Citation Nr: 1319285 Decision Date: 06/13/13 Archive Date: 06/21/13 DOCKET NO. 10-01 169 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Winston-Salem, North Carolina THE ISSUE Entitlement to a total disability based on individual unemployability (TDIU) due to service-connected disabilities. ATTORNEY FOR THE BOARD Rutkin, Joshua M. INTRODUCTION The Veteran served on active duty from February 1966 to February 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 210 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina, . The Board remanded this issue in October 2012 for further development, and it now returns for appellate review. The Veteran submitted additional evidence after a February 2013 Supplemental Statement of the Case (SSOC) was issued, and waived initial consideration of this evidence by the agency of original jurisdiction (AOJ) in accordance with 38 C.F.R. § 20.1304(c) (2012) (providing that any pertinent evidence accepted directly at the Board must be referred to the AOJ for initial review unless this procedural right is waived by the appellant). Therefore, the Board may proceed with appellate review. See id. A review of the Virtual VA paperless claims processing system does not reveal any additional documents pertinent to the present appeal. FINDINGS OF FACT 1. The Veteran does not have a service-connected disability rated as 60 percent or more disabling, and does not have a combined disability rating of 70 percent or more. 2. The combined impact of the Veteran's service-connected disabilities is not sufficiently incapacitating as to prevent him from obtaining and maintaining substantially gainful employment in a sedentary capacity. CONCLUSION OF LAW The criteria for entitlement to a TDIU have not been met on a schedular basis, and referral for extraschedular consideration is not warranted. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.3, 4.15, 4.16, 4.18, and 4.19 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION In this decision, the Board will discuss the relevant law which it is required to apply. This includes statutes enacted by Congress and published in Title 38, United States Code ("38 U.S.C.A."); regulations promulgated by VA under the law and published in the Title 38 of the Code of Federal Regulations ("38 C.F.R.") and the precedential rulings of the United States Court of Appeals for the Federal Circuit (Federal Circuit) (as noted by citations to "Fed. Cir.") and the United States Court of Appeals for Veterans Claims (Court) (as noted by citations to "Vet. App."). The Board is bound by statute to set forth specifically the issue under appellate consideration and its decision must also include separately stated findings of fact and conclusions of law on all material issues of fact and law presented on the record, and the reasons or bases for those findings and conclusions. 38 U.S.C.A. § 7104(d) (West 2002); see also 38 C.F.R. § 19.7 (2012) (implementing the cited statute); see also Vargas-Gonzalez v. West, 12 Vet. App. 321, 328 (1999); Gilbert v. Derwinski, 1 Vet. App. 49, 56-57 (1990) (the Board's statement of reasons and bases for its findings and conclusions on all material facts and law presented on the record must be sufficient to enable the claimant to understand the precise basis for the Board's decision, as well as to facilitate review of the decision by courts of competent appellate jurisdiction. The Board must also consider and discuss all applicable statutory and regulatory law, as well as the controlling decisions of the appellate courts). I. The Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (2000) (codified as amended at 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5107 (West 2002), sets forth VA's duty to notify and assist claimants in substantiating a claim for VA benefits. See 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). Under the VCAA, when VA receives a complete or substantially complete application for benefits, it is required to notify the claimant and his representative, if any, of any information and medical or lay evidence that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b). In order to satisfy its duty to notify the claimant under the VCAA, the United States Court of Appeals for Veterans Claims (Court) held that VA must inform the claimant of any information and 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, 187 (2002). All notice under the VCAA should generally be provided prior to an initial decision on a claim by the agency of original jurisdiction (AOJ). Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). However, a delay in timing of the notice is "cured," and therefore harmless, when a fully compliant VCAA notification letter is followed by readjudication of the claim (such as through issuing a statement of the case or supplemental statement of the case) after the claimant has had an opportunity to submit additional evidence. See Mayfield v. Nicholson, 499 F.3d 1317, 1323 (Fed. Cir. 2007); Prickett v. Nicholson, 20 Vet. App. 370 (2006). This issue of entitlement to a TDIU stems from the rating decision granting service connection claim for PTSD. The Veteran appealed the initially-assigned rating. In his May 2010 notice of disagreement (NOD), he also raised the issue of entitlement to a TDIU. In Rice v. Shinseki, 22 Vet. App. 447, 453 (2009), the Court held that a request for TDIU is not a separate claim for benefits, but rather involves an attempt to obtain an appropriate rating for a disability or disabilities, either as part of the initial adjudication of a claim or as part of a claim for increased compensation. Moreover, in Goodwin v. Peake, 22 Vet. App. 128, 136 (2008), the Court held that in cases where service connection has been granted and an initial disability rating and effective date have been assigned, the typical service- connection claim has been proven and thus section 5103(a) notice is no longer required because the purpose that the notice is intended to serve has been fulfilled. Significantly, the United States Supreme Court held in Shinseki v. Sanders 556 U.S. 396, 407, 410 (2009) that the "rule of prejudicial error" requires a case-by-case determination as to whether the error in question was harmless, and that it is the burden of the claimant to show that the error in question was harmful by at least providing an explanation as to how the error caused harm. See also 38 U.S.C.A. § 7261(b)(2) (West 2002). Thus, the Board must consider the specific facts of a veteran's case to determine whether he has actually been prejudiced by any notice error. The Court has provided guidance in making this determination. Specifically, in Mayfield v. Nicholson, 19 Vet. App. 103, 121 (2005), rev'd on other grounds, Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006), the Court held that lack of prejudicial harm may be shown in three ways with regard to VCAA notice errors: (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. A June 2011 statement of the case (SOC) set forth the regulations governing entitlement to TDIU, and also provided the regulations pertaining to the Veteran's and VA's respective responsibilities for obtaining records on his behalf. The October 2009 VCAA notice letter addressing the Veteran's service connection claim for PTSD likewise provided such notice, and also informed the Veteran of how VA determines the degree of disability. Accordingly, the Veteran could reasonably be expected to know the requirements for showing entitlement to a TDIU and his and VA's respective responsibilities for obtaining evidence on his behalf. See Mayfield, 19 Vet. App. at 121. He has had ample opportunity to submit additional information and evidence in support of his appeal prior to readjudication of this issue in a number of SSOC's. Thus, any VCAA notice error was harmless. See id.; see also Sanders, 556 U.S. at 407, 410. VA's duty to assist under the VCAA includes helping the claimant to obtain service treatment records and other pertinent records, as well as providing an examination or obtaining a medical opinion when such is necessary to make a decision on the claim. See 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c). The Veteran's service treatment records and VA medical records are in the claims file. Private medical records identified by the Veteran have also been associated with the file. He has not identified any other records or evidence that remains outstanding relevant to the issue on appeal. Thus, the duty to obtain relevant records on the Veteran's behalf is satisfied. See 38 C.F.R. § 3.159(c). The duty to assist also includes providing a medical examination or obtaining a medical opinion when such is necessary to make a decision on the claim, as defined by law. See 38 U.S.C.A. § 5103A; 38 C.F.R. §§ 3.159(c)(4), 3.326(a); McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). However, unless the claimant challenges the adequacy of the examination or opinion, the Board may assume that the examination report and opinion are adequate, and need not affirmatively establish the adequacy of the examination report or the competence of the examiner. Sickels v. Shinseki, 643 F.3d, 1362, 1365-66 (Fed. Cir. 2011) (holding that although the Board is required to consider issues independently raised by the evidence of record, the Board is still "entitled to assume" the competency of a VA examiner and the adequacy of a VA opinion without "demonstrating why the medical examiners' reports were competent and sufficiently informed"); see also Rizzo v. Shinseki, 580 F.3d 1288, 1290-1291 (Fed. Cir. 2009) (holding that the Board is entitled to assume the competency of a VA examiner unless the competence is challenged). Id. In November 2012, a VA general examination and a VA psychiatric examination were performed to address the impact of the Veteran's service-connected disabilities on his ability to work. The examination reports are adequate for deciding this issue, as the examiners reviewed the claims file and pertinent medical history, examined the Veteran, recorded the clinical findings, and provided clear explanations for the opinions stated which are consistent with the examiners' findings and the credible evidence of record. See Monzingo v Shinseki, 26 Vet. App. 97, 107 (2012) (holding that "examination reports are adequate when, as a whole, they sufficiently inform the Board of a medical expert's judgment on a medical question and the essential rationale for that opinion" even when the rationale does not explicitly "lay out the examiner's journey from the facts to a conclusion") (citing Acevedo v. Shinseki, 25 Vet. App. 286, 293 (2012) (noting that the law imposes no reasons-or-bases requirement on examiners)); see also D'Aries v. Peake, 22 Vet. App. 97, 104 (2008) (holding that an examination is adequate when it is based on consideration of the claimant's medical history and describes the disability in sufficient detail so that the Board's evaluation of the disability will be a fully informed one). There are no apparent inconsistencies or ambiguities in the examination reports, and the Veteran has not challenged their adequacy or thoroughness, or the competency of the examiners. See Sickels, 643 F.3d at 1365-66; Rizzo, 580 F.3d at 1290-1291. Accordingly, VA's duty to obtain a VA examination and opinion is satisfied. See 38 C.F.R. §§ 3.159(c)(4); 3.326(a); McLendon, 20 Vet. App. at 83; Barr, 21 Vet. App. at 312. In sum, VA's duty to notify and assist under the VCAA has been satisfied. The Veteran has had ample opportunity to participate in the development of his claim. See Arneson v. Shinseki, 24 Vet. App. 379, 389 (2011) (citing Overton v. Nicholson, 20 Vet. App. 427, 435 (2006) (finding that any error depriving a claimant of "a meaningful opportunity to participate effectively in the processing of his or her claim . . . . must be considered prejudicial")). Any defect in the notice or assistance provided did not affect the outcome of this claim or compromise the "essential fairness of the adjudication," as shown in the above discussion. See Mayfield v. Nicholson, 19 Vet. App. 103, 116 (2005), rev'd on other grounds, Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). Thus, any error in the notice or assistance provided was harmless, and no prejudice exists. See Shinseki v. Sanders 556 U.S. 396, 407, 410 (2009) (holding that the "rule of prejudicial error" requires a case-by-case determination as to whether the error in question was harmless, and that it is the burden of the claimant to show that the error was harmful by at least providing an explanation as to how the error caused harm); see also 38 U.S.C.A. § 7261(b)(2) (West 2002). Accordingly, the Board may proceed with appellate review. II. Procedural Due Process The Board remanded this issue in October 2012 for further development. In Stegall v. West, 11 Vet. App. 268, 271 (1998), the Court held that a remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with its remand instructions, and imposes upon VA a concomitant duty to insure compliance with the terms of the remand. See also D'Aries v. Peake, 22 Vet. App. 97, 105 (2008) (holding that only substantial rather than strict compliance with the Board's remand directives is required under Stegall). The Board's remand directives to obtain VA examinations and opinions addressing the combined effect of the Veteran's service-connected disabilities on his ability to work, and then to readjudicate this issue and provide an SSOC, have been satisfied, as shown in the above discussion regarding VA's duty to assist under the VCAA. Accordingly, there has been compliance with the Board's remand directives. See id. III. Analysis The Board has thoroughly reviewed all the evidence in the claims file, and has an obligation to provide an adequate statement of reasons or bases supporting its decision. See 38 U.S.C.A. § 7104 (West 2002); Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). While the Board must review the entire record, it need not discuss each piece of evidence. See id. The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the claimant). The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Caluza v. Brown, 7 Vet. App. 498, 506 (1995) The standard of proof to be applied in decisions on claims for veterans' benefits is the benefit-of-the-doubt rule set forth in 38 U.S.C.A. § 5107 (West 2002). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See 38 C.F.R. § 3.102. When the evidence is in relative equipoise, the claimant prevails. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The preponderance of the evidence must weigh against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). The Board must assess the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). This evaluation generally involves a three-step inquiry. First, the Board must determine whether the evidence is competent. See, e.g. See Jandreau v. Nicholson, 492 F. 3d 1372, 1376-77 (Fed. Cir. 2007). Second, the Board must determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007) (observing that once evidence is determined to be competent, the Board must determine whether such evidence is also credible). Third, the Board must assess the probative value and weight of the evidence in light of the entire record. Gonzales, 218 F.3d at 1380-81. As observed by the Federal Circuit, lay evidence must "demonstrate some competence." See King v. Shinseki, 700 F.3d, 1339, 1345 (Fed. Cir. 2012) (citing 38 U.S.C.A. § 5107(b) and 38 C.F.R. § 3.307(b)) (internal quotation marks omitted). The Board may therefore discount the probative value of lay evidence if it finds such evidence not to be competent. See id. (affirming the Court's finding that the Board did not improperly discount the probative value of a lay opinion in finding a medical expert's opinion more probative on the issue of medical causation); see also Layno v. Brown, 6 Vet. App. 465, 469 (1994) (holding that in order for testimony to be probative of any fact, the witness must be competent to testify as to the facts under consideration). However, the Board may not "categorically" require medical evidence or disregard lay evidence without first assessing its competence. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (holding that it was error in a cause-of-death claim to find "categorically" that a medical opinion was required to prove a nexus between the Veteran's service-connected mental disorder and his drowning death, and likewise to reject categorically the claimant's testimony on this issue as not competent simply because she was a lay person); see also Kahana v. Shinseki, 24 Vet. App. 428, 434 (2011) (holding that the Board erred in categorically rejecting lay evidence without analyzing and weighing it). Importantly, lay statements submitted by or on behalf of a claimant can be competent with respect to both the diagnosis and the etiology or cause of a disability. See Davidson, 581 F.3d at 1316. Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. See 38 C.F.R. § 3.159(a)(2); Layno, 6 Vet. App. at 469 (holding that lay testimony is not competent to prove that which would require specialized knowledge, training, or medical expertise). Lay evidence is competent if it is provided by a person who has first-hand knowledge of facts or circumstances, or conveys matters that can be observed and described by a lay person. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005) (holding that appellant was competent to testify as to factual matters of which he had first-hand knowledge, such as experiencing pain in his right hip and thigh in service, reporting to sick call, being placed on limited duty, and undergoing physical therapy). For example, the Court has held that a lay person is competent to diagnose a disease with "unique and readily identifiable features" such as varicose veins. Barr v. Nicholson, 21 Vet. App. 303, 309 (2007). Similarly, the Court has found a lay person competent to identify tinnitus and flat feet, which are disorders that can be identified based on lay observation alone. See Charles v. Principi, 16 Vet. App. 370 (2002) (tinnitus); Falzone v. Brown, 8 Vet. App. 398 (1995) (flatfeet). However, lay testimony is not competent with respect to determinations that are "medical in nature" or require medical knowledge due to their complexity. See Barr, 21 Vet. App. at 309. For example, the Court held that a claimant was not competent to determine whether he had rheumatic fever, which was a more medically complex condition. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). The Federal Circuit has held that lay evidence may be competent and sufficient to establish a diagnosis of a condition in the following circumstances: (1) when the condition is simple, such as a broken leg, as opposed to when the condition is more complex, such as a form of cancer; (2) when the layperson is reporting a contemporaneous medical diagnosis, or; (3) when lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F. 3d 1372, 1377 & n4 (Fed. Cir. 2007). Competent medical evidence, as distinguished from lay evidence, is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. 38 C.F.R. § 3.159(a)(1). Competent medical evidence may include statements conveying sound medical principles found in medical treatises. Id. It would also include statements contained in authoritative writings such as medical and scientific articles and research reports or analyses. Id. The competency of evidence differs from the weight assigned to the evidence, which varies according to its credibility, probative value, and relationship to other items of evidence. See Layno, 6 Vet. App. at 469 (holding that the weight and credibility of testimony, as distinguished from its competency, is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted); accord Rucker v. Brown, 10 Vet. App. 67, 74 1997); see also Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (holding that the Board has the "authority to discount the weight and probity of evidence in the light of its own inherent characteristics in its relationship to other items of evidence"); Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (stating that "although interest may affect the credibility of testimony, it does not affect competency to testify."). The Board discounts the weight of evidence it finds not to be credible. See Washington, 19 Vet. App. at 368 (noting that the witness's credibility affects the weight to be given to his testimony). In determining whether statements submitted by a veteran are credible, the Board may consider their internal consistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. at 711, aff'd, 78 F.3d 604 (Fed. Cir. 1996) (per curiam) (table). Further, the Federal Circuit has held that while the absence of contemporaneous medical records does not, in and of itself, render lay testimony not credible, the Board may weigh the absence of contemporaneous records when assessing the credibility of lay evidence. See Buchanan, 451 F.3d at 1336 ("Nor do we hold that the Board cannot weigh the absence of contemporaneous medical evidence against the lay evidence of record."). Moreover, although the Board cannot reject a claimant's statements merely because he is an interested party, the claimant's interest may affect the credibility of his testimony when considered in light of the other factors. See Cartright, 2 Vet. App. at 25; accord Buchanan, 451 F.3d at 1337 (holding that "the Board, as fact finder, is obligated to, and fully justified in, determining whether lay evidence is credible in and of itself, i.e., because of possible bias . . . ."). Total disability will be considered to exist 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. § 4.15. To establish a total disability rating based on individual unemployability, there must be impairment so severe that it is impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. Substantially gainful employment is defined as work which is more than marginal and which permits the individual to earn a living wage. Moore v. Derwinski, 1 Vet. App. 356 (1991). In making such a determination, the central inquiry is whether the Veteran's service-connected disabilities alone are of sufficient severity to produce unemployability. Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Total disability ratings for compensation may be assigned, where the schedular rating is less than 100 percent, 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 one or more service-connected disabilities without regard to advancing age. See 38 C.F.R. §§ 3.341(a), 4.16(a). If unemployability is the result of only one service-connected disability, this disability must be ratable at 60 percent or more. See 38 C.F.R. § 4.16(a). If it is the result of two or more service-connected disabilities, at least one must be ratable at 40 percent or more, with the others sufficient to bring the combined rating to 70 percent or more. Id. Disabilities of one or both upper extremities, or one or both lower extremities, including the bilateral factor, disabilities resulting from a common etiology or a single accident, and disabilities affecting a single body system such as orthopedic disabilities, will be considered as one disability for TDIU purposes. Id. Service connection has been established for PTSD, rated as 50 percent disabling, residuals of a gunshot wound to the right thigh, rated as 10 percent disabling, residual scarring of the right thigh, rated as 10 percent disabling, and degenerative arthritis of the right hip, rated as 10 percent disabling. The combined evaluation of his service-connected disabilities is 60 percent. See 38 C.F.R. § 4.25 (2012). Thus, the schedular criteria for entitlement to TDIU have not been met as the Veteran does not have a service-connected disability rated as 60 percent or more, or a combined rating of 70 percent or more. See id. Although the Veteran's service-connected disabilities do not meet the schedular criteria for TDIU consideration, 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(b). Rating boards will refer to the Director of the Compensation and Pension Service for extra-schedular consideration all cases of veterans who are unemployable by reason of service connected disabilities but who fail to meet the percentage requirements set forth in 38 C.F.R. § 4.16(a). The Veteran's service-connected disabilities, employment history, educational and vocational attainment, and all other factors having a bearing on the issue must be addressed. 38 C.F.R. § 4.16(b). The preponderance of the evidence shows that the Veteran's service-connected disabilities, whether considered separately or in their combined effects, are not sufficiently incapacitating as to prevent him from obtaining and maintaining substantially gainful employment in a sedentary capacity. According to his May 2010 application for TDIU, the Veteran worked as a Mobile Unit Assistant (MUA) from September 1985 to November 2005. He stated that he stopped working due to the pain and weakness in his right thigh and leg associated with his service-connected residuals of a gunshot wound. In a February 2008 statement, he wrote that he drove large trucks and buses with a heavy clutch, and had severe pain and weakness in the thigh. He stated that medications he took for his symptoms had side effects that made it difficult to drive, such as causing dizziness and drowsiness. The Veteran's explanation for his reason to retire does not appear wholly credible. A February 2010 VA examination report reflects that the Veteran stated that he was "forced to retire because [his employer was] cutting back" jobs, and "he was thinking of [retiring] anyway because he had enough years in and was also becoming more irritable and self isolated." See Caluza, 7 Vet. App. at 511 (holding that when determining whether lay evidence is satisfactory, the Board may properly consider, among other things, its consistency with other evidence submitted on behalf of the Veteran); Madden, 125 F.3d at 1480 (observing that "lay evidence which is in fundamental conflict with other lay evidence and is, for that reason, found not credible in a given case, is surely suspect"). Thus, although the Veteran's service-connected disabilities may have affected his employment as a driver, the Board assigns little weight to his contention that he retired due to his service-connected disabilities in assessing their impact on his ability to work. See Washington, 19 Vet. App. at 368 (observing that the witness's credibility affects the weight to be given to his testimony). The medical evidence does not otherwise support the Veteran's contention. A July 2005 private treatment record, dated shortly before his retirement, reflects that the Veteran drove for a living and that using the accelerator and brakes seemed to worsen his discomfort. A December 2005 private treatment record states that the Veteran had a burning sensation in the mid femur and groin area from time to time which did not affect his activities of daily living. It was noted that he could function "fairly well," although "work [made] it worse." A March 2006 VA examination report states that the Veteran drove a van for work and that he would develop a progressively worsening ache in the medial mesal of the right thigh that was triggered with prolonged driving. Sometimes the pain became moderately severe and required him to get out of his truck and walk around. He stated that these flare-ups occurred three times per week and persisted for hours. An August 2006 VA examination report reflects a finding that the Veteran's pain was in the groin and musculature, and not in the right hip. However, his gait was relatively normal. A February 2008 VA scars examination reflects a finding that the Veteran's right thigh scar did not result in limitation of motion or loss of function. In a February 2008 VA examination of the Veteran's right thigh muscles, the examiner stated that the Veteran probably would not be able to drive a van or bus due to right thigh pain. It was also noted that he used a cane when walking long distance. A December 2008 private treatment record shows a diagnosis of sensorimotor axonal polyneuropathy "likely related to [the Veteran's] diabetes." It was noted that he walked three to four times weekly. Private treatment records dated in August 2009 also show diagnoses of sensorimotor axonal polyneuropathy secondary to diabetes which was noted to inhibit some of the Veteran's function, and occasionally slowed or disrupted ambulation. Significantly as it bears upon his employability, service connection has not been established for polyneuropathy or diabetes. A September 2009 VA treatment record reflects that the Veteran's right leg "gave out" and he almost fell the previous week. He denied any significant hip or knee pain, but reported localized pain in the distal right thigh. In a November 2010 VA PTSD examination report, the examiner found that the Veteran had mild to moderate impairment in social, occupational, recreational, and familial adjustment. He had moderate insomnia, moderate anxiety and depression, decreased energy and occasional panic attacks. The examiner concluded that the Veteran had moderate impairment in occupational reliability and productivity. In the November 2012 VA general examination report, the examiner opined after reviewing the claims file and examining the Veteran that his gunshot wound residuals in the right thigh and degenerative joint disease of the right hip would "adversely affect any sustained or strenuous work," but "would allow sedentary or limited employment." The November 2012 VA mental disorders examination report reflects that the Veteran gave a history of graduating from high school but not having significant education after high school apart from on-the-job training to become a machinist. He worked briefly in a bakery and then worked as a machinist from early 1966 to 1985. He began working as a bus and truck driver in 1985 until his retirement in 2005. The examiner noted that there was no evidence that the Veteran had any difficulties in this capacity in terms of job performance. The examiner stated that it appeared that both the Veteran's leg and hip pain as well as his increasing symptoms of PTSD and depression interfered with his ability to work. However, there was no evidence that he was totally incapacitated. The examiner further stated that after consulting with the VA examiner who performed the November 2012 general examination, it appeared that the Veteran could perform sedentary work, but could not perform a job that demanded physical activity such as lifting, carrying, walking, and driving. With regard to the Veteran's mental health, the examiner found that he would have no more than moderate impairment of occupational reliability and productivity from his depression and PTSD. He would be able to tolerate a job that involved relatively low stress and with little need for interaction with others. Thus, the examiner concluded that it was less likely as not that the Veteran would be unable to secure or follow a substantially gainful occupation due to the combined effects of his service-connected disabilities, both physical and psychiatric. The above evidence shows that while the Veteran's right leg symptoms likely prevent him from engaging in work involving physical activity, he can still do sedentary work. The findings of the November 2012 VA examiners are highly probative, as they were made by medical professionals based upon a review of the Veteran's medical history and an examination of him. Moreover, they are generally supported by the evidence of record. Specifically, the evidence shows that the Veteran's right thigh scar and right hip degenerative joint disease impose no functional limitations, and that it is only his right thigh pain and service-connected PTSD that impact his ability to work. With regard to his right thigh pain and weakness, it was the use of a heavy clutch when driving a truck or van that aggravated his symptoms, according to the Veteran's own statements. There is no indication that he could not perform sedentary work that did not require such intensive use of his leg and foot. With regard to his PTSD, the probative evidence shows that it causes moderate impairment in occupational functioning, rather than severe or total impairment. Thus, the VA examiners' opinions are supported by the evidence of record. Indeed, there are no opinions or findings of record by a medical professional suggesting a more severe level of impairment, let alone any opinions that the Veteran's service-connected right thigh disorders or PTSD are sufficiently disabling as to prevent him from working. Thus, the VA opinions finding that the Veteran could still perform sedentary work carry significant probative weight in the Board's determination. Notably, the December 2008 and August 2009 private treatment records reflect that the Veteran has polyneuropathy associated with his service-connected diabetes which also impacts his functioning. Service connection for these disorders has not been established. This evidence shows that the Veteran's functional limitations are not due to his service-connected disabilities alone, which further weighs against entitlement to TDIU. The Board has considered the Veteran's contention that he is unable to work due to his service-connected disabilities, but accords more weight to the findings of the VA examiners who found that he could still perform sedentary work. The VA examiners are medical professionals who have the expertise to make an accurate assessment in this regard, while the Veteran, as a lay person, does not possess such expertise. Thus, his statements are outweighed by the VA examiners' opinions. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012) (affirming the Court's conclusion that the Board did not improperly discount the weight of a lay opinion in finding a medical expert's opinion more probative on the medical issue in question); Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (holding that the Board has the "authority to discount the weight and probity of evidence in the light of its own inherent characteristics in its relationship to other items of evidence"). The Veteran's employment history and educational and vocational background do not otherwise weigh against his ability to perform sedentary work, and he has not submitted any evidence or specific argument as to why he could not work in a sedentary capacity. Indeed, the VA psychiatrist who examined the Veteran in November 2012 considered this history and found that he could still perform sedentary work. In sum, as there is no indication that the Veteran's service-connected disabilities are sufficiently incapacitating as to prevent him from obtaining and maintaining substantially gainful activity in a sedentary capacity, referral for extraschedular consideration of entitlement to TDIU is not warranted. 38 C.F.R. § 4.16(b). Accordingly, the preponderance of the evidence is against the Veteran's claim. Consequently, the benefit-of-the-doubt rule does not apply, and entitlement to a TDIU is denied. See 38 C.F.R. §§ 3.102, 4.3; Gilbert, 1 Vet. App. at 55. ORDER Entitlement to a total disability based on individual unemployability (TDIU) due to service-connected disabilities is denied. ____________________________________________ Vito A. Clementi Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs