Citation Nr: 1319801 Decision Date: 06/19/13 Archive Date: 06/27/13 DOCKET NO. 05-04 275 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUE Entitlement to a total disability rating (evaluation) based on individual unemployability due to service-connected disabilities (TDIU). REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant (Veteran) ATTORNEY FOR THE BOARD C. Ferguson, Counsel INTRODUCTION The Veteran, who is the appellant in this case, had active service from February 1972 to June 1980. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2003 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. The Board has reviewed the Veteran's physical claims file, as well as the electronic file on the "Virtual VA" system, to ensure a complete review of the evidence in this case. In June 2009, the Veteran, accompanied by his representative, testified at a personal hearing (Travel Board) before the undersigned Veterans Law Judge (VLJ) in Montgomery, Alabama. A transcript of the hearing has been associated with the record. In Bryant v. Shinseki, 23 Vet. App. 488 (2010), the United States Court of Appeals for Veterans Claims (Court) held that 38 C.F.R. § 3.103(c)(2) requires that the VA employee who conducts a hearing fulfill two duties to comply with the above the regulation. These duties consist of (1) the duty to fully explain the issues and (2) the duty to suggest the submission of evidence that may have been overlooked. In this case, the undersigned VLJ identified the issues on appeal at that time, which included the issue of entitlement to a TDIU, and posed several questions during the course of the hearing in order to solicit additional information from the Veteran regarding the symptomatology and treatment associated with the service-connected disabilities and the impact of the Veteran's service-connected disabilities on the ability to work. The representative acknowledged that the Veteran did not meet the schedular criteria for a TDIU and asked the Board to consider the award of a TDIU on an extraschedular basis. See Board hearing transcript, page 23; see also Dalton v. Nicholson, 21 Vet. App. 23, 30 (2007) (Court was convinced that appellant had demonstrated actual knowledge of the information and evidence necessary to establish the claim). The undersigned also advised the Veteran that further medical examination of the service-connected disabilities may be ordered to obtain more contemporaneous evidence of their current severity. Pursuant to the Board's August 2009 remand directive, medical examinations were provided in June 2010. In light of the foregoing actions, the Board finds that the undersigned VLJ sufficiently explained the issue on appeal and suggested that additional evidence be obtained regarding the current severity of the Veteran's service-connected disabilities as causing occupational impairment (i.e., a contemporaneous medical examination) that may be missing from the record. In a July 2011 decision, the Board denied the issue of entitlement to a TDIU, as well as increased ratings for the Veteran's service-connected disabilities. The Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court), and the decision was partially vacated pursuant to a September 2011 Joint Motion for Partial Remand (JMR or joint motion). The parties requested that the Court vacate the portion of the Board's July 2011 decision denying a TDIU and remand the matter so the Board could provide further discussion regarding whether the Veteran could potentially perform substantially gainful employment and whether such employment would provide an annual income that exceeds the poverty threshold for one person. The parties also agreed that the Board should consider and discuss the relevance of the Veteran's educational level, prior vocational training, and work experience. The Court granted the joint motion and remanded the case to the Board. In a May 2012 decision, the Board again denied the Veteran's appeal for a TDIU. The Veteran appealed the Board's decision to the Court, and the decision was vacated pursuant to a JMR. The parties requested that the Court vacate the Board's decision regarding the denial of a TDIU and remand the matter so the Board could provide further discussion of favorable evidence, which consisted of the Veteran's hearing testimony regarding how the service-connected bilateral knee disability affected the ability to work and his account at the June 2010 VA medical examination of knee symptomatology and reported inability to work due to knee pain. In December 2012, the Court granted the joint motion and remanded the matter to the Board for actions consistent with the terms of the joint motion. In April 2013, additional evidence pertinent to the appeal was received. Although the Veteran initially indicated that he wanted the case remanded to the agency of original jurisdiction (AOJ) for its initial consideration of the evidence, the Veteran through the representative subsequently waived the right to initial consideration by the AOJ. See May 2013 Post-Remand Brief. Therefore, the Board will consider the evidence in the first instance during the course of appellate review. The additional treatment records added to the Veteran's Virtual VA file in May 2013 are either duplicative of records already contained in the physical claims file or primarily relate to the medical treatment of non-service-connected disabilities. The service-connected disabilities are primarily referenced in the listed active problems or medical history. The treatment records do not indicate a material change in condition for any service-connected disability since the most recent medical examination, and include no medical opinion evidence regarding the impact of the Veteran's service-connected disabilities on his employability. In consideration of the foregoing, the Board finds that they are not relevant to the appeal and no waiver is needed. FINDINGS OF FACT 1. The Veteran reported that he had two years of college education, has past relevant work experience as a postal worker, and has not worked since 1988. 2. Service connection is currently in effect for a disability of the right eye, rated as 30 percent disabling; hypertension, rated as 20 percent disabling; a scrotal disability, rated as 10 percent disabling; chondromalacia of the right knee, rated as 10 percent disabling; chondromalacia of the left knee, rated as 10 percent disabling; and chalazion with resolved lid cellulitis, rated as zero percent disabling; the combined evaluation is 60 percent; and special monthly compensation has been awarded for loss of use of one eye having only light perception. 3. The Veteran is not unable to secure or follow a substantially gainful occupation solely as a result of his service-connected disabilities. CONCLUSION OF LAW The criteria for the award of a TDIU have not been met. 38 U.S.C.A. §§ 1155, 5103(a), 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.159, 3.340, 3.341, 4.1, 4.3, 4.15, 4.16 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) enhanced VA's duty to notify and assist claimants in substantiating their claims for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and the representative of any information, and any 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). Proper notice from 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. 38 C.F.R. § 3.159(b)(1). 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). If complete notice is not provided until after the initial adjudication, such a timing error can be cured by subsequent legally adequate VCAA notice, followed by readjudication of the claim, as in a Statement of the Case or Supplemental Statement of the Case. Moreover, where there is an uncured timing defect in the notice, subsequent action by the RO which provides the claimant a meaningful opportunity to participate in the processing of the claim can prevent any such defect from being prejudicial. Mayfield v. Nicholson, 499 F.3d 1317, 1323-24 (Fed. Cir. 2007); Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006). The claim for a TDIU is, in essence, a claim for an increased rating. See Rice v. Shinseki, 22 Vet. App. 447 (2009); Norris v. West, 12 Vet. App. 413, 420 (1999). A TDIU claim is an alternative way to obtain a total disability rating without recourse to a 100 percent evaluation under the rating schedule. See, e.g., Parker v. Brown, 7 Vet. App. 116, 118 (1994). In a claim for increase, the VCAA requirement is generic notice, that is, the type of evidence needed to substantiate the claim, namely, evidence demonstrating a worsening or increase in severity of the disability and the effect that worsening has on employment, as well as general notice regarding how disability ratings and effective dates are assigned. Vazquez-Flores v. Shinseki, 580 F.3d 1270 (Fed. Cir. 2009). In a December 2002 notice letter sent prior to the initial denial of the claim, the RO advised the Veteran of the evidence needed to establish a TDIU, and described the types of information and evidence that he should submit in support of the claim. The RO explained what evidence VA was responsible for obtaining or would assist in obtaining on the Veteran's behalf in support of the claim. The RO explained that VA may be able to pay him from the date that VA received the claim if the requested information or evidence was received within one year from the date of the letter. In consideration thereof, the Board finds that the notice letter satisfied VCAA notice requirements for the Veteran's TDIU claim, and there is no outstanding duty to inform the Veteran that any additional information or evidence is needed. During the June 2009 Travel Board hearing, to assist the Veteran, the undersigned asked questions to help direct the Veteran's testimony, and specifically asked questions regarding symptoms and occupational impairment caused by individual service-connected disabilities. The Veteran's representative also asked questions as to how service-connected disabilities impacted or interfered with the Veteran's ability to work. The Veteran testified regarding employability, including dates and reasons for termination of employment, that he had sought employment, the reasons why he was not accepted for employment, and how his individual service-connected disabilities caused impairment of functioning. As the issue of TDIU was fully explained, and there was no indication that evidence was missing or may have been overlooked, the hearing duties under 38 C.F.R. § 3.103 (2012) were fulfilled. See Bryant v. Shinseki, 23 Vet. App. 488 (2010). Additionally, the specific criteria for TDIU, as well as an analysis of the evidence of record against that criteria, and indications of which criteria are not met, were indicated to the Veteran and representative in various adjudications during this appeal, including a February 2009 statement of the case, a March 2011 supplemental statement of the case, and vacated Board decisions in July 2011 and May 2012. In March 2012, the Veteran indicated that he had nothing else to submit in this case. Regarding VA's duty to assist in claims development, the RO afforded the Veteran with multiple VA medical examinations throughout the course of the appeal. The medical examination reports collectively include all relevant findings needed to evaluate fairly the Veteran's appeal for a TDIU. The VA medical examiners obtained a thorough and accurate history regarding the service-connected disabilities and their impact on his former employment as a postal worker. The VA medical examiners also considered the Veteran's reported current symptomatology and performed a thorough examination of the Veteran. In consideration thereof, the Board finds that the VA medical examiners had adequate facts and data regarding the history and current severity of the Veteran's service-connected disabilities. See VAOPGCPREC 20-95 (interpreting that the determination as to whether review of prior medical records is necessary in a particular case depends largely upon the scope of the examination and the nature of the findings and conclusions the examiner is requested to provide, so that in some cases an accurate history by a veteran may be a valid basis for an examination report rather than claims file review); Kowalski v. Nicholson, 19 Vet. App. 171, 177 (2005) (holding that a medical opinion cannot be disregarded solely on the rationale that the medical opinion was based on history given by the veteran). There has been no allegation or indication that there has been a material change in condition of the Veteran's disabilities since the last medical examination. For these reasons, the Board finds that the medical examination reports are adequate for rating purposes, and there is no need for further medical examination. Also, post-service treatment records adequately identified as relevant to the Veteran's appeal have been obtained, or otherwise submitted, and are associated with the record. Records from the Social Security Administration (SSA) were destroyed and are not available. See September 2009 response from SSA. The additional treatment records found in the Virtual VA folder contain no evidence pertinent to the TDIU appeal. The Veteran has not made the RO or the Board aware of any other evidence relevant to the appeal that needs to be obtained. Based on the foregoing, the Board finds that all relevant facts have been properly and sufficiently developed in this appeal and no further development is required to comply with the duty to assist the Veteran in developing the facts pertinent to the claims adjudicated herein. In view of the foregoing, the Board will proceed with appellate review. It is the Board's responsibility to evaluate the entire record on appeal. See 38 U.S.C.A. § 7104(a) (West 2002). The Board has thoroughly reviewed all the evidence in this case. The analysis below focuses on the most 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 veteran). TDIU Legal Criteria 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. § 3.340. If the total rating is based on a disability or combination of disabilities for which the Schedule for Rating Disabilities provides an evaluation of less than 100 percent, it must be determined that the service-connected disabilities are sufficient to produce unemployability without regard to advancing age. 38 C.F.R. § 3.341. Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3. In evaluating total disability, full consideration must be given to unusual physical or mental effects in individual cases, to peculiar effects of occupational activities, to defects in physical or mental endowment preventing the usual amount of success in overcoming the handicap of disability and to the effects of combinations of disability. 38 C.F.R. § 4.15. If the schedular rating is less than total, a total disability evaluation can be assigned based on individual unemployability if a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disability, provided that he has one service-connected disability rated at 60 percent or higher; or two or more service-connected disabilities, with one disability rated at 40 percent or higher and the combined rating is 70 percent or higher. 38 C.F.R. § 4.16(a). For the purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable, (2) disabilities resulting from common etiology or a single accident, (3) disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular-renal neuropsychiatric, (4) multiple injuries incurred in action, or (5) multiple disabilities incurred as a prisoner of war. Id. It is provided further that the existence or degree of non-service-connected disabilities or previous unemployability status will be disregarded where the percentages referred to above for the service-connected disability or disabilities are met and, in the judgment of the rating agency, such service-connected disabilities render a veteran unemployable. Id. Marginal employment shall not be considered substantially gainful employment. For purposes of 38 C.F.R. § 4.16, marginal employment generally shall be deemed to exist when a Veteran's earned annual income does not exceed the amount established by the U.S. Department of Commerce as the poverty threshold for one person. Marginal employment may also be held to exist, on a facts found basis (includes but is not limited to employment in a protected environment such as a family business or sheltered workshop), when earned annual income exceeds the poverty threshold. Consideration shall be given in all claims to the nature of the employment and the reason for termination. Id. A veteran's service-connected disabilities, alone, must be sufficiently severe to produce unemployability. Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). 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 or her age or to any impairment caused by non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. A veteran's employment history, his or her educational and vocational attainment, as well as his or her particular physical disabilities are to be considered in making a determination on unemployability. In order for a veteran to prevail in his claim for TDIU, the record must reflect circumstances, apart from non-service-connected conditions, that place him or her in a different position than other veterans who meet the basic schedular criteria. The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. A high rating in itself is recognition that the impairment makes it difficult to obtain or keep employment. The ultimate question is whether the veteran, in light of his or her service-connected disorders, is capable of performing the physical and mental acts required by employment, not whether he or she can find employment. See Van Hoose v. Brown, 4 Vet. App. 361 (1993). TDIU Analysis In the present case, the Veteran is service connected for a disability of the right eye, rated as 30 percent disabling; hypertension, rated as 20 percent disabling; a scrotal disability, rated as 10 percent disabling; chondromalacia of the right knee, rated as 10 percent disabling; chondromalacia of the left knee, rated as 10 percent disabling; and chalazion with resolved lid cellulitis, rated as zero percent disabling. The combined disability evaluation is 60 percent. Thus, the Veteran has two or more service-connected disabilities; however, he has no service-connected disability rated at 40 percent or higher, and the combined rating for the service-connected disabilities is less than 70 percent. The combined 60 percent rating is not due to a single disability or a combination of disabilities from a common source; therefore, the threshold percentage requirements for the award of a TDIU under the provisions of 38 C.F.R. § 4.16(a) are not met. Although the Veteran has not met the threshold percentage requirements for a schedular TDIU, he may otherwise be entitled to a TDIU if the evidence shows that he is unable to secure or follow a substantially gainful occupation as a result of the service-connected disabilities. 38 C.F.R. § 4.16(b). After careful review of the lay and medical evidence of record, the Board finds that the weight of the evidence is against the award of a TDIU, as explained below. Preliminarily, the Board notes that the Veteran reported that the highest level of education attained was two years of college. On VA Forms 21-8940 (Veteran's Application for Increased Compensation Based on Unemployability) submitted in August 2002 and October 2006, he reported that he previously worked as a postal worker but became too disabled to work in 1988; however, he has provided inconsistent and unreliable statements regarding the reasons why he left his employment with the postal service. On the August 2002 VA Form 21-8940, the Veteran stated that blood pressure and diabetes prevented him from securing or following any substantially gainful occupation and checked "Yes" when asked if the listed disabilities caused him to leave his employment with the postal service. He later wrote, on the October 2006 VA Form 21-8940, that high blood pressure, his knees, and his eyes prevented him from securing or following any substantially gainful occupation and checked "Yes" when asked whether these listed disabilities caused him to leave employment with the postal service. Neither statement, however, is consistent with the evidence contemporaneous to the time that the Veteran left employment with the postal service or other credible evidence of record. Indeed, a June 1988 hospital discharge summary notes that after service the Veteran suffered a back injury while lifting some heavy objects at work. Consistent with a finding that the post-service injury was severe enough to render the Veteran unable to work, the final summary sheet for the Veteran's hospitalization for a herniated nucleus pulposus L5-S1 and lumbar laminectomy lists "workmans compensation" as the insurance company. In an April 1992 letter, a treating medical provider noted that the Veteran had been under his care since December 1988 for an April 1988 on-the-job back injury, which had not improved, and it was his opinion that the Veteran was totally disabled for gainful employment because of the presence of pain at rest and during activity. As this evidence is closer in time to the end of the Veteran's employment with the postal service, it is deemed credible and highly probative in resolving the reason why the Veteran left employment with the postal service in 1988. It is also noted that the SSA, in a September 2000 decision, found that the Veteran had not engaged in substantially gainful activity since April 1988, which is when the Veteran suffered the post-service on-the-job back injury. Additionally, the Veteran testified at the Board hearing that he left his employment with the postal service because of a back disability. See June 2009 Board hearing transcript, page 19. The February 2003 VA medical examiner noted that the history showed that the Veteran stopped working in 1988 after the lumbar disc surgery. This evidence is consistent with, and tends to show, that the Veteran's employment with the postal service ended in 1988 due to a post-service on-the-job related back injury and related treatment; therefore, despite the Veteran's inconsistent assertions to the contrary on the more recent VA Forms 21-8490, which the Veteran made for compensation purposes, the Board finds that the Veteran stopped working in 1988 due to a non-service-connected back disability, and not due to any service-connected disability. The Board also observes that the Veteran has provided inconsistent statements regarding whether he has tried to obtain employment since he became too disabled to work. On both the August 2002 and October 2006 VA Forms 21-8940, the Veteran checked "No" when asked if he had tried to obtain employment since he had become too disabled to work; however, at the Board hearing, the Veteran testified that he had tried to seek employment since leaving the postal service but was turned down because the potential employer discovered his condition and decided that he was a liability and did not hire him. In weighing the statements, the Board finds the Veteran's report that he has not tried to obtain employment since 1988 to be more credible and of greater probative value. Aside from the hearing testimony before the undersigned, the record does not show that the Veteran has tried to obtain employment since leaving the postal service in 1988. The reported inconsistencies on this ancillary factual question further indicate that the histories the Veteran has provided for VA disability compensation purposes are at odds with his own, more contemporaneous histories that were previously given for other purposes including for treatment purposes, and are not credible. In turning to the question of whether the Veteran is unable to obtain or sustain gainful employment due to his service-connected disabilities, the Board notes that the SSA found that the Veteran was unable to perform the requirements of past relevant work due to severe impairment related to (non-service-connected) back pain and surgery, (non-service-connected) headaches, right eye blindness, and (non-service-connected) depression. The SSA decision reflects that the determination of unemployability was based on evidence and findings that included evidence of herniated and bulged discs, diskectomy, increased intensity of back and leg pain since the 1988 accident, daily leg pain (from non-service-connected back disability) with tingling, and revision laminotomy in 1996; in 1998 cervical pain and right leg giving way causing him to fall and hit his head; and in 1999 the Veteran reported that in 1988 he had hurt his back when lifting some mail containers; in August 1999, the Veteran reported sciatica down the right leg, which continued with motion, inability to stand for 10 to 15 minutes to perform a job before he had to sit down due to pain, and the additional symptoms and impairments of hip numbness due to low back disability. The Veteran is service connected for right eye blindness, but is not service-connected for a back disability, headaches, or depression; therefore, the SSA determination indicates that it was the combined effect of the Veteran's service-connected right eye blindness and his non-service-connected back disability, headaches, and depression that had rendered him unemployable; however, the Board notes, that the Veteran's service-connected blindness in the right eye was a disability he had at the time of his discharge from service in 1980 and with which he was able to work for the post office until his low back injury, disability, and surgery caused him to leave the post office where he had worked for several years. The SSA decision was based on evidence outside the scope of the rating period; however, the Board considers all evidence of record as it bears on the question of TDIU, as the Veteran's disability picture and its impact on his employability is viewed in relation to its history. See 38 C.F.R. § 4.1; see also 38 U.S.C.A. § 7104(a) (West 2002) ("Decisions of the Board shall be based on the entire record in the proceeding and upon consideration of all evidence and material of record"); 38 U.S.C.A. § 5107(b) (West 2002) ("Secretary shall consider all information and lay and medical evidence of record in a case"). The Veteran contends that he is entitled to a TDIU on the bases that his service-connected disabilities alone render him unemployable; however, many of the disabilities identified on the VA Forms 21-8940 and specifically mentioned in his statements and during the Board hearing testimony as contributing to his unemployability are not service-connected disabilities. The most impairing disability, that of the low back, is not a service-connected disability. For example, on the August 2002 VA Form 21-8940, the Veteran wrote that blood pressure and diabetes prevented him from securing or following any substantially gainful occupation; however, the Veteran is not service connected for diabetes mellitus. Similarly, on the October 2006 VA Form 21-8940, the Veteran wrote that he was unable to secure or follow substantially gainful occupation due to his high blood pressure, knee disabilities, and back disabilities. Service connection is not in effect for a back disability. SSA disability determination also reflects that non-service-connected headaches and depression were disabilities that contributed to unemployability. Also, at the Board hearing, the Veteran testified how symptoms of both his service-connected disabilities and non-service-connected disabilities interfered with his ability to work. During the hearing, the Veteran reported that symptoms of pain, swelling, aching, and giving way associated with the bilateral knee disability had interfered with his past employment. In addition, the Veteran presented testimony of symptomatology and treatment associated with non-service-connected disabilities of the back, neck, and hands and indicated that the non-service-connected disabilities impacted his employability. See Board hearing transcript, pages 13, 20. Thus, the Veteran's own statements and hearing testimony suggest that he believes that it is the combined effect of his service-connected and non-service-connected disabilities that prevents him from obtaining and/or sustaining gainful employment, rather than the service-connected disabilities alone. Non-service-connected disabilities are not to be considered when determining whether a TDIU is warranted. See Van Hoose, 4 Vet. App. at 363. Treatment records relevant to the rating period show that the Veteran suffers from and is being treated for numerous disabilities, both service-connected and non-service-connected; however, the records primarily show complaint and medical treatment of non-service-connected disabilities such as those involving the back, neck, and a mental disability. See, e.g., June 2002 physical therapy assessment (showing complaint of chronic low back pain); March 2002 neurosurgery note (referencing the anterior cervical decompression and fusion three weeks before); January 2005 VA mental health note (noting the Veteran's report that he was "always" in a lot of pain from back and neck problems). This evidence shows that the Veteran's disability picture for occupational impairment as it relates to the non-service-connected disabilities is of greater severity than the disability picture due to service-connected disabilities. The Board also notes that the treatment records do not contain medical evidence showing that the Veteran is unable to secure or maintain substantially gainful employment due to a single service-connected disability or any combination of the service-connected disabilities standing alone; the competent opinion evidence regarding unemployability is based on various combinations of multiple non-service-connected disabilities, with service-connected disabilities also included as contributors. The collective VA medical examination reports similarly do not show that the Veteran is unemployable due to service-connected disabilities, standing alone. At the February 2003 VA general medical examination, the Veteran reported a surgical history that included multiple surgeries on the back, surgery on the neck, and removal of an abdominal tumor. The Veteran told the VA medical examiner that he had not been able to work since the first lumbar surgery in 1988 because of chronic back pain. Notably, in 1990, the Veteran's low back disability was rated as 60 percent disabling for non-service-connected pension purposes, which indicates severe back disability. Multiple other histories and assessments of record reflect the severity of back disability and symptoms and the impact on employability; indeed, the back disability due to a specific post-service on-the-job injury was the reason the weight of the credible evidence shows the Veteran became unemployable in 1988. When the Veteran underwent medical examination in May 2007, the VA medical examiner evaluated both service-connected and non-service-connected disabilities. Some of the service-connected disabilities (i.e., high blood pressure, scrotal disability, knee pain), as well as non-service-connected disabilities (i.e., low back pain, neck pain, posttraumatic stress disorder), were each noted to have significant effects on the Veteran's occupational activities. The right eye disability, which is the Veteran's most severe service-connected disability (i.e., rated at 30 percent), was noted to have no significant effect on the Veteran's usual occupation or daily activities, which is consistent with the Veteran's work history of having worked at the Post Office full time with this disability until such employment was terminated by the post-service on-the-job back injury. When asked for the reasons for unemployment, the May 2007 VA medical examiner wrote that the Veteran was unable to work due to pain in the knees, low back, neck, and being drowsy due to pain medication. This assessment was based on the Veteran reporting that he took pain medication for the service-connected knee disabilities and scrotal disability, as well as the non-service-connected disabilities of the neck and back. It is notable, and inconsistent with this more recent history presented by the Veteran to the VA compensation examiner for compensation purposes, that the February 2003 VA medical examiner had previously noted that the Veteran's chondromalacia of the knees demonstrated minimal pain on examination, and the Veteran had recovered from the scrotal surgery secondary to the hematoma. At the May 2007 VA medical examination, the Veteran demonstrated bilateral knee pain; however, the genitourinary examination was normal, and the scar on the scrotal wall was non-tender. The Veteran was shown to be in moderate pain secondary to the (non-service-connected) back and neck at that time. This evidence weighs against finding that the Veteran's service-connected disabilities, standing alone, are the reason for the Veteran's unemployability. Pursuant to the August 2009 Board remand directive, the Veteran underwent further medical examination in June 2010. The June 2010 VA medical examiner who evaluated the Veteran's right eye disability noted that the Veteran's (non-service-connected) back disability and (service-connected) knee conditions were the reasons for unemployment. The June 2010 VA medical examiner who evaluated the Veteran's scrotal disability and hypertension noted that "health issues" were the reasons for unemployment and specifically assessed that the Veteran's hypertension, while uncontrolled, had no effects on his usual occupation and daily activities. The statement that "health issues" were the reason for unemployment indicates that the totality of the Veteran's disability