Back to BVA DecisionsGRANTEDSpecial Benefit TDIU Docket No. 251030-606798
DEPRESSIVE DISORDER, SINGLE EPISODE, SEVERE, OR RECURRENT, SEVERE
J.M. ESTES · 2026 · Case ID: A26015651
Summary
The Veteran, who served from March 1969 to December 1970, appeals the denial of an increased disability rating for major depressive disorder and entitlement to Total Disability based on Individual Unemployability (TDIU). The Board reviewed the evidence of record as of October 2025, noting the Veteran elected Direct Review under the Appeals Modernization Act. The Veteran has a history of service-connected lumbar spine and bilateral knee disabilities, radiculopathy, bilateral pes planus, and tinnitus, which contribute to his current major depressive disorder. The Board considered medical opinions from VA and a private psychologist, Dr. D.W. The VA examination noted symptoms causing occupational and social impairment, but found them mild or transient. Dr. D.W. diagnosed PTSD and major depressive disorder, attributing them to chronic pain and noting significant deficits in memory, concentration, and emotional functioning, concluding these symptoms precluded substantially gainful employment. However, the Board found the Veteran's testimony and reports contained inconsistencies and did not fully support the severity required for a 70% rating or TDIU based solely on psychiatric symptoms. The Board found the combined impact of his physical and psychiatric disabilities, rather than psychiatric symptoms alone, limited his ability to work. Ultimately, the Board granted an increased rating of 50% for major depressive disorder, finding the symptoms more closely approximated that level of impairment. The Board also granted entitlement to TDIU, effective June 24, 2021, concluding that the combined effects of his service-connected disabilities prevented him from securing or following substantially gainful employment.
Rationale
Severity, frequency, and duration of symptoms approximate 50% rating criteria; Occupational and social impairment with reduced reliability and productivity; Benefit of the doubt afforded for overlapping symptoms
Full Decision Text
Citation Nr: A26015651 Decision Date: 02/20/26 Archive Date: 02/20/26 DOCKET NO. 251030-606798 DATE: February 20, 2026 ORDER Entitlement to an increased initial evaluation of 50 percent, but no higher, for major depressive disorder is granted. Entitlement to a total disability rating based upon individual unemployability (TDIU) due to service-connected disabilities is granted. FINDINGS OF FACT 1. Throughout the review period, the severity and manifestations of the Veteran's major depressive disorder more closely approximate occupational and social impairment with reduced reliability and productivity; occupational and social impairment with deficiencies in most areas has not been shown. 2. The Veteran remained unemployed throughout the review period, and his service-connected disabilities prevented him from securing or following a substantially gainful occupation. CONCLUSIONS OF LAW 1. The criteria for an initial 50 percent disability rating for major depressive disorder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.125, 4.126, 4.130, Diagnostic Code 9434. 2. The criteria for entitlement to TDIU have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1969 to December 1970, with additional service in the National Guard. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2025 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In the October 2025 VA Form 10182 Decision Review Request: Board Appeal, under the Appeals Modernization and Improvement Act (AMA), the Veteran elected Direct Review. Therefore, the Board may only consider the evidence of record at the time of the October 2025 rating decision. 38 C.F.R. § 20.301. If evidence was associated with the claims file during a period when additional evidence was not allowed, the Board has not considered it in this decision. 38 C.F.R. § 20.300. If the Veteran would like VA to consider any evidence that was added to the claims file 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, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a supplemental claim are included with this decision. The Board finds that entitlement to a TDIU was raised by the record; the Veteran reported a history of problems and difficulty getting along with his coworkers and supervisors, and his evaluating psychiatrist and psychologists opined that the severity of his chronic depression symptoms, primarily due to the chronic pain from his service-connected disabilities, caused major impairment at work and an inability to seek and maintain gainful employment. See Rice v. Shinseki, 22 Vet. App. 447 (2009); September 2016 Dr. H.J. Psychiatric Assessment; June 2025 Dr. D.W. Psychiatric Evaluation. The Board appreciates that 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 agency of original jurisdiction (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). Although the period to change dockets has not elapsed, the Veteran, through his authorized representative, explicitly waived his right to select a different Board review option and requested that a decision be issued as soon as possible. See October 2025 VA Form 10182. Therefore, there is no prejudice to the Veteran in proceeding to adjudicate the appeal. This appeal has been advanced on the docket pursuant to 38 U.S.C. § 7107(b); 38 C.F.R. § 20.902(c). 1. Entitlement to an initial evaluation greater than 30 percent for major depressive disorder. The Veteran contends that his current evaluation does not adequately represent 37 Vet. App. 305 (2024). Although the period to change dockets has not elapsed, the Veteran, through his authorized representative, explicitly waived his right to select a different Board review option and requested that a decision be issued as soon as possible. See October 2025 VA Form 10182. Therefore, there is no prejudice to the Veteran in proceeding to adjudicate the appeal. This appeal has been advanced on the docket pursuant to 38 U.S.C. § 7107(b); 38 C.F.R. § 20.902(c). 1. Entitlement to an initial evaluation greater than 30 percent for major depressive disorder. The Veteran contends that his current evaluation does not adequately represent the severity of the symptoms of his major depressive disorder. See October 2025 VA Form 10182. He specifically contends that, since prior to his initial June 2021 claim, he has suffered from the same symptoms at the same level of severity as indicated by Dr. D.W. during his June 2025 private psychological evaluation. See October 2025 VA Form 21-4138; October 2025 VA Form 10182. The Veteran was granted service connection and an initial 30 percent evaluation for major depressive disorder secondary to his service-connected lumbar spine and bilateral knee disabilities in the October 2025 rating decision on appeal. Therefore, the review period begins on June 24, 2021, the date of service connection for his acquired psychiatric disorder disability. Disability ratings are determined by applying the criteria set forth in 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. With the initial rating assigned upon a grant of service connection, separate (staged) ratings may be assigned for separate periods of time, based on the facts found. See Fenderson v. West, 12 Vet. App. 119, 126 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. The Veteran's entire history is to be considered when making disability evaluations. 38 C.F.R. § 4.1; see also Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. The Veteran's major depressive disorder is currently assigned an initial 30 percent rating from June 24, 2021, under the General Rating Formula for Mental Disorders (Formula) pursuant to 38 C.F.R. § 4.130, Diagnostic Code 9434. Under this Formula, a 30 percent rating under is warranted where there is occupational and social impairment with 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), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss (such as forgetting names, directions, recent events). Id. A 50 percent rating is warranted where 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. Id. A 70 percent rating is warranted when there is occupational and social impairment with deficiencies in most areas, such as work, school, family relationships, 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 ability to function independently, appropriately and effectively; impaired yped 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. Id. A 70 percent rating is warranted when there is occupational and social impairment with deficiencies in most areas, such as work, school, family relationships, 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 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); and inability to establish and maintain effective relationships. Id. A 100 percent rating is warranted for total occupational and social impairment, due to such symptoms as gross impairment in thought processes or communication; persistent delusions; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent ability 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, own occupation, or own name. Id. The symptoms listed are not exhaustive but rather serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). A Veteran may only qualify for a given disability rating under § 4.130 by demonstrating symptoms associated with that percentage, or others of similar severity, frequency, and duration. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013). While symptomatology should be the primary focus when deciding entitlement to a given disability rating, § 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused the requisite occupational and social impairment. Id. In addition to frequency, severity and duration of symptoms, the Board must also consider the length of remissions and the Veteran's capacity for adjustment during periods of remission and then 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. 38 C.F.R. § 4.126. After careful consideration, the Board finds that the severity, frequency, and duration of the Veteran's acquired psychiatric disorder symptoms at the time of his initial evaluation and throughout the review period, more closely approximate those contemplated by a 50 percent rating. Initially, the Veteran has been noted to have multiple diagnoses causing overlapping impairment and symptoms, which have not been clearly differentiated between diagnosis. When it is not possible to separate the effects of a service-connected condition from a non-service-connected condition, reasonable doubt should be resolved in the claimant's favor with regard to the question of whether certain signs and symptoms can be attributed to the service-connected disability. See Mittleider v. West, 11 Vet. App. 181, 182 (1998) (per curiam). Thus, where there is doubt, the Veteran's impairment will be attributed to the service-connected depressive disorder. The Veteran's history of recurrent depression, anxiety, chronic sleep impairment, disturbed motivation and mood, numbness, detachment, tendency to "hide out and not associate", to include that he "always distanced himself" from his children and his "entire family", did not talk to his wife, or participate in any festivities, or in "any place with large groups of people", his periodic inability to move due to "intense pain", chronic back pain while sitting, walking, and sleeping, as well as his limping and dragging of his right foot, and his limited mobility, including the need for help tying his shoes were observed by his family members and noted in his VA treatment records. See August 2021 VA Mental Health Note; March 2023, May 2024, July 2024, and December 2024 VA Neurosurgery Notes; July 2024 VA Primary Care Note; July 2024 S.T. and T.S. Statements; July 2024 Board Hearing Transcript; October 2024 VA Emergency Department Note; January 2025 VA Primary Care Note; February 2025 VA Physical Therapy Note. During a January 2025 VA psychological evaluation, the Veteran was diagnosed with other specified trauma and stressor related disorder. See January 2025 VA PTSD Examination. While the VA psychologist indicated no other observed by his family members and noted in his VA treatment records. See August 2021 VA Mental Health Note; March 2023, May 2024, July 2024, and December 2024 VA Neurosurgery Notes; July 2024 VA Primary Care Note; July 2024 S.T. and T.S. Statements; July 2024 Board Hearing Transcript; October 2024 VA Emergency Department Note; January 2025 VA Primary Care Note; February 2025 VA Physical Therapy Note. During a January 2025 VA psychological evaluation, the Veteran was diagnosed with other specified trauma and stressor related disorder. See January 2025 VA PTSD Examination. While the VA psychologist indicated no other diagnoses, the Board notes that the Veteran had been previously diagnosed with PTSD and major depressive disorder by a VA psychologist, and a September 2021 rating decision included his prior diagnosis as a favorable finding. See November 2017 VA Mental Health Consult; September 2021 Rating Decision. During the January 2025 VA examination, the Veteran reported that his wife complains a "great deal", but his marriage was "generally going well", he had been unemployed since 2008, but when he worked, the work "went well", he stayed in touch with his children, was close to his brother, sister and uncle, was involved with his church, and enjoyed visiting family. See January 2025 VA PTSD Examination. The VA psychologist noted that the Veteran's symptoms included depression, anxiety, chronic sleep impairment, disturbed motivation and mood, and irritable behavior and angry outbursts with little, or no provocation, typically expressed as verbal or physical aggression toward people or objects, and concluded that his symptoms caused occupational and social impairment due to mild or transient symptoms which decreased his work efficiency and ability to perform occupational tasks only during periods of significant stress. Id. The examination report noted that the Veteran appeared appropriately dressed and well groomed, exhibited a normal range of affect, openly wept, had to leave once or twice, required the help of a cane to walk, and that his responses to questions regarding his symptoms were vague and ambiguous. Id. During a June 2025 private psychological assessment, Dr. D.W. diagnosed the Veteran with PTSD and major depressive disorder due to chronic back and knee pain, noting that his chronic back and knee pain were the primary contributor to his depression and that it was not possible to differentiate the symptoms of his two diagnosed psychiatric disorders due to symptom overlap. See June 2025 Dr. D.W. Disability Benefits Questionnaire, June 2025 Dr. D.W. Psychiatric Evaluation. The Veteran reported "significant" depression, crying spells due to limitations caused by his chronic back pain and knee issues; that he was "bad"; "his whole nervous system was permanently ruined"; he slept only four hours a night; he had a history of marital difficulties due to his mood liability, which he attributed to chronic pain and anxiety; that he "loses his temper easily", which caused problems in his marriage and at work when he was working; that he had trouble driving, as he gets very anxious and is prone to paranoia and road rage; and that although he has contact with his children, he had no friends, and had difficulty getting along with people at work when he last worked in 2008. Id. Dr. D.W. concluded that the Veteran's chronic pain led to dysphoria, lack of energy, lack of motivation, hopelessness and anhedonia, with persistent and exaggerated negative beliefs about himself, a persistent negative emotional state and inability to experience positive emotions, markedly diminished interest or participation in significant activities, feelings of detachment and estrangement, sleep disturbance, problems with concentration and memory, and irritable behavior with angry outbursts with little or no provocation typically expressed as verbal or physical aggression toward people or objects. Id. The symptoms identified by Dr. D.W. included near-continuous panic or depression that affected the Veteran's ability to function independently, appropriately and effectively, anxiety, suspiciousness, chronic sleep impairment, mild memory loss, such as forgetting names, directions or recent events, disturbed motivation and mood, difficulty establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, including work or a work like setting, neglect of his personal appearance and hygiene, and panic attacks. Id. Dr. D.W. observed that the Veteran presented with a casual appearance, normal speech and orientation, demonstrated a depressed, flattened affect, appeared credible, was "generally" able to follow the clinical interview, but showed "significant" deficits in memory, insight and judgment, and reported paranoid ideation. Id. Dr. D.W. noted the Veteran's history of employment and relational difficulties, his inability to tolerate the stress of being in the presence of coworkers or interact with forgetting names, directions or recent events, disturbed motivation and mood, difficulty establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, including work or a work like setting, neglect of his personal appearance and hygiene, and panic attacks. Id. Dr. D.W. observed that the Veteran presented with a casual appearance, normal speech and orientation, demonstrated a depressed, flattened affect, appeared credible, was "generally" able to follow the clinical interview, but showed "significant" deficits in memory, insight and judgment, and reported paranoid ideation. Id. Dr. D.W. noted the Veteran's history of employment and relational difficulties, his inability to tolerate the stress of being in the presence of coworkers or interact with them effectively, maintain regular attendance, or adapt to "even simple stressful circumstances", and opined that his symptoms caused occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking, and mood, due to his symptoms of "significant" deficits in memory, concentration, and emotional functioning, his history of impaired impulse control, paranoid ideation, and inability to control his anger. Id. Based upon the foregoing, the Board finds that the severity, frequency, and duration of the symptoms of the Veteran's acquired psychiatric disorder more closely approximate occupational and social impairment with reduced reliability and productivity. The Veteran's VA examinations, treatment records, and private psychiatric assessment demonstrate difficulty with social and work relationships as shown by his report of a history of marital problems, uncontrolled anger, irrational rage, anxiety, difficulty getting along with coworkers, social avoidance, paranoia, and isolation. However, the Veteran that when he was working it "went well", that his twenty-year marriage was "generally good", he stayed in touch with his children, was close to his brother, sister, and uncle, was involved in his church, and enjoyed visiting family and going outside in good weather. The evidence indicates difficulty with insight and judgment and a lack of impulse control as shown by the Veteran's report of panic attacks, paranoia, crying spells, road rage, and frequent loss of temper. However, the Veteran's mental health treatment providers also noted that he demonstrated appropriate insight and judgment, exhibited normal range of effects, and other than road rage, no specific examples of verbal or physical aggression toward people were indicated. While the June 2025 private psychological assessment indicated "significant deficits" with the Veteran's concentration, memory, and emotional functioning, neglect of his personal appearance and hygiene, again, no specific details were provided, and the remainder of the Veteran's treatment records indicate that he presented as appropriately dressed and adequately groomed, exhibited a normal range of affect, and was generally able to follow the conversation and provide appropriate responses. The Board has considered the Veteran's report that he is worried by and has difficulty adapting to stressful situations, out of fear of the effect of his medical conditions and his continued difficulty sleeping and anxiety about his health. However, the Board does not find that the evidence shows occupational and social impairment with deficiencies in most areas. The Veteran did not express or demonstrate on examination, or elsewhere during the review period that he had any suicidal ideation, obsessional rituals, illogical speech, spatial disorientation, persistent delusions or hallucinations, an inability to perform the activities of daily living, neglect of his personal appearance or hygiene, grossly inappropriate behavior, or the inability to remember his own name, occupation or the names of close relatives. Further, while the Veteran testified to some impulse control impairment while driving, and some marital problems, he did not exhibit or express any violent behavior nor other reactions, thus showing he maintained impulse control. Further, this irritability was not reported or noted as being unprovoked. While he reported that he did not have friends, avoided large social gatherings, and isolated, he also expressed the ability to maintain a "good" relationship with his children, a twenty-year marriage, attend church, and that he was "close" to his family. Regarding insight, while the Veteran reported that he engaged in road rage, unprovoked verbal and physical aggression, and was often irritable and short tempered, and the VA and private psychologists observed that the Veteran displayed a depressed mood, and exhibited crying spells, the evidence shows that he had good personal hygiene, a normal range of affect, was generally able to track conversation, had a normal speech pattern, was coherent, able to maintain normal conversation, and showed intact judgment, insight, and a clear thought process. The Board acknowledges the serious nature of the Veteran's prior report of suicidal ideation several days a week due to his health issues and his mood, it notes that on further inquiry he confirmed that he had only passive thoughts, with no specific intentions or plans to take his life, he specifically denied any active or passive suicidal thoughts, and throughout the review period he reported irritable and short tempered, and the VA and private psychologists observed that the Veteran displayed a depressed mood, and exhibited crying spells, the evidence shows that he had good personal hygiene, a normal range of affect, was generally able to track conversation, had a normal speech pattern, was coherent, able to maintain normal conversation, and showed intact judgment, insight, and a clear thought process. The Board acknowledges the serious nature of the Veteran's prior report of suicidal ideation several days a week due to his health issues and his mood, it notes that on further inquiry he confirmed that he had only passive thoughts, with no specific intentions or plans to take his life, he specifically denied any active or passive suicidal thoughts, and throughout the review period he reported no suicidal or homicidal ideations, and none of his examiners or providers found him to be in imminent or persistent danger of hurting himself or others. See November 2017 VA Psychology Note; January 2025 VA PTSD Examination; June 2025 Dr. D.W. Psychological Evaluation; see also e.g. September 2023, July 2024, and January 2025 VA Primary Care Notes; August 2021, November 2023, October 2024, and April 2025 VA Emergency Department Notes; May 2020, August 2021 VA Mental Health Notes. Therefore, the Board finds that a higher 70 percent rating for his major depressive disorder is not warranted. Accordingly, after affording the Veteran the benefit of the doubt, the Board finds the evidence from June 24, 2021, weighs in favor of assigning an initial rating of 50 percent, but not higher, for the Veteran's service-connected major depressive disorder. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021). 2. Entitlement to a TDIU. As previously outlined, the Board finds the issue of entitlement to a TDIU was raised as part and parcel of the Veteran's underlying claim for an increased rating for his major depressive disorder, which stems from the initial evaluation, effective June 24, 2021. See Rice, supra. VA will grant a TDIU when the evidence shows that the Veteran is precluded, by reason of his service-connected disabilities, from securing or following "substantially gainful employment" consistent with his education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. As the Veteran's TDIU claim is part of his increased rating claim on appeal, the question before the Board is whether he was unable to secure and maintain substantially gainful employment due to his service-connected disabilities from June 24, 2021. A TDIU may be assigned when a Veteran is unable to secure or follow a substantially gainful occupation because of service-connected disabilities. 38 C.F.R. § 4.16. 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, while the noneconomic component requires determination as to whether the Veteran is able 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 to perform the types of activities required by the occupation at issue; and whether the Veteran has the mental ability to perform the activities required by the occupation at issue. Id. An award of TDIU is an individualized determination, specific to a Veteran's particular circumstances, for example, 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. See Roberson v. Principi, 251 F.3d 1378, 1385 (Fed. Cir. 2001). The ultimate question is whether they can perform the physical and mental acts required by employment, not whether they can find employment. See Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Medical evaluations are probative evidence to understanding the level of functional impairment; however, the ultimate determination of unemployability is a legal question, not a medical one. See Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 100 percent unemployability. See Roberson v. Principi, 251 F.3d 1378, 1385 (Fed. Cir. 2001). The ultimate question is whether they can perform the physical and mental acts required by employment, not whether they can find employment. See Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Medical evaluations are probative evidence to understanding the level of functional impairment; however, the ultimate determination of unemployability is a legal question, not a medical one. See Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013). The Veteran is currently service connected for major depressive disorder, caused by his service-connected lumbar spine and knee disabilities, as well as bilateral pes planus, radiculopathy of the sciatic and femoral nerves of his bilateral lower extremities, and tinnitus. The Veteran completed the eleventh grade, earned a general educational development (GED) high school equivalency test while in service, and completed auto body repair and truck driver training. See January 1971 VA Form 21E-1990; August 1975 VA Form 22-1999; January 2025 VA PTSD Examination. He worked at a service station prior to service, served as a Pershing Missile Crewman in service, and worked for forty years as a machinist after his discharge. See DD Form 214; January 2025 VA PTSD Examination; June 2025 Dr. D.W. Psychological Evaluation. His employment history includes a forty-year career as a machinist, involving concentration and attentiveness to detail, along with additional work experience in careers with significant social interaction and mobility requirements; he has limited education, and no training or work experience transferable to other vocations. While the record reflects he retired voluntarily, the Board analyzes only his occupational capability due to his service-connected disabilities during the review period. His VA treatment records, and examination reports show that throughout the review period his service-connected back, knee, nerve, and foot disabilities caused repeated emergency department admissions for persistent pain, resulted in limited range of motion, numbness and instability, an antalgic gait, limping, dragging of his right foot, and continually worsening pain that kept him awake at night, and interfered with sitting, standing, and walking, for which he required the use of muscle relaxants, a cane, braces, and surgical intervention. See e.g. August 2021, January 2024 VA Emergency Department Notes; July 2024 VA Primary Care Note; March 2023, April 2023, May 2024, and July 2024 VA Neurosurgery Clinic Notes; February 2025 VA Knee and Lower Leg Examination. His family members stated that he was always in "excruciating pain", had problems walking and moving due to his back and foot pain, and that at times the intense pain made it too hard for him to move, and rendered him "motionless", and he reported that he required help tying his shoes, but was otherwise independent in his activities of daily living. See July 2024 T.S., and S.T. Statements; July 2024 Board Hearing Transcript; July 2024 VA Primary Care Note. The Veteran reported that the ringing in his ears made it difficult to hear, and his examiners opined that his tinnitus and musculoskeletal disability symptoms resulted in occupational impairment, decreased productivity, and missed work. See e.g. October 2017 VA Hearing Loss and Tinnitus Examination; January 2020 Dr. A.W. Foot Conditions Disability Benefits Questionnaire; April 2021 and February 2025 VA Knee and Lower Leg Examinations. The Board acknowledges that the evidence shows the Veteran's major depressive disorder symptoms caused near constant depression, anxiety, panic, paranoia, increased irritability with angry outbursts, problems interacting with coworkers and supervisors, road rage, frustration, concentration and memory problems that negatively impacted his ability to focus, concentrate, maintain motivation, and resulted in social withdrawal, and that based on these symptoms, Dr. D.W. concluded that his psychiatric symptoms caused functional impairment that made it difficult for him to maintain regular employment, do his work, adapt to stressful situations, and interact in social and occupational settings such that he was precluded from being able to seek or maintain gainful employment. See January 2025 VA PTSD Examination; June 2025 Dr. D.W. Psychological Evaluation. Therefore, the Board has considered whether the Veteran is entitled to a TDIU based on his service-connected major depressive disorder symptoms alone. See Buie v. Shinseki, 24 Vet. App. 242 negatively impacted his ability to focus, concentrate, maintain motivation, and resulted in social withdrawal, and that based on these symptoms, Dr. D.W. concluded that his psychiatric symptoms caused functional impairment that made it difficult for him to maintain regular employment, do his work, adapt to stressful situations, and interact in social and occupational settings such that he was precluded from being able to seek or maintain gainful employment. See January 2025 VA PTSD Examination; June 2025 Dr. D.W. Psychological Evaluation. Therefore, the Board has considered whether the Veteran is entitled to a TDIU based on his service-connected major depressive disorder symptoms alone. See Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); Bradley v. Peake, 22 Vet. App. 280, 294 (2008). However, based on the totality of the evidence, the Board does not find that the symptoms of his psychiatric disorder disabilities alone warrant entitlement to a TDIU; rather, the Board finds that the combined impact of the Veteran's service connected musculoskeletal and psychiatric disabilities, and not any one disability alone, significantly limited his ability to work in any capacity and specifically precluded him from performing any type of work, to include the type of work he is trained and experienced in. Notably, his prior career fields involved physical labor, significant mobility, technical precision, and attention to detail in environments with some social interaction. Therefore, while the Board acknowledges the Veteran's problems interacting socially at work due to the functional impact of his psychiatric symptoms, and his inability to adapt to stressful situations, it finds that his inability to obtain and maintain gainful employment was more significantly impacted by the severely limiting symptoms of his physical disabilities, and that therefore, his entitlement to a TDIU is not based on a single disability alone, but rather the combined effects of all of his service connected disabilities. After careful review of the record and considering the Veteran's education, training, and employment history, the Board finds that the evidence persuasively shows that he was unable to secure or follow substantially gainful employment due to the totality of his service-connected disability symptoms from June 24, 2021. Therefore, entitlement to a TDIU is granted, from June 24, 2021. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.16(a); Lynch, 21 F.4th at 776. J.M. ESTES Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Zahn, C. 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.