POSTTRAUMATIC STRESS DISORDER (PTSD)

T. SHERRARD · 2022 · Case ID: 22048571

MIXED

Summary

The veteran, who served from September 1965 to September 1967, appeals the denial of a higher disability rating for PTSD and the denial of a TDIU prior to May 31, 2016. The Board granted an initial rating of 70 percent for PTSD prior to April 29, 2016, but denied any rating higher than 70 percent thereafter. The Board also granted a TDIU as of September 12, 2011. The Board considered multiple VA examinations and the veteran's lay statements. While a December 2012 VA exam suggested a 30 percent rating, later opinions from Dr. W.A. in April 2016 and a March 2017 VA examination supported a 70 percent rating, finding occupational and social impairment with deficiencies in most areas. The Board found these later opinions more persuasive, noting the veteran's ongoing symptoms like irritability, difficulty adapting to work stress, and interpersonal issues, which precluded him from maintaining substantial gainful employment. The Board determined that the veteran's PTSD, combined with other service-connected disabilities, rendered him unemployable, thus warranting a TDIU. The Board also considered and denied an extraschedular rating for PTSD, finding the schedular criteria adequately contemplated the veteran's symptoms and functional impairment.

Rationale

March 2017 VA examination and Dr. W.A. opinion supported 70% rating; Veteran's symptoms approximated 70% criteria throughout appeal period; Symptoms did not meet criteria for 100% rating

Special Benefit

TDIU

Docket No.

16-13 101

Full Decision Text

Citation Nr: 22048571
Decision Date: 08/25/22 Archive Date: 08/25/22

DOCKET NO. 16-13 101
DATE: August 25, 2022

ORDER

Prior to April 29, 2016, an initial rating of 70 percent for an acquired psychiatric disorder, including posttraumatic stress disorder (PTSD) with major depressive disorder (MDD) and moderate and alcohol use disorder (AUD) in partial remission (heretofore collectively called PTSD), but no higher, is granted.

A rating higher than 70 percent for PTSD from April 29, 2016, onwards is denied.

A total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is granted as of September 12, 2011.

FINDINGS OF FACT

1. Throughout the period on appeal, the severity, frequency, and duration of the Veteran's psychiatric disability symptoms manifested occupational and social impairment with deficiencies in most areas but did not more closely approximate total occupational and social impairment.

2. Throughout the appeal period, the Veteran's service-connected disabilities prevented him from performing substantial gainful employment.

CONCLUSIONS OF LAW

1. Resolving reasonable doubt in favor of the Veteran, the criteria for a 70 percent disability rating, but no higher, have been met for the rating period prior to April 29, 2016. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411.

2. The criteria for a disability rating in excess of 70 percent for PTSD have not been met at any time during the period on appeal. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411.

3. The criteria for a TDIU have been met for the entire period on appeal (from September 12, 2011). 38 U.S.C. §§ 5110, 7105; 38 C.F.R. §§ 3.156, 3.340, 3.341, 3.400, 4.16, 4.19.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from September 1965 to September 1967. These matters come before the Board of Veterans' Appeals (Board) on appeal from January 2013 and January 2017 Rating Decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO).

In July 2019, the Board remanded the issues on appeal for further development. In August 2021, the Board denied entitlement to an initial rating in excess of 50 percent prior to April 29, 2016, and in excess of 70 percent thereafter for posttraumatic stress disorder (PTSD), and denied a TDIU prior to May 31, 2016. The Veteran appealed these claims to the Court of Appeals for Veterans' Claims (Court). A Joint Motion for Partial Remand (JMR) returned all three claims to the Board for further consideration.

The Veteran's representative provided hyperlinks to some articles found online. The Board did not review these articles. Hyperlinked content is often not static and web pages may be continuously edited. Therefore, the Board cannot guarantee that hyperlinked content has not been altered from the time of submission of the brief to the time it is accessed by the Board to the time the Board decision is issued. In Bowey v. West, the Court held the mere reference to non-VA documents is insufficient to incorporate them into the record. 11 Vet. App. 106, 108-09 (1998); see also Hilkert v. West, 12 Vet. App. 145, 151 (1999).

1. Prior to April 29, 2016, an initial rating of 70 percent for PTSD, but no higher, is granted.

2. A rating higher than 70 percent for PTSD from April 29, 2016, onwards is denied.

The Veteran contends that he is entitled to a higher rating than 50 percent for his PTSD prior to April 29, 2016, and higher than 70 percent thereafter.

1. Prior to April 29, 2016, an initial rating of 70 percent for PTSD, but no higher, is granted.

2. A rating higher than 70 percent for PTSD from April 29, 2016, onwards is denied.

The Veteran contends that he is entitled to a higher rating than 50 percent for his PTSD prior to April 29, 2016, and higher than 70 percent thereafter.

Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10.

In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disability.

If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21.

In deciding this appeal, the Board has considered whether separate ratings for different periods of time, based on the facts found, are warranted, a practice of assigning ratings referred to as "staged" ratings.

Given the nature of the present claim for a higher initial evaluation, the Board has considered all evidence of severity since the effective date for the award of service connection. Fenderson v. West, 12 Vet. App. 119 (1999).

Under the General Rating Formula for Mental Disorders, the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013).

A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. See 38 C.F.R. § 4.130, Diagnostic Code 9411.

A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. Id.

A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name. Id.

Evidence shows that during the entire period on appeal, the Veteran's symptoms most closely approximate the level of impairment associated with a 70 percent rating.

A December 2012 VA examination report shows that the Veteran was going to church on Sundays with neighbors. He
judgment, thinking, or mood. Id.

Evidence shows that during the entire period on appeal, the Veteran's symptoms most closely approximate the level of impairment associated with a 70 percent rating.

A December 2012 VA examination report shows that the Veteran was going to church on Sundays with neighbors. He was married and living with his wife of 20 years. He described his marriage as stable and good. He went fishing about once a month and watched football games. He read the newspaper occasionally and talked to two or three friends at least once a week. He also reported that he occasionally visited family, while avoiding crowds and noisy places.

His identified symptoms included nightmares, avoidance issues, fatigue, decreased attention and concentration, feeling numb and detached from others, short temper with episodic angry outbursts, intrusive thoughts, feeling watchful and jumpy, depressed mood, anxiety, suspiciousness, chronic sleep impairment, mild memory loss, and disturbances of motivation and mood.

The December 2012 VA examiner opined that the Veteran had occupational and social impairment with an occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal).

VA treatment records from October and November 2012 show that the Veteran experienced irritability, cognitive distortions, depression, severe anhedonia, difficulty sleeping, hypervigilance, abuse of alcohol, and inability to get along with people in a work environment. The Veteran reported that his symptoms began seven years earlier.

The August 2013 Notice of Disagreement (NOD) includes the Veteran's lay statements indicating that his PTSD was manifested by symptoms associated with a 70 percent rating, such as: near continuous depression affecting the ability to function independently, appropriately and effectively; impaired impulse control, such as unprovoked irritability with periods of violence; difficulty in adapting to stressful circumstances, including work or a worklike setting; and an inability to establish and maintain effective relationships.

In April 2016, when meeting with Dr. W.A., the Veteran reported that that he had difficulty speaking with others and that he would get into verbal arguments at work. He stated he opted to retire when he was told he would need to change his interpersonal style to obtain a job. He added that he experiences indifferent mood most of the day, nearly every day. Anhedonia, insomnia, fatigue, loss of energy, and concentration difficulties were reported. Cognitive difficulties, including the diminished ability to think, and indecisiveness, were reported. Recurrent thoughts of death were described. He also noted suspiciousness, mild memory loss, difficulty with speech, impaired judgment, trouble maintaining relationships, trouble adapting to stressful circumstances, spatial disorientation, delusions or hallucinations, and disorientation to time and place. Troubles were noted on measures of visual set shifting, visual motor precision, auditory rote recall and reversal, serial sevens, expressive and receptive language capacities, verbal fluency, and a delayed recall measure, on which Mr. [REDACTED] was unable to remember any of five possible items. Dr. W.A. opined that the Veteran had occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.

The March 2017 VA examination report, and August 2020 addendum, show that the Veteran's PTSD was manifested by symptoms associated with a 70 percent rating (occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood), and no symptoms associated with a 100 percent rating. Symptoms included nightmares, avoidance behaviors, detachment from others, irritability/anger outbursts, hypervigilance, exaggerated startle response, sadness, low self-esteem, social withdrawal, anhedonia, increased appetite with weight gain, decreased libido, low energy, fatigue, decreased attention and concentration, poor social and familial interactions, decreased pace and persistence when performing simple and complex tasks, memory difficulties, and difficulty managing stress. During the examination, the following was noted, the Veteran still lived with his wife, he had one friend, he watched television, and there were no changes in the Veteran's lifestyle since the prior VA examination.

VA treatment records from January 2017 to January 2021 show that the Veteran's had the following symptoms at
, avoidance behaviors, detachment from others, irritability/anger outbursts, hypervigilance, exaggerated startle response, sadness, low self-esteem, social withdrawal, anhedonia, increased appetite with weight gain, decreased libido, low energy, fatigue, decreased attention and concentration, poor social and familial interactions, decreased pace and persistence when performing simple and complex tasks, memory difficulties, and difficulty managing stress. During the examination, the following was noted, the Veteran still lived with his wife, he had one friend, he watched television, and there were no changes in the Veteran's lifestyle since the prior VA examination.

VA treatment records from January 2017 to January 2021 show that the Veteran's had the following symptoms at some, but not at each, mental status examination: negative beliefs/expectations, depressive symptoms, nightmares, memory problems, psychological distress to cues, negative emotional states, diminished interest/participation, avoidance, irritability, hypervigilance, poor concentration, and reckless behavior.

In September 2017, doctors felt the Veteran was competent to continue physical therapy on his own at home, meaning the Veteran could follow directions.

In August 2019, the Veteran reported that he was a Miami Hurricanes season ticket holder. In January 2020, the Veteran reported walking for an hour three times per week and going to the sauna. He added that he works around the house on a daily basis. In May 2020, the Veteran reported that he walks most days and does yardwork. Treatment notes from May 2020 through July 2020 show that the Veteran was driving, that he was able to go to the grocery store, that he cooked on occasion, he did yardwork, walked most days, and worked around the house.

A 70 percent rating is warranted for the entire period. Both Dr. W.A. and the VA examiner from March 2017 opined the Veteran's acquired psychiatric disability manifested to the equivalent of a 70 percent rating. The VA examiner from December 2012 opined the Veteran had a disability with the equivalent of a 30 percent rating. The Board finds the March 2017 opinion to be contrary to the December 2012 opinion. The March 2017 report states the Veteran has not changed from the prior VA examination. Thus, the March 2017 opinion should be interpreted as retrospective. Dr. W.A. and the March 2017 VA examiner's opinion both support finding that a 70 percent rating is appropriate. These two opinions are given greater weight than the December 2012 opinion because they lend one another credibility.

The fact that the Veteran associated with his wife, friends, and other Veterans, occasionally visited his family, went to the grocery store, did yardwork, work around the house, and went to church show that he is not totally occupational and socially disabled.

The March 2021 appellate brief introduces the argument that the Veteran should be entitled to an extraschedular rating for his PTSD with MDD and AUD due to the adverse effects on his daily life, specifically his employment, but also his relationships with his family, due to his irritability and being easily overwhelmed. Having asserted such entitlement, consideration of an extraschedular rating requires a three-step inquiry. The first question is whether the schedular rating criteria adequately contemplate the Veteran's disability picture. If the schedular evaluation does not contemplate the level of disability and symptomatology shown and is found inadequate, then the second inquiry is whether the exceptional disability picture exhibits other related factors, such as marked interference with employment or frequent periods of hospitalization. See Thun v. Peake, 22 Vet. App. 111 (2008). The first Thun element compares a claimant's symptoms to the rating criteria, while the second addresses the resulting effects of those symptoms. Thus, the first and second Thun elements, although interrelated, involve separate and distinct analyses. Yancy v. McDonald, 27 Vet. App. 484, 495(2016). If the Veteran's disability picture meets the second inquiry, then the third step is to refer the case to the Director of Compensation Services to determine whether an extraschedular rating is warranted. See Thun, 22 Vet. App. 111. In regard to the first element, comparison of the Veteran's symptoms and associated functional impairment does not show that the rating criteria are inadequate to describe his disability picture. The rating criteria for mental disorders specifically contemplate the functional effects of occupational and social impairment due to the symptoms of mental disorders. Therefore, when the symptoms of a claimant's mental disorder result in adverse effects on employment and family relationships, those effects are contemplated by the schedular rating criteria. Thus, here, the adverse effects on the Veteran's daily life, specifically his employment, but also his relationships with his family,
refer the case to the Director of Compensation Services to determine whether an extraschedular rating is warranted. See Thun, 22 Vet. App. 111. In regard to the first element, comparison of the Veteran's symptoms and associated functional impairment does not show that the rating criteria are inadequate to describe his disability picture. The rating criteria for mental disorders specifically contemplate the functional effects of occupational and social impairment due to the symptoms of mental disorders. Therefore, when the symptoms of a claimant's mental disorder result in adverse effects on employment and family relationships, those effects are contemplated by the schedular rating criteria. Thus, here, the adverse effects on the Veteran's daily life, specifically his employment, but also his relationships with his family, due to his irritability and being easily overwhelmed from his PTSD with MDD and AUD are reasonably contemplated by the assigned diagnostic code. The threshold issue under Thun is thus not met, and further consideration of an extraschedular rating is not warranted. Therefore, referral to the Director for extraschedular consideration is not warranted.

For the aforementioned reasons, a 70 percent rating, but no higher, is granted for the entire period on appeal. The criteria for a 100 percent disability rating have not been met at any time during the appeal period, as total occupational and social impairment has not been demonstrated.

3. A TDIU is granted as of September 12, 2011.

The Veteran seeks a TDIU prior to May 31, 2016. He contends that his service-connected PTSD renders him unemployable. TDIU has been awarded from May 31, 2016.

While the Veteran's formal application for TDIU was received May 31, 2016, his TDIU claim is tied to his increased rating claim for PTSD. Therefore, the period on appeal begins with the appeal period for the Veteran's PTSD claim, which is the date of service connection, September 12, 2011. Thus, the period on appeal is from September 12, 2011, until May 31, 2016.

A TDIU may be assigned, where the schedular rating is less than total, where a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16(a). To qualify for schedular consideration of a TDIU, if there is only one such disability, this disability shall be ratable at 60 percent or more, and, if there are two or more 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. Id.

For the purposes of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) Disabilities of one or both upper extremities, one or both lower extremities, including the bilateral factor, if applicable; (2) disabilities resulting from common etiology or a single accident; (3)disabilities affecting a single body system, e.g., orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric; (4) multiple injuries incurred in action; or (5) multiple disabilities incurred as a prisoner of war. 38 C.F.R. § 4.16(a); see Moody v. Wilkie, 30 Vet. App. 329, 339 (2018) (combining disabilities as "one disability" to meet the rating threshold of § 4.16(a) requires the use of the combined rating table).

The phrase "unable to secure and follow a substantially gainful occupation" contains both economic and noneconomic components. See Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). The economic component refers to 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 requires a determination as to a veteran's ability to secure and follow such employment. Id. Attention should be given to the veteran's history, education, skills, and training; whether the veteran has the physical ability (both exertional and nonexertional) to perform the types of activities required by the occupation at issue (e.g., lifting, bending, sitting, standing, walking, climbing, as well as auditory and visual limitations); and whether the veteran has the mental ability to perform the activities required by the occupation at issue (e.g., memory, concentration, ability to adapt to change, handle work place stress, get along with coworkers, and demonstrate reliability and productivity). Id.

An award of TDIU is an individualized determination
determination as to a veteran's ability to secure and follow such employment. Id. Attention should be given to the veteran's history, education, skills, and training; whether the veteran has the physical ability (both exertional and nonexertional) to perform the types of activities required by the occupation at issue (e.g., lifting, bending, sitting, standing, walking, climbing, as well as auditory and visual limitations); and whether the veteran has the mental ability to perform the activities required by the occupation at issue (e.g., memory, concentration, ability to adapt to change, handle work place stress, get along with coworkers, and demonstrate reliability and productivity). Id.

An award of TDIU is an individualized determination, specific to a veteran's particular circumstances, e.g., their history, education, skills, and training. See Todd v. McDonald, 27 Vet. App. 79, 85 (2014). It does not require a showing of 100 percent unemployability. Roberson v. Principi, 251 F.3d 1378, 1385 (Fed. Cir. 2001). The ultimate question is whether they are capable of performing the physical and mental acts required by employment, not whether they can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993).

During the period on appeal, the Veteran had the following disabilities that are service connected: posttraumatic stress disorder (PTSD) (rated 70 percent,); tinnitus (rated 10 percent); and bilateral hearing loss (rated 0 percent). Based on the foregoing, the Veteran has one disability rated 60 percent or more. Accordingly, the Board may consider the claim for a TDIU on a schedular basis. 38 C.F.R. § 4.16(a).

For the reasons that follow, the Board finds that a TDIU is warranted.

With respect to the economic component, on his February 2017 VA Form 21-8940 the Veteran indicated that he last worked full-time in December 2010 as a union laborer for a nuclear power plant. The PTSD disability benefits questionnaire (DBQ), filled out by Dr. W.A. and submitted by the Veteran in May 2016, reflects that the Veteran struggled at work due to his confrontational interpersonal style and was told he would have to change. The Veteran reported that as a result, he chose to retire at the age of 62. On the VA Form 21-8940, the Veteran reported that he has not worked since 2010 nor earned more than a marginal income throughout the period on appeal. Therefore, the Veteran meets the economic criteria to be eligible for a TDIU during the period on appeal.

Turing to the non-economic component, the Veteran's VA Form 21-8940 indicates that the Veteran graduated high school and completed two years of college. He worked at a number of jobs before working over 20 years as a union laborer at the nuclear power plant, where he advanced to the position of supervisor or foreman, according to the PTSD DBQ. In addition, the Veteran reported on the VA Form 21-8940 that between 1985 and 2005 he received training in "nuclear de-coning."

The medical record also illuminates some key facts concerning the Veteran's ability to work. At the December 2012 VA examination, the VA examiner indicated that the Veteran's service-connected PTSD would impact his ability to work. The examiner indicated that the Veteran would suffer from decreased work efficiency and intermittent periods of inability to perform occupational tasks.

The Veteran provided additional lay assertions regarding how his PTSD impacts his ability to work on his August 2013 NOD. The Veteran reported that he had difficulty adapting to stressful circumstances, including work and work-like settings, and stated that he could no longer maintain gainful employment due to his PTSD causing him to become extremely irritable with coworkers. He reported being laid off on multiple occasions due to his PTSD.

In April 2016, the Veteran reported that that he had difficulty speaking with others at work and that he would get into verbal arguments at work. He stated he opted to retire when he was told he would need to change his interpersonal style to obtain a job at St. Lucie nuclear power plant. He added that he experiences indifferent mood most of the day, nearly every day. Anhedonia, insomnia, and concentration difficulties were reported. Experiences of fatigue and loss of energy were reported. Cognitive difficulties, including the diminished ability to think, and indecisiveness, were reported to occur. He also noted suspiciousness, mild memory loss, difficulty with speech, impaired judgment, trouble maintaining relationships, trouble adapting to stressful circumstances, spatial
April 2016, the Veteran reported that that he had difficulty speaking with others at work and that he would get into verbal arguments at work. He stated he opted to retire when he was told he would need to change his interpersonal style to obtain a job at St. Lucie nuclear power plant. He added that he experiences indifferent mood most of the day, nearly every day. Anhedonia, insomnia, and concentration difficulties were reported. Experiences of fatigue and loss of energy were reported. Cognitive difficulties, including the diminished ability to think, and indecisiveness, were reported to occur. He also noted suspiciousness, mild memory loss, difficulty with speech, impaired judgment, trouble maintaining relationships, trouble adapting to stressful circumstances, spatial disorientation, delusions or hallucinations, and disorientation to time and place. Troubles were noted on measures of visual set shifting, visual motor precision, auditory rote recall and reversal, serial sevens, expressive and receptive language capacities, verbal fluency, and a delayed recall measure, on which Mr. [REDACTED] was unable to remember any of five possible items.

In May 2016, after meeting the Veteran, Dr. P.Y. articulated that the Veteran was unemployable due to his PTSD, ischemic heart disease, and irritable bowel syndrome. It is unclear how much Dr. P.Y. attributed the Veteran's inability to work to PTSD.

Once again in March 2017, after the period on appeal, a VA examiner found occupational impairment noting that due to his impaired attention and concentration, and mood and memory difficulties associated with his service-connected mental health condition, the Veteran would require close supervision and additional time to complete tasks or learn new skills. Further the examiner found that excessive workloads, quick decision making, rapid changes, and multiple demands in the workplace should be avoided. The examiner concluded that, given his difficulty managing stress and tendency to become easily angry and overwhelmed, the Veteran would have difficulty maintaining a fulltime work schedule and would need to work in a flexible environment where he could leave to relax as necessary. During that examination, the Veteran reported no significant changes in his lifestyle since the last VA examination. Therefore, it is logical to believe that this examiner would believe that work restrictions identified would apply to the Veteran as of the December 2012 examination.

The Board finds that the Veteran would require too many accommodations to be able to maintain substantial gainful employment. First, the Veteran would not be able to work around others and would need limited interaction with managers, in order to avoid conflict. However, in order to perform work, the Veteran would need close supervision. These requirements are in opposition. This is in addition to the required breaks the Veteran would need, which would leave him off task for periods of the day. Given the forgoing, the Veteran's service-connected PTSD precludes him from the ability to secure and maintain substantially gainful employment consistent with his education, skills, training, and work history. Accordingly, a TDIU is warranted.

T. SHERRARD

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board P. Chalker, Associate 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.

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