Citation Nr: 1324093 Decision Date: 07/29/13 Archive Date: 08/07/13 DOCKET NO. 05-23 711 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Detroit, Michigan THE ISSUES 1. Entitlement to service connection for a psychiatric disorder, to include bipolar disorder. 2. Entitlement to a total disability rating based on individual unemployability. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant and his spouse ATTORNEY FOR THE BOARD D. Whitehead, Counsel INTRODUCTION The Veteran served on active duty from October 1986 to April 1991. This matter comes properly before the Board of Veterans' Appeals (Board) on appeal from rating decisions dated in January 2004 and November 2004 issued by the Department of Veterans Affairs (VA) Regional Office in Detroit, Michigan (RO). FINDINGS OF FACT 1. The Veteran's bipolar disorder did not preexist his military service, was not incurred in service, and is not otherwise related to his period of active military service. 2. The Veteran's service-connected painful back and ankles, and chronic fatigue syndrome disabilities do not render him unable to secure or follow substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for service connection for a psychiatric disorder, to include bipolar disorder, are not met. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. § 3.303 (2012). 2. The criteria for entitlement to a total disability rating based on individual unemployability are not met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.340, 3.341, 4.16 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS VA's Duty to Notify and Assist With respect to the Veteran's claims herein, VA has met all statutory and regulatory notice and duty to assist provisions. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326 (2012). VA's duty to notify has been satisfied. The Veteran was notified via letters dated in May 2002, March 2004, February 2008, in a March 2005 statement of the case, and a September 2009 supplemental statement of the case of the information required to substantiate his claims and of his and VA's respective duties for obtaining evidence. He was also informed regarding how VA determines disability ratings and effective dates. See Dingess v. Hartman, 19 Vet. App. 473, 490-91 (2006) aff'd sub nom. Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007). Although the notice provided in the March 2005 statement of the case and September 2009 supplemental statement of the case were provided after the initial adjudication of his claims, the claims were readjudicated, with the most recent adjudication occurring in a May 2013 supplemental statement of the case. Nothing more is required. VA also has a duty to assist a Veteran in the development of his claims. This duty includes assisting him in the procurement of service treatment records and other pertinent records, and providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The RO has obtained available service treatment records and identified VA and private treatment records. The records associated with his claim for benefits from the Social Security Administration (SSA) have also been included in the record. Additionally, the Veteran has submitted written statements and provided testimony as to his contentions. Moreover, the Veteran has been afforded VA examinations and/or VA opinions have been obtained in this case. Most recently, the claims were remanded so that VA could obtain a medical opinion with regards to the Veteran's psychiatric disability claim. The requested opinion was provided in an April 2013 report. Collectively, the VA examination reports are thorough and adequate upon which to base a decision with regard to the Veteran's claims, as the VA examiners considered all of the pertinent evidence of record, to include pre-service, service, and post-military treatment records, and the statements of the Veteran, and provided a complete rationale for the opinions stated. See Barr v. Nicholson, 21 Vet. App. 303 (2007) (defining adequacy with respect to medical examinations and opinions as those providing sufficient detail so that the Board can perform a fully informed evaluation). 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 for a Psychiatric Disorder The Veteran claims that his currently diagnosed bipolar disorder began during his military service and that he has experienced a continuity of psychiatric symptoms since that time. In the alternative, the Veteran claims that he had a preexisting psychiatric disorder that was aggravated by his active duty service. Generally, service connection may be granted for disability due to a disease or injury that was incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. In addition, service connection may be granted for any disease diagnosed after separation, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In order to establish service connection for a claimed disorder, the following must be shown: (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Hickson v. West, 12 Vet. App. 247, 253 (1999); see also Pond v. West, 12 Vet. App. 341, 346 (1999). Under 38 C.F.R. § 3.303(b), an alternative method of establishing the second and third elements required for service connection is through a demonstration of continuity of symptomatology. However, 38 C.F.R. § 3.303(b), applies to only those chronic diseases, to include psychoses. 