Citation Nr: 18150408 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 16-30 798 DATE: November 15, 2018 ORDER Entitlement to service connection for an acquired psychiatric disability, to include as secondary to service-connected left wrist disability, is denied. Entitlement to a rating in excess of 20 percent for service-connected left navicular fracture is denied. Entitlement to a total disability rating for compensation purposes based on individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran has, or has had at any time during the appeal, a diagnosed acquired psychiatric disability. 2. The Veteran’s service-connected left navicular fracture is manifested by pain, productive of functional impairment, at its most severe, comparable to the equivalent of favorable ankylosis of the left wrist in 20 to 30 degrees of dorsiflexion. 3. The most probative evidence of record does not reflect that it is at least as likely as not that the Veteran is unable to secure or follow a substantially gainful occupation as a result of his service-connected disabilities. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for an acquired psychiatric disability, to include as secondary to service-connected left wrist disability, are not met. 38 U.S.C. §§ 1110, 5107 (b) (2012); 38 C.F.R. §§ 3.303, 3.310 (2017). 2. The criteria for a rating in excess of 20 percent for service-connected left navicular fracture are not met. 38 U.S.C. §§ 1155, 5107 (b) (2012); 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.10, 4.14, 4.20, 4.21, 4.40, 4.44, 4.59, 4.71a, Diagnostic Codes 5215-5214 (2017). 3. The criteria for entitlement to a TDIU are not met. 38 U.S.C. §§ 1155, 5107 (b) (2012); 38 C.F.R. §§ 3.340, 3.341, 4.16 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from March 1974 to March 1976. These matters come before the Board of Veterans’ Appeals (Board) on appeal of March 2014 (left navicular fracture) and June 2015 (psychiatric disability and TDIU) rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. These matters have been merged into the instant appeal. The Veteran initially submitted a claim for entitlement to service connection for depression. A claim for service connection for an acquired psychiatric disability cannot be “limited only to that diagnosis, but must rather be considered a claim for any mental disability that may be reasonably encompassed.” Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). In essence, a veteran does not file a claim to receive benefits for a particular psychiatric diagnosis that is named on a claims form, but instead makes a general claim for compensation for the difficulties posed by the mental disability. Id. Accordingly, the Board has reframed the psychiatric disability issue on appeal. Duty to Notify and Assist With respect to the Veteran’s claim herein, VA has met all statutory and regulatory notice and duty to assist provisions. See 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326 (2017); see also Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015), Dickens v. McDonald, 814 F.3d 1359 (Fed. Cir. 2016). Service Connection – Legal Criteria Service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty in active service, or for aggravation during service of a preexisting injury or disease. 38 U.S.C. §§ 1110, 1131. To establish service connection for a disability on a direct-incurrence basis, a veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also 38 C.F.R. § 3.303. A disability which is proximately due to or the result of a service-connected disease or injury shall be service-connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310 (a). Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will also be service connected. 38 C.F.R. § 3.310 (b). Service Connection – Acquired Psychiatric Disability The Veteran seeks entitlement to service connection for an acquired psychiatric disability (claimed as depression), to include as due to service-connected left wrist disability. The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1110; see Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that interpretation of 38 U.S.C. §§ 1110 and 1131 as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Veteran had a VA psychiatric examination in June 2015. The examiner reviewed the claims folder and interviewed the Veteran. She determined that the Veteran did not have a mental disorder, and had never been diagnosed with one. The Veteran denied symptoms including obsessive-compulsive behavior, mania, hallucinations, anxiety, suicidal/homicidal ideation, depressed mood, and sleep disturbance. The examiner observed congruent affect, intact memory and concentration, and no apparent problems with psychotic thoughts or impaired judgment. The Veteran stated that he had not made a claim for depression due to his wrist condition. On his VA Form 9, Appeal to Board of Veterans’ Appeals, submitted in June 2016, the Veteran stated that he could not work due to his service-connected disabilities, and that this was upsetting him. He indicated that should be compensated because his condition resulted from service-connected injuries. The Board finds that the record does not establish that the Veteran has a diagnosed acquired psychiatric disability, nor that he has had one at any time during the pendency of the claim. Brammer, 3 Vet. App. at 224. No medical evidence has diagnosed an acquired psychiatric disability, and there can be no valid claim without proof of a present disability. Id. The Veteran is competent to report symptoms that are capable of lay observation. Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, he is not considered competent to relate such symptoms to an acquired psychiatric disability diagnosis, as doing so requires specialized medical knowledge that the Veteran has not been shown to possess. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Therefore, the Board affords more weight to the medical evidence of record. In sum, the preponderance of the evidence is against finding that the Veteran has an acquired psychiatric disability for VA compensation purposes. The benefit of the doubt does not apply, and the claim is denied. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 58 (1990). Legal Criteria – Rating Disabilities Disability ratings are determined by the application of VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Pertinent regulations do not require that all cases show all findings specified by the schedule, but that findings sufficient to identify the disease and the resulting disability and above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). Further, a disability rating may require re-evaluation in accordance with changes in a veteran’s condition. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings,” whether it is an initial rating case or not. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505, 519 (2007). In rating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated innervation, or other pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. Pain on movement, swelling, deformity, or atrophy of disuse as well as instability of station, disturbance of locomotion, interference with sitting, standing, and weight bearing are relevant considerations for determination of joint disabilities. 38 C.F.R. § 4.45. Painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011) (holding that 38 C.F.R. § 4.59 applies to disabilities other than arthritis). However, painful motion alone is not a functional loss without some restriction of the normal working movements of the body. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). Increased Rating – Left Wrist The Veteran seeks an increased rating for his service-connected residuals of a left navicular fracture, now with segmentation and avascular necrosis of the proximal segment, chronic tri-quetzal fracture, and moderate radiocarpal and intercarpal joint degenerative changes. The disability is currently rated under 38 C.F.R. § 4.71a, Diagnostic Code 5215-5214, at 20 percent disabling. The effective date of a rating and award of compensation based on a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. However, an increased rating may be awarded up to one year prior to receipt of the claim if the evidence shows an increase in disability was factually ascertainable during that period. 38 C.F.R. § 5110 (b) (2); 38 C.F.R. § 3.400 (o) (2). For this purpose, the evidence must show that the increase in disability was sufficient to warrant a higher rating under the rating criteria. Hazan v. Gober, 10 Vet. App. 511, 519 (1992). VA received the claim for an increased rating on October 5, 2009. Although rating decisions were issued in January 2010, April 2012, and April 2013, the Veteran submitted additional evidence within one year of each of those decisions. As such, these decisions did not become final. See 38 C.F.R. §§ 3.156 (b), 3.160 (c), 20.302. Therefore, the rating period for consideration is from October 5, 2008, one year prior to the October 4, 2009 date of receipt of the claim, if it is factually ascertainable that an increase occurred during that period. 38 C.F.R. § 3.400 (o)(2). The Veteran had a VA examination in November 2009. The Veteran reported being right-handed, and having constant, severe throbbing pain and stiffness in the left wrist, aggravated by lifting or hitting it against something. Range of motion testing revealed left wrist flexion to 45 degrees, extension to 40 degrees, radial deviation to 10 degrees, and ulnar deviation to 25 degrees, with objective evidence of pain on active motion and following repetitive motion. There was no additional limitation in range of motion after three repetitions. The Veteran reported employment in full-time “computer work” for the previous 2 to 5 years, and that he lost less than 1 week in the last 12-months, due to the flu. The examiner concluded that there were significant effects on the Veteran’s usual occupation, including decreased manual dexterity, and decreased upper-extremity strength. The Veteran has had VA medical treatment for his wrist disability during the appeal period. In November 2009, a clinician indicated that the Veteran reported left wrist pain. Radiographic imaging revealed a prior left scaphoid fracture, a chronic triquetral fracture, and moderate radiocarpal and intercarpal degenerative changes. A March 2011 orthopedic consultation revealed pain and swelling of the left wrist. The physician diagnosed left wrist degenerative joint disease secondary to an old scaphoid nonunion. He opined that the best option to alleviate the Veteran’s pain included only a wrist fusion surgery. In February 2013, radiographic findings showed degenerative changes with narrowing and sclerosis in the left wrist. The clinician indicated that the deformity of the left scaphoid is likely related to remote trauma. Records from September 2013 show that the Veteran reported pain and numbness in his left wrist. The Veteran had a VA examination in March 2012. The examiner diagnosed degenerative arthrosis of the left wrist. The Veteran refused to attempt any range of motion testing of the left wrist or to take off his wrist brace due to the claimed severity of his pain. The examiner stated that the Veteran’s disability did not impact his ability to work. The Veteran had a VA examination in March 2013. The examiner reviewed the claims file and evaluated the Veteran. Range of motion testing revealed left wrist flexion to 5 degrees, and extension to 5 degrees, each with objective evidence of painful motion at 0 degrees. The Veteran performed repetitive use testing with no additional loss of range of motion. The examiner indicated functional loss in the left wrist consisting of less movement than normal, weakened movement, excess fatigability, pain on movement, swelling, and atrophy of disuse. The examiner stated that the Veteran’s condition would prevent employment of a physical, but not sedentary, nature. Private medical records were submitted in October 2013. The Veteran complained of left wrist pain, and experienced swelling and pain on palpitation. Range of motion was to 40 degrees of extension and 50 degrees of flexion. The Veteran was able to flex and extend his wrist. X-rays were consistent with left wrist arthritis. The physician, Dr. C.J., discussed treatment options with the Veteran, and recommended surgery, if conservative treatment options proved unsuccessful. The Veteran had a VA examination in February 2014. The examiner reviewed the claims file and examined the Veteran. Range of motion findings for the left wrist revealed 30 degrees palmar flexion, and 40 degrees extension, both with objective evidence of painful motion at 10 degrees. Post-test range of motion was unchanged. The Veteran did not have additional limitation in range of motion following repetitive use testing. Functional loss was present in the left wrist, including weakened movement and pain on movement. The Veteran had pain on palpitation/localized tenderness. Muscle strength testing was normal, and there was no ankylosis. The examiner did not provide any opinion regarding functional impact of the wrist disability. The Veteran had a VA examination in May 2015. The Veteran reported chronic, severe pain in the left hand and wrist, with frequent numbness in the palm and fingers, and stated that he could no longer hold tools or perform tasks requiring both hands in unison for the last 10-12 months. Range of motion testing revealed left wrist flexion to 30 degrees, extension to 20 degrees, ulnar deviation to 15 degrees, and radial deviation to 15 degrees. Pain was noted on examination and caused function loss. There was evidence of pain on weightbearing and of localized tenderness/pain to palpitation. The Veteran was unable to perform repetitive use testing due to pain after making two attempts. The examiner noted less movement than normal (due to ankylosis, adhesions, etc.) but also stated that there was no ankylosis of the left side. The Veteran reported wearing a brace constantly. The examiner indicated that the Veteran has combined effects from advanced degenerative wrist disease and effects from carpal tunnel syndrome, making it difficult to distinguish their contribution, but generally, the Veteran had little functional use of his left hand/wrist due to these combined effects. After careful review, the Board finds that the criteria for a rating in excess of 20 percent for the left wrist disability on appeal have not been met. The Veteran has not manifested functional impairment that would be better approximated by a higher rating. Specifically, he has not manifested functional impairment equivalent to unfavorable ankylosis of the wrist in any degree of palmar flexion, or with ulnar/radial deviation, or in any other position except favorable. 38 C.F.R. § 4.71a, Diagnostic Code 5215-5214. Ankylosis is defined as immobility and consolidation of a joint due to disease, injury, or surgical procedure. See Augustine v. Principi, 18 Vet. App. 505, 506 (2004). The clinical findings, while reflecting limitation of motion, stiffness, lack of strength, weakness, and swelling, do not show any evidence of unfavorable ankylosis. Although the May 2015 VA examiner suggested that the Veteran had less movement than normal due to factors that could include ankylosis, adhesions, etc., the examiner nevertheless documented that there was no ankylosis of the left wrist. The Board has considered whether the Veteran is entitled to a higher rating based on additional functional loss or impairment under 38 C.F.R. §§ 4.40, 4.45, and 4.59; see DeLuca, 8 Vet. App. at 202; Burton, 25 Vet. App. at 1. The Veteran has not reported flare-ups, but has indicated constant pain and numbness. Such pain has limited his range of motion, at its lowest, to 5 degrees flexion and 5 degrees extension in March 2013. However, such findings appear to be an outlier, as the Veteran has otherwise tested between 30 and 50 degrees of left wrist flexion and between 20 to 40 degrees of left wrist extension during the period on appeal. These findings exceed the threshold for a compensable rating for limitation of motion of the wrist. See 38 C.F.R. § 4.71a, Diagnostic Code 5215. Additionally, the VA examination reports in November 2009, March 2013, and November 2014, indicated that the Veteran did not have additional restrictions of motion after repetitive use testing. Although the March 2012 and May 2015 examination reports indicated that the Veteran was unable to perform repetitive use testing due to pain, the Veteran refused to attempt any left wrist range of motion testing in March 2012, and exhibited range of motion exceeding the threshold for a compensable rating in May 2015. See id. As such, the preponderance of the evidence is against a finding that the demonstrated left wrist functional impairment due to pain, of limitation of motion, is not contemplated by the current assigned rating. Even with consideration of the Veteran’s complaints of pain, functional impairment does not manifest to the degree required to more closely approximate a higher rating. See 38 C.F.R. §§ 4.40, 4.45, and 4.59; DeLuca, 8 Vet. App. at 202; Burton, 25 Vet. App. at 1. Additionally, the Board notes that the Veteran is also separately service-connected for left wrist carpal tunnel syndrome, rated 20 percent. The Veteran is competent to report symptoms such as pain, and is considered credible in his belief that he is entitled to a higher rating. See Layno, 6 Vet. App. at 469. However, the Veteran is not competent to offer a medical opinion, for example, as to the relative severity of his left wrist disability in conjunction with the schedular rating criteria, as doing so requires medical knowledge and expertise the Veteran has not been shown to possess. See Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011). Therefore, the Board relies on the medical evidence of record, which provides sufficient detail to rate the Veteran under the relevant criteria. See Prejean v. West, 13 Vet. App. 444, 448 (2000). The Board has also considered whether the Veteran is entitled to referral for assignment of compensation on an extra-schedular basis for his left wrist disability. Ordinarily, the rating schedule will apply unless there are exceptional or unusual factors which would render application of the schedule impractical. See Fisher v. Principi, 4 Vet. App. 57, 60 (1993). According to the regulations, an extra-schedular disability rating is warranted based upon a finding that the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization that would render impractical the application of the regular schedular standards. See Fanning v. Brown, 4 Vet. App. 225, 229 (1993). Under Thun v. Peake, 22 Vet. App. 111 (2008), there is a three-step inquiry for determining whether a veteran is entitled to an extra-schedular rating. First, the Board must consider whether the evidence presents such an exceptional disability picture that the available schedular rating for the service-connected disability is inadequate. Second, if the schedular rating is found inadequate, the Board must determine whether the claimant’s disability picture exhibits other related factors such as those provided by the regulation as “governing norms.” If the first two factors are met, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether the Veteran’s disability picture requires the assignment of an extra-schedular rating. With respect to the first prong of Thun, the evidence in this case does not show such an exceptional disability picture that the available schedular ratings for the disability are inadequate. Specifically, the Veteran receives a rating that accounts for both his limitation of motion and reports of pain/numbness, and has not experienced frequent hospitalizations or marked interference with employment. 38 C.F.R. § 4.40; Mitchell, 25 Vet. App. at 37. The Board concludes that the Veteran’s symptoms are not considered exceptional or unusual and functional loss has been adequately considered under the schedular rating criteria. In sum, the Board finds that the criteria for a rating in excess of 20 percent for left navicular fracture have not been met, and there is no basis for staged ratings. See Fenderson, 12 Vet. App. at 126-27. As the preponderance of the evidence is against the claim, the benefit of the doubt does not apply, and the claim is denied. See 38 U.S.C. § 5107 (b); Gilbert, 1 Vet. App. at 58. Entitlement to a TDIU The Veteran seeks entitlement to a TDIU, alleging that his service-connected disabilities prevent him from obtaining and keeping substantially gainful employment. The Veteran is currently rated at 20 percent for residuals of a fracture, left navicular, now with segmentation and avascular necrosis of the proximal segment, chronic tri-quetzal fracture, and moderate radiocarpal and intercarpal joint degenerative changes, 20 percent for tendinosis of the left thumb, 20 percent for carpal tunnel syndrome of the left wrist, 10 percent for tendinosis of the left long finger, and 10 percent for tendinosis of the left index finger. He is also service-connected for tendinosis of the left ring finger and tendinosis of the left little finger, each rated noncompensable. His combined schedular rating was 20 percent from June 1, 1999, 50 percent from September 29, 2011, and 60 percent from February 28, 2013. A TDIU may be granted where a veteran is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability rated at 60 percent or higher, or as a result of two or more service-connected disabilities, provided at least one disability is ratable at 40 percent or higher, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16 (a). 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 impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. When a Veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disability, but the percentage requirements of § 4.16 (a) are not met, the matter may be referred to the Director, Compensation Service, for consideration of entitlement to a TDIU on an extraschedular basis. 38 C.F.R. § 4.16 (b). The Veteran’s service-connected disabilities, employment history, educational and vocational attainment, and all other factors having a bearing on the issue must be addressed. 38 C.F.R. § 4.16 (b). Substantially gainful employment is defined as work that is more than marginal and that permits the individual to earn a living wage. See Moore v. Derwinski, 1 Vet. App. 356 (1991). Marginal employment shall be deemed to exist when a Veteran’s earned annual income does not exceed the poverty threshold for one person, or on a facts found basis when earned annual income exceeds the poverty threshold. See 38 C.F.R. § 4.16 (a). Marginal employment shall not be considered substantially gainful employment. Id. A determination of whether a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disability is a factual determination rather than a medical question. Therefore, VA is responsible for the ultimate determination of whether a veteran is capable of securing or following substantially gainful employment, not a medical examiner. Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013); see also 38 C.F.R. § 4.16; Floore v. Shinseki, 26 Vet. App. 376, 381 (2013). 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 disability makes it difficult to obtain or keep employment. The ultimate question is whether the Veteran, in light of his service-connected disabilities, is capable of performing the physical and mental acts required by employment, not whether he can find employment. Van Hoose v. Brown, 4 Vet. App. 361 (1993). For the purposes of assigning effective dates, TDIU claims are treated as if they are increased rating claims. 38 C.F.R. § 3.400 (o). The Veteran submitted a blank VA Form 21-8940 on November 10, 2014, and a completed form on January 16, 2015. However, at the TDIU claim is considered part and parcel of the claim for an increased rating for service-connected left navicular fracture, the rating period for consideration on appeal is from October 5, 2008, one year prior to the October 4, 2009 date of receipt of the claim for increase, if it is factually ascertainable that an increase warranting a TDIU occurred during that period See 38 C.F.R. §§ 3.155 (a), 3.159 (a)(3); Brokowski v. Shinseki, 23 Vet. App. 79, 85 (2009); see also Hurd v. West, 13 Vet. App. 449, 451-52 (2000); c.f. Rice v. Shinseki, 22 Vet. App. 447, 454 (2009) (evidence of TDIU, when submitted during the appeal of a rating, makes TDIU part and parcel of the underlying appeal). As conceded by the RO, the Veteran meets the criteria for assignment of a TDIU on a schedular basis from June 28, 2013. The Veteran’s disabilities arise from a single accident, and have a combined rating of at least 60 percent from June 28, 2013. 38 C.F.R. § 4.16 (a)(2). The schedular requirements of § 4.16(a) were not met prior to that date. Nevertheless, for the rating period on appeal prior to, and from June 28, 2013, the question for the Board is whether the Veteran is unable to work due to his service-connected disabilities. The record contains lay statements from the Veteran regarding the occupational effects of his left wrist disability. For example, in February 2004, the Veteran reported suffering from constant severe pain and swelling in his wrist, with numbness in his left hand. He indicated that it impaired his employment “slinging boxes” in a warehouse, and that he had to use his right hand to do any lifting. The Veteran’s Form DD-214 shows the Veteran’s military occupational specialty as armorer/unit supply specialist, with no further military education or training. In January 2015, the Veteran reported working as a civilian clerk at an Army supply depot from 1977 until 2010. He worked 40 hours a week, and lost 15 to 20 days per year due to illness. He submitted evidence showing that he had retired from his former position. The Veteran’s retirement form was signed by a representative of his former employer, and indicated “age (mandatory)” as the type of retirement, rather than “disability.” The Board draws attention to the above merely for its probative value as a lay statement, and does not consider age to be a factor in the Veteran’s claim for TDIU. See Van Hoose, 4 Vet. App. at 363. At a VA examination in November 2009, the Veteran reported being employed full-time in “computer work” for the previous 2 to 5 years. The examiner concluded that there were significant effects on the Veteran’s usual occupation, including decreased manual dexterity, and decreased upper-extremity strength. After a VA examination in March 2012, the examiner remarked that the Veteran’s left wrist disability did not have a functional impact on his ability to work. The April 2012 VA examiner indicated that the Veteran’s disability impacted his ability to work. As rationale, he stated that the Veteran had impairment resulting from chronic tendinosis of the left hand from pain-related disuse, which limits use of the hand and fingers. The March 2013 VA examiner indicated that the Veteran’s wrist disability would “prevent employment of a physical but not sedentary nature.” The March 2013 VA examiner also completed an examination for the Veteran’s finger disabilities. He diagnosed tendinosis in all the left fingers. Range of motion testing revealed limitation of motion with all digits on the left hand, and a gap of between 1-2 inches between the thumb pad and fingers on the left hand. Objective evidence of painful motion began at a gap of less than one inch on the left thumb. The Veteran had limited finger flexion with a 1-inch gap or greater between his left fingers and his palm when attempting to touch the palm with the fingertips. Painful motion began at a gap of less than 1 inch for all the left fingers. There was no limitation of extension or evidence of painful motion for the index finger or long finger. The Veteran performed range of motion testing, which resulted in additional limitation of motion to gap of 1 inch or more in each of the left fingers. The examiner noted functional loss including less movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement in all digits of the left hand. He opined that the Veteran’s finger disabilities would “inhibit physical but not sedentary duties.” The May 2015 VA examiner indicated that he could not assess unemployability without resorting to speculation, but stated that generally, the Veteran had little functional use of his left hand/wrist due to the combined effects of his disability. The Veteran had a VA examination for peripheral nerve conditions in April 2016. The Veteran reported constant, severe numbness and tingling pain in the left hand, becoming worse with movement and use. The examiner documented symptoms of severe constant pain, paresthesias and/or dysesthesias, and numbness in the left upper extremity. Muscle strength and reflex testing were normal. Sensory testing revealed decreased sensation to light touch in the left inner/outer forearm, left hand/fingers, left lower leg/ankle, and in the right and left feet and toes. The Veteran had moderate incomplete paralysis of the left median, radial, and ulnar nerves, and of the middle radicular group. The examiner opined that the Veteran may need to decrease tasks requiring repetitive wrist motion and extremes of wrist bending (flexion, extension). She stated that accomodation may be required at workstations, such as ergonomically designed computer keyboards to provide hand and wrist support. The Veteran submitted an opinion from Dr. W.C., Ph. D., dated May 2016. Dr. W.C. reviewed records from the March and April 2012, February 2014, May 2015 and April 2016 VA examinations, and considered the Veteran’s education, military experience, and work history. He observed that the Veteran’s previous employment at the Army depot was semi-skilled in nature and required a heavy level of exertion. Dr. W.C. opined that when considering the Veteran’s education, work background, loss of function, and degree of pain associated with his left hand and wrist, the Veteran would have a 100 percent loss of employability and is not able to perform at a substantially gainful occupation. The Board finds that the probative evidence of record shows that the Veteran is unable to secure or follow an occupation involving heavy physical exertion due to his service-connected disabilities. However, it does not show that it is at least as likely as not that the Veteran is unable to secure or follow all substantially gainful employment consistent with his educational and occupational experience solely as a result of service-connected disabilities. In arriving at this conclusion, the Board recognizes that the Veteran’s service-connected disabilities impacts his occupational functioning. The evidence shows that the Veteran’s service-connected disabilities limit his ability to lift, carry, push, or pull heavy loads. In essence, it shows that the Veteran is unable to perform heavy exertional, physical work. However, the most probative evidence indicates that the Veteran is able to perform work that does not require him to lift, carry, push, or pull heavy loads. In this regard, the Board attaches high probative weight to the opinion of the April 2016 VA examiner. The examiner reviewed the claims file, evaluated the Veteran, considered the Veteran’s reports of pain, and opined that the Veteran may need to decrease tasks requiring repetitive wrist motion and extremes of wrist bending, but indicated that the Veteran could perform labor with accommodations such as an ergonomic keyboard. Because the examiner reviewed the claims file, considered the Veteran’s reports of pain, and provided persuasive rationale supported by medical evidence, the Board affords the opinion high probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). While the May 2015 VA examiner stated that the Veteran generally had little functional use of his left hand and wrist, he also indicated that he could not provide an opinion on the extent on functional impact on employment posed by the Veteran’s wrist disability without resorting to speculation. As the examiner’s opinion is speculative and equivocal, the Board affords it lower probative weight. Obert v. Brown, 5 Vet. App. 30, 33 (1995); Tirpak v. Derwinski, 2 Vet. App. 609 (1992). The April 2012 VA examiner opined that the Veteran’s disability posed functional limitations, including decreased use of the left hand and fingers. The November 2009 VA examiner opined that the disability reduced manual dexterity, and decreased upper extremity strength. However, those examiners did not indicate that the Veteran would be precluded from substantially gainful employment as a result of service-connected disabilities. Further, the May 2015 VA examination report noted that the Veteran is right hand dominant. The Board has considered Dr. W.C.’s report. However, as a psychologist, his ability to opine on the medical severity and functional impairment of a left wrist disability is questionable. See Kahana, 24 Vet. App. at 435. Nevertheless, his testimony can be considered competent lay evidence, particularly as to the Veteran’s background and work experience. Id. Dr. W.C. restated the findings of several VA examiners of record, and noted that the Veteran’s previous position involved a heavy level of exertion. However, he did not explain why the Veteran would be precluded from labor not involving excessive strain on the wrist. See Prejean, 13 Vet. App. at 449 (the Board may consider the thoroughness and detail of a medical opinion as factors affecting probative weight). Notably, he did not consider the VA examination reports from March 2013, in which the examiner opined that the Veteran’s wrist and finger disabilities would not preclude all labor. See Nieves-Rodriguez, 22 Vet. App. at 304 (critical pieces of information from a claimant’s medical history can lend credence to the opinion of the medical expert who considers them and detract from the medical opinions of experts who do not). Therefore, the Board affords Dr. W.C.’s statements less probative weight. The Board has considered the Veteran’s level of education and occupational history. He has a high school diploma, and his work history involves 33 years as a warehouse supply clerk. In November 2009, the Veteran indicated that he had been performing “computer work” for the past 2-5 years. Although his previous employment involved moving boxes, which would now be precluded due to his disability, the record does not establish that the Veteran would be prevented from transitioning into substantially gainful employment primarily involving use of his dominant hand. The Board has also considered the Veteran’s lay statements. However, the determination of whether a Veteran is unable to secure and maintain substantially gainful employment as a result of his service-connected disabilities is ultimately to be determined by VA. 38 C.F.R. §§ 4.16 (a) and (b); Geib, 733 F.3d at 1354. The Board understands that the Veteran’s disabilities are painful, and can pose limitations on his employment. Nevertheless, the test for a TDIU is whether a Veteran is incapable of securing and maintaining substantially gainful employment by reason of service-connected disabilities. See id.; Van Hoose, 4 Vet. App. at 363. The preponderance of the evidence, including with consideration of the   Veteran’s education and occupational history, is against a finding that the Veteran is unable to perform substantially gainful employment due to his service-connected disabilities. The benefit of the doubt does not apply, and the claim must be denied. 38 U.S.C. § 5107 (b). U. R. POWELL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Reed, Associate Counsel