Citation Nr: 25005437 Decision Date: 04/22/25 Archive Date: 04/22/25 DOCKET NO. 24-00 215 DATE: April 22, 2025 ORDER Entitlement to an initial disability rating greater than 70 percent for post-traumatic stress disorder (PTSD) is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) is granted, subject to the laws and regulations governing the award of monetary benefits. FINDINGS OF FACT 1. The Veteran's PTSD is not manifested by total social and occupational impairment. 2. Resolving any doubt in favor of the Veteran, his service-connected PTSD precludes him from securing and maintaining substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for an initial disability rating greater than 70 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.126, 4.130, Diagnostic Code 9411. 2. The criteria for entitlement to a TDIU have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.3, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1968 to March 1971. This appeal has a lengthy and complex procedural history that warrants a detailed summary before turning toward the merits of the issues on appeal. This case comes before the Board of Veterans' Appeals (Board) on appeal from a May 2017 rating decision issued by the Department of Veterans Affairs (VA) the agency of original jurisdiction (AOJ) which granted entitlement to service connection for PTSD, and assigned a 70 percent evaluation, effective November 15, 2015. In June 2017, the Veteran submitted a new claim along with a statement asserting that a higher evaluation was warranted as he was unable to work due to his PTSD symptoms. The AOJ provided the Veteran with a TDIU application and conducted further development, including scheduling a new PTSD examination. In July 2017, the AOJ proposed a reduction in the Veteran's PTSD evaluation from 70 to 50 percent disabling, based on the results of the June 2017 examination. In October 2018, the AOJ reduced the Veteran's PTSD evaluation from 70 to 50 percent, to be effective January 1, 2019. In November 2018, the Veteran submitted a notice of disagreement (NOD) asserting that the rating reduction was not warranted and further explained how his PTSD symptoms interfered with his ability to work. The Veteran also submitted a TDIU application (VA 21-8940). In December 2018, the AOJ issued a decision restoring the Veteran's evaluation for PTSD to 70 percent, effective November 15, 2015. A December 12, 2018, VA Form 21-0820, Report of General Information reflects that VA called the Veteran and informed him of the restoration. The Veteran indicated his satisfaction with the restoration of the 70 percent schedular evaluation for PTSD and also confirmed his continued interest in seeking a TDIU. The Veteran was informed that his TDIU claim would be addressed at a later date by another department. In March 2022, the Veteran filed a formal claim (VA form 21-526EZ) seeking an increased rating for PTSD and submitted lay evidence in support of his claim. In June 2022, the AOJ issued a rating decision which continued the 70 percent evaluation for PTSD. In March 2023, the Veteran filed a Supplemental Claim (VA Form 21-0995) seeking an increased evaluation for PTSD pursuant to the Appeals Modernization Act (AMA) review system. The Board notes that the Veteran did not properly opt-in the claim to the AMA system. Under 38 C.F.R. § 3.2400, a legacy appeal can only be opted into the AMA through the Rapid Appeals Modernization Program (RAMP) or with a timely (60 days) opt-in response to a Statement of the Case (SOC) or SSOC. Here, as the AOJ had not issued an SOC, there was no SOC from which to properly opt-in to the AMA. The Veteran also submitted an updated TDIU application and a personal statement in support of his TDIU claim. In August 2023, the AOJ processed the supplemental claim and issued an AMA rating decision which continued the 70 percent evaluation for PTSD and denied the Veteran's claim for a TDIU. In February 2024, after further development, the AOJ issued another AMA rating decision stemming from the improperly submitted March 2023 supplemental claim and continued the 70 percent evaluation for PTSD. In a July 2024 email to VA, the Veteran's attorney requested that the AOJ issue an SOC for the issue of an increased evaluation for PTSD in the legacy review system, as an SOC had never been issued in response to the Veteran's November 2018 NOD. The attorney explained that while the Veteran noted on the NOD that he disagreed with the reduction, and the reduction did not occur, the issue of an increased rating for PTSD remained on appeal and the Veteran was still owed an SOC. In August 2024, the AOJ issued an SOC for the issue of an increased evaluation for the Veteran's PTSD and continued the 70 percent rating. In response to the SOC, in September 2024, the Veteran filed a VA Form 9 and appealed the issue of an increased evaluation for PTSD to the Board. In November 2024, the AOJ issued another AMA rating decision stemming from the improperly submitted March 2023 supplemental claim and denied an evaluation of greater than 70 percent for PTSD and denied entitlement to a TDIU. The Board finds that the filing of the March 2023 supplemental claim (VA Form 21-0995) and issuance of the AMA rating decisions in August 2023, February 2024, and November 2024 were improper, as the PTSD and TDIU claims were already pending before the Board under the Legacy system. Specifically, the Veteran had not properly elected to opt-in to the modernized review system, which would have had to follow within 60 days of the issuance of an SOC for these issues. See 38 C.F.R. § 3.2400. Therefore, the Board will proceed with adjudication of the Veteran's claim of entitlement to an increased rating for PTSD and entitlement to a TDIU as if the August 2023, February 2024, and November 2024 decisions had not been issued. The Veteran's legacy appeal for the issues of an increased disability rating for PTSD and for a TDIU is now properly before the Board. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.800. 38 U.S.C. § 7107. Period on Appeal At the outset, the Board believes it helpful to specify the period on appeal. As noted in the introduction, the Veteran filed an intent to file a claim on November 15, 2015, followed by a timely initial formal claim (VA Form 21-526EZ) for entitlement to service connection for PTSD on November 10, 2016. This benefit was granted, and an initial 70 percent rating was assigned for PTSD in a May 2017 rating decision, effective November 15, 2015. In June 2017, before expiration of the one-year period to appeal, the Veteran filed a higher rating claim supported by new and material evidence. New and material evidence received within a one-year period following issuance of a rating decision is to be considered as having been received in connection with the claim addressed in the decision. In such situation, the applicable rating action will not become final, and any subsequent decision based on such evidence will be considered to be on the original claim. Buie v. Shinseki, 24 Vet. App. 242, 252 (2010). Accordingly, in this case, the May 2017 rating decision did not become final. See 38 C.F.R. § 3.156(b). Subsequently, the new evidence was addressed in an October 2018 rating decision which reduced the Veteran's PTSD evaluation. In November 2018, the Veteran filed a timely NOD, stating that he disagreed with the evaluation and explained how the severity of his PTSD symptoms interfered with his ability to work. In December 2018, the AOJ restored the 70 percent rating. The Board considers this a partial grant of the claim, as the Veteran's claim for an increased rating for PTSD remained on appeal. See AB v. Brown, 6 Vet. App. 35 (1993) (holding that claimants are presumed to seek the maximum available benefit for a disability). However, it appears that the AOJ interpreted the Veteran's NOD to encompass only the rating reduction, and as the reduction was restored, the AOJ did not issue an SOC at that time. Following the July 2024 email from the Veteran's attorney requesting that the AOJ issue an SOC for the issue of an increased evaluation for PTSD, the AOJ issued an SOC for the issue in August 2024. In response, the Veteran filed a timely Form 9 in September 2024, perfecting his appeal of this issue to the Board. As the initial rating decision for PTSD was properly and continuously pursued under the legacy system, the appeal period extends back to November 15, 2015, and the Veteran is presumed to seek the maximum benefits for the entirety of the appellate period. 38 C.F.R. § 3.156(b); AB, 6 Vet. App. at 35. 1. Entitlement to an initial disability rating greater than 70 percent for PTSD Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where the question to consider is the propriety of the initial evaluation assigned, consideration of the medical evidence since the effective date of the award of service connection and consideration of the appropriateness of a "staged" rating are required. See Fenderson v. West, 12?Vet. App.?199, 125-26 (1999); Hart v. Mansfield, 21?Vet. App.?505, 509-10 (2007). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Veteran's PTSD is rated under 38 C.F.R. § 4.130, DC 9411 and is subject to the criteria listed under the General Rating Formula for Mental Disorders. Evaluation under § 4.130 is symptom-driven, meaning that symptomatology should be the fact-finder's primary focus when deciding entitlement to a given disability rating under that regulation. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). In Vazquez-Claudio, the United States Court of Appeals for the Federal Circuit explained that the frequency, severity, and duration of the symptoms also play an important role in determining the rating. Id. at 117. The list of symptoms under the rating criteria are meant to be examples of symptoms that would warrant the rating, but are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. 38 C.F.R. § 4.21; Mauerhan v. Principi, 16?Vet. App.?436, 442-43 (2002). If the evidence shows that the Veteran suffers symptoms listed in the rating criteria or symptoms of similar severity, frequency, and duration, that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the criteria for a particular rating, the appropriate equivalent rating will be assigned. Mauerhan, 16 Vet. App. at 443; see also Vazquez-Claudio, 713 F.3d at 117. Under DC 9411, a 70 percent rating is warranted for occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships. A 100 percent evaluation is warranted where there is total occupational and social impairment, due to such symptoms as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. The Veteran contends an initial disability rating higher than 70 percent is warranted for his service-connected PTSD. See September 2024 Form 9 and December 2024 attorney's brief. In order to obtain a higher rating, the evidence must show that the Veteran's PTSD symptomatology results in total occupational and social impairment. Evidence of record includes lay statements from the Veteran, VA examinations conducted in April 2017, June 2017, March 2022, April 2023, January 2024, and August 2024 (with an addendum opinion in September 2024), a private evaluation conducted in June 2024, and VA and private treatment records. While all the evidence of record has been thoroughly reviewed, only the most relevant and salient evidence is discussed below. See Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000). The analysis in this decision focuses on what the evidence of record shows or fails to show with respect to the matters that are decided herein. The Veteran should not assume that pieces of evidence not explicitly discussed herein have been overlooked. See Allday v. Brown, 7 Vet. App. 517, 527 (1995). In September 2016, the Veteran submitted a statement in support of his claim in which he described traumatic events which occurred during his combat service in the Vietnam War, including being exposed to grave danger and being used as a "tunnel rat" by the reconnaissance patrol to retrieve dead bodies from caverns. See September 2016 statement. In his June 2017 statement, the Veteran stated that his current PTSD symptoms stemming from the traumatic events in service interfere with his ability to work. Specifically, he described how he was put on sick leave during his last job due to anxiety and panic attacks. His anxiety has also affected his driving, as he worries that he will have breathing problems while driving. Turning toward the medical evidence of record, the Veteran was afforded an initial PTSD examination in April 2017. The examiner noted the Veteran's symptoms for VA rating purposes of anxiety, panic attacks that occur weekly or less often, chronic sleep impairment, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, including work or a work like setting, inability to establish and maintain effective relationships, and impaired impulse control, such as unprovoked irritability with periods of violence. As to social functioning, the Veteran reported that he married in 1971 and the marriage lasted 18 years before they eventually divorced due to his difficulties with anger and drinking. Their union did not produce any children. He currently has a live-in partner since 1991. He described his relationship in positive terms. The Veteran reported one friend with whom he has occasional contact and stated that the friendship was adequate for his needs. As to occupational functioning, after leaving military service, he worked for the Army for about 10 years refueling aircraft. He then worked for the Navy for 20 years handling explosives until 2011 when he retired. The April 2017 VA examiner determined that the Veteran's symptoms resulted in occupational and social impairment which decreased work efficiency and the ability to perform occupational tasks only during periods of significant stress, which is commensurate with a 10 percent rating under the General Rating Formula. In June 2017, the Veteran attended another VA examination. The examiner noted symptoms for VA rating purposes of depressed mood, anxiety, panic attacks that occur weekly or less often, chronic sleep impairment, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and difficulty adapting to stressful circumstances, including work or a work like setting. The June 2017 VA examiner determined that the Veteran's 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, selfcare and conversation, which is commensurate with a 30 percent rating under the General Rating Formula. In March 2022, the Veteran attended another VA examination. The examiner noted symptoms for VA rating purposes of depressed mood, anxiety, suspiciousness, chronic sleep impairment, mild memory loss (such as forgetting names, directions or recent events), impairment of short- and long-term memory (for example, retention of only highly learned material, while forgetting to complete tasks), flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and difficulty adapting to stressful circumstances, including work or a work like setting. The March 2022 VA examiner determined that the Veteran's symptoms resulted in occupational and social impairment with reduced reliability and productivity, which is commensurate with a 50 percent rating under the General Rating Formula. In April 2023, the Veteran attended another VA examination. The examiner noted symptoms for VA rating purposes of depressed mood, anxiety, chronic sleep impairment, panic attacks that occur weekly or less often, mild memory loss (such as forgetting names, directions or recent events), difficulty in understanding complex commands, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and difficulty adapting to stressful circumstances, including work or a work like setting. The April 2023 VA examiner determined that the Veteran's symptoms resulted in occupational and social impairment with reduced reliability and productivity. In January 2024, the Veteran attended another VA examination. The examiner noted symptoms for VA rating purposes of depressed mood, anxiety, suspiciousness, chronic sleep impairment, mild memory loss (such as forgetting names, directions or recent events), impairment of short- and long-term memory (for example, retention of only highly learned material, while forgetting to complete tasks), flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and difficulty adapting to stressful circumstances, including work or a work like setting. The January 2024 VA examiner determined that the Veteran's symptoms resulted in occupational and social impairment with reduced reliability and productivity. In July 2024, the Veteran submitted an extensive private evaluation in support of his claim, conducted by Dr. K.B. in June 2024. The psychologist noted that as a result of in-service trauma, the Veteran developed avoidant coping strategies. He avoids being in crowds and around heavy traffic. He prefers not to drive. He feels detached from other people and stated that he does not have many friends and does not interact with his neighbors. On occasion he will go out for a meal with his partner but otherwise does not go to social settings. When he was working, he would isolate himself. He stated that his most recent job was a good fit at the time because he could work in isolation. While the other employees would frequently go out to the bar together, he never joined them. The Veteran also has reactivity and arousal symptoms that are problematic. He awakens often during the night and averages four hours of sleep. He drinks alcohol every night to help him sleep. He feels irritable daily and reports a long history of anger problems which he states led to divorce in his first marriage. Currently he estimates episodes of explosive anger once every month or two. He endorsed constant hypervigilance and stated he was always aware of his surroundings and noises. He endorsed an exaggerated startle response and a history of infrequent panic attacks when around other people. He reported a history of suicidal ideation on a few occasions since getting out of the Army. For VA rating purposes, the Dr. K.B. noted symptoms of anxiety, panic attacks that occur weekly or less often, suspiciousness, chronic sleep impairment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, including work or a work like setting, and suicidal ideation, inability to establish and maintain effective relationships, impaired impulse control, such as unprovoked irritability with periods of violence, and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. The private psychologist determined that the Veteran's symptoms resulted in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood, which is commensurate with a 70 percent rating under the General Rating Formula. In August 2024, the Veteran attended another VA examination. The examiner noted a worsening of the Veteran's symptoms with no change in diagnosis. For VA rating purposes, the August 2024 VA examiner noted symptoms of depressed mood, anxiety, suspiciousness, chronic sleep impairment, near-continuous panic or depression affecting the ability to function independently, appropriately and effectively, mild memory loss (such as forgetting names, directions or recent events), impairment of short- and long-term memory (for example, retention of only highly learned material, while forgetting to complete tasks), flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, including work or a work like setting, and suicidal ideation. The August 2024 VA examiner determined that the Veteran's symptoms resulted in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood, which is commensurate with a 70 percent rating under the General Rating Formula. In October 2024, a VA addendum opinion regarding conflicting medical evidence was associated with the file, conducted in September 2024. Upon review of the entire file, the VA examiner stated that the August 2024 VA examiner and the private psychologist both determined a 70 percent impairment was appropriate for the Veteran due to experiences during the Vietnam War and behavioral health sequelae that have persisted to present. The examiner found that such findings were also commensurate with the Veteran's initial PTSD VA evaluation in 2017. The examiner noted that the Veteran endured multiple combat traumas that continue to limit his social and occupational functioning. The examiner opined that it would be unconscionable to decrease his disability rating for combat related PTSD when his symptoms have neither ameliorated nor resolved. The examiner concluded that the Veteran is unable to maintain a typical work schedule due to severe behavioral health symptoms which have been noted across all VA evaluations by three different psychologists over a seven-year time period. The Board notes that the VA examiners reported similar observations during their in-person interviews with the Veteran. The examiners found the Veteran to be well-groomed and dressed appropriately. He was oriented to time, place, person, and situation. His speech was of normal rate, rhythm and volume and he responded in an open and cooperative manner. The content of his thought was logical, linear and goal directed. Intellectual ability appeared average. Generally, the examiners found the Veteran's insight and judgment to be good. The April 2023 examiner noted insight and judgment as fair. The reports were negative for delusions, obsessions, auditory hallucinations, and visual hallucinations. The Veteran denied any thoughts or impulses to hurt himself or others. VA treatment records over the period on appeal reflect a continued diagnosis of PTSD and depression with consistent reports of related symptoms including flashbacks, anxiety, hypervigilance, nightmares, insomnia, and alcohol use. He treated with therapy and intermittently with medication as some medications were unsuccessful or caused side-effects. For example, October 2017 psychiatry progress notes indicate that the Veteran reported flashbacks triggered by explosions and certain weather, nightmares 2-3 times a week, and treated with sertraline but had an allergic reaction. The physician noted that the Veteran avoided activities and numbed with isolation. Arousal symptoms included sleep problems, irritability/anger, difficulty concentrating, hypervigilance, and startle response. In September 2018, the Veteran reported hypervigilance, nightmares once a week, and anxiety attacks triggered by the smell of "wet" or rain. He stopped taking Buspar as it made him more anxious and stopped taking Mirtazapine due to headaches. In October 2019, the Veteran reported that if he could sleep at night, he could stop drinking. In January 2020, the Veteran agreed to again try Escitalopram for his anxiety and depression. He reported continued nightmares, flashbacks, and hypervigilance. See March 2023 CAPRI, psychiatry notes of October 17, 2017, September 4, 2018, October 3, 2019, and January 7, 2020. After a thorough review of the evidence, the Board finds that the nature, frequency, duration, and severity of the Veteran's psychiatric symptomatology more nearly approximates the level of severity associated with a 70 percent rating, as currently assigned, but not total occupation and social impairment. The Board finds the June 2024 private medical evaluation offered by Dr. K.B highly probative to support the finding that the Veteran's PTSD symptoms for the period on appeal have caused occupational and social impairment with deficiencies in most areas such as work, family relations and mood. The private psychologist based her extensive evaluation on an in-person interview (via video conference), addressed the Veteran's relevant medical history in great detail, provided a symptom list which was well-supported with examples of how the Veteran's symptoms were impacting his day-to-day functioning, and discussed relevant medical literature. Nieves-Rodriguez v. Peake, 22?Vet. App.?295, 302-04 (2008) (holding that it is the reasoning underlying the conclusion that contributes probative value to a medical opinion). The Board also finds the September 2024 VA addendum opinion highly probative as it is based on a full and detailed review of the evidence of record in the determination that an initial 70 disability evaluation percent is appropriate for the entire period on appeal. Moreover, all of the VA examiners have consistently found that the Veteran's severe PTSD symptoms make it difficult for him to adapt to stressful circumstances, including work or a work like setting, which is contemplated by the 70 percent rating. The Board acknowledges that the August 2024 VA examination report reflects that the Veteran's PTSD symptomatology may have increased in severity, as the examiner found new severe symptoms of near-continuous panic or depression affecting the ability to function independently, appropriately and effectively, and suicidal ideation. However, such symptomatology is contemplated in the currently assigned 70 percent disability rating As to the symptoms which may be contemplated by a 100 percent rating, there is no evidence of record of any psychotic symptoms including auditory or visual hallucinations, paranoid ideation, or ideas of reference. The record additionally provides no evidence of grossly inappropriate behavior; persistent danger of hurting self or others; disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name, or equivalent symptomology. The Board also acknowledges that the June 2024 private psychologist identified the symptom of an intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene, which is contemplated by a 100 percent disability rating. However, the presence or absence of any one symptom listed in the criteria is not necessarily dispositive of any particular disability level. Mauerhan, 16 Vet. App. at 436, 442. The pertinent issue is the level of occupational and social impairment resulting from the Veteran's symptomatology. Here, the Veteran's level of social impairment resulting from his psychiatric symptomatology does not suggest a total impairment. The evidence of record reflects that the Veteran has been with his current live-in partner for over 30 years (since 1991), and he described his relationship in positive terms. He also reported having one good friend with whom he has occasional contact. Vet Center treatment notes from 2017 note that the Veteran is also close to his brother and a nephew. See November 2017 Medical Treatment Record - Government Facility, progress notes of February 2, 2017. Therefore, while the Veteran's social interactions have been limited, they are not entirely absent. Given the above, the Board concludes that while the evidence reflects an occupational and social impairment with deficiencies in most areas, a greater level of impairment is not shown. Accordingly, the Board finds that the most probative and persuasive evidence is against an initial rating in excess of 70 percent. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.7, 4.130; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021). 2. Entitlement to a TDIU As previously discussed, the Veteran's claim for an increased initial rating for PTSD remained pending since November 2015. The Veteran's claim for entitlement to TDIU is part and parcel of that claim. See Rice v. Shinseki, 22 Vet. App. 447 (2009) (holding that a request for TDIU, whether expressly raised by the Veteran or reasonably raised by the record, is not a separate "claim" for benefits, but rather, is part of a claim for increased compensation). Accordingly, the Board must decide whether the Veteran could not obtain or retain substantially gainful employment because of his service-connected PTSD from November 15, 2015. In addition, the Veteran has expressly asserted that he is unable to work due to the symptom of his service-connected PTSD. See June 2017 statement. He submitted a formal claim for TDIU (VA Form 21-8940) in November 2018 and an updated TDIU claim in March 2023. It is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. 38 C.F.R. § 4.16(b). A TDIU will be considered to exist when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that if there is only one such disability, this disability shall be ratable at 60 percent or more, and that, 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). For the purpose of determining whether there is one disability evaluated at 60 percent, or one disability evaluated at 40 percent where the combined rating of all service-connected disabilities is 70 percent or greater, disabilities resulting from a common etiology will be considered as "one disability." In this case, the Veteran's service-connected disabilities are PTSD, rated at 70 percent disabling from November 15, 2015; tinnitus, rated at 10 percent disabling from November 15, 2015; and hypertension, rated at 10 percent disabling from March 20, 2023. The Veteran has a combined evaluation of 70 percent from November 15, 2015, and a combined evaluation of 80 percent from March 20, 2023. Therefore, the schedular criteria for an award of TDIU is met for the entirety of the period on appeal. Having determined that the Veteran meets the percentage threshold requirements, the remaining inquiry is whether he is unable to secure or follow a substantially gainful occupation as a result of his service-connected PTSD. The Court of Appeals for Veterans Claims (Court) held that the phrase "unable to secure and follow a substantially gainful occupation" in § 4.16(b) has economic and noneconomic components. See Ray v. Wilkie, 31?Vet. App.?58, 73 (2019). The economic component simply means an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. Id. The noneconomic component concerns the ability of the Veteran to secure or follow substantially gainful occupation employment. In determining whether a veteran can secure and follow a substantially gainful occupation, attention must be given to the Veteran's history, education, skill, and training. Additionally, attention must be given whether the Veteran has the 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. Factors that may be relevant include, but are not limited to, the veteran's limitations, if any, concerning lifting, bending, sitting, standing, walking, climbing, grasping, typing, and reaching, and also auditory and visual limitations. Further, attention should be given to whether the Veteran has the mental ability to perform the activities required by the occupation at issue. Factors that may be relevant include, but are not limited to, the Veteran's limitations, if any, concerning memory, concentration, ability to adapt to change, handle workplace stress, get along with coworkers, and demonstrate reliability and productivity. Id. Entitlement to a TDIU is a legal determination, not a medical one. Geib v. Shinseki, 733 F.3d 1350 (Fed. Cir. 2013). As with any claim, when there is an approximate balance of positive and negative evidence regarding any matter material to the claim, the claimant shall be given the benefit of the doubt. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. As the Veteran has been unemployed for the entire period on appeal, the economic component is met. Turning toward the non-economic component, the Board has considered the Veteran's education and employment history, the Veteran's statements, VA and private examinations of record, and VA and private treatment records. The evidence of record reflects that the Veteran entered into the Army before finishing high school at age 17 in 1968. He served three years in service, including combat tours in Vietnam from 1969 to 1971. After service, the Veteran attended courses to obtain a General Educational Development (GED) certificate; however, the record is unclear as to whether he obtained his GED. The Veteran worked for the Department of the Navy for the recreational department for about 18 months. Following that, he worked at Universal Honeywell for about a year, and thereafter in a civil service job doing sheet metal work for eight years. In his most recent position, the Veteran worked full-time for the Department of the Navy as a fuel distribution systems worker for approximately 30 years, from April 1981 to April 2011. See March 2023 VA form 21-8940. The Veteran reported that he left that employment after a change in supervisors, after which he became too distraught to be able to continue working. See November 2018 VA form 21-8940. The Veteran indicated that he has been unemployed since April 2011. The Veteran submitted a statement asserting that his PTSD symptoms prevent him from obtaining gainful employment. While he enjoyed the work at his previous job, and stayed for decades, he stated that he was successful there because he had been able to work in isolation and was not expected to deal with other people. This was also helpful as he had trouble with anxiety and losing his patience. The Veteran described an event a couple of years prior to when he stopped working, when a new supervisor began targeting and harassing him. The Veteran became more and more anxious and began having panic attacks more often. These increased symptoms on top of his existing PTSD symptoms became too much for him. His doctor advised him to take some time away from work. Upon his return to work, his supervisor suspended him for 15 days without pay. After determining that he was unable to transfer away from this supervisor, the Veteran decided to retire early. He stated that he was unable to get another job after that due to his PTSD and other medical conditions. In that regard, the Veteran stated that he had difficulty maintaining relationships generally and he does not like to leave the house. He avoids parties and public events and even going to the grocery store will make him anxious. He stated that he quickly loses his temper when there are too many people around him. Loud noises and small spaces also trigger his PTSD. See March 2023 statement. Relevant medical records dated prior to the period on appeal indicate that the Veteran sought mental health treatment in June 2009 due to severe work stress. The Veteran reported a buildup of work stress for the past 18 months. The Veteran reported that he was at the same job for 28 years and due to stress from a new supervisor, he was experiencing anxiety, depression, hopelessness, poor concentration and focus, poor sleep, irritability, and excessive worry. Progress notes from later that month indicate the Veteran continued to endorse "worry, depression, insomnia, difficulty controlling worry, staying up all night worrying, feeling keyed up and on edge, and irritability with a short temper for more than six months." The Veteran reported that memories from Vietnam were entering his mind which created feelings of anxiety and anger. The physician prescribed medication and provided the Veteran with a letter suggesting a work transfer to prevent worsening of symptoms. See October 2022 Medical Treatment Record - Non-Government Facility, Kaiser medical records, progress notes of June 1, 2009, June 11, 2009, and June 22, 2009. His treating therapist also recommended that the Veteran be placed off work for two weeks. See June 2017 : Medical Treatment Record - Non-Government Facility, work status report of L.T. dated June 17, 2009. Turning to the medical evidence of record during the period on appeal, as discussed at length above, recent medical opinions addressing the impact of the Veteran's PTSD on his ability to work indicate that the symptomatology of his PTSD results in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood. In addition, Vet Center therapy treatment notes from 2016 reflect that the Veteran's need for isolation made it difficult for him to be around people, including a work environment. The Veteran reported that he has struggled with his emotions and his thoughts towards others ever since his military experience. He stated he did not like working with people and lives in a secluded environment. See November 2017 Medical Treatment Record - Government Facility, Vet Center individual therapy notes of October 19, 2016. In Vet Center treatment notes from 2017, the clinician noted that the Veteran tended to isolate and had conflict in work environments. See November 2017 Medical Treatment Record - Government Facility, Vet Center individual therapy notes of July 27, 2017. The June 2017 VA examiner opined that the Veteran's functional impairments, to "include not interacting well with others, were due to the effects of his mental disorders." The April 2023 VA examiner opined that the effects from the Veteran's service-connected disabilities did not impair his ability to function in an occupational environment, other than the need for reasonable accommodations for breaks to regulate emotions. He noted that the Veteran stated he could do yard work and likely work remotely. The January 2024 VA examiner found that the Veteran's PTSD symptoms would cause functional impairment for the Veteran in public locations and when interacting with others, such as co-workers and supervisors. In addition, problems with attention, focus, concentration, anxiety and suspicion would impair his ability to perform physical and sedentary activities of employment, including attendance problems, difficulty adapting to stressful work situations, difficulty establishing and maintaining appropriate work relationships, and difficulty sustaining a traditional work-day or work-week without interruption from mental health symptoms. In the June 2024 report from private psychologist Dr. K.B., the clinician opined that the symptoms from the Veteran's service-connected PTSD would more likely than not prevent him from maintaining substantially gainful employment due to impairments in interpersonal relations, low motivation, mood dysregulation, and poor sleep. She further explained that the Veteran's re-experiencing symptoms would reduce his productivity due to his inability to focus on work tasks. The symptoms would also contribute to his increased work absences. Avoidance symptoms would interfere with his ability to interact appropriately with the environment and peers in a workplace setting. Arousal and reactivity symptoms would make him more reactive to normal workplace stressors and interpersonal conflicts. Negative thoughts and feelings would contribute to an increased risk for suicidal thoughts and depressive symptoms which in turn would decrease his work productivity. She cited several medical journal articles in support of her evaluation. Dr. K.B included a residual functional capacity report which evaluated the Veteran's (mental) ability to do work related activities. The report estimated that due to mental health problems, the Veteran would miss two days of work per month, he would need to leave early from work three or more days per month, he would not be able to stay focused for more than three days a month, and the Veteran would respond in an angry manner more than once a month when subject to the normal pressures and constructive criticisms of a job, but he would not actually become violent. The August 2024 VA examiner opined, after review of the evidence of record for the entire period on appeal, that the Veteran cannot maintain employment due to interruption from behavioral health symptoms each day. In the September 2024 addendum opinion, she confirmed that the Veteran's severe combat PTSD symptoms have neither ameliorated nor resolved, and they continue to limit his social and occupational functioning. Upon review, the Board finds that the symptoms of the Veteran's service-connected PTSD would more likely than not be productive of significant occupational effects that would impact his ability to get along with coworkers and supervisors, complete required tasks, adapt, and attend work consistently. While it is noteworthy that the Veteran has not worked for an employer for approximately 14 years, the Board finds the January 2024 and August/September 2024 VA examination reports and the June 2024 private evaluation to be highly probative. These reports were based on a complete review of the record and provided a thorough and detailed analysis in support of the negative impact of the Veteran's PTSD on his ability to secure and maintain substantially gainful employment. See Nieves-Rodriguez, 22 Vet. App.?at 295, 304. Therefore, based on a review of the entire record, the Board finds the evidence to be at least in approximate balance in showing that the Veteran is precluded, by reason of his service-connected PTSD, from obtaining and maintaining gainful employment consistent with his education and occupational experience. See Geib, 733 F.3d at 1350, 1354 (noting that "applicable regulations place responsibility for the ultimate TDIU determination on the [adjudicator], not a medical examiner"). Accordingly, after resolving all reasonable doubt in the Veteran's favor, the Board finds that entitlement to a TDIU is warranted based on the Veteran's service-connected PTSD for the entire period on appeal. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch, 21 F.4th at 776. The Board considered whether entitlement to special monthly compensation (SMC) is warranted by virtue of the grant of a TDIU and finds that it is not. VA's duty to maximize a claimant's benefits includes consideration of whether his or her disabilities establish entitlement to SMC under 38 U.S.C. § 1114. See Bradley v. Peake, 22 Vet. App. 280, 294 (2008). SMC is payable at the housebound rate where the Veteran has a single service-connected disability rated as 100 percent and, in addition: (1) has a service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability, and involving different anatomical segments or bodily systems, or (2) is permanently housebound by reason of service-connected disability or disabilities. 38 U.S.C. § 1114(s). In this case, the Veteran does not have an additional disability independently ratable at 60 percent. The remaining disabilities for this period consist of tinnitus, rated as 10 percent disabling from November 15, 2015, and hypertension, rated as 10 percent disabling from March 20, 2023. Therefore, the Veteran does not meet the statutory criteria for SMC based on housebound status. The evidence also does not show that the Veteran is housebound in fact. Accordingly, the Board finds that the criteria for SMC at the housebound rate are not met. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Horan, Deborah E. 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.