Citation Nr: 21064113 Decision Date: 10/19/21 Archive Date: 10/19/21 DOCKET NO. 17-43 061 DATE: October 19, 2021 ORDER An initial 70 percent disability rating for unspecified anxiety disorder throughout the period of the claim is granted, subject to the criteria applicable to the payment of monetary benefits. The claim of entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is granted, subject to the criteria applicable to the payment of monetary benefits. FINDINGS OF FACT 1. Throughout the pendency of the appeal, the Veteran's unspecified anxiety disorder has been productive of occupational and social impairment which most nearly approximates with deficiencies in most areas; it has not been manifested by symptomatology of such severity as to result in total occupational and social impairment. 2. Resolving all reasonable doubt in the Veteran's favor, the evidence of record demonstrates that his service-connected disabilities rendered him unable to obtain or maintain a substantially gainful occupation. CONCLUSIONS OF LAW 1. For the period prior to April 22, 2021, the criteria for an initial disability rating of 70 percent for unspecified anxiety disorder have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1-4.14, 4.130, Diagnostic Code 9413. 2. The criteria for an initial disability rating of 70 percent for unspecified anxiety disorder have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1-4.14, 4.130, Diagnostic Code 9413. 3. The criteria for establishing entitlement to TDIU benefits have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had honorable active duty service in the United States Army from April 2009 to November 2014. In April 2019, the Board remanded the case for additional development. 1. Entitlement to an increased rating for unspecified anxiety disorder, rated as 30 percent prior to April 22, 2021, and 70 percent thereafter. Disability ratings are determined by applying the criteria set forth in the VA Schedule of Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § § 1155; 38 C.F.R. § § 4.1. Separate diagnostic codes identify the various disabilities. Disabilities must be reviewed in relation to their history. 38 C.F.R. § § 4.1. Other applicable, general policy considerations are: interpreting reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability, 38 C.F.R. § § 4.2; resolving any reasonable doubt regarding the degree of disability in favor of the claimant, 38 C.F.R. § § 4.3; where there is a questions as to which of two evaluations apply, assigning a higher of the two where the disability pictures more nearly approximates the criteria for the next higher rating, 38 C.F.R. § § 4.7; and, evaluating functional impairment on the basis of lack of usefulness, and the effects of the disability upon the person's ordinary activity, 38 C.F.R. § § 4.10. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). A claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Thus, separate ratings can be assigned for separate periods of time based on the facts found - a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). It is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified; findings sufficiently characteristic to identify the disease and the disability therefrom are sufficient; and above all, a coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § § 4.21. In accordance with 38 C.F.R. § §§ 4.1, 4.2, 4.41, 4.42 (2018) and Schafrath v. Derwinski, 1 Vet. App. at 589, the Board has reviewed all evidence of record pertaining to the history of the service-connected disability under appeal. The Board has found nothing in the historical record which would lead to the conclusion that the current evidence of record is not adequate for rating purposes. Moreover, the Board is of the opinion that this case presents no evidentiary considerations which would warrant an exposition of remote clinical histories and findings pertaining to the disability under review. In addition, the Board notes that it has reviewed all of the evidence of record, with an emphasis on the evidence relevant to this appeal. Although there is an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that VA must review the entire record, but does not have to discuss each piece of evidence). As such, the Board will summarize the relevant evidence where appropriate and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to the Veteran's claim. The Veteran asserts that he is entitled to a higher disability rating for his service-connected unspecified anxiety disorder. Under the General Formula for Mental Disorders (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). The Veteran's unspecified anxiety disorder is currently rated pursuant to 38 C.F.R. § 4.130, Diagnostic Code 9413. Under Diagnostic Code 9413, a 30 percent evaluation is warranted when the psychiatric disorder results in 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). A 50 percent evaluation is warranted when the psychiatric disorder results in 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 evaluation is warranted when the psychiatric disorder results in occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships. A 100 percent evaluation is warranted when the psychiatric disorder results in total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. The Veteran was afforded a VA examination in December 2014. The examiner provided a diagnosis of adjustment disorder with anxiety. The examiner determined that the Veteran's psychiatric symptoms were not severe enough either to interfere with occupational and social functioning or to require continuous medication. The only symptom was anxiety. A May 2015 VA examination report included a diagnosis of unspecified anxiety disorder. The Veteran reported that he did not maintain contact with anybody and that he grew apart from his old friends. His daily activities consisted of watching television, playing video games, and thinking about life. He described his mood as depressing at times. He was unemployed due to physical limitations. His symptoms were depressed mood, anxiety, flattened affect, and disturbances of motivation and mood. The examiner stated that the Veteran's unspecified anxiety disorder were not severe enough either to interfere with occupational and social functioning or to require continuous medication. July 2015 VA treatment records showed that the Veteran endorsed symptoms of insomnia, decreased interest, guilt, and increased problems with concentration. He reported sleeping three to four hours per night. His lack of concentration was noticeable with his schoolwork and attendance. He denied suicidal ideation. The Veteran remained married to his wife and they had three children. He communicated with his family throughout the day on Facebook. He explained that he was isolated and did not want to see people in person. He was uncomfortable being around crowds. He stated that he no longer played poker, visited the casino, read autobiographies, or play video games. He was attending school full time, though most of his classes were online. The mental status examination revealed mildly dysphoric affect, logical and linear thought process, auditory hallucinations, no delusions, and good judgment and insight. He described auditory hallucinations where he heard someone calling his name and no one is there. He reported this occurs two to three times per week. The psychologist determined that the Veteran had symptoms of mild depression and anxiety. His biggest concerns are the lack of interest in the things he used to enjoy, low energy and motivation, and isolation from others. A November 2016 VA psychiatry noted that the Veteran's poor sleep was the result of him staying up until 8 or 9 in the morning because he is playing video games throughout the night. The Veteran reported problems with depression and self-motivation. He rated his depression as a 6 out of 10. The psychologist noted that delusions, hallucinations, suicidal ideations, and aggressiveness were absent. The Veteran underwent a VA examination in June 2017. His symptoms were depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, and chronic sleep impairment. The examiner determined that the Veteran's unspecified anxiety disorder symptoms caused 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. In August 2017, the Veteran submitted mental disorders disability benefits questionnaire (DBQ) completed by H.G., Ph.D. The Veteran lived at home with his wife and four children, though he was socially isolated and withdrawn. His symptoms were depressed mood, anxiety, suspiciousness, panic attacks more than once per week, near-continuous panic or depression affecting the ability to function, chronic sleep impairment, mild memory loss, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, inability to establish and maintain effective relationships, suicidal ideation, persistent delusions or hallucinations, neglect of personal appearance and hygiene, and intermittent inability to perform activities of daily living. It was noted that is symptoms caused great ongoing difficulty and that he no longer enjoyed the simplest of activities. At the time of examination, he endorsed symptoms of anxiety as he was vague with response, suspicious, and paranoid when speaking with the examiner. A mental status examination revealed normal attention, variable concentration, increased trouble with short-term memory, normal speech flow, average judgment, appropriate thought content an anxious mood, and restricted affect. His organization of thought was goal directed. There was report of overt hallucinations. His fund of knowledge, intellectual abilities, capacity for abstraction, and ability to interpret proverbs were below average. The Veteran had trouble remembering basic information. Dr. G. determined that the Veteran's psychiatric symptoms caused occupational and social impairment with deficiencies in most areas, such as work, family relations, judgment, thinking and/or mood. It was noted that the Veteran needed assistance performing his daily tasks as his wife was responsible for food shopping, meal preparation, household chores, and reminding him to shower and get a haircut. He showered every eight to 10 days. He reported suicidal ideation without intent. His visual hallucinations consisted of seeing things that are not present. His chronic sleep impairment included broken sleep. Dr. G. determined that the Veteran's anxiety disorder and social impairment were emotionally debilitating and that his symptom complex dated back to November 2014. Dr. G. opined that the Veteran could not sustain the stress from a competitive work environment or be expected to engage in gainful activity due to his generalized anxiety disorder. A February 2018 private medical opinion noted that the Veteran experienced panic attacks that occurred several times per week. His panic attacks and isolation were so severe that his uncle or cousin had to come over to care for his children when they occurred. The Veteran was afforded a VA examination in April 2021. His symptoms were anxiety, chronic sleep impairment, difficulty adapting to stressful circumstances, and suicidal ideation. The Veteran stated that he hated his current job as a security guard, which he worked since July 2019. He worked as a security guard previously and stopped working when he was in school. He stated that he quit because of his feet pain. He reported depression and crying spells and he cried every day at work. He had anxiety because of his children. He worried about finances and "the fake interactions with people with the people" at his job. He had problems falling to sleep most nights and wakes up frequently. He also socially isolated himself. He reported thoughts of death and conducted internet research about the purpose of life. He stated that he could not shoot himself and that he would choose to die by way of drug overdose. He stated that sometimes he was tired of living. He checked his insurance policy and learned that the policy didn't cover death by suicide. The Veteran reported that his heart raced when he thought about how he was forced out of the military before he was financially ready. He reported thoughts of seeking revenge by slashing tires or hitting the people who lied to him. His typical day involved taking the children to school, sleeping, listening to music, and playing video games. The examiner determined that the Veteran's psychiatric disorder caused 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. On examination, the Veteran had appropriate hygiene, full orientation, a euthymic mood, normal speech, linear thoughts, and no evidence of psychotic processes. Based on the evidence discussed in detail above, and assessing the severity, frequency, and duration of his unspecified anxiety disorder symptoms, the Board finds that the Veteran's service-connected unspecified anxiety disorder has been productive of occupational and social impairment that more nearly approximated deficiencies in most areas throughout the entire period on appeal. As discussed in detail above, the Veteran's psychiatric disorder was manifested by symptoms associated with a 70 percent rating, such as suicidal ideation, near-continuous depression, irritability, difficulty adapting to stressful circumstances, and an inability to establish and maintain effective relationships. The Board also notes that the Veteran had unlisted symptoms such as decreased interest, guilt, poor concentration, and suspiciousness. However, such symptoms are similar in severity and frequency to depression, difficulty adapting to stressful circumstances, and an inability to establish and maintain effective relationships. The Board also recognizes that the Veteran experienced persistent delusions or hallucinations, intermittent inability to perform activities of daily living, and maintenance of minimal personal hygiene, symptoms listed in the criteria for a 100 percent rating. However, the evidence overall does not demonstrate the level of impairment associated with a 100 percent rating. As noted above, the Veteran's other remaining symptoms were either contemplated by or more consistent with a 70 percent rating. Further, while the Veteran has been granted a TDIU based partly on his unspecified anxiety disorder, he was not totally socially impaired. Although the Veteran was socially isolated, he maintained contact with relatives on Facebook and remained married to his wife. He had help from his uncle and cousin when he experienced panic attacks or self-isolation. He also reported being present in his children's lives, although he did express frustration in regard to his children. The Board notes that the Veteran expressed suicidal ideation, which is similar to persistent danger of self-harm, which is contemplated by the 100 percent criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017). However, the severity, frequency, and duration of the Veteran's suicidal ideation has not risen to the level contemplated by the 100 percent disability rating. Although there are multiple instances of suicidal ideation documented during the appeal period, there are also multiple instances where the Veteran denied such. Overall, his psychiatric disorder was not shown to manifest the type, extent and severity of symptoms demonstrating "total occupational and social impairment" within the meaning of the rating schedule at any point during the appeal period. Therefore, the evidence does not suggest total social and occupational impairment. The preponderance of the evidence weighs against finding that the severity, frequency, and duration of the Veteran's symptoms resulted in the level of impairment required for a 100 percent rating. Accordingly, a 70 percent rating is warranted for the Veteran's unspecified anxiety disorder for the entire period on appeal under 38 C.F.R. § § 4.130, Diagnostic Code 9413. 2. Entitlement to a TDIU. The Veteran contends that he is entitled to TDIU benefits. After reviewing the evidence of record, the Board finds that TDIU benefits are warranted. It is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. 38 C.F.R. § 4.16. A TDIU may be assigned when the schedular rating for service-connected disabilities is less than 100 percent when it is found that the service-connected disabilities are sufficient to produce unemployability without regard to advancing age, provided that, if there is only one such disability, it is ratable at 60 percent or more, or, if there are two or more disabilities, there is at least one disability ratable at 40 percent or more and additional disabilities to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16. A finding of total disability is appropriate, "when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation." 38 C.F.R. §§ 3.340 (a)(1), 4.15. "Substantially gainful employment" is that employment, "which is ordinarily followed by the nondisabled to earn their livelihood with earnings common to the particular occupation in the community where the veteran resides." Moore (Robert) v. Derwinski, 1 Vet. App. 356, 358 (1991). Marginal employment is not considered substantially gainful employment and generally is deemed to exist when a veteran's earned income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. 38 C.F.R. § 4.16 (a). Marginal employment may also be held to exist in certain cases when earned annual income exceeds the poverty threshold on a facts-found basis (includes but is not limited to employment in a protected environment such as a family business or sheltered workshop). Id. In determining whether unemployability exists, consideration may be given to a 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. Throughout the period on appeal, service connection has been in effect for unspecified anxiety disorder, rated as 30 percent prior to April 22, 2021, and 70 percent thereafter; obstructive sleep apnea, rated as 50 percent disabling; thoracolumbar spine strain with IVDS, rated as 40 percent disabling; bilateral pes planus, rated as 30 percent disabling; left shoulder strain, rated as 10 percent disabling; right shoulder strain, rated as 10 percent disabling; tinnitus; rated as 10 percent disabling; pseudofolliculitis barbae, rated as 10 percent disabling; radiculopathy of the right lower extremity, rated as 10 percent disabling; radiculopathy of the left lower extremity, rated as 10 percent disabling; gastroenteritis, rated as noncompensable; seborrheic dermatitis of the scalp, rated as noncompensable; eczema, rated as noncompensable; and acne with scarring, rated as noncompensable. The Veteran's DD-214 showed that his military occupational specialty was a multichannel transmission systems operator. A December 2014 VA foot examination showed that the Veteran was unable to stand or walk for long periods when his feet are aching and tingling. A December 2014 back examination documented the Veteran's report of daily pain and stiffness that prevented him from lifting more than 20 lbs. The examiner found that the Veteran's lumbar spine disorder impacted his ability to work. Specifically, the Veteran was only able to lift less than 20 lbs., walk 1/4 mile, walk one to two hours during an 8 hour day, stand one hour before changing positions, sit two hours before changing positions, sit six hours during an 8 hour day, and stand two hours during an 8 hour day. A December 2014 examiner found that the Veteran's gastroenteritis impacted his ability to work. The Veteran reported that his symptoms affected his ability to lift or focus when the pain flared. The Veteran underwent a VA psychiatric examination in December 2014. The Veteran reported that he graduated high school and completed seven semesters of college until he flunked out. From 2007 to 2009, he worked odds and ends jobs, security, hospital, etc., until he joined the military. He was a transmission systems operator during his military service. During the examination he expressed his desire to go to college. In December 2014 and May 2015, VA examiners found that the Veteran's psychiatric symptoms were not severe enough either to interfere with occupational and social functioning or to require continuous medication. During the May 2015 VA examination, the Veteran stated that he had been unemployed since his separation from service. He reported that he was looking for work, but that he had major physical limitations. He was taking college courses to obtain a degree in criminal justice. In July 2015, the Veteran reported that his bilateral pes planus, thoracolumbar spine disorder, unspecified anxiety disorder, and bilateral shoulder strain prevented him from securing or following any substantially gainful occupation. The Veteran indicated that he had not been employed since his separation from service. He stated that he completed one year of college and that he was enrolled in the criminal justice program at a community college. In July 2015, the Veteran reported that he was recently denied employment at General Motors. He attended school fulltime. A July 2017 VA examination report noted that the Veteran transferred to the University of Missouri and majored in computer science for two semesters until he flunked out. It was noted that the Veteran was initially majoring in criminal justice and then switched to computer science, a field that he did not have the background for. Specifically, he did not have a background in physics, calculus, and statistics, which the examiner determined were the most difficult courses in college. The examiner found that the Veteran could function in the social science field and could function in a field that would be less strenuous. The examiner noted that the Veteran had not worked since he left active duty as he was always in school. It was found that the Veteran was able to work fairly well most of the time. His performance may be affected if he is under severe stress, such as speed and accuracy, but he would still be able to perform. A June 2017 VA examination noted that the Veteran experienced intermittent bilateral shoulder pain triggered by overuse and movements. The examiner found that the Veteran's bilateral shoulder disorder did not impact his ability to perform any type of occupational task. Similarly, June 2017 VA examinations indicated that the Veteran's skin disorders and scar did not impact his ability to work. As for the Veteran's gastroenteritis, a June 2017 VA examination report noted that the Veteran's condition was stable and that he had no current symptoms. There was no functional impairment caused by the gastroenteritis. A June 2017 VA back examination noted that the Veteran experienced constant low back pain with intermittent numbness and tingling down his right leg. The back pain worsened with movements, like bending forward. He reported that he could not run or lift more than 15 lbs. A June 2017 VA examination report noted that the Veteran experienced intermittent bilateral plantar pain with walking or running. He reported that he could not stand more than 15 minutes or run. In August 2017, Dr. G. opined that the Veteran could not sustain the stress from a competitive work environment or be expected to engage in gainful activity due to his generalized anxiety disorder. The examiner explained that his inconsistent mood would create problems in his work life. His nervousness, worrying, irritability, and anxiety issues created a safety hazard on the job. He would also struggle with appropriate work interaction due to his paranoia. Moreover, his physical signs of depression included extreme fatigue, hypersomnia, appetite issues, weight fluctuation, and emotional outbursts. Such physical signs of depression interfered with his daily work. It was also noted that his suicidal ideation caused fatigue and lack of concentration. Dr. G. noted that at least three days per month the Veteran's unspecified anxiety disorder would cause him to miss work or leave work early. He was also unable stay focused at least seven hours during an eight hour workday. The Veteran would also respond to normal pressures and constructive criticisms of a job by displaying anger. The Veteran submitted a February 2018 medical opinion from M.B., M.D. Dr. B. reviewed the VA examination reports and noted the manifestations of the Veteran's service-connected disorders. The Veteran stated that he alternated between sitting in a recliner, standing, and lying down because he could not do any activity for more than five minutes without significant pain. He had to sit with his legs elevated due to his back and leg pain. He also relied on his cousin and uncle to do household chores and outside work because the pain from his feet, back, and legs made even the most common household activity challenging. He reported tiredness throughout the day due to problems falling asleep and staying asleep. His chronic sleep impairment resulted in problems concentrating, focusing, and remembering things. He needed reminders for many daily tasks and had to frequently pause/rewind when watching television. He endorsed panic attacks and isolation episodes that occurred twice per week. They were severe enough that he was unable to care for his children during such times. He would lock himself in the room because he didn't want anyone to see him cry or have a panic attack. Dr. B. found that the Veteran would be able to stand, sit, walk, and/or stoop for less than two hours per day. He could lift or carry less than 10 lbs. consistently. It was also found that due to the Veteran's service-connected disorders, the Veteran would have to leave work early more than three days per month, would not be able to remain focused for seven hours a day, and would need more than one additional break during the day. Therefore, Dr. B. stated that the Veteran would be unable to maintain substantial gainful employment as a result of his service-connected disorders. The Veteran submitted an April 2018 vocational opinion from R.B., Rh.D. Dr. B. reviewed the Veteran's claims file, including the VA examination reports. Based on the evidence, Dr. B. concluded that the Veteran was unable to sustain any work activity at a substantial gainful activity level. He was limited to no more than sedentary work due to his physical limitations. He could not attend and concentrate regularly even for simple unskilled work. An April 2021 VA examination report noted that the Veteran quit working as a security guard because of feet pain. He returned to working as a security guard in July 2019. He cried every day at work. His workday consisted sitting at a desk most of the day and completing two patrols every shift. The patrols caused feet pain. A June 2021 VA back examination noted that the Veteran's lumbar spine disorder was manifested by constant right leg tightness and numbness, as well as tightness and stiffness in the back that occurred 85 percent of the time. He was unable to move his back during flare-ups, which occurred weekly. The flare-up occurred when he lifted anything and when he tried to cut the grass. The examiner determined that the Veteran's lumbar spine disorder impacted his ability to work. He missed 1 week of work over the last 12 months due to his lumbar spine disorder. It was noted that he could not lift anything over 15 lbs. Pushing/pulling also increased his lumbar spine pain, even if the object is less than 10 lbs. He stumbled because of weakness and tingling of the right leg. The examiner noted that his equilibrium was off. In a September 2021 statement, the Veteran reported that the only job he held since service was as a security guard. He was employed from July 2018 to May 2019 and from July 2019 to July 2021. He reported that he was recently fired because he wasn't allowed to reduce his hours. He stated that he started working as a security guard to repay a tax debt and to cover household expenses. He stated that he forced himself to work even with the constant feet and back pain because of his financial obligations. The Veteran spent most of his time seated while at work, but that increased his back pain. He had issues with his supervisor due to his employer's unwillingness to reduce his hours. He stated that at times he went to the bathroom to cry because he felt overwhelmed by the pain, anxiety, and fatigue. His chronic sleep impairment resulted in tiredness and problems focusing. Based on the foregoing, and resolving all doubt in favor of the Veteran, the Board finds that the service-connected disorders rendered him unable to maintain substantially gainful employment consistent with his education and occupational background. In this regard, the Veteran was employed as a security guard following his separation from service. He explained that that he forced himself to work in order to repay a tax debt. He quit the job at least twice during the appeal period because of his inability to fulfill his duties as a security guard. He couldn't work the number of hours requested by his employer because of the constant back and feet pain. He consistently described significant physical limitations due to his service-connected pes planus, lumbar spine disorder, and lower extremity radiculopathy. The Veteran was limited in how many hours he could sit during a workday and had to alternate positions due to back pain. Moreover, his unspecified anxiety disorder impacted his ability to handle a stressful work environment, concentrate, and remember tasks. The Veteran attended school throughout the appeal period and majored in criminal justice and computer science. However, the records showed that he did not complete the programs and/or flunked out. In sum, the Board is satisfied that the service-connected disabilities have been so severe as to render the Veteran unable to maintain any form of substantially gainful employment consistent with his education and occupational background throughout the entire period on appeal. Accordingly, a TDIU is warranted. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. McKinley, 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.