picture, which includes both service-connected and various non-service-connected disabilities, were the reasons for unemployment, and weigh against finding that the Veteran is unemployable due to service-connected disabilities, especially in the context of the specific history of unemployability in 1988 due to non-service-connected low back disability caused by a post-service on-the-job work injury for which the Veteran claimed workers compensation. Also, the June 2010 VA medical examiner who evaluated the Veteran's bilateral knee disabilities considered the Veteran's report that knee pain significantly affected his activities of daily living in that he was unable to walk or stand for prolonged periods of time, to perform normal housework or any recreational activities, and to work due to knee pain. On objective examination, the examiner found that the Veteran demonstrated excellent range of motion of the knees bilaterally with full range of motion from 0 to 130 degrees bilaterally, and showed no significant fatigability with repetitive motion. The examiner diagnosed bilateral knee moderate chondromalacia and noted that it was conceivable that knee pain could further limit the Veteran's knee function, but noted that was particularly the case when the Veteran had been on his feet all day. The VA medical examiner's statement, which considered the Veteran's complaint that he was unable to work due to knee pain, indicates that the Veteran's knee disabilities, alone, did not render him unemployable. The Veteran's knee disabilities are not shown to preclude him from performing work at the postal service, or in a similar work environment, that allowed him to sit for all or most of the day. See also January 1981 VA medical examination report (reflecting the Veteran's complaint of bilateral knee pain relieved to some extent by sitting and showing that the Veteran has received vocational training in television and radio repair); 38 C.F.R. § 4.1. The Board has not considered this opinion in isolation as determinative of the question of unemployability, but has considered the opinion as it bears on the question of occupational impact caused by the knee disabilities, in the context of all the other evidence and opinion evidence tending to show the causes of unemployability. The opinion tends to show that the service-connected knee disabilities did not preclude work at the post office, which is consistent with the weight of the evidence showing that the non-service-connected back disability did preclude employment at the post office. The Board has considered the Veteran's Board hearing testimony discussing how his service-connected bilateral knee disability interfered with his past employment at the postal service, as well as the report at the June 2010 VA medical examination that knee pain significantly affected the activities of daily living in that he was unable to walk or stand for prolonged periods of time, perform normal housework or recreational activities, and unable to work due to knee pain. The fact that the Veteran's knee disabilities interfered with his employment/employability is not in dispute. The current 10 percent disability ratings assigned for each knee recognize the average impairment in earning capacity resulting from the disabilities. 38 C.F.R. § 4.1. The knee disabilities specifically manifest in knee pain and some noncompensable limitation of motion. The question presented in this case is whether the Veteran's service-connected disabilities, to include the knee disabilities, prevent the Veteran from securing or following substantially gainful employment apart from age or any non-service-connected disability. The evidence shows that the Veteran has provided inconsistent statements regarding the disabilities that he believes have rendered him unemployable, which undermines his credibility. The Veteran has also indicated on VA Forms 21-8940 that he left employment with the postal service, in part, due to service-connected disabilities, which is not consistent with other, more credible evidence. The more contemporaneous, credible, and probative lay and medical evidence shows that the Veteran left employment with the postal service in 1988 due to a work-related back injury and treatment. The medical records also show that the Veteran has received medical treatment primarily for non-service-connected disabilities throughout the course of the appeal, rather than for service-connected disabilities. The Veteran is not shown by competent opinion to be precluded from performing sedentary work that allows him to sit for prolonged periods due to service-connected disability. The Board finds that the other evidence of record outweighs the Veteran's hearing testimony and report at the June 2010 VA medical examination regarding knee symptomatology and the impact of knee pain on his employability. The record shows that the Veteran has reported two years of college education, is shown to have had some vocational training in the area of television and radio repair, and has a work history that includes his work as a postal worker until 1988 when he suffered an on-the-job back injury and underwent back surgery. The evidence does not show that the Veteran is rendered unemployable due to service-connected disabilities, standing alone. Fore these reasons, the Board finds that the preponderance of the evidence is against the claim; therefore, the benefit of the doubt doctrine is inapplicable. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. ORDER A TDIU is denied. ____________________________________________ J. PARKER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs