidal thoughts since being married in March 2015. See January 2016 VA treatment record. During the February 2016 VA examination, the Veteran reported having a good relationship with his wife, kids, and grandchildren and stated that he continued to go to the grandchildren's activities but not as much since married. He stated that he continued to see his family at church, but he noted that he changed churches and no longer sang in the choir. He also reported that he stopped going to the flea market, fishing, and playing pool about two years ago because he did not feel like it, but he stated that he went on vacation with his wife in May 2015. He reported that he typically ate at home because he does not like crowds at restaurants. He also reported having poor sleep but stated that he slept 7-8 hours a day. The Veteran also endorsed feeling anxiety and hyper during the day with nightmares continuing two to three times a week. Otherwise, the medical evidence dated in 2016 shows the Veteran reported that his medication was doing good, but he was advised to cut back on alcohol and, eventually, clinicians recommended that he discontinue Lorazepam due to his alcohol use. See e.g., VA treatment records dated April, July, and August 2016. In April 2016, his Lorazepam was reduced, after which the Veteran was noted to be angry at the recommendation that he discontinue Lorazepam due to his alcohol use, although he was not interested in reducing alcohol or referral for treatment. Indeed, the Veteran reported that he could not function and felt hopeless without it; however, clinicians noted the dangers associated with benzodiazepines mixed with alcohol. The Veteran continued to report having nightmares, hypervigilance, hyper startle response, depressed mood, sleep problems, and intrusive thoughts and he also began to consistently endorse experiencing avoidance and isolation. See VA treatment records dated July, August, and September 2016; February 2017. The subsequent evidence namely the evidence dated in July 2017 and thereafter - shows the Veteran continued to endorse having depressed mood, hypervigilance, intrusive thoughts, and flashbacks but, after July 2017, his reports of anergia, anhedonia, and amotivation were more consistent. Both he and his wife expressed desire for him to be back on Lorazepam, but he continued to report drinking daily to keep things off his mind, which he denied was a problem. See also October 2017VA treatment record. In analyzing the evidence of record, the Board notes that the foregoing evidence shows the Veteran's PTSD has always been manifested by symptoms that undoubtedly impacted his occupational functioning, to include his mood fluctuations with depression, anxiety, panic attacks, and irritability, in addition to his concentration problems that were impacted by his fatigue caused by an inability to sleep through the night due (at least partially) to nightmares and tinnitus. The Veteran also reported that his hearing impacted his ability to communicate and understand with background noise. While the Veteran has asserted that he was unable to perform substantially gainful employment after December 2011 and the private opinions provided in support of his claim are favorable in this regard, the Board finds that the evidence persuasively weighs against this conclusion, as the evidence reflects that the symptoms the Veteran experienced on and shortly after December 2011 were largely similar in severity, frequency, and duration to those symptoms he experienced prior to that date when he was employed and performing substantially gainful employment. Indeed, the evidence shows that both prior to and after December 2011, the Veteran endorsed having anxiety, panic attacks more than once a week, mood swings, persistent sleep impairment or disturbance, impaired memory, concentration, and attention at least partially due to tinnitus and nightmares, and isolative tendencies and behaviors. The evidence shows that, despite his symptoms, the Veteran maintained substantially gainful employment prior to retiring in December 2011 and there is no indication that he received disciplinary action at work, required a reduction in hours or change in responsibilities at work, or experienced a significant impairment in his functioning or relationship with coworkers, supervisors, or the general public because of the symptoms associated with his service-connected disabilities. In evaluating this claim, the Board finds persuasive that the evidence dated in December 2011 and shortly thereafter does not reflect a significant change or decrease in overall functioning as a result of his service-connected disabilities. The Board also finds persuasive that the evidence shows that, after retiring in December 2011, the Veteran reported maintaining good social relationships with his grandchildren and girlfriend, being outside of his home often, including visiting a nursing home for church, singing in the choir, driving the van to pick up the elderly and homebound, and visiting the VFW and stores, albeit when there were less people around. Notably, the Veteran also reported that his former employer asked him to return to work and he expressed interest in finding a part time job that did not involve working with the public. The Board acknowledges that, given the moderate to severe impairment the Veteran experienced as a result of his PTSD symptoms, as well as the impairment due to tinnitus and hearing loss, he likely experienced some impairment in occupational functioning; however, the Veteran has reported that he was asked to be a supervisor at his previous job, which he declined because he did not want the responsibility. He also reported that his previous employer asked to return to work a few times after he retired. The Board notes that it is not likely the Veteran would have been asked to be a supervisor or to return to work after he retired, even on a short-term or limited basis, if his ability to perform his duties had been impaired to the extent that he could not follow or hear instructions, concentrate for a reasonable amount of time to complete his duties, remember his duties, or interact appropriately with co-workers or customers due to disturbances in motivation and mood, fatigue, concentration, or hearing difficulties. While the activities he continued to pursue and perform in and after December 2011 were not as structured as a work environment and likely did not require the same amount of concentration and motivation as his previous employment, the lay and medical evidence of record persuasively establishes that the Veteran retained the motivation and ability to perform duties that were consistent with his education and employment history and also accounted for any impairment caused his service-connected disabilities. The evidence also shows that, when specifically asked if and how his service-connected PTSD and other service-connected disabilities impacted his occupational functioning, the Veteran described how increased absenteeism, difficulty concentrating, and difficulty hearing resulted in difficulty working but indicated that his inability to continue working (as opposed to difficulty working) was because of his physical impairment due to joint pain and problems. See e.g., VA treatment records dated April and May 2009, August 2009, February 2010; VA PTSD examinations dated May 2011, December 2011, and December 2013. In this context, the Board finds probative that records from the Social Security Administration (SSA) show that, when the Veteran was seeking benefits, he was asked to describe the conditions that limit his ability to work and, in response, he reported pain, an inability to bend, needing assistance rising up, and being tired a lot. See April 2012 Function Report. The Board acknowledges that, during appeal, the Veteran submitted a number of statements wherein he described the symptoms he believed prevented him from working; however, his statements are not generally consistent with his presentation during clinical visits and evaluations, to include as objectively observed by clinicians or as described by the Veteran. For example, in statements submitted in support of the claim in 2011, the Veteran indicated that he feared his hearing impairment would cause harm to himself and his co-workers and that he was unable to work full-time due to his memory impairment and constant depression. However, the Veteran's speech recognition ability was deemed excellent during the February 2011 VA audiologic examination and the pure tone thresholds demonstrated supported the assignment of a noncompensable rating. The Board also finds that probative that a February 2012 vocational analysis conducted in conjunction with the Veteran's SSA claim noted that he did not have any communicative limits, including due to hearing and speaking. In this regard, the Board notes that, while the Veteran has consistently stated that his tinnitus and hearing loss disabilities impacted his ability to hear at work and concentrate, the rating criteria for hearing loss contemplates the functional effects of decreased hearing and difficulty understanding speech in an everyday work environment because the audiometric tests are designed to precisely measure these effects. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017). Despite the Veteran's lay reports of a memory impairment in 2011, the May 2011 VA examination shows that his memory was normal, and he specifically denied experiencing diminished interest in activities or having concentration problems. See lay statements dated January, April, October, and December 2011; May 2011 VA PTSD examination. Similarly, in 2012, the Veteran stated that his work suffered due to an inability to perform occupational tasks and his memory problems, but, during clinical evaluation, his memory, concentration, and attention were intact. See VA treatment records dated January, May, and October 2012. In fact, during his April 2012 SSA function report, the Veteran reported that he could pay attention a long time and follow instructions. This evidence suggests that the Veteran's reported memory impairment was no more than mild, or at a minimum, was not of the severity, frequency, or duration to result in an impairment that was measurable on objective evaluation or significantly impact his ability to perform various tasks, such as work duties. In this context, the Board notes that, in support of this claim, the Veteran has submitted statements that purport to provide additional context and explanation about statements and findings reflected in the evidence of record. For example, in a statement dated in April 2018, the Veteran stated that he retired because PTSD was profoundly affecting his employment during the last couple years of work and that he typically missed one day a month due to PTSD, although he sometimes missed two to three days at a time because he could not go into work. He stated that he avoided customers and co-workers because interacting would lead to panic attacks that he experienced almost every day when he was working, to include blacking out on a couple of occasions. He stated that he experienced significant memory difficulties, as he forgot the names of co-workers and certain job responsibilities, and he was concerned someone would get hurt because he forgot to properly maintain his area. The Veteran acknowledged that he was asked to come back to work a few times in 2012 to 2013 to repair machines with which he was familiar, but he stated that his PTSD symptoms had worsened since he retired. In this regard, he reported having panic attacks a couple times a week and needed to isolate himself to calm down. He also stated that he was unable to go to public places and interacted with as few people as possible. He stated that tinnitus affected his daily life and reported difficulty communicating with people because of frequent episodes of loud ringing. In July 2018, the Veteran stated that he retired as soon as was eligible because could no longer tolerate the stress of work due to PTSD. He endorsed experiencing debilitating panic attacks most days while working and stated that he began to forget his job responsibilities and the names of co-workers. In this statement, he reiterated that, during the October 2015 hearing, he testified that he could not handle the pressure of work anymore and also endorsed increased absenteeism since January 2008. The Veteran also stated that he was unable to perform occupational tasks or remember instructions and indicated that his frequent panic attacks reduced productivity. In a statement received in November 2021, the Veteran stated that he has had consistently good relationships with his family because they are the only people he trusts and loves and hung out with them to avoid triggers. He stated that, while working, he maintained machines for the same people repetitively and, as such, he knew the people he helped and made small talk with them. He explained that his church was small, consisted of mostly family, and he was comfortable there, and, in this context, he stated that he knew the people who needed rides when he drove the church van. He also stated that he stood away from crowds during his grandchildren's activities and took trips to the flea market early in the day with less people. The Veteran stated that his hobbies distracted him and explained that he went to VFW once a month because he found it relaxing and went when less people were there, but they were always the same people. He also stated that, after his daughter passed in 2016, he did not go to the flea marker anymore, fish, garden, or play pool. He also stated that he switched to a different church and saw his son and grandchildren less often but usually around the holidays. Despite the Veteran's subsequent reports and statements, the Board finds that the evidence shows he was generally functioning satisfactorily, including at work and in his social activities in December 2011 and shortly thereafter. In fact, the Veteran reported that he considered his co-workers as friends and never reported difficulty remembering their names or avoiding interacting with them or customers due to his PTSD symptoms. Indeed, the evidence does not contain any reports of having panic attacks on a daily basis, including attacks that were so severe that he blacked out. The evidence also shows the Veteran did not report any significant impairment in his ability remember instructions that were given to him at work or difficulty hearing due to tinnitus or hearing loss that prevented him from performing his duties at work, to include communicating with others or maintaining his concentration for an extended period of time. If the Veteran had been experiencing the level of social and occupational functioning that he has subsequently described, it is reasonable to expect that he would have described such symptomatology when he received outpatient treatment from VA and when he was evaluated by VA and SSA when seeking benefits. It is also reasonable to expect that the clinicians who evaluated the Veteran's service-connected PTSD, tinnitus, and hearing loss disabilities would have noted a significant impairment in his memory, concentration, and communication abilities that would likely result in him being unable to work. In this regard, the Board, again, notes that, while there are notations of impairments in the Veteran's concentration, attention, and other functions due to his PTSD and tinnitus disabilities, the evidence persuasively suggests that the impairments resulted in difficulty working but did not preclude him from working due to an inability to perform the mental and physical acts to secure and maintain employment. In assessing the credibility of evidence, the Board may consider any number of factors, to include conflicting statements or evidence and the potential bias of the declarant. The lack of contemporaneous evidence is also relevant, but it may not generally serve as the sole basis for discrediting lay statements or testimony; however, the Board may draw inferences against a claimant from a lack of documentation if the Board lays a proper foundation "to demonstrate that such silence has a tendency to prove or disprove a relevant fact." In this case, the Board finds that a proper foundation exists, as the Veteran's report of avoiding co-workers, an inability to remember instructions or maintain his concentration for the requisite amount of time to complete his work duties, having panic attacks every day, and blacking out during certain panic attacks would ordinarily be of record. Indeed, it is reasonable to conclude that the Veteran would have reported these symptoms when he received treatment for his disabilities, and it also reasonable to conclude that the treating clinicians would have noted these symptoms if reported and also observed and documented a severe impairment in functioning due to such symptoms during clinical evaluation. However, the evidence does not show that clinicians who evaluated the Veteran in 2011 or for several years thereafter determined that the Veteran's service-connected PTSD, tinnitus, and hearing loss disabilities were of the severity that they prevented him from securing or maintaining substantially gainful employment. See e.g., February 2011 VA audio examination; May and December 2011 VA PTSD examination; December 2013 VA audio and PTSD examination; and February 2016 VA examination. While the examiner's opinions are not dispositive as to the issue of unemployability, the statements made by the Veteran and observations and findings reported by the examiners at the time of those evaluations and examinations are considered highly probative as to the nature and severity of the Veteran's service-connected disabilities and the functional impairment caused thereby. Based on the facts of this case, the Board finds that the absence of such evidence tends to prove that the symptoms and functional impairment reported by the Veteran years later did not exist in 2011 or for several years thereafter. The Board acknowledges the Veteran is competent to report the nature and severity of his symptoms, to include how they impacted his ability to work and interact with other people. However, the Board finds that his contemporaneous statements made to medical providers and the clinical findings reflected in the treatment records are significantly more credible and probative than subsequent statements made to VA and other clinicians for purposes of seeking compensation. See Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (VA cannot ignore a veteran's testimony simply because the veteran is an interested party; personal interest may, however, affect the credibility of the evidence); see also Curry v. Brown, 7 Vet. App. 59, 68 (1994) (contemporaneous evidence has greater probative value than subsequently reported history). It follows, then, that the conclusions provided by Dr. Morris in July 2018 and the vocational assessment from P. Thal in June 2020 are also afforded lessened probative value to the extent that they purport to establish that the Veteran's service-connected disabilities have rendered him unemployable since December 2011, as they appear to be primarily based on the Veteran's report of the nature, severity, and impact of his symptoms in December 2011 and thereafter. In evaluating this claim, the Board finds the contemporaneous evidence to be persuasive, as it suggests that the Veteran retained the physical and mental ability to perform occupational tasks, to include those that required interaction with others, maintaining concentration and attention to perform various tasks, and following directions, albeit for a less consistent or extended period of time. Indeed, the foregoing, coupled with the Veteran's repeated statements that his primary problem with occupational functioning was due to his physical problems, not to include as a result of his tinnitus and hearing loss, and that he was retiring due to age and length of work, weighs against finding that his service-connected disabilities rendered him unemployable in or shortly after December 2011. At this juncture, the Board notes that the evidence shows the Veteran was prescribed Lorazepam for more than 35 years to treat his service-connected PTSD disability until approximately 2016. In this context, the Board acknowledges that an increased rating claim, including TDIU, may not be denied on the basis of relief provided by medication when those effects are not specifically contemplated by the rating criteria. See Jones v. Shinseki, 26 Vet. App. 56, 63 (2012). However, Diagnostic Code (DC) 9411, which provides the criteria for evaluating PTSD, expressly authorizes VA to take into account the ameliorative effects of medication when evaluating PTSD. 38 C.F.R. § 4.130, DC 9411 (providing a noncompensable PTSD evaluation when, inter alia, "symptoms are not severe enough... to require continuous medication" and a 10 percent evaluation when, inter alia, "symptoms [are] controlled by continuous medication"). Therefore, the ameliorative effects of the Veteran's PTSD medication will not be discounted in the context of his claim for entitlement to a TDIU. In this case, the evidence shows that, when clinicians discontinued his prescription for Lorazepam, the Veteran experienced a decline in functioning manifested by more severe and more consistent reports of irritability, isolative and avoidant tendencies, anergia, and amotivation. This decline in functioning occurred in approximately July 2016. The Board acknowledges that the Veteran experienced moderately severe and serious symptoms while he was taking Lorazepam and, in no way, discounts or rejects the functional impairment, or suffering, he experienced as a result of his symptoms prior to July 2016. However, the evidence shows that the severity, frequency, and duration of those symptoms increased significantly after his prescription for Lorazepam was discontinued such that he was likely no longer able to perform the mental tasks required to perform substantially gainful employment. Nevertheless, the Board notes that evidence dated as early as April 2013 shows a decrease in functioning associated with a reduction in the Veteran's use of Lorazepam. Indeed, the evidence reflects that the Veteran was encouraged to cut back on Lorazepam in April 2013, but he was unsuccessful and, when his medication ran out, he reported that he was doing poorly and struggling, as he experienced chronic depression, anxiety, feeling on edge, some anhedonia, irritability, continued poor sleep and fleeting thoughts of death. See VA treatment records dated April and December 2013. In 2014, the Veteran, again, reported a decrease in functioning associated with modification of the use of Lorazepam, as he stated that, without that particular medication, he became extremely anxious, was unable to sit still or sleep, and also consistently reported having poor energy, continued nightmares, flashbacks, hypervigilance, and hyper startle response. See VA treatment records dated March and September 2014 . The evidence shows the Veteran continued to be prescribed Lorazepam until July 2016 and, as noted, the evidence shows he experienced a significant and prolonged decline in functioning when the medication was discontinued completely. However, the Board notes that the decreased functioning shown in 2013 as a result of a reduction in his use of the medication was accompanied by reports of a history of fleeting and occasional suicidal thoughts, which indicates a severe impairment in thinking that would likely impact the Veteran's overall functioning, to include his ability to concentrate and maintain attention on various tasks. See April and October 2013 VA treatment records. In this regard, the Board notes that, while the Veteran endorsed having a history of suicidal thoughts, the evidence dated prior to April 2013 does not reflect any such reports or indication that he experienced active suicidal ideation. This statement is not intended to suggest that the Veteran did not experience suicidal thoughts prior to April 2013 but, instead, is proffered to suggest that, in April 2013, the Veteran began experiencing a more severe impairment as a result of his suicidal thoughts, as he began communicating the occurrence of such thoughts at that time (which is not shown previously in the evidence of record), but is shown in April 2013 and, as noted, is accompanied by an additional decrease in functioning associated with a reduction in the use of Lorazepam, with more severe and consistent reports of irritability, chronic depression, feeling on edge, some anhedonia, irritability, and poor energy. Based on the foregoing, and after resolving reasonable doubt in favor of the Veteran, the Board finds that the evidence dated from April 24, 2013 persuasively establishes an increase in the severity of the Veteran's symptoms and decrease in overall functioning that would likely prevent him from securing or maintaining substantially gainful employment. In making this determination, the Board acknowledges that the Veteran experienced moderately severe and serious symptoms between December 2011 and April 2013; however, as noted, the evidence does not show a significant change in the severity, frequency, and duration of the symptoms the Veteran experienced between 2011 and 2013 whereas the Board finds that the evidence shows a decline in his functioning when his use and prescription for Lorazepam changed; a decline that likely rendered him unable to perform the mental tasks required to perform substantially gainful employment. In this regard, the Board notes that, between 2011 and 2013, the Veteran continued to endorse panic attacks multiple times a week, problems with his memory, mood swings, persistent sleep disturbance due to tinnitus, nightmares, and physical pain, which resulted in difficulty concentrating during the day, anxiety most days, hypervigilance, and startle response. The evidence also shows that he maintained adequate social relationships with his family, significant other, church, and other outside entities such as the local VFW. Again, the Board is not discounting or rejecting the severity of the symptoms the Veteran experienced prior to April 2013. Indeed, the Board notes that the moderately severe and serious symptoms experienced prior to April 2013 are shown to have caused a serious occupational impairment as a result of his service-connected disabilities due to the symptoms and functional impairment caused by his service-connected disabilities, to include when they are considered singly or combined. However, the Board finds that the Veteran's impairment in occupational and overall functioning is adequately reflected and contemplated by the 50 percent rating assigned for PTSD prior to April 2013, as well as the 10 percent and noncompensable ratings assigned for tinnitus and hearing loss. In this regard, the Board notes that the assignment of a high rating, to include the 60 percent combined rating assigned during the period in question is, in itself, recognition that the impairment caused by the disabilities makes it difficult to obtain and keep employment. Indeed, while the Veteran's PTSD, tinnitus, and hearing loss symptoms resulted in difficulty working as a mechanic and would likely result in difficulty functioning in other employment settings, the evidence does not persuasively establish that he was unable to secure and maintain substantially gainful employment in December 2011. Instead, the evidence persuasively establishes that, despite the symptoms and functional impairment caused by his service-connected disabilities, the Veteran remained capable of performing the physical and mental acts to perform the types of activities required to perform his usual occupation as a mechanic until approximately April 24, 2013, when the evidence shows he began experiencing a decline in overall functioning as a result of changes and eventually discontinuance of his Lorazepam, as manifested by his new reports of having suicidal thoughts, as well as more consistent reports of chronic depression, increased anxiety, anhedonia, irritability, and isolative and avoidant tendencies. The Board acknowledges that the evidence dated prior to April 24, 2013 shows the Veteran experienced many of the same symptoms but, the Board finds that the evidence dated in April 2013 and thereafter reflect more severe and more frequent reports of symptoms that were not consistently present before that date and likely prevented him from performing the mental tasks necessary for employment. Accordingly, entitlement to a TDIU is warranted from April 24, 2013, but no earlier. As explained above, the competent, credible, and probative evidence of record persuasively weighs against a finding that the Veteran's service-connected disabilities, when considered singly or combined, prevented him from securing or following any substantial gainful employment from December 2011 to April 24, 2013, and, as such, entitlement to a TDIU, to include on an extraschedular basis, is denied prior to April 24, 2013. Scott W. Dale Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Turnipseed, 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.