38 C.F.R. § 3.309(a); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). However in this case, a diagnosis of a psychosis is not of record. A Veteran is presumed to have been sound upon entry into the military, except as to conditions noted at the time of the acceptance, examination, or enrollment, or where clear and unmistakable evidence demonstrates that the disorder existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C.A. § 1111. As an initial matter, the claims file reflects that the Veteran previously filed a claim for service connection for posttraumatic stress disorder (PTSD), which was adjudicated separately and denied in an October 2002 rating decision. The Veteran did not appeal this decision and the claim for service connection for PTSD is not presently before the Board. Thus, the claim currently on appeal does not include a claim for PTSD. But see Clemons v. Shinseki, 23 Vet. App. 1 (2009) (holding that a claim for service connection for PTSD encompass all psychiatric disorders afflicting a Veteran). Turning to the merits of the claim, the Veteran's service treatment records have been reviewed and are negative for a diagnosis of bipolar disorder. The Veteran's history of a psychiatric hospitalization was noted on his July 1986 enlistment report of medical history. However, on the enlistment examination, the psychiatric examination was normal. Subsequent service treatment records are negative for reports or treatment of any psychiatric symptomatology, but show treatment for an alcohol-related incident. The March 1991 separation report of medical examination shows that the psychiatric examination was normal. The Veteran denied having depression, excessive worry, or nervous trouble of any sort on the associated March 1991 separation report of medical history. Post-military VA treatment records show the earliest evidence of bipolar disorder diagnosis in 1994, at which time he was hospitalized for treatment. An associated December 1995 private psychological history and initial intake report relays that the Veteran was hospitalized at the age of 14 after exhibiting behavior problems and becoming involved in drugs. He was noted to have stabilized after this hospitalization. The Veteran reported that he was without symptoms until 1994 when he was in Germany and discovered that he had to return to the United States. Private treatment records dated in December 1995 and January 1996 associated with the Veteran's in-patient treatment document his report of a long history of psychiatric problems starting when he was 15 years old. The December 1995 record includes his claim that he was given a diagnosis of bipolar disorder during a hospital admission at that age. These records note that he served in the military from 1986 to 1991, and reflect his report that he did well during service. As reflected these records, the Veteran denied any hospitalizations or psychiatric breakdowns while in the military. Private medical records associated with the Veteran's claim for SSA benefits reflect diagnoses of bipolar disorder, attention deficit hyperactivity disorder, and PTSD in September and October of 2001. In a July 2002 statement, the Veteran's sister testified that the Veteran had received a diagnosis of bipolar disorder after his return from the military, a diagnosis which she stated he did not have prior to service. She went on to describe her observations regarding the Veteran's symptomatology and the impact of his diagnosis on his daily life. During the April 2005 RO hearing, the Veteran testified as to his belief that service connection is warranted for his current bipolar disorder diagnosis. He stated that he was given a diagnosis of attention deficit hyperactivity disorder prior to his military service and that he was given a bipolar disorder diagnosis in 1994 after his discharge. He denied any in-service psychiatric treatment. The Veteran claimed that his mental condition was "aggravated" by his service in the Gulf War, and he identified the major event as witnessing a scud missile misfire and hit a building. In an April 2008 letter, the Veteran's sister provided further testimony in support of the Veteran's claim for service connection. His sister reported that the Veteran's military service changed his life in that when he came home, he had severe mental illness. It was her belief that the Veteran was exposed to something during his military service that did him physical and mental harm. A November 2008 VA examination report reflects a continued diagnosis of bipolar disorder. The examiner noted the Veteran's medical history significant for two hospitalizations at the age of 15 for an adjustment disorder, with depressed mood. The examiner highlighted that a diagnosis of bipolar disorder was not made during these hospitalizations. A review of the claims file did not show any psychiatric treatment during service, but did show an admission for an alcohol-related event. The examiner noted that the Veteran was hospitalized in 1994 for a brief reactive psychosis, with symptoms suggestive of a manic episode. Following the examination, the examiner highlighted that the Veteran had no documented history of bipolar disorder prior to his military service. The examiner opined that the Veteran's bipolar disorder was "at least as likely as not" a result of his military service. The examiner did not provide the underlying medical rationale for this opinion. In an April 2009 addendum report, the November 2008 examiner stated that the results of the November 2008 examination and the claims file were reviewed for the purpose of providing a clarifying opinion. The examiner stated that a current bipolar disorder was not in question, and that the Veteran's first psychiatric episode in relation to this diagnosis occurred in 1994, approximately three years after his discharge from the military. The examiner also noted that he underwent two hospitalizations at the age of 15 for an adjustment disorder, with depressed mood. The examiner opined that it was "likely" that this admission was a prodromal for his now established bipolar disorder. The examiner further opined that the Veteran's current bipolar disorder was "at least as likely as not" aggravated or exacerbated by his military service. Again, the examiner did not identify the underlying medical rationale for the opinions rendered. In a September 2009 statement, the Veteran stated that his bipolar disorder was not diagnosed prior to 1994 because he hid his symptoms through his alcoholism. He stated that he was never ordered for a psychiatric evaluation while on active duty, but instead he attended an alcohol program. The Veteran relayed that he did not seek treatment from 1991 to 1994 because he was living in Germany and was isolated from everyone. A bipolar disorder was first diagnosed in 1994, which he stated was the first time that he seriously tried to get sober. In a February 2010 report, the November 2008 examiner provided further comment as to the etiology of the Veteran's bipolar disorder. The examiner was unable to link the Veteran's bipolar to his military service without resort to speculation. The examiner explained that the Veteran did not receive psychiatric treatment in the military and did not receive the bipolar diagnosis at the time of his two hospitalizations at the age of 15. However, the examiner speculated that it was "at least as likely as not" that his bipolar disorder either was a result of his military service or his preexisting psychiatric disorder was exacerbated by his military service. With respect to the April 2009 opinion, the examiner opined that the Veteran's preexisting psychiatric disorder increased in severity due the natural progression of the disorder. The examiner noted, however, that this opinion was based on speculation, bearing in mind the known longitudinal course of bipolar disorder, since there were no specific service records. The Veteran underwent a VA examination with respect to his claim in February 2011, and the examiner reviewed the claims file in connection with the examination. The Veteran reported a history of a hospitalization at the age of 15 following an attempted suicide, and a history of alcohol use in service. The Veteran denied any significant traumatic events while in the service and described his overall military experience as "fine." The examiner noted that the Veteran was hospitalized for psychiatric treatment following his discharge from service. The clinical examination revealed a diagnosis of bipolar disorder. The examiner opined that based on a review of the medical history, the Veteran's psychiatric disorder was "at least as likely as not" aggravated by service related experiences. The rationale for this opinion was not provided. The Veteran underwent an additional VA examination in August 2012, at which time the claims file was reviewed by the VA examiner. The clinical examination confirmed the bipolar disorder diagnosis. The examiner noted the Veteran's history of a psychiatric hospitalization at the age of 15. The examiner highlighted, however, that the Veteran was not diagnosed with bipolar disorder at that time and there was no follow up treatment. The Veteran did not report any specific traumatic events during his military service, and the examiner was unable to locate any treatment for bipolar disorder in the service treatment records. The examiner further noted the Veteran's in-service history of heavy alcohol use and post-service history of substance abuse treatment. The records did not show treatment for bipolar disorder until 1994. Based on a review of the claims file and history provided by the Veteran and his spouse, the examiner opined that the Veteran's bipolar disorder was "at least as likely as not" triggered or aggravated by his serious alcohol abuse problem while in the military that continued until 1997. In April 2013, the August 2012 examiner provided an addendum report that further clarified the August 2012 opinion. The report reflects that the examiner reviewed the claims file. In discussing whether the Veteran's bipolar disorder preexisted his military service, the examiner noted the Veteran's diagnosis of "brief depressive reaction" at the age of 15 and that there was no documentation of bipolar disorder during childhood. According to the examiner, the Veteran had a normal psychological evaluation, was discharged to home without medication, and was recommended to have psychotherapy. Regarding whether the Veteran's bipolar disorder was related to his military service, the examiner highlighted that there was no documentation of a diagnosis or treatment for a mood disorder, including depressive disorder or bipolar disorder, during the Veteran's military service. Instead, the evidence showed that the Veteran was treated for alcohol abuse; the examiner noted the Veteran's February 2011 report that he drank during service due to boredom. The examiner also highlighted that the Veteran did not report experiencing any traumatic events while in the military and instead described his overall military experience as "fine" during the February 2011 VA examination. The examiner noted that the continued to do well after his discharge until he was hospitalized and treated for bipolar disorder in 1994. Based on a review of the this information, the examiner reiterated the previous opinion that the Veteran's bipolar disorder was "less likely than not" related to his military experiences. Having reviewed the foregoing, the Board finds that the preponderance of the evidence is against the claim for service connection for a psychiatric disorder, to include bipolar disorder. Although the medical evidence of record reflects that the Veteran currently has a diagnosis of bipolar disorder, the preponderance of the evidence does not indicate that this condition was caused by or is otherwise related to the Veteran's military service. Accordingly, the claim for service connection is denied. As an initial matter, the Board finds that the Veteran did not have a preexisting bipolar disorder at the time of his enlistment in October 1986. The Board acknowledges the medical evidence showing that the Veteran was briefly treated for psychiatric symptomatology in 1981 prior to his enlistment and his later reports of having psychiatric problems since that time. The Veteran also claims to have been diagnosed with attention deficit hyperactivity disorder prior to his enlistment. However, a bipolar disorder diagnosis was not "noted" at the time of the Veteran's July 1986 enlistment examination or at any time during his military service. As such, the presumption of soundness is not rebutted. Although a VA examiner essentially opined in April 2009 that the Veteran's hospitalization at 15 was likely prodrome for his current bipolar disorder, this opinion has limited probative weight because it was not supported by any medical rationale. Moreover, the Board highlights that the same VA examiner later clarified in the February 2010 report that opinion regarding any preexisting bipolar disorder was based on a resort to speculation. Bloom v. West, 13 Vet. App. 185, 187 (1999) (holding that a medical opinion based on speculation, without supporting clinical data or other rationale, does not provide the required degree of medical certainty); see also Reonal v. Brown, 5 Vet. App. 458, 461 (1993); Sklar v. Brown, 5 Vet. App. 140 (1993). As highlighted by the August 2012 examiner, the Veteran was not diagnosed with bipolar disorder prior to his enlistment. To the extent that the Veteran argues or the evidence suggests that his current bipolar disorder existed prior to his military service, this argument fails and the presumption of soundness has not been rebutted in this case. The Veteran primarily contends that his bipolar disorder began during his military service and that he has experienced continuing psychiatric symptoms since that time. The Veteran is competent to describe his psychiatric symptomatology and his military experiences. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). Although the Veteran is competent to describe the onset and progression of his psychiatric disability, the Board does not find his statements as to the onset and continuity of in-service psychiatric symptomatology to be credible. Here, the Board highlights that the Veteran's service treatment records are entirely negative for reported symptomatology or diagnoses related to a psychiatric disorder during his active duty service. Curry v. Brown, 7 Vet. App. 59, 68 (1994) (finding that contemporaneous evidence has greater probative value than history as reported by the claimant). Indeed, by the Veteran's own report in January 1996, he did well during his military service and did not experience any psychiatric symptomatology. He also reported in December 1995 that, with the exception of prior to his enlistment, he was without any psychiatric symptoms until after his discharge from service. On multiple occasions, the Veteran has denied experiencing any traumatic events during service and has positively described his military experiences. This stands in contradiction to his other report of experiencing traumatic events during service during the Gulf War. See Macarubbo v. Gober, 10 Vet. App. 388 (Fed. 1997) (holding that the credibility of lay evidence can be affected and even impeached by inconsistent statements, internal inconsistency of statements, and inconsistency with other evidence of record). The Board also finds that the preponderance of the medical evidence weighs against the claim for service connection. In this regard, the Board finds the April 2013 VA opinion to be the most probative evidence as to pertinent questions of etiology in this case. Based on a review of the claims file and the Veteran's military history, along with consideration of the Veteran's competent lay statements, the examiner provided an opinion and a rationale for the decision. The Board finds the April 2013 VA medical opinion to be highly probative and compelling evidence against the Veteran's claim that his bipolar disorder is in any way related to his military service. See Nieves-Rodriguez, 22 Vet. App. 295, 299-301 (2008); see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). In reaching the above determination, the Board recognizes the November 2008, April 2009, and February 2011 VA medical opinions suggesting that the Veteran's bipolar disorder was a result of or aggravated by his military service. While the conclusions of a physician are medical conclusions that the Board cannot ignore or disregard, the Board is free to assess medical evidence and is not compelled to accept a physician's opinion. See Willis v. Derwinski, 1 Vet. App. 66 (1991); Wilson v. Derwinski, 2 Vet. App. 614 (1992). As the April 2013 VA examiner's opinion is supported by a detailed rationale, examination of the Veteran, review of the evidence of record, and consideration of the Veteran's statements, the Board gives this opinion greater weight, as compared to the November 2008, April 2009, and February 2011 VA opinions. As detailed above, the November 2008 VA examiner suggested that the Veteran's bipolar disorder was a result of the Veteran's military service or that his military service aggravated his childhood psychiatric condition. The Board highlights however, that the November 2008 examiner did not provide any medical rationale to support the opinions offered in November 2008 and April 2009. Bloom, 13 Vet. App. at 187. Moreover, the November 2008 examiner later clarified in the February 2010 report that the opinions offered with respect to the Veteran's claim were based on a resort to mere speculation. Id. Thus, the examiner's November 2008 and April 2009 opinions are of limited probative value. As for the February 2011 VA examiner's opinion, the Board similarly notes that the examiner did not provide any medical explanation for the opinion that the Veteran's psychiatric disorder was aggravated by his military experiences. Thus, the February 2011 opinion is of little probative weight and does not support the grant of service connection in this case. Bloom, 13 Vet. App. at 187; see also Stefl v. Nicholson, 21 Vet. App. 120, 124 92007) ("[A] medical opinion ... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions."). Importantly, with regard to the opinions that the Veteran had a pre-existing psychiatric disorder that was aggravated by his military service, these opinions are of little probative weight, as the presumption of soundness on entrance into service has not been rebutted. In reaching the above decision, the Board again highlights that consideration has been given to the lay statements from the Veteran and his sister regarding their belief that his bipolar disorder is related to his military service. While these statements are competent evidence of what the Veteran experienced and his sister observed regarding the Veteran's reported military history and post-military symptoms, these statements are not competent evidence to establish that his bipolar disorder is related to his military service. Whether the Veteran's current psychiatric disorder is related to or was caused by service does not lie within the range of common experience or common knowledge, but requires special experience or special knowledge. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); see also Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). It is not shown that the Veteran or his sister possess the ability, knowledge, or experience to provide a competent etiological opinion regarding the relationship between his military service and the immediate and his current psychiatric disorder. See Jandreau, 492 F.3d 1372; see also Woehlaert v. Nicholson, 21 Vet. App. 456 (2007); Barr v. Nicholson, 21 Vet. App. 303 (2007). Accordingly, the Board finds that the lay statements from the Veteran and his family member as to medical causation are not competent evidence to establish service connection. Id. Accordingly, the claim for service connection for the Veteran's bipolar disorder must be denied for the foregoing reasons. In arriving at this decision, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim of entitlement to service connection in this case, the doctrine is not applicable. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). As such, entitlement to service connection for a psychiatric disorder is not warranted. A Total Disability Rating Based On Individual Unemployability A total disability rating based on individual unemployability (TDIU) may be assigned where the schedular rating is less than total when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to 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 benefits 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. See 38 C.F.R. § 4.16(b). TDIU requires the presence of impairment so severe that it is impossible for the average person to follow a substantially gainful occupation. See 38 U.S.C.A. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. In reaching 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). In arriving at a conclusion, consideration may be given to the Veteran's level of education, special training, and previous work experience, but not to his/her age or the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. In this case, the Veteran's service connected disabilities include chronic fatigue syndrome, rated as 20 percent disabling, and painful back and ankles, also rated as 20 percent disabling. The Veteran has a combined disability rating of 40 percent. Thus, the Veteran does not have a combined disability rating of 70 percent or more and he does not meet the schedular criteria for TDIU under 38 C.F.R. § 4.16(a). Considering the Veteran's claim under 38 C.F.R. § 4.16(b), the evidence of record does not demonstrate that the Veteran is unable to secure or follow a substantially gainful occupation due to his service-connected disabilities. The Veteran claims that he is unable to secure and maintain substantially gainful employment due to his service-connected disabilities. In a January 2002 statement, he claimed that he experiences fatigue requiring him to sleep during day and evenings, and that he has no set pattern of sleep. The Veteran also stated that he tired easily. He claimed that he was only able to work part-time because of his constant pain, fatigue, and inability to deal with people. During an August 2002 VA examination, the Veteran reported that he was no longer able to work in his previous job as an over-the-road truck driver because of the "bouncing" caused by driving the truck and because he did not sleep a normal schedule. At that time, he reported that he worked part-time as a automotive parts delivery driver. In numerous statements submitted during the pendency of the appeal, the Veteran also attributed his claimed inability to work to his psychiatric symptomatology. The evidence of record shows that the Veteran previously worked as a truck driver but he is currently unemployed. However, the preponderance of the evidence does not demonstrate that he is unemployable solely due to his service-connected painful back and ankles and chronic fatigue syndrome disabilities. Indeed, as just described, the Veteran has claimed in numerous statements that he is unable to work due, in part, to his nonservice-connected psychiatric disorder. In this regard, an August 2002 VA mental disorders examination report includes a competent and credible medical opinion that the Veteran's psychiatric symptoms seriously impair his ability to develop useful employment. The Veteran has not submitted, and the medical evidence does not otherwise include, a competent medical opinion indicating that he is unable to work solely due to his service-connected disabilities. The Board also highlights that the Veteran reported in 2006 that he operated his own business, thus further indicating that he is not precluded from obtaining or maintaining employment solely due to his service-connected disabilities. The evidence of record relevant to the Veteran's claim of entitlement to TDIU does not show that he is completely precluded from securing or following substantially gainful employment as a result of his service-connected disabilities alone, without regard to any nonservice-connected disabilities. 38 C.F.R. § 4.16(b). Accordingly, the preponderance of the evidence is against entitlement to TDIU. The Veteran does not meet the percentage criteria under 38 C.F.R. § 4.16(a) and the evidence does not otherwise demonstrate an inability to secure or follow a substantially gainful occupation due to his service-connected painful back and ankles and chronic fatigue syndrome disabilities. TDIU is not warranted. In reaching this decision, the Board considered the doctrine of reasonable doubt. However, as the preponderance of the evidence is against the Veteran's claim for TDIU, the doctrine is not for application. Gilbert, 1 Vet. App. at 56. ORDER Service connection for a psychiatric disorder, to include bipolar disorder, is denied. TDIU is denied. ____________________________________________ JOY A. MCDONALD Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs