POSTTRAUMATIC STRESS DISORDER (PTSD)

V. CHIAPPETTA · 2024 · Case ID: 24023887

GRANTED

Summary

The Veteran, a Navy Veteran who served from April 1969 to January 1971, appeals the denial of an increased rating for his service-connected Posttraumatic Stress Disorder (PTSD) and entitlement to Total Disability based on Individual Unemployability (TDIU). The Veteran was initially rated at 50% for PTSD, with the agency of original jurisdiction (AOJ) increasing this to 70% during the appeal. The Board reviewed evidence including the Veteran's testimony, his brother's testimony, various VA treatment records, and multiple VA psychiatric examinations. The Veteran's symptoms fluctuated, with some periods showing significant impairment and others showing better functioning, including church involvement. However, multiple examiners noted potential over-reporting of symptoms. The Board found the evidence in approximate equipoise regarding the severity of the Veteran's PTSD and his ability to secure gainful employment. Applying the benefit of the doubt, the Board granted the 70% rating for PTSD retroactively to November 12, 2015, and also granted TDIU effective from the same date. The Board found that the Veteran's PTSD symptoms, including anxiety, depression, sleep disturbances, and difficulty with focus and social interaction, precluded him from securing or maintaining substantially gainful employment, despite some ability to engage in church activities.

Rationale

Evidence in approximate equipoise regarding severity of PTSD; Benefit of the doubt resolved in Veteran's favor; Symptoms consistent with 70 percent rating criteria

Service Branch

NAVY

Special Benefit

TDIU

Diagnostic Code

9411

Docket No.

19-04 482

Full Decision Text

Citation Nr: 24023887
Decision Date: 06/18/24 Archive Date: 06/18/24

DOCKET NO. 19-04 482
DATE: June 18, 2024

ORDER

Entitlement to an initial rating of 70 percent, but no higher, for service-connected posttraumatic stress disorder (PTSD) is granted.

A total disability rating based on individual unemployability due to service-connected disability (TDIU) is granted for the entire period on appeal.

FINDINGS OF FACT

1. For the entire period on appeal, the evidence is at least in approximate equipoise as to whether the Veteran's PTSD symptoms manifest in impairment causing occupational and social impairment with deficiencies in most areas; however, the evidence weighs persuasively against a finding that the Veteran's PTSD symptoms manifesting in impairment causing total occupational and social impairment.

2. The evidence is at least in approximate equipoise as to whether the Veteran has been unable to secure or follow a substantially gainful occupation as a result of his service-connected PTSD throughout the period on appeal.

CONCLUSIONS OF LAW

1. The criteria for an initial rating of 70 percent, but no higher, for PTSD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411.

2. The criteria for an award of a TDIU, effective November 12, 2015, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.3, 4.16.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Navy from April 1969 to January 1971.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office. In that decision, the agency of original jurisdiction (AOJ) awarded entitlement to service connection for PTSD, and assigned an initial 50 percent rating effective November 12, 2015. The Veteran disagreed with the assigned initial rating, and perfected this appeal.

In June 2022, the Veteran and his brother testified before the undersigned Veterans Law Judge at a Travel Board hearing. A transcript of the hearing is of record.

The matter was most recently before the Board in March 2023, at which time the issues were remanded to the AOJ for further development, including VA examination. In September 2023, after taking further action, the AOJ increased the rating for PTSD to 70 percent, effective April 26, 2023. The prior ratings were otherwise confirmed and continued and the case was returned to the Board. See September 2023 Supplemental Statement of the Case (SSOC). As the requested development has been completed, the matter is once again before the Board for adjudication.

1. Entitlement to an initial rating in excess of 50 percent for service-connected posttraumatic stress disorder (PTSD)

The Veteran is currently rated under Diagnostic Code 9411 for PTSD. For rating purposes, Diagnostic Code 9411 is included among the General Rating Formula for Mental Disorders ("Rating Formula") of 38 C.F.R. § 4.130.

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

A 70 percent rating is warranted for disability manifesting in 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);
work and social relationships. 38 C.F.R. § 4.130, DC 9411.

A 70 percent rating is warranted for disability manifesting in 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. Id.

A 100 percent rating is warranted for disability manifesting in 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. Id.

Ratings are assigned according to the manifestation of particular symptoms. However, the use of the term "such as" in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002). In Vasquez-Claudio v. Shinseki, F.3d 112, 117 (Fed. Cir. 2013), the Court also held that a Veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration.

When evaluating a psychiatric disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, length of remissions, and the veteran's capacity for adjustment during periods of remission. 38 C.F.R. § 4.126(a). The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. Id. However, when evaluating the level of disability from a psychiatric disorder, the rating agency will consider the extent of social impairment but shall not assign an evaluation solely on the basis of social impairment. 38 C.F.R. § 4.126(b).

Upon review of the evidence of record, it appears that the severity of the Veteran's disability has waxed and waned over the course of the appeal period. There are times when the Veteran appears to have been capable of managing PTSD symptoms without significant impact on day to day life; however, there are also times when it appears the Veteran's disability is more impactful, manifesting in serious symptoms that affect several areas of his life. This is evident by the fact that when VA examiners have been asked to assess the Veteran's overall level of impairment due to PTSD, the conclusions have varied, with August 2016 and April 2023 examiners noting impact with occupation and social impairment in most areas (consistent with the criteria for a 70 percent rating), and November 2018 and September 2022 examiners noting a lesser impact, with occupational and social impairment with reduced reliability and productivity (consistent with the criteria for a 50 percent rating).

When the Veteran first filed his service-connection claim in November 2015, he reported having continuous nightmares and an inability to socialize. He stated he lived alone, and did not feel comfortable in public. His treating physician submitted a statement at the time also describing the Veteran's symptoms of nightmares, recurrent intrusive thoughts, flashbacks, avoidance of thoughts/feelings, and avoidance of most people and places. The physician also indicated that the Veteran experienced a loss of interest, a sense of feeling detached, disrupted sleep, irritability, hypervigilance and an exaggerated startle response. See the September 22, 2015 letter from Dr. J.P.D.

As noted above, upon examination in August 2016, a VA examiner concluded that the Veteran's disability manifested in occupational and social impairment in most areas, and highlighted several debilitating symptoms of depression and anxiety. The Veteran alluded to hearing someone calling him at times, but could not describe the last time that such occurred. The examiner also noted that the Veteran has experienced impaired impulse control, such as unprovoked irrit
ings, and avoidance of most people and places. The physician also indicated that the Veteran experienced a loss of interest, a sense of feeling detached, disrupted sleep, irritability, hypervigilance and an exaggerated startle response. See the September 22, 2015 letter from Dr. J.P.D.

Subsequent records of VA care show temporary gains in the ability to function. The Veteran has been able to maintain involvement in his church, serving as a deacon and Sunday school teacher, and maintaining some relationships with friends. Indeed, a July 2017 psychiatry outpatient note reflects that the Veteran was approved to become a deacon at his church and will be teaching a class at one of the sister churches. He reported that he does not skip these classes because he feels a sense of responsibility for his obligations. He denied any suicidal/homicidal ideation or psychotic symptoms.

In September 2017, the Veteran reported his mood was pretty good, he visited his mother's house on a regular basis for solace, and interacted with his family regularly. He reported deriving pleasure from serving as a deacon in his church and teaching young members. The attending psychiatrist reported that the Veteran was appropriately groomed; calm, cooperative, with normal speech; thought process was linear, logical and goal-directed; affect was dysphoric with fair range; and he denied any suicidal/homicidal ideation or psychotic symptoms.

In November 2017, he reported adequate control of his anxiety, and stated that he was able to give four sermons without any worry. He reported stable energy and appetite. He reported he continues to participate in church and goes fishing with friends. He denied suicidal/homicidal ideation, psychosis, or paranoia.

However, at a November 6, 2018 VA psychiatric care visit, the Veteran reported increased impairment due to nightmares, to include with sleep, energy and focus. The Veteran reported being disoriented upon waking, palpitations and diaphoresis. He noted he had been experiencing trouble with concentration when it comes to preparing the lessons for church service/school. He noted that he could not focus on the material and found he had to spend an inordinate amount of time doing what he used to do in a shorter period. He noted anhedonia and avoidance over the last month, with withdrawal from social activities.

Upon VA examination three days later, the examiner concluded that the Veteran's disability only manifested in occupational and social impairment with reduced reliability and productivity. The examiner indicated that examination results were suggestive of overreporting of symptomatology, making it difficult to determine any potential changes in level of functioning without resort to speculation. Notably, the Veteran reported a prior suicide attempt when on drugs, and prior thinking about taking a lot of pills and killing himself. It is unclear from the report when this occurred. The Veteran denied any current suicidal ideation.

A May 29, 2019 VA treatment report notes that the Veteran had a panic attack in the lobby while waiting for the appointment, having become overwhelmed with the noise, the conversations and the number of people. He reported having "gone to a dark place" about six weeks prior when he felt physically ill and stopped taking his mental health medications.

A July 29, 2019 VA treatment report documented the Veteran's report of his mood going up and down like a roller coaster. He reported energy impairment, and concentration impairment as shown by his inability to put together his church lessons. He again was experiencing anhedonia and avoidance.

A September 4, 2019 VA treatment report notes that the Veteran was taking his medication at doses higher than recommended.

In March 2020, he reported his mood was "ok" and his PTSD symptoms are baseline. His nightmares were less intense and he was sleeping through the night, other than instances of nocturia. He reported intermittent intrusive thoughts and flashbacks from his military service. He paced himself in social situations. He continued to deny any suicidal/homicidal ideation or psychotic symptoms. In April 2020, he reported that everything was good, he was involved with church, and very future oriented.

A July 2020 treatment record reflects that the Veteran's sleep had been disrupted secondary to pain from a motor vehicle accident in May. He endorsed adequate control of his anxiety on a daily basis. He reported that his church had reopened, but not a lot of people have returned and nobody is attending Bible study. The psychiatrist noted that he was unable to assess the Veteran's appearance, motor, and affect over the phone. However, he did note that the Veteran was calm, cooperative, with normal speech; thought process was linear, logical and goal-directed; insight and judgment were fair; and he denied any suicidal/homicidal ideation or psychotic symptoms.

In November 2020, he reported sleep issues due primarily to rumination and occasional nightmares. He endorsed baseline anxiety levels. He reported that he was dating a woman and being selective on social gatherings. The Veteran was found to be calm, cooperative, with normal speech; thought process was linear, logical and goal-directed; insight and judgment were fair; and he denied any suicidal/homicidal ideation or psychotic symptoms.

In January 2021, the Veteran reported he was hospitalized due to being hyperglycemic after falling at church. Otherwise, he endorsed generalized worry on a daily basis. He denied any suicidal/homicidal ideation or psychotic symptoms. In February 2021, he reported a baseline level of PTSD symptoms that are constant. He continued to report hypervigilance, intrusive thoughts, and some nightmares. However, he denied suicidal/homicidal ideation, psychotic symptoms, and irritability.

At a September 2021 session, he reported his mood was up and down due to experiencing the death of two friends. PTSD symptoms remained present and he admitted to some avoidance. The Veteran was found to be calm, cooperative, with normal speech; thought process was linear, logical and goal-directed; insight and judgment were fair; and he denied any suicidal/homicidal ideation or psychotic symptoms. The Veteran made similar complaints in November 2021, reporting an up and down mood due to financial stressors. He continued to deny suicidal/homicidal ideation, psychotic symptoms.

During the Veteran's June 2022 Board hearing, he testified that he had suicidal ideations and hallucinations sometimes. He further testified that he stayed to himself and had not been in a relationship for seven years, he did not go to family gatherings, and he cannot stand crowds. He testified that he had issues with hygiene and that he was not working. The Veteran also testified that he had problems with memory, focus, and anger. See June 2022 hearing transcript. Given these reports, the Board remanded the appeal in August 2022 so an updated examination could be provided.

The Veteran appeared for this examination in September 2022. As pointed out by the Board in its March 2023 remand, the September 2022 examiner did not identify the presence of the symptoms described by the Veteran as his June 2022 Board hearing. However, the examiner also did not comment on the Veteran's testimony, or otherwise clarify whether the September 2022 assessment was based on the Veteran's presentation that day only, or whether the Veteran's disability picture simply did not include the severe symptoms described at the hearing. As such, the Board remanded the appeal again for a more responsive assessment.

An April 2023 examiner confirmed the Veteran's PTSD diagnosis and opined that his PTSD resulted in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood. The VA examiner reported symptoms for VA rating purposes included depressed mood; anxiety; chronic sleep impairment; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances, including work or a work-like setting; inability to establish and maintain effective relationships; suicidal ideation; and obsessional rituals which interfere with routine activities. The VA examiner reported that the Veteran was appropriately dressed neatly in casual attire, appropriate for the weather, with good hygiene and grooming. The Veteran was alert and oriented; his speech was normal; his thought process and content were logical and goal-directed without evidence of thought disorder; and his affect was congruent, blunted in range, and appropriate to topic
and/or mood. The VA examiner reported symptoms for VA rating purposes included depressed mood; anxiety; chronic sleep impairment; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances, including work or a work-like setting; inability to establish and maintain effective relationships; suicidal ideation; and obsessional rituals which interfere with routine activities. The VA examiner reported that the Veteran was appropriately dressed neatly in casual attire, appropriate for the weather, with good hygiene and grooming. The Veteran was alert and oriented; his speech was normal; his thought process and content were logical and goal-directed without evidence of thought disorder; and his affect was congruent, blunted in range, and appropriate to topic, based on demeanor and conversational topic. The Veteran reported no auditory, visual or tactile hallucinations, or sensory distortions; no fixed delusions of paranoia, grandiosity, or reference, and revealed no specific obsessions or preoccupations during interview; and no grossly inappropriate behavior was described or observed. With respect to suicidal/homicidal ideation, the Veteran denied any current plan or intent. However, the examiner again suggested that the Veteran may have been over-reporting his symptoms.

As discussed above, the evidence above shows that the Veteran's disability has waxed and waned in severity over the course of the appeal period. Complicating the matter is the fact that more than one examiner has suggested the Veteran may have been over-reporting his symptoms. That stated, the AOJ has already awarded the Veteran a 70 percent rating based on the Veteran's presentation at his April 2023 examination, and the rating was made effective the date of the examination. Upon consideration of the entire record, the Board finds the evidence to be at least in approximate equipoise that the Veteran's PTSD disability has manifested in occupational and social impairment in most areas for the entirety of the appeal period, warranting the assignment of a 70 percent rating effective November 12, 2015.

Indeed, the Veteran's initial examination in 2016 gave the examiner the impression that impairment from PTSD was so severe. Such was also the impression of the April 2023 examiner. Even though some medical examiners speculated the Veteran may have exaggerated symptoms at times, there is no dispute that the disability has caused significant problems with anxiety, depression and mood that impact his ability to focus, concentrate and interact with others. At best, the Veteran appears able to serve within his church community and go on small social outings with close friends. At worst, the Veteran appears becomes overwhelmed with anxiety and depression and then pulls back, feeling no pleasure in life's experiences (anhedonia) and social avoidance. He reported a prior suicide attempt at his November 2018 examination, and again noted suicidal ideation at his Board hearing that was ultimately recognized at the April 2023 examination as well. As noted above, the Veteran has reported going to a "dark place" when symptoms are at their worst, and has at least on one occasion been counseled for over-medicating. Thus, while there are clearly fluctuations in the Veteran's ability to function, the Board will resolve all doubt in the Veteran's favor and find that his PTSD manifests in a level of disability consistent with the 70 percent rating throughout the period under review.

That stated, the evidence weighs persuasively against a finding that a 100 percent rating is warranted, as the Veteran has at no time exhibited total occupational and social impairment due to his PTSD. While the Veteran's disability may prevent him from being able to secure and follow gainful occupation (as discussed in more detail below) the record shows that the Veteran has retained some occupational and social abilities, showing regular engagement with a church community, to include even in leadership roles as a deacon and a Sunday school teacher. He maintains some close friendships and is able to take care of his daily needs while living on his own. Although the Veteran reported at times hearing voices, there is no indication that he experiences frequent gross impairment in thought processes or communication or persistent delusions or hallucinations. In fact, given what the Veteran has reported during medical treatment, it is clear the Veteran appears for the most part well-grounded and oriented, noting when things are going well and when things are not, and working cooperatively with VA physicians to effectuate plans for getting better. Although the Veteran described problems with maintaining hygiene at his Board hearing, the other evidence of record demonstrates the ability to maintain good grooming and hygiene at his medical appointments and assessments. The evidence does not show intermittent inability to perform activities of daily living, to include maintaining minimum personal hygiene.

As noted above, symptoms endorsed at the April 2023 VA examination included depressed mood; anxiety; chronic sleep impairment; disturbances of motivation and mood; difficulty in establishing and maintaining effective work
In fact, given what the Veteran has reported during medical treatment, it is clear the Veteran appears for the most part well-grounded and oriented, noting when things are going well and when things are not, and working cooperatively with VA physicians to effectuate plans for getting better. Although the Veteran described problems with maintaining hygiene at his Board hearing, the other evidence of record demonstrates the ability to maintain good grooming and hygiene at his medical appointments and assessments. The evidence does not show intermittent inability to perform activities of daily living, to include maintaining minimum personal hygiene.

As noted above, symptoms endorsed at the April 2023 VA examination included depressed mood; anxiety; chronic sleep impairment; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances, including work or a work-like setting; inability to establish and maintain effective relationships; suicidal ideation; and obsessional rituals which interfere with routine activities. Considering the Veteran's abilities both socially and occupationally, these symptoms are consistent with a 70 percent rating for this Veteran.

Accordingly, entitlement to an initial 70 percent rating, but no higher, is granted for service-connected PTSD.

2. Entitlement to a TDIU

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. See 38 C.F.R. § 4.16. In determining whether unemployability exists, consideration may be given to the Veteran's level of education, special training and previous work experience, but not to his or her age or to any impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19.

A total disability rating 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. If there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more and the combined rating must be 70 percent or more. See 38 C.F.R. § 4.16(a). For consideration under these provisions, disabilities resulting from common etiology or a single accident will be evaluated as one disability. Id.

The ultimate question of whether a Veteran is capable of substantial gainful employment is not a medical one; that determination is for the adjudicator. Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013); Floore v. Shinseki, 26 Vet. App. 376, 381 (2013). As such, the focus of the examiner is not on whether the Veteran is unemployable due to his or her service-connected disabilities, but the functional impairment caused solely by his or her service-connected disabilities.

The issue of TDIU was raised during the pendency of increased initial rating claim for PTSD, therefore, the Board considers the issue of TDIU to stem from the date of that claim as well. See Rice v. Shinseki, 22 Vet. App. 447 (2009) (noting that a TDIU claim is implicit to a claim of increased rating when raised by the record during the pendency of the increased rating claim). As of November 2015, when the Veteran filed his claim for service connection for PTSD, the Veteran was service connected for PTSD, now evaluated at 70 percent. Therefore, the Veteran meets the schedular criteria for consideration of a TDIU for the entire period on appeal.

The Board next looks to whether the Veteran has been unable to secure or follow a substantially gainful occupation due to service-connected disabilities.

The phrase "unable to secure and follow a substantially gainful occupation" contains both economic and noneconomic components. The economic component requires a determination as to whether a Veteran's income exceeds the poverty threshold. The noneconomic component requires a determination as to a Veteran's ability to secure and follow such employment. With regard to the latter component, attention should be given to the Veteran's history, education, skill, and training. Consideration should also be given to both the Veteran's physical and mental abilities. From a physical standpoint, possible relevant factors include the Veteran's limitations as to lifting, bending, sitting, standing, walking, climbing, grasping, typing, and reaching, as well as audio and visual limitations. Regarding the Veteran's mental ability, possible relevant factors include limitations as to memory, concentration, ability to adapt to change, handle workplace
component requires a determination as to whether a Veteran's income exceeds the poverty threshold. The noneconomic component requires a determination as to a Veteran's ability to secure and follow such employment. With regard to the latter component, attention should be given to the Veteran's history, education, skill, and training. Consideration should also be given to both the Veteran's physical and mental abilities. From a physical standpoint, possible relevant factors include the Veteran's limitations as to lifting, bending, sitting, standing, walking, climbing, grasping, typing, and reaching, as well as audio and visual limitations. Regarding the Veteran's mental ability, possible relevant factors include limitations as to memory, concentration, ability to adapt to change, handle workplace stress, get along with coworkers, and demonstrate reliability and productivity. See Ray v. Wilkie, 31 Vet. App. 58 (2019). In determining whether unemployability exists, consideration should not be given to the Veteran's age or to any impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19.

The Board notes the AOJ sent the Veteran notice with VA Form 21-8940 in August 2022. However, to this date, the Veteran has not submitted a VA Form 21-8940. Nevertheless, failure to complete this form is not fatal to the claim; the claims file contains enough information about his employment, education, and training history to decide the claim. The evidence of record notes the Veteran left school in the tenth grade, and later earned his General Educational Development (GED) while in prison. See, e.g., April 2023 VA PTSD examination. Additionally, the Veteran has been unemployed during the period on appeal. See August 2015 VA treatment record (noting that "due to health issues [the Veteran] is not actively seeking employment at this time"); August 2018 VA treatment record (noting "Veteran is not seeking employment or additional education at this time"); November 2018 VA PTSD examination (noting "the last time he had a job outside [prison] was in 2003 painting houses"); August 2020 VA treatment record (noting "Veteran is currently unemployed"); January 2021 VA treatment record (noting "employment status: retired"); April 2023 VA PTSD examination ("The Veteran reported he is not currently working").

At issue, then, is whether the Veteran's service-connected PTSD have precluded him from securing or maintaining substantially gainful employment throughout the period on appeal.

Here, the evidence supports a finding that the Veteran's PTSD precluded him from securing or maintaining substantially gainful employment. The Veteran's ability to secure and follow a substantially gainful occupation is impacted by the mental effects of his PTSD. The April 2023 VA examination, as discussed above, shows that his disability resulted in difficulty in establishing and maintaining effective work and social relationships, as well as difficulty in adapting to stressful circumstances, including work or a worklike setting. The examination demonstrates that his service-connected psychiatric disorder is manifested by symptoms including disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances, including work or a work-like setting; inability to establish and maintain effective relationships; suicidal ideation; and obsessional rituals which interfere with routine activities. Such evidence supports a finding that the symptoms of the Veteran's service-connected psychiatric disorder results in functional limitations, including limited ability to interact with others or otherwise function in a normal work environment.

Notably, the August 2016 examiner similarly noted that the Veteran's ability to respond appropriately to coworkers, supervisors, or the general public was moderately impaired and his ability to respond appropriately to changes in the work setting was considered severely impaired.

While the Veteran does demonstrate the ability to perform occupational tasks in performance of his duties as a deacon or as a Sunday school teacher, there is evidence that his PTSD at times limits concentration and focus such that he has increased impairment in performing these duties. More, there is no indication that such activity equates to gainful employment.

Considering the totality of the Veteran's service-connected symptoms, the Board is persuaded that the requirements for an award of a TDIU for the entire period on appeal, effective November 12, 2015. The evidence, at a minimum, gives rise to a reasonable doubt on the matter. 38 C.F.R. § 4.3. As such, the appeal is granted.

V. Chiappetta

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board R. Kettler, Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not

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