Citation Nr: 18150177 Decision Date: 11/14/18 Archive Date: 11/14/18 DOCKET NO. 15-15 430 ORDER The appeal for entitlement to service connection for sleep apnea is dismissed. Service connection for right ear hearing loss is denied. Service connection for tinnitus is denied. A rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is denied. Entitlement to a total disability based on individual unemployability (TDIU) is denied. REMANDED Entitlement to service connection for left ear hearing loss is remanded. FINDINGS OF FACT 1. Prior to the promulgation of a decision in the appeal, the Veteran withdrew his service connection claim for sleep apnea at the December 2017 Board hearing. 2. Exposure to noise exposure in service is conceded. 3. The Veteran’s right ear hearing loss and tinnitus did not manifest to a compensable degree within one year of separation from service; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury, event, or disease. 4. Throughout the appeal period, the Veteran’s PTSD manifested with symptoms that cause no more than moderate occupational and social impairment. 5. The Veteran’s service-connected disabilities do not render him unable to secure or follow a substantially gainful occupation. CONCLUSIONS OF LAW 1. The criteria for withdrawal of the appeal for service connection for sleep apnea have been met. 38 U.S.C. § 7105(b)(2), (d)(5); 38 C.F.R. § 20.204. 2. The criteria for service connection for right ear hearing loss have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(a), 3.385. 3. The criteria for service connection for tinnitus have not been met. 38 U.S.C. § 1110, 5107(b); 38 C.F.R. § 3.102, 3.303, 3.307, 3.309. 4. The criteria for a rating in excess of 50 percent for PTSD have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. § 3.159, 3.321, 4.1, 4.3, 4.7, 4.130, Diagnostic Code (DC) 9411. 5. The criteria for a TDIU have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.1, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1968 to June 1970, with service in the Republic of Vietnam. These matters are before the Board of Veterans’ Appeals (Board) on appeal from the September 2013 and August 2015 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). In December 2017, the Veteran testified before the undersigned Veterans Law Judge at a hearing. A copy of the transcript is of record. Additional, pertinent evidence was associated with the claims file after the most recent issuance of the supplemental statement of the case. The Veteran has waived his right to have such evidence reviewed by the agency of original jurisdiction (AOJ) in the first instance. 38 C.F.R. § 20.1304(c). Withdrawn Claim Service connection for sleep apnea. The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.204. Withdrawal may be made by the appellant or by his or her authorized representative. Id. During the December 2017 Board hearing, in the presence of his representative, the Veteran expressed that he wished to withdraw his appeal for the claim of service connection for sleep apnea. See Hearing Transcript, 2. A written transcript of the Veteran’s testimony is of record. Thus, there remains no allegations of errors of fact or law with respect to this issue on appeal. Accordingly, the Board does not have jurisdiction to review the appeal and this claim is dismissed. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Pursuant to 38 C.F.R. § 3.303(b), where a chronic disease, such as hearing loss, is shown as such in service, subsequent manifestations of the same chronic disease are generally service connected. If a chronic disease is noted in service but chronicity in service is not adequately supported, a showing of continuity of symptomatology after separation is required. See 38 C.F.R. §§ 3.303(b), 3.309(a); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Hearing loss, for VA disability compensation purposes, is considered a disability when the auditory threshold in any of the frequencies at 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; when the auditory thresholds for at least three of the above frequencies are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Service connection for right ear hearing loss and tinnitus. The Veteran seeks service connection for right hearing loss and tinnitus due to in-service noise exposure. He asserts that as a result of his training and time in Vietnam that he spent a lot of time firing different weapons that were loud and ‘shocking to the ears.’ See November 2012 Statement in Support of Claim. The Veteran’s Form DD 214 reflects a military specialty of military policeman. His military personnel records reflect service in Vietnam. As such, noise exposure in service is conceded. The Veteran’s private and VA treatment records document a current diagnosis of tinnitus. A September 2013 VA examination shows a right ear sensorineural hearing loss disability per 38 C.F.R. §3.385. The relevant question at issue is whether these disabilities are related to service. For the reasons that follow, the Board finds they are not. Review of the service treatment records show tinnitus and right ear hearing loss were not complained of, or diagnosed in service. The Veteran’s April 1970 separation examination shows an audiogram was within normal limits. On the corresponding Report of Medical History, the Veteran marked “no” to ear, nose, and throat trouble and for hearing loss. There are no medical records showing complaint or diagnosis of hearing loss or tinnitus within a year of service discharge. The file includes record from a private ear, nose and throat (ENT) physician dated in March 2012. This ENT specialist noted that the Veteran reported the onset of tinnitus was gradual and not associated with any definite precipitating event. The ENT also noted that the Veteran reported moderate bilateral hearing loss for several years, but denied a history of excessive noise exposure. The ENT diagnosed hearing loss and subjective tinnitus. He indicated that the tinnitus is secondary to the hearing loss; he did not provide a nexus opinion on the hearing loss. At the September 2013 VA examination, an examiner opined that the right ear hearing loss and tinnitus were less likely than not related to service. The rationale was that there was no evidence of hearing loss or tinnitus during service or at the time of separation and the Veteran denied such concerns at the time of separation. Further, there was no evidence of chronicity or continuity of care for either condition shown during the four-decade period since military separation. The examiner also noted a positive history of civilian occupational noise exposure following service. The Veteran submitted a letter from his primary care physician in support of his claim in October 2013. The physician referenced the March 2012 ENT record and noted that the Veteran’s tinnitus is secondary to his hearing loss condition. The physician opined that the Veteran’s bilateral hearing loss and tinnitus was due to service when the Veteran worked in the setting of gunfire and explosions. At the hearing before the undersigned, the Veteran contended that his bilateral hearing loss and tinnitus were caused by noise exposure during service. He asserted that he was exposed to a ‘tremendous explosion’ in February 1969, and that was when he noticed his ears ringing. See Hearing Transcript 5. He stated that he first noticed hearing loss years later after service. See Hearing Transcript, 4-9. At the hearing, his representative asked, “[I]n another question is when you were, when you left service were you exposed to loud noises in your civilian jobs? The Veteran responded, “[N]ot necessarily and when I was, I was, I didn’t have ear protection when I would be around loud noises and civilians. But I had no ear protection in the military.” In continued questioning regarding post-service occupational noise exposure, the Veteran responded that he was exposed to noise exposure while working in shipping and receiving, but that he was mostly in the office. He stated that he used hearing protection when he went out into the plant. Based on consideration of all evidence of record, a nexus between the current right ear hearing loss and tinnitus and in-service noise exposure is not established. The most probative nexus opinion is the September 2013 VA medical opinion. The Board finds that it outweighs the October 2013 opinion of the private primary care physician, based on the depth of discussion and consideration of the entire history of both the tinnitus and right ear hearing loss, including review of the service treatment records and audiogram. The private primary care physician did not indicate review the Veteran’s entire claims file and therefore, may not have a full history of the disabilities. He also did not include any consideration of the Veteran’s post-service loud noise exposure through his employment. Further, the VA examiner is an audiologist who has more specialized training and expertise regarding such disabilities, as opposed to a primary care physician. For these reasons, the Board assigns less probative value regarding the October 2013 opinion. The Veteran, himself, is not competent to provide an etiological connection regarding his hearing loss because he does not possess the requisite medical training or expertise. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The Board acknowledges that both hearing loss and tinnitus are considered “chronic” disabilities under § 3.309(a). This raises the possibility of service connection via a continuity of symptomatology under § 3.303(b) or on presumptive basis as a chronic disease under § 3.307. As noted, the service records do not reflect complaints of hearing loss or tinnitus during service. The Veteran’s Report of Medical History completed in conjunction with his separation examination shows he denied hearing problems and ear trouble. This is contemporaneous affirmative evidence that the Veteran did not notice decreased hearing acuity or tinnitus in service. On the Veteran’s June 2012 application for VA compensation benefits (VA Form 21-526), he reported that the onset of his hearing loss and tinnitus was in January 2012. The Veteran now places the onset of tinnitus in 1969 (during service), but this is not consistent with the objective service records or other more recent statements. He informed the ENT specialist in March 2012 that the onset of tinnitus was gradual and not associated with any definite precipitating event. The inconsistency between the Veteran’s statements regarding the onset of tinnitus render them less than credible, and thus not probative. The Veteran reports that onset of hearing loss was years after discharge, and he has been consistent in this regard. As there is no credible and competent evidence of tinnitus and right ear hearing loss noted in service or manifested to a compensable degree within a year of discharge, both presumptive service connection and service connection based on a continuity of hearing loss symptomatology since service are precluded. In sum, the preponderance of the evidence is against the claim; there is no doubt to be resolved. Accordingly, service connection for right ear hearing loss and tinnitus is not warranted. See 38 U.S.C. § 5107; 38 C.F.R. §3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Higher Ratings Disability ratings are determined by applying a schedule of reductions in earning capacity from specific injuries or a combination of injuries that is based upon the average impairment of earning capacities. 38 U.S.C. § 1155 (2012). Each disability must be viewed in relation to its entire history, with emphasis upon the limitations proportionate to the severity of the disabling condition. 38 C.F.R. § 4.1 (2017). When rating the Veteran’s service-connected disability, the entire medical history must be reviewed. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The Board must also fully consider the lay assertions of record. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Where there is a question as to which of the two disability evaluations is applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence of record, any reasonable doubt remaining will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. Where service connection has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). The Board acknowledges that multiple distinct degrees of disability might be experienced which result in different compensation levels from the time the increased rating claim was filed until a final decision is made. Staged ratings apply to both initial and increased rating claims. See Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). A rating for PTSD in excess of 50 percent. The Veteran seeks a higher rating for his PTSD. The appeals period before the Board begins on May 6, 2014, one year prior to the date VA received the claim for an increased rating. Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010); see May 2015 VA Form 21-526b. The Veteran’s PTSD is currently evaluated at 50 percent under 38 C.F.R. § 4.130, DC 9411. Under the General Rating Formula for Mental Disorders, a 50 percent rating is warranted when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent rating is warranted where objective evidence demonstrates occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships. Id. A 100 percent evaluation is assignable where there is total occupational and social impairment, due to such symptoms as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); and disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. Throughout the period on appeal, the Veteran’s PTSD has manifested with symptoms causing no more than moderate occupational and social impairment that more closely aligns with the current 50 percent rating criteria. Therefore, a rating in excess of 50 percent is not warranted. VA treatment records since May 2014 indicated that the Veteran attended group and individual sessions. The individual sessions reflected that the Veteran reported that people stress him out, he had trust issues with others, and that he could not deal with people. He reported good relationships with his children and grandchildren, whom he saw regularly. His marital relationship was not going well, but they are still married. The Veteran has a couple of veteran-friends, but felt that he is a loner or is a shy person. He reported nightmares, some panic attacks, and described irritability and anger. He was found to be consistently well- or casually dressed and appropriately groomed. The clinicians found that he was pleasant and cooperative, with good eye contact, and exhibited normal speech. His mood was okay or good and his affect was congruent to his mood. He was oriented to person, time, and place. He had linear, spontaneous, logical, and goal-directed thoughts. He denied auditory or visual hallucinations and delusions. He also denied suicidal or homicidal ideation. His judgment and insight were found to range from fair to good. The Veteran’s individual sessions were reported to be the same as or better than his prior visits. The PTSD group sessions reflected that the Veteran continued ongoing, weekly sessions in 2016. He appeared to have a positive reaction to these sessions and showed a willingness to continue the PTSD group. These notes reflected that he continuously denied suicidal or homicidal ideation. A March 2015 letter written by his PTSD group therapist was submitted in support of the Veteran’s claim. The clinician noted that at the time, he had a 30 percent rating assigned. He opined that his symptoms have become worse since his last rating; his most recent symptoms included a low tolerance for stress, irritability, anger, fatigue, hypervigilance, poor concentration, nightmares, exaggerated startled responses, and intrusive thoughts of combat situations. He felt detached in relationships. The clinician also noted that the Veteran was discovering that the possibility of maintaining any type of employment was unrealistic and possibly unsafe. At the July 2015 VA examination, the Veteran reported that he has a relationship with his spouse, but not as close as he would like. His relationships with his two children were pretty good. He stayed in touch with his brother, but they are not close. He had a big problem trusting people, but stayed in touch with a couple of veteran-friends, occasionally meeting for lunch. He attended meetings at the local American Legion. He liked to garden. The Veteran also reported feeling anxiety, depression, and anger. The examiner found that his PTSD manifested with depression, anxiety, chronic sleep impairment, mild memory loss, and had difficulty in establishing and maintaining effective work and social relationships. The examiner found him neatly and casually dressed, arriving about 45 minutes early for his appointment. He was cooperative, with clear and coherent speech. He was oriented to person, time, and place. His mood was sad and a little anxious. His affect was mild and congruent. Thought process was logical and goal-directed. Insight and judgment were intact. There was no evidence of thought disorder or hallucinations. He denied suicidal and homicidal ideation. The examiner found the Veteran’s PTSD symptoms to cause occupational and social impairment with reduced reliability and productivity. In September 2017, the Veteran submitted a private disability benefits questionnaire (DBQ) and mental status examination by Dr. J.A. in support of his claim. On the DBQ Dr. J.A. noted the following symptoms were present: mood, anxiety, chronic sleep impairment, mild memory loss, difficulty in establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, including work; difficulty understanding complex commands and near continuous depression affecting his ability to function independently, appropriately and effectively. In his mental status examination summary, Dr. J.A. noted that he only reviewed the August 2015 rating decision and prior VA examination reports. He noted that the Veteran reported nightmares, with diminished interests in socializing with friends. He enjoyed a little woodworking. Objectively, Dr. J.A. found his presentation to be somewhat nervous, a little vague and inexact, but cooperative. His speech was coherent. Affect was found to be normal. He denied suicidal ideation. He felt anxiety and depression. He denied anger, obsessions, compulsions, and hallucinations. He was oriented to person, time, and place. Dr. J.A. opined that the Veteran’s current PTSD symptoms caused marked social impairment. He also opined that when the Veteran was working his PTSD caused moderate impact, definite impairment, but some aspects of occupational functioning remain. Dr. J.A. opined that the overall global severity of the Veteran’s PTSD symptoms was moderate distress in functional impairment, but functions satisfactorily with effort. At the hearing, the Veteran reported nightmares, sleep impairment, trouble dealing with people, trusting people, but denied confrontations with people. He had occasional panic attacks and some anxiety attacks. See Hearing Transcript 14-17, 21. He reported socializing and getting together with friends occasionally. His grandchildren visit about every weekend. He preferred to stay at home. Id., 22. After a careful review of the record, the evidence does not support a higher rating. A rating of 70 percent requires deficiencies in most areas such as family relations, judgment, thinking, or mood. Throughout the appeals period, the Veteran’s symptoms were predominantly consistent with the currently assigned rating of 50 percent. The medical records and examinations show that his symptoms included anxiety and depression, panic attacks, nightmares, mild memory loss, and disturbances of motivation and mood. These are all symptoms consistent with the 50 percent rating criteria. Further, the evidence indicates that the Veteran has been able to maintain family and some social relations, showed logical and goal-directed thought processes, showed appropriate affect. He enjoyed hobbies such as gardening and woodworking. He attended meetings at the local American Legion and meets with his friends on occasion. On all mental status examinations, he was found to be well- or casually dressed with normal speech. Also, throughout the appeal period, the Veteran has denied suicidal and homicidal ideations, maintained his personal appearance, and denied hallucinations and delusions. These are all symptoms consistent with no more than a 50 percent rating. The Board has considered the March 2015 VA PTSD therapist letter and Dr. J.A.’s 2017 DBQ. In the March 2015 letter, the therapist noted symptoms that were consistent with the currently rated 50 percent criteria. The reported symptoms were also corroborated by the Veteran’s testimony. On the other hand, Dr. J.A. endorsed occupational and social impairment with deficiencies in most areas due to such symptoms as near-continuous anxiety or depression affecting the ability to function independently, appropriately and effectively; and difficulty in adapting to stressful circumstances. The Board acknowledges that this is favorable evidence that supports a 70 percent evaluation. However, despite these endorsements on the DBQ, Dr. J. A.’s summary of his examination findings resulted in his assessment that the Veteran’s overall degree of impairment was no more than moderate overall. This is not consistent with a 70 percent rating. Furthermore, in discussing the frequency of the Veteran’s depression, J.A. indicated that the Veteran reported feeling depression “some of the time;” with medication this occurs about two times a month for a few days (prior to medication he described the frequency as lasting days at a time). He also reported that his anxiety occurred “sometimes,” and episodes of increased anxiety reportedly occurred about twice a month for a day or so. The reported frequency and duration of the Veteran’s anxiety and depressive symptoms discussed in the examination summary do not support the DBQ findings of near-continuous anxiety or depression. Further, while J.A. also endorsed difficulty in adapting to stressful circumstances, the cumulative evidence shows that the Veteran’s overall level of occupational and social functioning is consistent with the moderate degree of impairment that is contemplated by a 50 percent rating. Indeed, he opined as much. Based on the severity, frequency, and duration of the symptoms noted throughout the appeal, the Board finds the level of occupational and social impairment caused by those symptoms is no more than moderate, and accurately reflected in the 50 percent rating currently assigned. Given the above, a 70 percent rating is not warranted. As the preponderance of the evidence is against the claim, the benefit of the doubt rule does not apply, and a higher rating for the Veteran’s service-connected PTSD is not warranted. 38 U.S.C. § 5107; 38 C.F.R. § 4.3. There are no additional expressly or reasonably raised issues presented on the record. TDIU A claim for TDIU was raised by the evidence of record. See Rice v. Shinseki, 22 Vet. App. 447 (2009). Although a claim of service connection for a left ear hearing loss is remanded, the Board finds that the issues are not inextricably intertwined as the Veteran has asserted that his inability to work is due solely to his PTSD. Total disability ratings for compensation may be assigned when a veteran is unable to secure and follow a substantially gainful occupation. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. If the schedular rating is less than total, a total disability evaluation can be assigned based on individual unemployability if the Veteran is unable to secure or follow a substantially gainful occupation as a result of service connected disability provided that if there is only one such disability, this disability shall be ratable at 60 percent or more; if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). It is also the established policy of the Department of Veterans Affairs 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. Therefore, rating boards should submit to the Director, Compensation 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 standards set forth in paragraph (a) of this section. 38 C.F.R. § 4.16(b). 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). Consideration may be given to the Veteran’s level of education, special training, and previous work experience when arriving at this conclusion; factors such as age or impairment caused by non-service connected disabilities are not to be considered. 38 C.F.R. §§ 3.341, 4.16, 4.19. The Veteran is service-connected for PTSD, which is rated 30 percent from June 13, 2012 and 50 percent from May 6, 2015. He is not service-connected for other disabilities. As a result, the Veteran does not meet the schedular criteria for a TDIU. Moreover, the Board finds that his service-connected disabilities do not render him unable to secure or maintain gainful employment such that referral for extraschedular consideration under 38 C.F.R. § 4.16(b) is warranted. A VA Form 21-8940, Application for Increased Compensation Based on Unemployability was submitted in September 2017. The Veteran specifically asserted that he was no longer able to work due to his service-connected PTSD. He also reported that he completed the 12th grade and had no other education or training. He reported that he was last employed with a towing company, delivering cars, from 2007 to 2014. He last worked on November 1, 2014. In October 2017, the RO received a VA Form 21-4192, Request for Employment Information in Connection with Claim for Disability from the Veteran’s former employer. On the form, the employer indicated that the Veteran was employed as a driver, delivering cars to dealerships and individuals. He retired on disability due to PTSD on November 1, 2014. VA records show the Veteran reported working at a poultry processing plant for a couple of years after separation from service, and then went into law enforcement as a deputy for about 3 years. He then worked with campus police at Wingate College for a couple of years. The Veteran next worked for a pharmaceutical company for 10 years and was laid off after the company closed. Afterward, he worked for 20 years at a box manufacturing plant until the plant closed. Since January 2007, he worked part-time for a private individual who does dealer trades. A March 2015 letter by the Veteran’s PTSD group therapist noted that ‘the Veteran is discovering that the possibility of maintaining any type of employment is unrealistic and possibly unsafe.’ He had to quit his job in recent months because of his increased symptoms and inability to deal with the general public. The clinician indicated that as his condition is chronic, he expected his mental health treatment to last indefinitely and do not feel that he should be expected to maintain gainful employment. The July 2015 VA examiner noted that the Veteran last worked in 2014, moving cars from dealer to dealer. The Veteran reported that he did not deal with people well and stayed stressed out, but did not have any real complications with anybody. He quit because he thought it was best, as it got to where he stayed antsy and stressed out and got old enough to where he could draw from social security retirement benefits. The examiner did not opine on how the Veteran’s PTSD affected his ability to work. The September 2017 DBQ completed by Dr. J.A. shows the Veteran quit working because of PTSD symptoms. J.A. opined that when the Veteran was working his PTSD caused moderate impact, definite impairment, but he also opined that some aspects of occupational functioning remain. Dr. J.A. further opined that the overall global severity of the Veteran’s PTSD symptoms was moderate distress in functional impairment, but functions satisfactorily with effort. During the Veteran’s hearing before the undersigned, he reported working at the shipping and receiving company for 20 years from approximately 1985 to when the plant closed in 2005. He reported taking retirement as he met his 20 years and was eligible. The Veteran reported that he last worked for a towing company until 2014 and had not attempted to look for jobs since 2014. He reported only one disciplinary action during his entire career. The Veteran indicated that he would not be able to maintain a job full-time dealing with people, but may be able to work if doing something strictly by himself. When asked by the undersigned if he thought he would be able to work somewhere if he did not have to interact with the public, he responded with maybe, yes. See Hearing Transcript, 19, 25-27, and 31. Given the above, the evidence of record does not show that the Veteran is incapable of securing or following a substantially gainful occupation, consistent with his education and work background. The Board acknowledges there is some evidence which tends to support the Veteran’s inability to work due to PTSD. The March 2015 letter supports the Veteran’s claim that his PTSD symptoms would affect his ability to maintain gainful employment. However, the preponderance of the evidence is not persuasively favorable. Dr. J.A. indicated that the Veteran retains occupational functioning abilities and that his impairment is moderate. Despite suggesting an inability to interact with customers and coworkers, the Veteran testified only one disciplinary action during the time he separated from service in 1970 to when he last worked in 2014. The fact that the Veteran could maintain a successful 44-year work history with only one disciplinary action suggests that he would be able to continue working in a position that does not require constant social interaction with coworkers and/or customers such as a deliverer of cars, tow truck driver, or security officer in an office building working overnight and/or weekend shifts. Moreover, the Veteran testified that he would be able to work somewhere if he was doing something strictly by himself or did not have to interact with the public. Given the entirety of the evidence of record, there is no basis for referral to the Director of Compensation for extraschedular consideration of a TDIU under 38 C.F.R. §4.16(b). As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable. The claim for a TDIU is not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). REASONS FOR REMAND 1. Entitlement to service connection for left ear hearing loss is remanded. As stated earlier, the Veteran contends that his left ear hearing loss is related to in-service noise exposure. The September 2013 VA examination audiogram did not reflect for VA disability purposes in his left ear. The October 2014 and October 2017 VA audiology notes reflected that audiometric examinations were provided. The October 2014 record showed that the results are found in QUASAR. The October 2017 result is not associated with the file. The Board is unable to access or view this audiogram report as it does not have access to QUASAR. There is insufficient information for the Board to adjudicate the Veteran’s claim for a left ear hearing loss disability at this time. Therefore, this claim is remanded so the RO can associate the audiograms with the claims file. The matters are REMANDED for the following action: Take all action necessary to obtain the October 2014 and October 2017 audiograms and associate the report with the claim file. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Tang, Associate Counsel