Citation Nr: 18160459
Decision Date: 12/28/18	Archive Date: 12/26/18

DOCKET NO. 09-27 778
DATE:	December 28, 2018
ORDER
Entitlement to an increased rating for posttraumatic stress disorder (PTSD) of 50 percent, effective November 22, 2006, and 100 percent, effective May 13, 2013, is granted, subject to the laws and regulations governing the payment of monetary benefits.
Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities on an extraschedular basis is denied, prior to May 13, 2013.
FINDINGS OF FACT
1. Effective November 22, 2006, the Veteran’s PTSD is manifested by occupational and social impairment with reduced reliability and productivity due to impaired judgment, disturbance of motivation and mood, and difficultly in establishing and maintaining effective work and social relationships.
2.  Resolving all doubt in the Veteran’s favor, effective May 13, 2013, the Veteran’s PTSD has resulted in total occupational and social impairment due to symptoms such as intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene). 
3. The Veteran’s service-connected disabilities did not preclude him from securing and following substantially gainful employment, prior to May 13, 2013.
CONCLUSIONS OF LAW
1. The criteria for an evaluation of 50 percent for PTSD, but no higher, effective November 22, 2006, have been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.130, Diagnostic Code 9411.
2. The criteria for an evaluation of 100 percent for PTSD, effective May 13, 2013, have been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.130, Diagnostic Code 9411. 
3. The criteria for entitlement to a TDIU are not met, prior to May 13, 2013.  38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341(a), 4.16(b).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
This matter comes before the Board from a December 2007 rating decision from the Regional Office, which granted service connection for PTSD and assigned a 30 percent rating, effective November 22, 2006. 
In April 2011, the Veteran testified before the undersigned Veterans Law Judge at a Board hearing at the RO. 
The Board remanded the case in December 2011 for additional development, and determined that the issue of entitlement to a TDIU had been raised by the record. During the course of the remand, the RO granted an increased rating of 50 percent for the Veteran’s PTSD, effective May 13, 2013; and denied entitlement to a TDIU. See June 2013 rating decision. The Board remanded the case again in August 2016 for another examination, as the evidence suggested a worsening of the Veteran’s PTSD. The case is now returned for appellate review. 
In reviewing the record, the Board finds substantial compliance with the remand directives as concerns these issues.  See Dyment v. West, 13 Vet. App. 141 (1999).
1. Entitlement to an increased rating for posttraumatic stress disorder (PTSD), rated as 30 percent disabling, effective prior to May 13, 2013, and 50 percent, thereafter 
The Veteran contends that his PTSD is more severe than represented by the currently assigned staged ratings of 30 and 50 percent, effective prior to May 13, 2013, and thereafter, respectively.  The Veteran’s representative argued that the Veteran’s obesity should be considered as a part of the Veteran’s PTSD, which would support a higher rating for PTSD and a grant of a TDIU.  See November 2018 appellant’s brief. 
The Board concludes that the Veteran’s PTSD warrants a rating of 50 percent, but no higher, effective November 22, 2006, and 100 percent rating, effective May 13, 2013.  
Disability ratings are based on the average impairment of earning capacity resulting from a disability.  38 U.S.C. § 1155; 38 C.F.R. § 4.1.  An evaluation of the level of disability present includes consideration of the functional impairment of the Veteran’s ability to engage in ordinary activities, including employment. 38 C.F.R. § 4.10.  Separate diagnostic codes identify the various disabilities.  Where there is a question as to which of two evaluations shall be applied, the higher evaluations will be assigned if the disability more closely approximates the criteria required for that rating.  38 C.F.R. § 4.7.  Otherwise, the lower rating will be assigned.  Id.  
As noted in the introduction, the Veteran’s PTSD is presently rated as 30 percent disabling prior to May 13, 2013, and 50 percent disabling, effective after that date. 
The criteria for evaluating PTSD are found at 38 C.F.R. § 4.130, Diagnostic Code 9411. A 30 percent evaluation is assigned when 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, mild memory loss (such as forgetting names, directions, recent events). Id.
A 50 percent evaluation 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; impaired judgment; impaired abstract thinking; disturbance of motivation and mood; and difficultly in establishing and maintaining effective work and social relationships.  Id. 
A 70 percent evaluation is warranted where there is 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); and inability to establish and maintain effective relationships.  Id. 
A 100 percent evaluation requires 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, own occupation, or own name.  Id. 
Symptoms listed in the VA’s general rating formula for mental disorders serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating, and are not intended to constitute an exhaustive list.  See Mauerhan v. Principi, 16 Vet. App. 436, 442-44 (2002).  The nomenclature employed in the rating formula is based upon the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, of the American Psychiatric Association (DSM-5). See 38 C.F.R. § 4.130. 
Effective August 4, 2014, VA amended the portion of its Schedule for Rating Disabilities that addressed mental disorders to remove outdated references to the DSM and to replace them with references to the recently updated DSM-5. The provisions of the interim final rule applied to all applications for benefits that are received by VA or that are pending before the agency of original jurisdiction on or after August 4, 2014. The Secretary did not intend for the provisions of the interim final rule to apply to claims that had been already certified for appeal to the Board, or that were pending before the Board, the United States Court of Appeals for Veterans Claims (Court), or the United States Court of Appeals for the Federal Circuit.  See 79 Fed. Reg. 45,093, 45,094 (Aug. 4, 2014).
The Veteran’s case was originally certified to the Board in December 2010, prior to the rule promulgated by the Secretary and becoming effective in August 2014.  Since the Secretary did not intend for the DSM-5 to apply in pending cases, the DSM-5 does not apply to the present case.  
According to the applicable rating criteria, when evaluating a mental disorder, the frequency, severity, duration of psychiatric symptoms, length of remissions, and the veteran’s capacity for adjustment during periods of remission must be considered.  See 38 C.F.R. § 4.126(a).  In addition, the evaluation must be 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. Further, when evaluating the level of disability from a mental disorder, the extent of social impairment is considered, but the rating cannot be assigned solely on the basis of social impairment.  See 38 C.F.R. § 4.126(b). 
Within the DSM-IV, Global Assessment Functioning (GAF) scale scores ranging from 1 to 100, reflect “psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness.”  Carpenter v. Brown, 8 Vet. App. 240, 242 (1995); see also Richard v. Brown, 9 Vet. App. 266, 267 (1996). 
Scores ranging from 41 to 50 reflect serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in social, occupational or school functioning (e.g., no friends, inability to keep a job).  DSM-IV at 46-47.      
The medical evidence is conflicting as to the severity of the Veteran’s PTSD.  The Board will resolve all doubt in the Veteran’s favor and assign a 50 percent rating, effective November 22, 2006, and 100 percent rating, effective May 13, 2013.
Effective November 22, 2006, overall, the Veteran is shown to have occupational and social impairment with reduced reliability and productivity due to such symptoms as impaired judgment, disturbance of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships.
An October 2007 VA examination report shows that the Veteran had an irritable mood with no current suicidal or homicidal thoughts, though he had suicidal thoughts in the past. He was employed as a truck driver, and had been so employed for 30 years. He had previously drunk alcohol excessively but stopped 12 years ago. He had no history of psychiatric treatment and still had episodes of anger and explosive behavior. He reported that his recollections about Vietnam sometimes affected his concentration while driving, and that he had road rage, at times.
A June 2008 statement from a private social worker notes that the Veteran never discussed things at the VA examination which he experienced: such as having panic attacks whenever he was in public. He reportedly spent most of his time locked in his darkened garage and only felt safe there. The social worker noted that the Veteran worked for a long term but only because he was able to drive a truck and avoid contact with most people. He also had been forced to retire early because of numerous problems he was having on the job. Although he was married for a long time, his PTSD symptoms continued to make things extremely difficult for them.
In an August 2008 statement, the Veteran indicated that he would get a panic attack any time he was in a crowd and did not like to go out. 
A January 2009 VA treatment record notes that the Veteran struggled with anger issues and often got into arguments with his wife. He denied any physical violence between him and his wife, but stated that in the past there was physical violence. He reported experiencing anxiety attacks approximately three times per month. He also noted frequent passive suicidal thoughts with no plan or intent. It was noted that he had retired from his job as a truck driver in June 2008 and had a difficult adjustment. He reportedly felt a little useless at times and was not particularly ready to retire but did not have many options from a health and financial standpoint. He described his mood as depressed. He was assigned GAF scores of 42 and 50.
The Veteran testified at the April 2011 Board hearing that he felt that he had to quit working because of his anger problems; he also noted that he only had one or two friends. His wife testified that the relationship with the Veteran was very draining. He would sit in the dark at home; sometimes he would sit in the garage in the dark. She did not have meaningful conversations with him; he would get extremely angry or anguished. The Veteran noted that he had memory problems with a short concentration span, and also periods of depression. The Veteran’s wife stated that the Veteran had very little motivation to get dressed, and that in general, almost everything seemed worse.
These symptoms more closely meet the criteria for a 50 percent rating since November 22, 2006. Occupationally, the Veteran worked until June 2008, but indicated a desire to continue working. He noted anger issues on the job, and felt that he had to stop working due to his PTSD symptoms. Socially, he had a few friends but did not like to go out often, because he would get panic attacks. He reported panic attacks a few times a month. His wife stated that he would sit in the dark at home and that their relationship suffered greatly due to his PTSD symptoms. Based on these findings, which reflect occupational and social impairment with reduced reliability and productivity due to such symptoms as impaired judgment, disturbance of motivation and mood, and difficultly in establishing and maintaining effective work and social relationships, a 50 percent rating is assigned. 
The next higher 70 percent rating is not warranted based on the reported symptoms prior to May 13, 2013. The Veteran is significantly limited in his social interaction, but is still able to go out of the house for social occasions. He describes disturbances in motivation and mood, but does not have deficiencies with most areas. He still has some friends and though his relationship has suffered, he still has maintained a relationship with his wife for many years, and not had any recent verbal or physically violent interactions with her. He also reportedly still wanted to work. While the Veteran’s symptoms are significant and he is shown to have occupational and social impairment with reduced reliability and productivity, his occupational and social impairment does not rise to criteria for a 70 percent rating. The Veteran’s GAF score range from 42 to 50 demonstrates serious symptoms. The GAF scores do not undermine the assessment of a 50 percent rating being the most appropriate for the Veteran’s PTSD symptoms, effective November 22, 2006.
Effective May 13, 2013, overall, he is shown to have total occupational and social impairment due to his PTSD symptoms.  A May 2013 VA examination report shows the Veteran had occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, though generally functioning satisfactorily. These findings mirror the rating criteria for a 30 percent rating. However, the report also notes that the Veteran was unable to focus on tasks and had no interest in doing activities, which he used to find pleasurable, or any activities in general. He also reported (and his wife confirmed) that he, at times, had difficulties with activities of daily living and simple chores around the house. However, the examiner noted that the Veteran had been able to maintain employment for 30 years with the same company and according to his records had been able to perform goal-directed tasks, such as building models (as recently 2012 and early as 2013), which the examiner indicated that he was able to work in some capacity.
The Veteran reported increasing panic attacks, isolation from others, and difficulty engaging with family and friends. He did not like to go to social events and preferred not to go out unless he was familiar with the place. He and his wife noted a long history of angry outbursts. He described being verbally abusive, and at times physically aggressive with his wife during their marriage, but denied being violent currently or in the recent past. The Veteran was reported as having panic attacks that occurred weekly, flattened affect, disturbance of motivation and mood, and neglect of personal appearance and hygiene. The Veteran reportedly had started to self-medicate with food to replace his past alcohol addiction. Most days he reportedly found it difficult to self-motivate. He reported that he could get along with small groups but his morbid obesity would make physical activity difficult; and his anxiety, irritability, and unpredictable outbursts would make public service jobs where he was forced to interact with many other people a poor fit. Given his functional impairment, the examiner determined that he had limited options for employment, but noted that he had demonstrated the ability to control his symptoms enough to maintain employment for 30 years.
An August 2015 VA treatment record notes that the Veteran stated that he was “ok”. The Veteran’s wife complained, however, that he would not go anywhere, and had not left the house in three months. He said he felt more comfortable in the house. He also was afraid that in the winter he might fall; he had fallen a few times. He had panic attacks if he went out; he also got anxious. He was depressed because he did not get to see his children and grandchildren much and because his family was on him about losing weight. His wife said that his isolating started after he retired. He had become totally unsocial. He wore his underwear or pajamas seven days a week. His wife was very sad and tearful and had become his caregiver. 
A May 2017 VA examination report shows the Veteran had occupational and social impairment due to mild or transient symptoms, which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication. These findings mirror the criteria for a 10 percent rating for PTSD, but are not consistent with the rest of the record or the examination report. The Veteran was noted as having depressed mood, anxiety, suspiciousness, panic attacks that occurred weekly or less often, and chronic sleep impairment. It was noted that the Veteran’s insight and judgment were sound. Physically, he weighed 500 pounds and got around in a motorized scooter. The examiner found that it was more likely than not that the Veteran could function in an appropriate occupational setting providing that it did not require either complex cognitive operations or physical mobility. The Veteran even stated that he wanted to work again and had tried to find a job but that his size and inability to get around had prevented him from finding employment. The examiner commented that if he could find a job this might help his self-esteem and even help to lose weight and his overall health. 
Socially, the examiner noted that the Veteran was increasingly isolative and withdrawn. He spent the majority of his time alone and did not venture out of the house. He did this to reduce anxiety and possible conflict with others. 
In reviewing the medical evidence as of May 13, 2013, a 100 percent schedular disability rating is warranted for the Veteran’s PTSD. The Veteran’s PTSD symptoms seemed to worsen as of May 13, 2013, in that he stopped leaving his house at all for months at a time, and would go many days without dressing or changing his clothes. His wife had essentially become his caregiver. The May 2013 VA report further noted that the Veteran had neglect of personal appearance and hygiene. This demonstrates intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene), which is one of the criteria for a 100 percent rating for PTSD. 
While the rest of the criteria for a 100 percent rating are not met, not all of the criteria for a 100 percent rating for PTSD must be present, in order to be compensated at the 100 percent disability rating level.  See Vazquez-Claudio, 713 F.3d 116-17 (noting that the intermediate disability evaluations are distinguished not only by symptoms, but also by the frequency, severity, and duration of the symptoms); Mauerhan, 16 Vet. App. at 442. The list of symptoms under the rating criteria are meant to be examples of symptoms that would warrant the rating, but are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. 38 C.F.R. § 4.21; Mauerhan, at 442-43.
Considering the foregoing, the Board concludes that a higher rating of 50 percent, but no higher, effective November 22, 2006; and 100 percent, effective May 13, 2013, for the Veteran’s PTSD is warranted.  The benefit-of-the-doubt rule has been applied in arriving at this decision. 38 U.S.C. § 5107(b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990).  
The Board has also considered whether the Veteran’s PTSD presents an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards such that an extraschedular rating is warranted, the threshold factor for extraschedular consideration.  See 38 C.F.R. § 3.321(b)(1); Bagwell v. Brown, 9 Vet. App. 337, 338-39 (1996); see also Fisher v. Principi, 4 Vet. App. 57, 60 (1993) (“[R]ating schedule will apply unless there are ‘exceptional or unusual’ factors which render application of the schedule impractical.”).  
In the instant case, the Veteran has moderate to total social and occupational functional impairment due to his symptoms of PTSD.  However, this does not present an exceptional or unusual disability picture, and the assigned schedular evaluations are, therefore, adequate.  See Thun, 22 Vet. App. at 115.  
Effective November 22, 2006, the Veteran’s symptoms associated with his PTSD (i.e., occupational and social impairment with reduced reliability and productivity) are not shown to cause any impairment that is not already contemplated by the rating criteria. The 50 percent rating under Diagnostic Code 9411 specifically contemplates these symptoms. Effective May 13, 2013, the symptoms associated with the Veteran’s PTSD (i.e., total occupational and social impairment due to intermittent inability to perform activities of daily living) are not shown to cause any impairment that is not already contemplated by the rating criteria.  The 100 percent rating assigned under Diagnostic Code 9411 specifically contemplates these symptoms. 
While the examiner has stated that obesity has been caused by the Veteran’s PTSD, obesity, in and of itself is not considered a disability for rating purposes. VAOPGCPREC 1-2017. Thus, the Veteran may not be separately rated for his obesity, even if it is due to his service-connected PTSD.
The Board finds that the rating criteria reasonably describe the Veteran’s disability.  For these reasons, referral for consideration of an extraschedular rating is not warranted for this claim. 
2. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities on an extraschedular basis, prior to May 13, 2013
Initially, given the Board’s grant of a 100 percent disability rating for PTSD, effective May 13, 2013, the issue of entitlement to a TDIU as of that date is rendered moot. However, the issue of entitlement to a TDIU for the period from November 22, 2006 to May 13, 2013, is still on appeal.
The Veteran contends that he is unemployable because of his service-connected disabilities. He has stated that he was forced to retire in June 2008 due to his anger issues associated with his PTSD. 
The question for the Board is whether the Veteran’s service-connected disabilities render him unemployable prior to May 13, 2013. 
The Board concludes that the preponderance of the evidence weighs against finding that the Veteran’s service-connected disabilities render him unemployable prior to May 13, 2013. 
Total disability is considered to exist when there is any impairment in mind or body that is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340 (a)(1).  A total disability rating for compensation purposes may be assigned on the basis of individual unemployability, that is, 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. 38 C.F.R. § 4.16 (a).
If there is only one service-connected disability, it must be rated at 60 percent or more; if there are two or more service-connected disabilities, at least one disability must be rated at 40 percent or more, and sufficient additional disability must bring the combined rating to 70 percent or more.  Id.  Individual unemployability must be determined without regard to any non-service connected disabilities or the Veteran’s advancing age. 38 C.F.R. §§ 3.341 (a), 4.19 (2017); Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993).
In reaching a determination of TDIU, it is necessary that the record reflect some factor which takes the Veteran’s case outside the norm with respect to a similar level of disability under the rating schedule. 38 C.F.R. §§ 4.1, 4.15 (2017); Van Hoose, 4 Vet. App. at 363.  The fact that a claimant is unemployed or has difficulty obtaining employment is not enough.  The question is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether he can find employment.  See Beaty v. Brown, 6 Vet. App. 532, 538 (1994).
Prior to May 13, 2013, the Veteran did not meet the percentage requirements for consideration of a total evaluation under 38 C.F.R. § 4.16 (a). From November 22, 2006 to May 13, 2013, the Veteran’s current service-connected disabilities were (1) PTSD, rated 50 percent (as a result of this Board decision), effective November 22, 2006; (2) laceration scar on the face, rated 10 percent, effective November 27, 2002; and (3) bilateral hearing loss, rated as 0 percent, effective December 31, 1971.  The Veteran’s combined disability rating for his service-connected disabilities was 50 percent, from November 22, 2006 to May 13, 2013.  See generally 38 C.F.R. § 4.25, Table I – Combined Ratings Table.      
Nevertheless, the Veteran may be entitled to a TDIU on an extraschedular basis if it is established that he is unable to secure or follow substantially gainful employment because of the effect of his service-connected disabilities. 38 C.F.R. § 4.16(b).  Consequently, the Board must determine whether the Veteran’s service-connected disabilities preclude him from engaging in substantially gainful employment (work that is more than marginal, which permits the individual to earn a “living wage”).  Moore v. Derwinski, 1 Vet. App. 356 (1991).  In making its determination, VA considers such factors as the extent of the service-connected disability, and employment and educational background.  See 38 C.F.R. §§ 3.340, 3.341, 4.16(b), 4.19.
The Veteran reportedly stopped working in June 2008. As he reportedly working on a full-time basis prior to that date, no entitlement to a TDIU prior to June 2008 is warranted. As for the time after June 2008, while the Veteran contends that he had to stop working due to his PTSD, the medical evidence of record shows that the Veteran was not rendered unemployable as a result of his service-connected disabilities prior to May 13, 2013. 
A June 2008 statement from a private social worker notes that the Veteran worked for a long term but only because he was able to drive a truck and avoid contact with most people. He also had been forced to retire early because of numerous problems he was having on the job. 
A January 2009 VA treatment record notes that the Veteran noted that he had retired from his job as a truck driver in June 2008 and had a difficult adjustment. He reportedly felt a little useless at times and was not particularly ready to retire but did not have many options from a health and financial standpoint.
The Veteran testified at the April 2011 Board hearing that he felt that he had to quit working because of his anger problems.
A May 2013 VA examination report shows that the Veteran’s anxiety, irritability, and unpredictable outbursts would make public service jobs where he was forced to interact with many other people a poor fit. Given his functional impairment, the examiner determined that he had limited options for employment, but noted that he had demonstrated the ability to control his symptoms enough to maintain employment for 30 years.
A May 2017 VA examination report shows the examiner found that it was more likely than not that the Veteran could function in an appropriate occupational setting providing that it did not require either complex cognitive operations or physical mobility. The Veteran even stated that he wanted to work again and had tried to find a job but that his size and inability to get around had prevented him from finding employment. The examiner commented that if he could find a job this might help his self-esteem and even help to lose weight and his overall health.
The VA examiner’s opinion in May 2017 is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data.  Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). 
As noted, the ultimate question is whether the Veteran, because of service-connected disabilities, is incapable of performing the physical and mental acts required by employment, not whether he can find employment.  Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993).  This is so because a disability rating is recognition that the impairment makes it difficult to obtain or keep employment. Id.  In making its determination, VA considers such factors as the extent of the service-connected disability, and employment and educational background.  See 38 C.F.R. §§ 3.340, 3.341, 4.16(b), 4.19.  While there is some evidence the Veteran’s employment activities would be limited by his PTSD in that he would need limited interaction with others, and his PTSD would at times affect his motivation, none of the medical evidence establishes that the Veteran is prevented from working as a result of his service-connected disabilities either alone or in combination with each other. On the contrary, the examiner in May 2017 determined that the Veteran might benefit from working.
As for the Veteran’s employment history of being a truck driver, while the Veteran might not be working since June 2008, this alone, does not warrant entitlement to a TDIU.  The Veteran even commented that he was having a hard time transitioning to not working; and the medical evidence indicates that his PTSD symptoms might be improved if he started working again. Furthermore, the fact that a veteran is unemployed is not enough to warrant TDIU, unless the medical evidence shows that the Veteran is unable to obtain substantially gainful employment because of his service-connected disabilities.  As noted above, the medical evidence of record shows that the Veteran has not been rendered unemployable due to his service-connected disabilities.  The Veteran is limited in that he cannot work around other people. While his work history is mainly in truck driving, there is no medical finding of record that the Veteran could not work in another position that does not involve significant interaction with others.
While the Veteran believes his service-connected disabilities render him unemployable, he is not competent to provide a nexus opinion in this case.  This issue is also medically complex, as it requires knowledge of how physical and mental disabilities affect functioning in a work environment, and complicated diagnostic medical testing.  Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007).  Consequently, the Board gives more probative weight to the medical opinion provided in May 2017.  Based on the foregoing discussion, the Board finds that entitlement to a TDIU on an extraschedular basis prior to May 13, 2013, is not warranted.
 
S. L. Kennedy
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	Sarah B. Richmond 

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