Citation Nr: 1006944 Decision Date: 02/25/10 Archive Date: 03/05/10 DOCKET NO. 06-27 370 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Muskogee, Oklahoma THE ISSUES 1. Entitlement to service connection for a heart disorder to include as due to undiagnosed illness and as secondary to exposure to gases from oil fires. 2. Entitlement to service connection for a lung disorder to include as due to an unknown illness and as secondary to exposure to gases from oil fires. 3. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service connected disability. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Nadine W. Benjamin, Counsel INTRODUCTION The Veteran (appellant) served on active duty from September 1986 to August 1991. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma. FINDINGS OF FACT 1. There is no objective evidence corroborating that the Veteran has a heart disorder other than hypertension. 2. The Veteran's hypertension was not manifested in service, or within the first post-service year, and is unrelated to service. 3. The Veteran's diagnosed lung disorder has not been related to his period of service. 4. The Veteran has no service-connected disabilities. CONCLUSIONS OF LAW 1. The criteria for service connection for a heart disorder to include as due to an undiagnosed illness have not been met. 38 U.S.C.A. §§ 1101, 1110, 1112, 1117, 1131, 1137, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.317 (2009). 2. The criteria for service connection for a lung disorder, to include as due to undiagnosed illness have not been met. 38 U.S.C.A. §§ 1110, 1117, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.159, 3.317 (2009). 3. The criteria for entitlement to TDIU have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 2002); 38 C.F.R. § 4.16 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS VCAA As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2009). Proper notice from VA must inform the claimant of any information and medical or lay evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. Quartuccio v. Principi, 16 Vet. App. 183 (2002). This notice must be provided prior to an initial unfavorable decision on a claim by the RO. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). In addition, the notice requirements of the VCAA apply to all five elements of a service-connection claim, including: (1) Veteran status; (2) existence of a disability; (3) a connection between the Veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). Further, this notice must include information that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. Id. at 486. VCAA notice errors are presumed prejudicial unless VA shows that the error did not affect the essential fairness of the adjudication. To overcome the burden of prejudicial error, VA must show (1) that any defect was cured by actual knowledge on the part of the claimant; (2) that a reasonable person could be expected to understand from the notice what was needed; or, (3) that a benefit could not have been awarded as a matter of law. See Sanders v. Nicholson, 487 F.3d 881 (Fed. Cir. 2007). Here, the VCAA duty to notify was satisfied by way of letters sent to the Veteran in March 2005 and August 2007 that fully addressed all notice elements, and the March 2005 letter was sent prior to the initial RO decision in this matter. The letters informed him of what evidence was required to substantiate the claims and of his and VA's respective duties for obtaining evidence. There is no allegation from the Veteran that he has any evidence in his possession that is needed for full and fair adjudication of these claims. Under these circumstances, the Board finds that the notification requirements of the VCAA have been satisfied as to both timing and content. With respect to the Dingess requirements, in August 2007, the RO provided the Veteran with notice of what type of information and evidence was needed to establish a disability rating, as well as notice of the type of evidence necessary to establish an effective date. With that letter, the RO effectively satisfied the remaining notice requirements with respect to all issues on appeal. Therefore, adequate notice was provided to the Veteran prior to the transfer and certification of his case to the Board and complied with the requirements of 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b). Next, VA has a duty to assist the Veteran in the development of the claim. This duty includes assisting him in the procurement of service medical records and pertinent treatment records and providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the Veteran. See Bernard v. Brown, 4 Vet. App. 384 (1993). First, the RO has obtained private medical records and records from The Social Security Administration. Next, VA medical opinions pertinent to the issues on appeal were obtained. While an examination regarding the TDIU issue was not conducted, the Veteran has no service-connected disability, thus an examination would not be necessary. Therefore, the available records and medical evidence have been obtained in order to make adequate determinations as to these claims. Significantly, neither the Veteran nor his representative has identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claims that has not been obtained. Hence, no further notice or assistance is required to fulfill VA's duty to assist in the development of the claims. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd, 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002). Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service, and for some disorders manifested within the first post service year. 38 U.S.C.A. §§ 1101, 1110, 1112, 1131, 1137 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2009). Hypertension may be presumed to have been incurred in service if it is manifest to a degree of 10 percent within one year of discharge from service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1137 (West 2002); 38 C.F.R. §§ 3.307, 3.309 (2009). Service connection may also be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2009). Generally, to prove service connection, a claimant must submit (1) medical evidence of a current disability, (2) medical evidence, or in certain circumstances lay testimony, of in-service incurrence or aggravation of an injury or disease, and (3) medical evidence of a nexus between the current disability and the in-service disease or injury. Pond v. West, 12 Vet. App. 341, 346 (1999). Service connection may be established for a Persian Gulf Veteran who exhibits objective indications of chronic disability resulting from an undiagnosed illness which became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2011. 38 C.F.R. §3.317(a)(1) (2009). Objective indications of a chronic disability include both "signs," in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. Disabilities that have existed for six months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a 6-month period will be considered chronic. The 6-month period of chronicity will be measured from the earliest date on which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest. A chronic disability resulting from an undiagnosed illness referred to in this section shall be rated using evaluation criteria from the VA's Schedule for Rating Disabilities for a disease or injury in which the functions affected, anatomical localization, or symptomatology are similar. A disability referred to in this section shall be considered service-connected for the purposes of all laws in the United States. 38 C.F.R. § 3.317(a)(2-5) (2009). Signs or symptoms which may be manifestations of an undiagnosed illness include, but are not limited to: fatigue, signs or symptoms involving the skin, headache, muscle pain, joint pain, neurologic signs or symptoms, neuropsychological signs or symptoms, signs or symptoms involving the respiratory system (upper or lower), sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, or menstrual disorders. 38 C.F.R. § 3.317(b) (2009). Compensation shall not be paid under 38 C.F.R. § 3.317 if (1) there is affirmative evidence that an undiagnosed illness was not incurred during active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War; or (2) there is affirmative evidence that an undiagnosed illness was caused by a supervening condition or event that occurred between the Veteran's most recent departure from active duty in the Southwest Asia theater of operations during the Persian Gulf War and the onset of the illness; or (3) there is affirmative evidence that the illness is the result of the Veteran's own willful misconduct or the abuse of alcohol or drugs. Id. at (c). Recently, the law affecting compensation for disabilities occurring in Persian Gulf War Veterans was amended. See 38 U.S.C.A. §§ 1117, 1118 (West 2002). These changes became effective on March 1, 2002. Essentially, these changes revised the term "chronic disability" to "qualifying chronic disability," and included an expanded definition of "qualifying chronic disability" to include (a) an undiagnosed illness, (b) a medically unexplained chronic multi-symptom illness (such as chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome) that is defined by a cluster of signs or symptoms, or (c) any diagnosed illness that the Secretary determines, in regulations, warrants a presumption of service connection. 38 U.S.C.A. § 1117(a)(2)(B) (West 2002). Although the Veteran has claimed entitlement to service connection to include as due to undiagnosed illness, and while the record shows that he had service in the Persian Gulf, to the extent that these claims are for undiagnosed illness, if a diagnosed illness is identified, such claims have no legal entitlement. 38 U.S.C.A. § 1117 (West 2002); 38 C.F.R. § 3.317 (2009); see Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). The Veteran has been diagnosed as having interstitial fibrosis and has undergone a lung transplant and he has also been noted as having hypertension. Accordingly, those conditions are not, by definition, a manifestation of undiagnosed illness. Service connection under section 3.317 is available only for undiagnosed illnesses attributable to Southwest Asia service during the Persian Gulf War, i.e., those illnesses which "by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis." 38 U.S.C.A. § 1117 and 38 C.F.R. § 3.317. In Combee v. Brown, the United States Court of Appeals for the Federal Circuit held that, when a Veteran is found not to be entitled to a regulatory presumption of service connection for a given disability, the claim must nevertheless be reviewed to determine whether service connection can be established on a direct basis. Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994). Accordingly, the Board will consider whether service connection may be granted for the Veteran's claimed disorders regardless of his Persian Gulf service. The Evidence The service treatment records show that at enlistment in July 1986, the Veteran had no heart or lung disorders. His blood pressure was measured as 130/94; 130/74; and 130/70. He denied any history related to lung or heart problems. During service he was treated in June 1988 for bronchitis. Chest X- rays showed right upper lobe cystic lesion. X-rays taken a few days later that same month showed minimal irregular density of the right upper lobe with no evidence of a cyst. In December 1988, he was noted to have possible reactive airway disease. He also had several blood pressure readings taken during service. None reflect findings that were hypertensive and there is no diagnosis of hypertension. The latest inservice reading in December 1988 was 140/82. A June 1991 report shows that the Veteran was exposed to hazardous material in Kuwait/Saudi Theater between February 25, 1991 and March 23, 1991. It was noted that he was exposed to significant levels or sulfur dioxide and hydrogen sulfide gas due to oil well fires. A service separation examination report is not of record. After service, the Veteran was seen by private clinicians. The first diagnosis of a respiratory problem is noted in March 2000, when he was diagnosed with pulmonary fibrosis. Treatment continued from that time. In May 2000, a list on his medications was noted and no anti-hypertensive was among them. His blood pressure reading was 138/84. In January 2005, his reading was 160/100. In February 2005, his blood pressure was 152/120, and Cardizam was prescribed; in May 2005, he was prescribed Diltiazem and Vasotec. The Veteran was examined by VA in October 2005. The Veteran reported that he served in the Persian Gulf and that before entering service, he had no medical problems. The Veteran stated that during service, he had breathing problems in 1988 or 1989 and was told he had a spot on his lungs. He stated that after service he continued having breathing problems including shortness of breath and cough with congestion in the lungs. It was noted that he was diagnosed with idiopathic pulmonary fibrosis in March 2000 and that he was on the transplant list. He also stated that he was told that he had some valvular malfunction of heart, but denied any chest pain. He denied any other health problems including hypertension. He reported that he used to work in a steel plant, smoked for about six months while he was in the service and drinks alcohol occasionally. Among the medications listed was Enalapril. Examination showed his blood pressure to be as follows: 113/63; 121/72; 108/68; and 105/61. Heart sounds were normal with regular rate and rhythm. A few rales were heard on auscultation at the bases of both lungs. The diagnosis was, idiopathic pulmonary fibrosis on nasal oxygen. The examiner noted that the risk factors for idiopathic pulmonary fibrosis include smoking, environmental pollutants like metal dust and wood dust and chronic aspiration and drugs. The examiner opined that the Veteran's idiopathic pulmonary fibrosis is not likely etiologically related to exposure to sulfur dioxide and hydrogen sulfide fumes due to oil well fires while he was in Desert storm and also not likely due to undiagnosed illness. The examiner stated the opinion that the Veteran's pulmonary fibrosis condition is more likely caused by the exposure to metal dust while working at a steel metal and ceramic plant. In an addendum the examiner discussed diagnostic tests that were performed. Chest X-rays showed interstitial fibrosis type changes of both lungs prominent on the right side. A CT scan showed emphysema changes of both lungs and CT findings were noted to be consistent with pulmonary fibrosis. An electrocardiogram showed sinus tachycardia with a rate on 112 per minute and low voltage QRS complex and an echocardiogram was noted to show sinus rhythm, no evidence of significant pericardial effusion, normal systolic function and an ejection fraction estimated at 55%. In an April 2006 letter a private examiner stated that he had reviewed some medical records from the military which document the Veteran's exposure to sulfur dioxide and hydrogen sulfide gas due to oil well fires between February 25, 1991 and March 23, 1991. The clinician noted that in the near future the Veteran will be undergoing a lung transplant for interstitial fibrosis and that it is possible that this exposure to the oil well fires has contributed to this problem. The same examiner reported in a November 2006 letter that the Veteran has interstitial pulmonary fibrosis. The examiner stated that he had a service report showing the Veteran was exposed to hazardous material consisting of significant levels of sulfur dioxide and hydrogen sulfide gas due to oil well fires between February 25, 1991 and March 23, 1991. The clinician stated that it is possible that this exposure is responsible for his current interstitial pulmonary fibrosis. In June 2007, on a private pre-transplant evaluation, it was reported that the Veteran was noted to have enlarged main pulmonary artery, consistent with pulmonary arterial hypertension, unchanged. In July 2007, he underwent a bilateral lung transplant and a cardiopulmonary bypass. In April 2008, the Veteran was examined by VA. The claims file was reviewed. He reported that he was told that he had an enlarged heart while he was in service. He reported having hypertension about more than 10 years prior and has been taking medication. It was noted that there was no history of stroke or heart attack, no shortness of breath, no dizzy spells and no syncope. There was no history of congestive heart disease or rheumatic heart disease. Blood pressure was noted as 137/92. And ECG was normal. Essential hypertension on medication was diagnosed. The examiner noted that no heart condition was noticed. As to the lung disorder, the Veteran reported having difficulty breathing in service in 1988 and was treated at that time. He stated that he had a bilateral lung transplant in July 2007 and that he was diagnosed with end stage lung disease from idiopathic pulmonary fibrosis and pulmonary hypertension. He stated that he was taking prednisone. Examination showed a well healed transverse curved surgical scar across the anterior chest due to lung transplant. X- rays showed flattening presumed to be due to chronic obstructive pulmonary disease (COPD). The impression was status post sternotomy and COPD. The diagnosis was status post bilateral lung transplant for idiopathic interstitial pulmonary fibrosis. The examiner opined that the Veteran does not have any heart condition as all of the work up was within normal limits and it is was also his opinion that the lung condition is less likely as not caused by or the result of treatment of bronchitis during June 1988 and chest X-ray with borderline cardiac enlargement. The rationale provided was that the risk factors for idiopathic pulmonary fibrosis include chronic tobacco smoking, exposure to environmental pollutants like metal dust, and wood dust, chronic aspiration and drugs. The examiner noted that as it was previously stated by her in the previous VA examination, it was her opinion that the Veteran's pulmonary fibrosis is not related to exposure of sulfur dioxide and hydrogen sulfide fumes due to oil well fires while he was in Kuwait during Desert Storm and was not likely due to undiagnosed illness. The examiner reported that it was her opinion that his pulmonary fibrosis is more likely due to exposure to metal dust at his work while working at a steel metal plant and ceramic plant. It was noted that the lung condition is more likely occupational and work related at a steel metal plant. It was also noted that the Veteran does not have a heart condition. A Heart Disorder to Include Hypertension Based on the above evidence, the Veteran's only confirmed heart disorder has been attributed to a competent medical diagnosis--hypertension; therefore it is not the case that the claimed disability is unattributable to any known clinical diagnosis by medical experts. Service connection is therefore not warranted on the basis of an undiagnosed illness, regardless of whether the Veteran is considered to have had service in the Southwest Asia Theater during the Persian Gulf War. Upon careful review of the evidence, it is found that direct service connection for hypertension has not been established. VA regulations provide that the term hypertension means that the diastolic blood pressure is predominantly 90mm. or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm. or greater with a diastolic blood pressure of less than 90mm. See 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1). The Veteran has been diagnosed with hypertension; however, there is no objective indication in the service treatment records that hypertension was present in service. There was also no evidence that it was present within one year after service and, in fact, the record reflects that it was not diagnosed until many years after service. He had normal readings until 2005 when he was then prescribed medication for elevated blood pressure. This is six years after service discharge. Nor is there any objective medical opinion relating his hypertension to service. In sum, the preponderance of the evidence is against service connection for hypertension. The evidence reflects that hypertension was not manifested in service or to a degree of 10 percent within one year of service discharge, and that it is unrelated to any incident of service origin, including exposure to hazardous material. To the extent that the Veteran may be contending that he has had hypertension since service constitutes an assertion of continuity of symptomatology (see 38 C.F.R. § 3.303), his contention is outweighed by the absence of any contemporaneously recorded medical evidence indicative of hypertension until several years after service. The Board is cognizant that the Veteran contends that he has hypertension that is attributable to service. The Veteran, however, has not been shown to possess the requisite medical training or credentials needed to render a competent opinion as to medical causation. Accordingly, his lay opinions do not constitute competent medical evidence and lack probative value. See Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). Evidence that relates the current disorder to service must be medical unless it relates to a disorder that may be competently demonstrated by lay observation. The Veteran's own statements as to the onset and etiology of his hypertension are not competent, as he is a layperson. See Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992); Grottveit v. Derwinski, 5 Vet. App. 91, 93 (1993). Service connection for hypertension is not warranted. The preponderance of the evidence is against the claim and there is no doubt to be resolved. 38 U.S.C.A. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1991). Lung Disorder The Veteran's service treatment records do show that he was treated in service for respiratory complaints. He has been diagnosed with a respiratory disorder since service as noted above. Thus, the Veteran's lung complaints have been attributed to a competent medical diagnosis-status post lung transplant for idiopathic interstitial pulmonary fibrosis; therefore it is not the case that the claimed disability is unattributable to any known clinical diagnosis by medical experts. Service connection is therefore not warranted on the basis of an undiagnosed illness, regardless of whether the Veteran is considered to have had service in the Southwest Asia Theater during the Persian Gulf War. Upon careful review of the evidence, it is found that direct service connection for a lung disorder has not been established. While there is inservice treatment, and a current finding, the preponderance of the evidence does not show that the current findings are related to service. In this regard, the Board notes that there are differing opinions regarding the etiology of the Veteran's lung complaints. It is the responsibility of the Board to weigh the evidence, including the medical evidence, and determine where to give credit and where to withhold the same and, in doing so, the Board may accept one medical opinion and reject others. Evans v. West, 12 Vet. App. 22, 30 (1998). With regard to medical evidence, an assessment or opinion by a health care provider is never conclusive and is not entitled to absolute deference. A bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record. Miller v. West, 11 Vet. App. 345, 348 (1998). Further, a medical opinion based on speculation, without supporting clinical data or other rationale, does not provide the required degree of medical certainty. Bloom v. West, 12 Vet. App. 185, 187 (1999). The Board is not bound to accept any opinion (from a VA examiner, private physician, or other source) concerning the merits of a claim. Hayes v. Brown, 5 Vet. App. 60 (1993). Rather, it has a duty to assess the weight or credibility of the evidence in the adjudication of the merits. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). Factors that may be considered in assessing the probative value of a medical opinion include a physician's access to the claims file or pertinent evidence, the thoroughness and detail of the opinion, the accuracy of the factual premise underlying the opinion, the scope of examination, the rationale for the opinion offered, the degree of certainty provided, and the qualifications and expertise of the examiner. See generally Prejean v. West, 13 Vet. App. 444, 448-89 (2000); Sklar v. Brown, 5 Vet. App. 140 (1993); Reonal v. Brown, 5 Vet. App. 458 (1993); Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Two VA examination reports document that that there is no relationship between the Veteran's service, including the diagnosis of bronchitis and the exposure to hazardous material, and the current findings. The findings were based on a review of the claims file, and examination of the Veteran. The findings are definitive and are supported by rationale. These findings are highly probative. On the other hand there are two letters from the same private examiner which note the possibility that the current lung disorder is related to service. However, the private examiner's opinions are less probative. The Court has held that a medical opinion based on speculation, without supporting clinical data or other rationale, does not provide the required degree of medical certainty, see Bloom v. West, 12 Vet. App. 185, 187 (1999). Service connection may not be based on speculation or remote possibility. See 38 C.F.R. § 3.102; Obert v. Brown, 5 Vet. App. at 30, 33 (1993) (a medical opinion expressed in terms of "may" also implies "may or may not" and is too speculative to establish a plausible claim); see also Davis v. West, 13 Vet. App. 178, 185 (1999); Bostain v. West, 11 Vet. App. 124, 127-28 (1998). In this case, the private physician discussed merely the possibility that exposure to chemicals could lead to the development of the lung disorder. The Board concludes that such a statement amounts only to speculation; thus, this medical opinion does not have the required degree of medical certainty required for service connection. See Hinkle v. Nicholson, 19 Vet. App. 465 (2005) (medical opinions based on speculation are entitled to little, if any, probative value. While the Veteran is certainly competent to describe the extent of his current symptomatology, there is no evidence that he possesses the requisite medical training or expertise necessary to render him competent to offer evidence on matters such as medical diagnosis or medical causation. Cromley v. Brown, 7 Vet. App. 376, 379 (1995); Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992). However, it has been held that a layperson is competent to testify in regard to the onset and continuity of symptomatology. Heuer v. Brown, 7 Vet. App. 379, 384 (1995); Falzone v. Brown, 8 Vet. App. 398, 403 (1995); Caldwell v. Derwinski, 1 Vet. App. 466 (1991). The Veteran is competent to report symptoms and he has stated that he had breathing problems since service. Thus, once evidence is determined to be competent, the Board must determine whether such evidence is also credible. See Layno v. Brown, 6 Vet. App. 465 (1994) (distinguishing between competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the probative value of the evidence to be made after the evidence has been admitted"). In weighing credibility, VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness. Caluza v. Brown, 7 Vet. App. 498 (1995). While the Veteran has reported continuing problems since service, the first finding of a lung disorder in the record occurs in 2000, some nine years after discharge. Additionally, while the Veteran's post service medical records reflect his report of past episodes of breathing problems both during and after service, the records themselves contain no corresponding objective findings of a chronic disability respiratory condition to corroborate the Veteran's subjective symptomatology. During the Veteran's 9 years post service, there is no respiratory disorder recorded. As such, the Board finds the records of treatment to be more probative than the Veteran's contentions. As such, his statements that he experienced such symptoms since service are not deemed credible. Given that, of the evidence is against the Veteran's claim. TDIU A total disability rating for compensation purposes may be assigned on the basis of individual unemployability: that is, when the disabled person, in the judgment of the rating agency, is unable to secure or follow a substantially gainful occupation as a result of service connected disabilities. In such an instance, if there is only one such disability, it must be rated at 60 percent or more; if there are two or more 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. 38 C.F.R. § 4.16(a). Where these percentage requirements are not met, entitlement to the benefit on an extraschedular basis may be considered when the Veteran is unable to secure and follow a substantially gainful occupation by reason of service connected disabilities, and consideration is given to the Veteran's background including his employment and educational history. 38 C.F.R. §§ 3.321(b), 4.16(b); see also Fanning v. Brown, 4 Vet. App. 225 (1993). The Veteran is not service-connected for any disability, and therefore, entitlement to TDIU is not warranted. ORDER Service connection for lung disorder to include as due to undiagnosed illness and as secondary to exposure to gases from oil fires is denied. Service connection for a heart disorder to include as due to an unknown illness and as secondary to exposure to gases from oil fires is denied. Entitlement to TDIU is denied. ____________________________________________ F. JUDGE FLOWERS Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs