POSTTRAUMATIC STRESS DISORDER (PTSD)

S. SCHICK · 2025 · Case ID: A25109059

MIXED

Summary

The veteran, who served from June 1976 to May 1979, appeals the denial of an increased rating for persistent dysthymic disorder and the denial of a compensable rating for non-painful abdomen scars. The veteran also appeals the denial of an increased rating for painful abdomen scars. The Board granted entitlement to a 70 percent rating for persistent dysthymic disorder for the entire period on appeal, finding that the veteran's symptoms more closely approximated the criteria for this rating, including significant occupational and social impairment, suicidal ideation, and neglect of personal hygiene, though not total occupational and social impairment. The Board denied a compensable rating for non-painful abdomen scars, finding the veteran did not meet the criteria for area of scarring or underlying soft tissue damage. Similarly, the claim for an increased rating for painful abdomen scars was denied, as the veteran has two painful scars, which is contemplated by her current 10 percent rating, and does not meet the criteria for three or more painful or unstable scars. The Board granted entitlement to a total disability rating based on individual unemployability (TDIU) for the entire period on appeal, noting the veteran's threshold rating requirements were met and her service-connected disabilities rendered her unable to secure or follow substantially gainful employment, resolving all doubt in her favor.

Rationale

Symptoms more closely approximate 70% criteria; Occupational and social impairment noted; Suicidal ideation and neglect of hygiene present

Special Benefit

TDIU

Diagnostic Code

9433

Docket No.

250219-523522

Full Decision Text

Citation Nr: A25109059
Decision Date: 12/17/25 Archive Date: 12/17/25

DOCKET NO. 250219-523522
DATE: December 17, 2025

ORDER

For the entire period on appeal, entitlement to an increased rating of 70 percent, but no higher, for persistent dysthymic disorder is granted.

Entitlement to a compensable rating for non-painful abdomen scars is denied.

Entitlement to a in excess of 10 percent for service-connected painful abdomen scars is denied.

For the entire period on appeal, entitlement to a total disability rating based on individual unemployability (TDIU) is granted.

FINDINGS OF FACT

1. For the entire period on appeal, the Veteran's psychiatric disability has been manifested by occupational and social impairment, with deficiencies in most areas.

2. For the entire period on appeal, the Veteran's abdomen scars were not manifested by a scar with an area or areas of at least 6 square inches (39 sq. cm.) but less than 12 square inches (77 sq. cm.) associated with underlying soft tissue damage or a scar with an area or areas of 144 square inches (929 sq. cm.) or greater that is not associated with underlying soft tissue damage.

3. For the entire period on appeal, the Veteran's abdomen scars were manifested by one or two scars that are unstable or painful; three or four scars that are unstable or painful nor five or more scars that are unstable or painful were not shown.

4. For the entire period on appeal, the Veteran's service-connected disabilities have rendered her unable to secure or follow substantially gainful employment.

CONCLUSIONS OF LAW

1. For the entire period on appeal, the criteria for entitlement to a rating of 70 percent, but no higher, for persistent dysthymic disorder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9433.

2. The criteria for a compensable rating for non-painful abdomen scars have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.118, Diagnostic Code (DC) 7805.

3. The criteria for a rating in excess of 10 percent for painful abdomen scars have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.118, Diagnostic Code (DC) 7804.

4. For the entire period on appeal, the criteria for entitlement to a TDIU have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.3, 4.15, 4.16, 4.18, 4.19.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from June 1976 to May 1979.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from February 2024 Higher-Level Review (HLR)and October 2024 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO); therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In the February 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

The Board notes the Veteran has the right to select a different Board review option by submitting a new VA Form 10182 within one year from the date the AOJ mailed the decision on appeal, or within 60 days of the date the Board received the VA Form 10182, whichever date is later. 38 C.F.R. § 20.202(c)(2); See Williams v. McDonough, 37 Vet. App. 305 (2024). In a February 2025 correspondence, the Veteran effectively waived her right to select a different Board review option.

Therefore, the Board may only consider the evidence of record at the time of the September 2023 agency of original jurisdiction (AOJ) decision, which was subsequently subject to HLR and the October 2024 rating decision. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ
or within 60 days of the date the Board received the VA Form 10182, whichever date is later. 38 C.F.R. § 20.202(c)(2); See Williams v. McDonough, 37 Vet. App. 305 (2024). In a February 2025 correspondence, the Veteran effectively waived her right to select a different Board review option.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

In June 2025, the Veteran's representative withdrew, and the Veteran has not appointed a new representative and thus is proceeding pro se.

Increased Ratings

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 percentage ratings are based on the average impairment of earning capacity as a result of a service-connected disability, and separate diagnostic codes identify the various disabilities and the criteria for specific ratings. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

Where the question for consideration is the propriety of the initial evaluation assigned, consideration of the medical evidence since the effective date of the award of service connection is required. See Fenderson v. West, 12 Vet. App. 199, 125-26 (1999). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994).

VA has a duty to consider all regulations that are potentially applicable through the assertions and issues raised in the record. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). 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 Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings." Hart v. Mansfield, 21 Vet. App. 505 (2007).

When adjudicating a claim for an increased initial evaluation, the relevant time period is from the date of the claim. Moore v. Nicholson, 21 Vet. App. 211, 215 (2007), rev'd in irrelevant part, Moore v. Shinseki, 555 F.3d 1369 (2009). When adjudicating an increased rating claim, the relevant time period for consideration is the time period one year before the claim was filed. Hart, 21 Vet. App. at 509.

A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him or her through the senses. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007).

The Veteran's entire history is reviewed when making a disability determination. The evaluation of the same disability under various diagnoses, known as pyramiding, is generally to be avoided. 38 C.F.R. § 4.14. The critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the disabilities is duplicative or overlapping with the symptomatology of the other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994).

VA is responsible for determining
where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007).

VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a claimant prevailing in either event. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. The claimant is entitled to the benefit of the doubt when there is an "approximate" (meaning nearly equal) balance of positive and negative evidence regarding any material determination. Lynch v. McDonough, 999 F.3d 1391 (2021); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001).

1. For the entire period on appeal, entitlement to a rating of 70 percent, but no higher, for persistent dysthymic disorder is granted.

When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission. 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. When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment but shall not assign an evaluation solely based on social impairment. 38 C.F.R. § 4.126.

Although the Veteran's symptomatology is the primary consideration, the Veteran's level of impairment must be in "most areas" applicable to the relevant percentage rating criteria. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-19 (Fed. Cir. 2013).

The Veteran's persistent dysthymic disorder has been evaluated under 38 C.F.R. § 4.130, Diagnostic Code 9433; however, the actual criteria for rating the Veteran's disability are set forth in a General Rating Formula for evaluation psychiatric disabilities other than eating disorders. See 38 C.F.R. § 4.130.

In April 2019, the Veteran submitted an increased rating claim for her service-connected persistent dysthymic disorder. See April 2019 VA Form 21-526EZ. In an October 2024 rating decision, the AOJ denied the Veteran's claim for an increased rating for her service-connected persistent dysthymic disorder. The Veteran appealed this decision.

The Veteran is currently in receipt of a 50 percent rating for her persistent dysthymic disorder under DC 9433. The Veteran generally contends that her disability is more severe than her assigned disability rating would indicate. For the following reasons, the Board finds that a rating of 70 percent, but no higher, for the Veteran's persistent dysthymic disorder for the entire period on appeal is warranted.

A 50 percent rating is assigned when there is 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.

A 70 percent rating is assigned 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 worklike setting); inability to establish and maintain effective relationships.

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
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 worklike setting); inability to establish and maintain effective relationships.

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; and memory loss for names of close relatives, or for the Veteran's own occupation or name.

When determining the appropriate disability evaluation to assign, the Board's primary consideration is a veteran's symptoms, but it must also make findings as to how those symptoms impact occupational and social impairment. Vasquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013); Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). Because the use of the term "such as" in the rating criteria demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, the Board need not find the presence of all, most, or even some, of the enumerated symptoms to award a specific rating. Mauerhan, 16 Vet. App. at 442; Sellers v. Principi, 372 F.3d 1318, 1326-27 (Fed. Cir. 2004). Nevertheless, as all ratings in the general rating formula are also associated with objectively observable symptomatology and the plain language of the regulation makes it clear the veteran's impairment must be "due to" those symptoms, a veteran may only qualify for a given disability by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vasquez-Claudio, 713 F.3d at 118.

The Veteran was afforded a VA Mental Disorders Examination in April 2019. The examiner noted a diagnosis of persistent depressive disorder. The Veteran was reported to have occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. The Veteran was reported to experience depressed mood and chronic sleep impairment.

Regarding the Veteran's social functioning, the Veteran is twice divorced with her most recent marriage ending after 27 years. She has one child.

Regarding the Veteran's occupational functioning, the Veteran reported that following service she obtained a job in a manufacturing plant. She attended cosmetology school and worked for about a year until she began having problems with her back. The Veteran has not worked since 2003.

The examiner noted that the Veteran was dressed appropriately with good hygiene; was fully oriented and alert; affect was full range and congruent; and there was no indication of psychosis. The examiner further noted that the Veteran's moos was mildly depressed.

In a private medical opinion dated January 2024, the clinician noted that the Veteran experiences poor sleep habits which degrade her ability to maintain focus, patience, and mental acuity; memory loss, which impacts her ability to retain information and lean new material; hypervigilance and avoidance of people and crowds; inability to form or sustain effective relationships with others; and inability to get along well with others in the workplace.

The clinician noted that in an April 2021, medical note, the Veteran reported experiencing symptoms of depression and anxiety; isolating from others; feeling anxious when having to drive long distances; loss of interest in things she used to enjoy' trouble getting out of bed; becoming overwhelmed easily; and severe difficulty sleeping.

The clinician further noted that in a May 2023, Mental Disorders Disability Benefits Questionnaire (DBQ), the Veteran was reported to have occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. The Veteran was reported to experience depressed mood, anxiety, chronic sleep impairment, and disturbances of motivation and mood.

In a January 2024, Mental Disorders DBQ, the clinician noted occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. The Veteran was reported to experience depressed mood; anxiety; chronic sleep impairment; flattened affect; disturbances of
clinician further noted that in a May 2023, Mental Disorders Disability Benefits Questionnaire (DBQ), the Veteran was reported to have occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. The Veteran was reported to experience depressed mood, anxiety, chronic sleep impairment, and disturbances of motivation and mood.

In a January 2024, Mental Disorders DBQ, the clinician noted occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. The Veteran was reported to experience depressed mood; anxiety; 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; suicidal ideation; persistent danger of hurting self or others; neglect of personal appearance and hygiene; intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene.

Regarding social functioning, the Veteran was married twice with one son. The clinician noted that the Veteran's chronic, persistent depressive symptoms have negatively impacted her interpersonal relationships. The Veteran indicated that she has two friends with whom she feels close.

Regarding occupational functioning, the Veteran reported that she has not worked since 2004 due to her conditions. She has a cosmetology degree. The Veteran reported that she worked for Super Cuts as a cosmetologist from 2003 to 2004 but left due to back pain and emotion dysregulation.

The examiner noted that the Veteran was appropriately dressed, groomed and was cooperative. Her speech was normal; thought process was logical and linear; attention, concentration, and memory were adequate; and insight and judgment were adequate. The examiner further noted that the Veteran appeared dysthymic with a restricted range of affect.

Based on the foregoing, the Board finds the veteran's symptoms more nearly approximate the criteria for a 70 percent rating, but no higher, for the entire period on appeal. The evidence of record demonstrates that the Veteran's persistent dysthymic disorder was manifested by symptoms that more closely approximate occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. In this regard, the Veteran was noted to experience difficulty in establishing and maintaining effective work and social relationships, suicidal ideation, persistent danger of hurting self or others, neglect of personal appearance and hygiene, difficulty adapting to stressful circumstances, and intermittent inability to perform activities of daily living. See January 2024, DBQ. However, the record does not support that the Veteran's symptoms have been manifested by total occupational and social impairment. Notably, while the Veteran's depressive symptoms have negatively impacted her interpersonal relationships, she has reported that she has been able to maintain friendships with two friends whom she feels close with. Therefore, the Board finds that for the entire period on appeal, a 70 percent rating, but no higher is warranted.

2. Entitlement to a compensable rating for non-painful abdomen scars is denied.

The Veteran contents that she is entitled to a compensable rating for her service-connected non-painful abdomen scars. See February 2025 VA Form 10182. While the Veteran in her VA Form 10182 listed effective date as an issue, the February 2024 rating decision she appealed only addressed increase rating. As such, the analysis has been limited accordingly.

The Veteran is currently in receipt of a noncompensable rating for her service connected non painful abdomen scars. The Veteran contends that her disability is more severe than her current rating assigned.

Scars in general are evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.118, DCs 7800-7805. The Board notes that the rating criteria for scars were amended on August 30, 2002, October 23, 2008, and August 13, 2018. As the Veteran's increased rating claim was submitted in March 2023, the Board will apply the current version of the rating criteria.

DC 7800 deals with scars and disfigurement of the head, face, or neck. Therefore, discussion of the Veteran's right lower abdomen scar under DC 7800 is not necessary in this case.

DC 7801 evaluates burn scars or scars due to other causes, not of the head, face, or neck, that are associated with underlying soft tissue damage. Under these criteria, a scar with an area or areas of at least 6 square inches (39 sq. cm.) but less than 12 square inches (77 sq. cm.) warrants a 10 percent rating. A scar with an area or areas of at least 12 square inches (77 sq. cm.) but less than
current version of the rating criteria.

DC 7800 deals with scars and disfigurement of the head, face, or neck. Therefore, discussion of the Veteran's right lower abdomen scar under DC 7800 is not necessary in this case.

DC 7802 evaluates burn scars or scars due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage. Under these criteria, a scar with an area or areas of 144 square inches (929 sq. cm.) or greater warrants a 10 percent rating. 38 C.F.R. § 4.118. No higher ratings are available.

Under DC 7804, one or two scars that are unstable or painful scars warrants a 10 percent rating. Three or four scars that are unstable or painful scars warrants a 20 percent rating. Five or more scars that are unstable or painful warrants a 30 percent rating. 38 C.F.R. § 4.118. Note 1 to Diagnostic Code 7804 instructs that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note 2 instructs that if one or more scars are both unstable and painful, 10 percent is added to the evaluation based on the total number of unstable and painful scars. Id. The Board notes that the Veteran is in receipt of a separate 10 percent rating for painful scars under DC 7804.

DC 7805 provides that a scar may be rated on any disabling effect(s) not considered as part of DCs 7800 to 7804.

Turning to the evidence, the Veteran was afforded a VA Scars/Disfigurement examination in August 2023. The examiner noted a diagnosis of scars, low abdomen status post c-section. The Veteran was noted to have 2 painful scars on the trunk or extremities. Neither scar was noted to be unstable or due to burns. The examiner reported the Veteran's scars affected the anterior trunk.

Regarding scar one, it is located horizontally on the low abdomen and measures 19 cm by 0.2 cm, covering a total area of 3.8 sq. cm. Regarding scar tow, it is located vertically on the low abdomen and measures 8 cm by 0.5 cm, covering a total area of 4 sq. cm. Together both of the Veteran's scars cover 7.8 sq. cm. The scars were not unstable upon inspection nor was there underlying soft tissue damage. The scars were tender on palpation. The examiner noted that the scars did not result in limitation of function (to include limitation of motion) nor did they impact the Veteran's ability to work.

After review of the evidence discussed above, the Board finds that a compensable rating is not warranted for the Veteran's service-connected non-painful abdomen scars.

The Board acknowledges the Veteran's assertion that a compensable rating is warranted. However, as discussed, the Veteran has not shown the necessary criteria to warrant a compensable rating. In this regard, the evidence of record does not show that the Veteran's abdomen scars cover an area or areas of 144 square inches or greater. As such, the criteria for a compensable rating of 10 percent under DC 7802 are not met or more nearly approximated. Further, the evidence of record does not show that the Veteran's scar covers at least 6 square inches and is associated with underlying soft tissue damage. As such, the criteria for a compensable rating under DC 7801 is not met or more nearly approximated.

The Board has considered all evidence of record and finds that the Veteran is not entitled to a compensable rating for her service-connected non-painful abdomen scars and the claim is denied. As such, the benefit-of-the-doubt doctrine is inapplicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; see Lynch v. McDonough, 21 F.4th 776 (2021).

3. Entitlement to a rating in excess of 10 percent for painful abdomen scars is denied.

The Veteran contends entitlement to an initial rating in excess of 10 percent for her service-connected
DC 7801 is not met or more nearly approximated.

3. Entitlement to a rating in excess of 10 percent for painful abdomen scars is denied.

The Veteran contends entitlement to an initial rating in excess of 10 percent for her service-connected painful abdomen scars. See February 2025 VA Form 10182. While the Veteran in her VA Form 10182 listed effective date as an issue, the February 2024 rating decision she appealed only addressed increase rating. As such, the analysis has been limited accordingly.

Here, the Veteran is in receipt of a 10 percent rating under 38 C.F.R. 4.118, Diagnostic Code 7804. The Board notes that all other potential applicable diagnostic codes for scars have been previously discussed above. As such, the Board will only address DC 7804.

After review of the evidence discussed above, the Board finds that an initial rating in excess of 10 percent for the Veteran's painful abdomen scars is not warranted. In this regard, the evidence of record shows that the Veteran has two painful scars on her abdomen which is contemplated by her current 10 percent rating. Further, the evidence does not show that the Veteran has three or four painful or unstable scars (contemplated by a 20 percent rating) nor does the Veteran have five or more painful or unstable scars (contemplated by a 30 percent rating).

The Board has considered all evidence of record and finds that the Veteran is not entitled to an initial rating in excess of 10 percent for her service-connected painful abdomen scars and the claim is denied. As such, the benefit-of-the-doubt doctrine is inapplicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; see Lynch v. McDonough, 21 F.4th 776 (2021).

4. For the entire period on appeal, entitlement to a total disability rating based on individual unemployability (TDIU) is granted.

The Veteran filed a March 2019 claim for a TDIU. See March 2019 VA Form 21-8940. She contends that her service-connected disabilities prevent her from securing or following any substantially gainful occupation. Id.

Total disability will be considered to exist where there is present any impairment of mind and body that is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. Total disability ratings for compensation may be assigned, where the rating is less than total, when the disabled person is unable to
. For the entire period on appeal, entitlement to a total disability rating based on individual unemployability (TDIU) is granted.

Total disability will be considered to exist where there is present any impairment of mind and body that is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. Total disability ratings for compensation may be assigned, where the rating is less than total, when the disabled person is unable to secure or follow a substantially gainful occupation because of service-connected disabilities, provided that the Veteran meets the rating requirements.

Specifically, 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 that is ratable at 40 percent or more and enough additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a).

"Substantially gainful employment" is that employment "which is ordinarily followed by the non-disabled to earn their livelihood with earnings common to the particular occupation in the community where the veteran resides." Moore v. Derwinski, 1 Vet. App. 356, 358 (1991). "Marginal employment shall not be considered substantially gainful employment." 38 C.F.R. § 4.16(a).

In determining whether a veteran can secure and follow a substantially gainful occupation, the Court of Appeals for Veterans Claims (Court) in Ray v. Wilkie directed the Board to consider the following factors: (1) the veteran's history, education, skill, and training; (2) whether the veteran has the physical ability (both exertional and non-exertional) to perform the type of activities required by the occupation at issue; and (3) whether the veteran has the mental ability to perform the activities required by the occupation at issue. 31 Vet. App. 58, 73 (2019).

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 age or to any impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. The Veteran filed a claim for TDIU on March 28, 2019. The Board will consider evidence within the one-year period preceding the date of receipt of this claim. See 38 U.S.C. § 5110(b)(2); 38 C.F.R. § 3.400(o); Dalton, 21 Vet. App. at 31-32.

The ultimate question of whether a veteran is capable of substantial gainful employment is not a medical one; rather, that determination is for the adjudicator. See 38 C.F.R. § 4.16 (a); see also Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013). The medical evidence addressing the functional effects of a veteran's disability on his ability to perform the mental and/or physical acts required for substantially gainful employment is relevant to the unemployability determination. See 38 C.F.R. § 4.10; Floore v. Shinseki, 26 Vet. App. 376, 381 (2013).

When adjudicating entitlement to TDIU, VA is expected to give full consideration to the effect of combinations of disability. Geib v. Shinseki, 733 F.3d 1350, 1353-544 (Fed. Cir. 2013) (quoting 38 C.F.R. § 4.15).

The AOJ favorably found that the Veteran is not working. See October 2024 rating decisions.

Further, the Veteran has met the threshold rating requirement for entitlement to a TDIU for the entire period on appeal. See 38 C.F.R. § 4.16(a). In this regard, in light of the above, the Veteran is in receipt of service connection for persistent dysthymic disorder with a rating of 70 percent since May 2017; total abdominal hysterectomy with a rating of 50 percent, since May 1979; painful abdomen scars with a rating of 10 percent since March 2023; female sexual arousal disorder (FSAD) with associated total abdominal hysterectomy, rated noncompensable from March 2019;
Veteran is not working. See October 2024 rating decisions.

Further, the Veteran has met the threshold rating requirement for entitlement to a TDIU for the entire period on appeal. See 38 C.F.R. § 4.16(a). In this regard, in light of the above, the Veteran is in receipt of service connection for persistent dysthymic disorder with a rating of 70 percent since May 2017; total abdominal hysterectomy with a rating of 50 percent, since May 1979; painful abdomen scars with a rating of 10 percent since March 2023; female sexual arousal disorder (FSAD) with associated total abdominal hysterectomy, rated noncompensable from March 2019; and non-painful abdomen scars, rated noncompensable from March 2019

Thus, the issue before the Board is whether the Veteran has been unable to secure or follow a substantially gainful occupation because of her service-connected disabilities.

Regarding the Veteran's educational history, the Veteran reported she has one year of college education.

The Veteran's employment history included work in general merchandise and as a cosmetologist. The Veteran reported she has not worked since 2004 due to her service-connected persistent dysthymic disorder. See May 2024 VA Form 21-8940.

In an April 2019 Disability Benefit Questionnaire (DBQ), the clinician summarized the Veteran's occupational and social impairment as occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. The Veteran's symptoms were reported as depressed mood and chronic sleep impairment. The Veteran was noted to be dressed appropriately with good hygiene; fully oriented and alert; mildly depressed mood; affect was full range and congruent; no indication of psychosis; no thoughts of self-harm or harming others; and no unusual behavioral gestures. The clinician asserted that the Veteran is able to: communicate, remember, and follow instructions; use judgment, show insight, and think abstractly; concentrate, interact with coworkers and/or customers; adapt to changes or stress, demands at work; and work in public or in an enclosed space/cubicle.

In an April 21, 2021, medical note, the Veteran reported symptoms of depression; anxiety; isolating from others; feeling anxious when having to drive long distances; loss of interest in things she use to enjoy; trouble getting out of bed (including severe episodes of not bathing for days at a time); becoming overwhelmed easily; severe difficulty sleeping; and loss of motivation to do things she use to enjoy.

The Veteran was afforded a VA Mental Disorders examination in May 2023. The examiner summarized the Veteran's occupation and social impairments as occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. The Veteran's symptoms were reported as: depressed mood; anxiety; chronic sleep impairment; and disturbances of motivation and mood. The examiner noted that the Veteran reported that she attended cosmetology school and worked for one year but then she began having problems with her back and stopped working.

An August 2023 VA scars examination report indicated the Veteran's low abdomen scars caused painful irritation with difficulty bending and reaching.

In a January 2024 private medical opinion, the Veteran reported she has not worked since 2004 and that since she stopped working she has struggled with severe anxiety, depressed mood, lack of motivation, difficulty sleeping, fatigue, difficulty interacting with others, problems concentrating and difficulty handling stressful situations. The clinician reported that the Veteran's issues are inconsistent with an ability to sustain even sedentary employment, which at the very least requires a person to be able to attend work reliably, sustain a steady pace and concentration, and work productively. The clinician further opined that in his medical opinion, the Veteran has been unable to maintain substantially gainful employment as a result of her service-connected disabilities.

In a January 2024 DBQ, the clinician summarized the Veteran's occupational and social impairment as occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. The Veteran's symptoms were reported as: depressed mood; anxiety; 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; suicidal ideation; persistent danger of hurting self or others; neglect of personal appearance and hygiene; and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. The clinician noted the Veteran has not worked since 2004 due to her conditions. In the clinician's Residual Functional Capacity Evaluation report, it was
occupational and social impairment as occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. The Veteran's symptoms were reported as: depressed mood; anxiety; 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; suicidal ideation; persistent danger of hurting self or others; neglect of personal appearance and hygiene; and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. The clinician noted the Veteran has not worked since 2004 due to her conditions. In the clinician's Residual Functional Capacity Evaluation report, it was noted that the Veteran would frequently decompensate when subjected to the normal pressures and constructive criticisms of a job.

The Board has considered the Veteran's functional capacity and work experience in determining that no type of employment would appear to be appropriate for the Veteran. See 38 C.F.R. §§ 3.341 (a), 4.16, 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). The Board also notes that the Veteran appears able to perform certain aspects of daily living. However, the law recognizes that a person may be too disabled to engage in employment although he or she is fairly comfortable at home or upon limited activity. See 38 C.F.R. § 4.10. In addition, a Veteran does not have to prove that she is 100 percent unemployable in order to establish an inability to maintain a substantially gainful occupation, as required for a TDIU award. See 38 C.F.R. § 3.340 (a); Roberson v. Principi, 251 F.3d 1378, 1385 (Fed. Cir. 2001).

Given the overall disability picture, the Veteran's history of employment and resolving all doubt in the Veteran's favor, the Board finds that the Veteran's service-connected disabilities have rendered her unable to secure and follow a substantially gainful occupation by reason for the entire period on appeal. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F. 4th 776, 781-82 (2021).

S. Schick

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board K. Fuller, 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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