Citation Nr: 18150842 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 12-02 248 DATE: November 15, 2018 ORDER The claim for entitlement to a rating higher than 30 percent for asbestosis, bronchitis, and reactive airway disease is denied. The claim for entitlement to a rating higher than 30 percent for coronary artery disease (CAD), status post bypass graft surgery is denied. The claim for entitlement to service connection for neurological impairment of the right upper extremity, to include carpal tunnel syndrome as secondary to service-connected diabetes mellitus is denied. The claim for entitlement to service connection for neurological impairment of the left upper extremity, to include ulnar neuropathy and carpal tunnel syndrome as secondary to service-connected diabetes mellitus is denied. The claim for entitlement to a total disability rating due to individual unemployability resulting from service-connected disability (TDIU) is denied. FINDINGS OF FACT 1. The Veteran’s service-connected lung disease manifests calcified pleural plaques, a mild restrictive defect, symptoms of intermittent cough and shortness of breath on exertion, and pulmonary function test (PFT) results that are consistent with the current disability rating. 2. The Veteran’s CAD does not result in any episodes of acute congestive heart failure; a workload of greater than three metabolic equivalents (METs) but not greater than five METs resulting in dyspnea, fatigue, angina, dizziness, or syncope; or left ventricular dysfunction with an ejection fraction of 30 to 50 percent. 3. Neurological impairment of the right upper extremity, to include carpal tunnel syndrome, was not present in service or until years thereafter and is not etiologically related to any incident of active duty service and is not caused or aggravated by a service-connected disability. 4. Neurological impairment of the left upper extremity, to include ulnar neuropathy and carpal tunnel syndrome, was not present in service or until years thereafter and is not etiologically related to any incident of active duty service and is not caused or aggravated by a service-connected disability. 5. The Veteran’s service-connected disabilities do not preclude him from securing or following substantially gainful employment consistent with his education and industrial background. CONCLUSIONS OF LAW 1. The criteria for a rating higher than 30 percent for asbestosis, bronchitis, and reactive airway disease are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.159, 3.321, 4.3, 4.7, 4.97 Diagnostic Code 6833-6600. 2. The criteria for a rating higher than 30 percent for CAD are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.159, 3.321, 4.3, 4.7, 4.104 Diagnostic Code 7107. 3. Neurological impairment of the right upper extremity, to include carpal tunnel syndrome, was not incurred in or aggravated by active service and it is not proximately due to or the result of a service-connected disability. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310. 4. Neurological impairment of the left upper extremity, to include ulnar neuropathy and carpal tunnel syndrome, was not incurred in or aggravated by active service and it is not proximately due to or the result of a service-connected disability. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310. 5. The criteria for entitlement to a TDIU are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1962 to June 1974 and from December 1975 to April 1984. This case comes to the Board of Veterans’ Appeals (Board) on appeal from May 2010 and December 2012 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in November 2015 when it was remanded for additional development. It has now returned to the Board for further appellate action. The Board’s remand instructions in November 2015 included a directive that the Veteran should be provided “an appropriate VA examination, to be conducted, if possible, by a vocational rehabilitation specialist with respect to his TDIU claim…The examiner must opine whether…it is at least as likely as not that [the Veteran’s] service-connected disabilities, alone or in aggregate, render him unable to secure or follow a substantially gainful occupation.” The Veteran was not provided this examination, but the Board finds that no corrective action is necessary as the Board’s November 2015 remand instructions asked for an inappropriate opinion from a VA examiner. In a claim for TDIU, the ultimate question of whether a Veteran is capable of substantially gainful employment is not a medical one; that determination is for the adjudicator. See 38 C.F.R. § 4.16(a); see also Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013) (noting that “applicable regulations place responsibility for the ultimate TDIU determination on the [adjudicator], not a medical examiner”); Floore v. Shinseki, 26 Vet. App. 376, 381 (2013) (observing that “medical examiners are responsible for providing a ‘full description of the effects of disability upon the person’s ordinary activity,’ 38 C.F.R. § 4.10), but it is the rating official who is responsible for’ ‘interpret[ing] reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present,’ 38 C.F.R. § 4.2 (2013).”). Thus, the remand instruction asking for a medical opinion addressing the Veteran’s employability was not appropriate as the determination of employability is a determination to be made the adjudicator, i.e. the Board. VA’s failure to obtain the requested examination does not violate the duty to assist. The Board notes that the Veteran was provided VA examinations of his service-connected heart and respiratory disabilities in response to the November 2015 remand and the examiners provided opinions regarding the Veteran’s functional impairment and the impact of these conditions on the Veteran’s occupational activities. VA has therefore substantially complied with the Board’s remand instructions and the Board will proceed with a decision in this case. Increased Rating Disability evaluations are determined by comparing a Veteran’s present symptomatology with criteria set forth in VA’s Schedule for Rating Disabilities (Rating Schedule), which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran’s entire history is reviewed when making disability ratings. See generally 38 C.F.R. 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The Board must also consider whether staged ratings are appropriate when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. The relevant focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. Entitlement to a rating higher than 30 percent for asbestosis, bronchitis, and reactive airway disease. Service connection for asbestosis, bronchitis, and reactive airway disease was awarded in a November 2008 rating decision. An initial 30 percent evaluation was assigned effective June 29, 2007. The May 2010 rating decision on appeal continued the 30 percent evaluation. The Veteran contends that an increased rating is warranted as his respiratory function is limited by his service-connected lung disease. The Veteran’s service-connected disability is currently rated as 30 percent disabling under Diagnostic Code 6833-6800 indicating that the Veteran’s respiratory disability is compensated as asbestosis in the context of chronic bronchitis. Under Diagnostic Code 6833 and the General Rating Formula for Interstitial Lung Disease (Diagnostic Codes 6825 through 6833), a Forced Vital Capacity (FVC) of 65 to 74-percent predicted value, or; Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)) is 56 to 65-percent predicted, is rated 30 percent disabling. FVC of 50- to 64-percent predicted, or; DLCO (SB) of 40- to 55-percent predicted, or; maximum exercise capacity of 15 to 20 ml/kg/min oxygen consumption with cardiorespiratory limitation, is rated 60 percent disabling. FVC less than 50 percent of predicted value, or; DLCO (SB) less than 40-percent predicted, or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption with cardiorespiratory limitation, or; cor pulmonale (right heart failure) or pulmonary hypertension, or; requires outpatient oxygen therapy, is rated 100 percent disabling. 38 C.F.R. § 4.97. The Board will also consider whether an increased rating is warranted under Diagnostic Code 6600 for chronic bronchitis. Under this diagnostic code, a 30 percent rating is assigned where FEV-1 is 40 to 50 percent predicted, FEV-1/FVC is 56 to 70 percent, or DLCO is 56 to 65 percent. A 60 percent rating is warranted where there is FEV-1 of 40 to 55 percent, FEV-1/FVC to 40 to 55 percent, DLCO of 40 to 55 percent, or maximum oxygen consumption of 15 to 20 ml/kg in. Finally, a 100 percent rating is warranted were FEV-1 is less than 40 percent of predicted value, or; the ratio of FEV-1/FVC is less than 40 percent, or DLCO is less than 40 percent predicted, or; maximum exercise capacity is less than 15 ml/kg in oxygen consumption, or; cor pulmonale, or; right ventricular hypertrophy, or; pulmonary hypertension, or; episodes of acute respiratory failure, or; requires outpatient oxygen thereby. 38 C.F.R. § 4.97 Diagnostic Code 6600. After review of the evidence, the Board finds that a rating higher than 30 percent is not warranted for the Veteran’s service-connected lung disease. The competent evidence establishes that the Veteran experiences a mild restrictive defect due to asbestosis, bronchitis, and reactive airways disease with an intermittent cough and shortness of breath on exertion. The disability was specifically characterized as mild by the August 2009 VA examiner and the Veteran’s private pulmonologist in December 2013, June 2014, and December 2015. Chest imaging performed throughout the claims period also demonstrates stable pleural plaques of the lungs consistent with asbestos exposure. These findings are contemplated by the current 30 percent rating and do not most nearly approximate a higher rating under Diagnostic Code 6833 or 6600. PFTs performed during the claims period also demonstrate results that are consistent with the current 30 percent evaluation. The Veteran’s PFT results throughout the claims period (most performed by his private pulmonologist) consistently show a FVC and FEV-1 of 66 percent or better, FEV-1/FVC of 74 percent or better, and a DLCO of 79 percent or better. These findings are all contemplated by a 30 percent rating or lower. The Board notes that on one occasion the Veteran manifested a PFT result that is associated with an increased 60 percent evaluation. A July 2009 PFT conducted as part of the August 2009 VA examination demonstrated a FVC of 58 percent predicted. This result is contemplated by a 60 percent rating under Diagnostic Code 6833. However, this FVC value is inconsistent with all other PFTs performed during the claims period which demonstrate a much higher forced vital capacity of the lungs. For example, the Veteran’s FVC at the most recent May 2017 VA examination was 90 percent predicted. The July 2009 FVC result is also inconsistent with the characterization of the Veteran’s disability as mild restrictive by the 2009 VA examiner and the Veteran’s private pulmonologist. The Board therefore finds that the July 2009 PFT result is not indicative of the severity of the service-connected disability and does not support the assignment of a rating in excess of 30 percent at any time during the claims period. The Board has considered the Veteran’s statements in support of his claim, but finds that his lay statements are outweighed by the competent medical evidence against the claim—including the PFT results which establish a mild restrictive disability. To the extent the Veteran has also been diagnosed with an obstructive lung defect, the service-connected respiratory disability only manifests restrictive impairment of the lungs. The May 2017 VA examiner specifically found that the Veteran’s obstructive lung disease was not a manifestation of the service-connected disability and this conclusion is also supported by the findings of the Veteran’s private pulmonologist who relates his obstructive defect to smoking and obesity. The Board finds that the competent evidence sufficiently separates the symptomatology of the service and nonservice-connected disabilities and the current 30 percent evaluation is the appropriate rating for the service-connected asbestosis, bronchitis, and reactive airway disease. 2. Entitlement to a rating higher than 30 percent CAD, status post bypass graft surgery. Service connection for CAD, status post bypass graft surgery, was awarded in a September 2005 rating decision. An initial 30 percent evaluation was assigned effective April 20, 2005. The May 2010 rating decision on appeal continued the 30 percent evaluation for the service-connected heart condition. The Veteran has not provided any specific argument in support of his increased rating claim, but contends that his disability is productive of symptomatology that most nearly approximates a higher disability evaluation. The Veteran’s CAD is rated as 30 percent disabling under Diagnostic Code 7017 pertaining to coronary bypass surgery. Under this diagnostic code, a disability resulting in workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray, is rated 30 percent disabling. A disability resulting in more than one episode of acute congestive heart failure in the past year, or; workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent, is rated 60 percent disabling. A disability resulting in chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent, is rated 100 percent disabling. 38 C.F.R. § 4.104. For rating diseases of the heart, one MET is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. When the level of METs at which dyspnea, fatigue, angina, dizziness, or syncope develops is required for rating, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, an estimation by a medical examiner of the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shovelling snow) that results in dyspnea, fatigue, angina, dizziness, or syncope may be used. 38 C.F.R. § 4.104, Note 2. After review of the evidence, the Board finds that the Veteran’s CAD most nearly approximates the current 30 percent rating throughout the claims period. There is no evidence of congestive heart failure during this period and treatment records do not document any instances of a workload between three to five METs resulting in dyspnea, fatigue, angina, dizziness, or syncope. In fact, the Veteran’s CAD was characterized by his private cardiologists as asymptomatic and stable in April 2008, November 2009, August 2012, and August 2013. The Veteran was seen at a private hospital for an episode of near syncope in April 2010, but no abnormality was identified at the private facility or by the Veteran’s private cardiologist a week later. The Veteran has occasionally complained of shortness of breath with exertion, but this symptom is contemplated by the current 30 percent evaluation. Upon VA examination in May 2017, the Veteran’s METs capacity was estimated as five to seven and examination of the heart was normal. These findings and complaints are consistent with the current 30 percent disability rating. Private medical testing performed throughout the claims period also establishes that a 30 percent rating is appropriate. Echocardiograms and stress tests performed in December 2009, April 2010, December 2011, and July 2015 all demonstrate left ventricular function and ejection fractions consistent with a 30 percent evaluation. None of this medical evidence supports the assignment of a rating in excess of 30 percent for the Veteran’s CAD based on exercise function or left ventricular dysfunction. The Board has also considered the Veteran’s lay statements that his symptoms and manifestations of CAD warrant an increased rating. The Veteran is competent to report the symptoms he experiences, but he has not provided any specific statements in support of his claim. The Board also finds that he is not competent to state these symptoms are consistent with worsening left ventricular functioning or lower METs workloads. Jandreau v. Nicholson, 492 F.3d 1372 (Fed.Cir.2007). The record does not contain any medical or lay evidence indicating that the Veteran’s CAD by itself specifically limits his activities of daily living during the claims period. The Board has considered the Veteran’s complaints, but finds that the medical evidence, including objective testing is more probative regarding the severity of the service-connected CAD. The Board has considered whether there is any other schedular basis for granting a higher rating, but has found none. In addition, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable because the preponderance of the evidence is against the claim. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.7, 4.21. Service Connection Service connection is provided for a disability which is proximately due to, the result of, or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995). Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, 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”-the so-called “nexus” requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). See also Davidson v. Shinseki, 581 F.3d 1313 (Fed.Cir.2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed.Cir.2007). 3. Entitlement to service connection for neurological impairment of the right upper extremity, to include carpal tunnel syndrome as secondary to service-connected diabetes mellitus. 4. Entitlement to service connection for neurological impairment of the left upper extremity, to include ulnar neuropathy and carpal tunnel syndrome as secondary to service-connected diabetes mellitus. The Veteran contends that service connection is warranted for neurological impairment of the upper extremities as secondary to service-connected diabetes mellitus. The Board must also consider whether service connection is warranted for the claimed disabilities based on a direct link to service. Turning first to the Veteran’s contentions regarding secondary service connection, the record establishes the presence of chronic disabilities manifesting neurological impairment of the upper extremities. An electromyography (EMG) test of the upper extremities ordered by the Veteran’s private neurologist in July 2011 demonstrated impairment consistent with bilateral carpal tunnel syndrome and left ulnar neuropathy localized in the elbow. These diagnoses were confirmed by VA examiners in December 2011 and May 2017. Current diagnoses are therefore demonstrated. Although the Veteran clearly has chronic neurological impairment of the right and left upper extremities, the Board finds that the competent medical evidence of record does not demonstrate a relationship between the diagnosed conditions and service-connected diabetes mellitus. None of the Veteran’s treating physicians have identified a nexus between the Veteran’s carpal tunnel syndrome and ulnar neuropathy and service-connected diabetes. Furthermore, the December 2011 and May 2017 VA examiners both provided opinions against the claim by noting the distinctions between neuropathies associated with diabetes mellitus (such as the Veteran’s lower extremity diabetic neuropathy) and the Veteran’s bilateral carpal tunnel syndrome and left ulnar nerve neuropathy. After reviewing the claims file and physically examining the Veteran, both VA examiners determined that the Veteran’s upper extremity neurological impairment was not consistent with diabetes-related neuropathy based on the nature and presentation of the disabilities. The Board has also considered the statements of the Veteran in support of his claims. In March 2013 and January 2016 statements, the Veteran quoted two medical resources to support his contention that his carpal tunnel syndrome and ulnar neuropathy were caused or aggravated by service-connected diabetes mellitus. The Veteran did not provide copies of the original treatise evidence for the Board’s review, but the Board finds that the treatise evidence cited by the Veteran is of little probative value and is outweighed by the medical evidence weighing against the claim. The treatise evidence cited by the Veteran states that carpal tunnel and other entrapment and compression neuropathies are common in people with diabetes and diabetic neuropathy. This evidence, while noting that diabetic neuropathy and other types of neuropathies often co-exist, does not provide any actual mechanism for causation or aggravation of the Veteran’s upper extremity neuropathies and diabetes. The treatise evidence cited by the Veteran was also addressed by the May 2017 VA examiner who observed that while diabetes can be a risk factor for the development of entrapment neuropathies like carpal tunnel syndrome and ulnar nerve entrapment at the elbow, in this specific Veteran there is no objective evidence that his upper extremity neurological impairment is caused or aggravated by service-connected diabetes mellitus. The Board finds that the lack of specificity in the treatise evidence cited by the Veteran renders it of little probative value and it is outweighed by the May 2017 VA examiner’s medical opinion. The Board has considered the other statements of the Veteran linking his upper extremity neurological impairment to diabetes. The Veteran is competent to report observable symptoms of disability, but his opinion as to the cause of his condition simply cannot be accepted as competent evidence. Jandreau v. Nicholson, 492 F.3d 1372 (Fed.Cir.2007). Although lay persons are competent to provide opinions on some medical issues, the specific issue in this case (the etiology of the claimed neurological impairment) falls outside the realm of common knowledge of a lay person. Id at 1377. Thus, while the Veteran contends that his carpal tunnel syndrome and ulnar neuropathy are secondary to diabetes, the Board concludes that the Veteran’s lay statements are outweighed by the competent medical evidence of record which weighs against service connection on a secondary basis. As a final matter, the Board must also consider whether service connection is warranted for the upper extremity neurological impairment as directly due to service. In this case, there is no competent evidence of a link between the Veteran’s carpal tunnel syndrome and ulnar neuropathy and active duty. Service treatment records are completely negative for any complaints or treatment related to neurological impairment of the upper extremities. The Veteran was neurologically normal at a September 1982 submarine service examination (a year and a half before his discharge) and he specifically denied any history or problem with neuritis on the accompanying report of medical history. Post-service treatment records do not document any complaints related to neurological impairment of the upper extremities until March 2009, 25 years after service, when the Veteran complained of numbness in his hands and legs to his private physician. The absence of lay or medical evidence of the claimed disability for many years after service is a factor weighing against the Veteran’s claim for direct service connection. The Board also observes that there is no competent medical evidence in support of the claim for direct service connection and none of the Veteran’s physicians have identified a link between the Veteran’s neurological impairment and an in-service event or injury. In sum, the record shows that the first evidence of the Veteran’s claimed disability was many years after his separation from active duty. In addition, the competent medical evidence does not establish that any of the currently diagnosed neurological disabilities of the upper extremities were incurred secondary to a service-connected disability or directly due to active service. The Board therefore concludes that the evidence is against a nexus between the Veteran’s bilateral carpal tunnel syndrome and left ulnar neuropathy and a service-connected disability or active duty service. The Board must conclude that the preponderance of the evidence is against the claims and they are denied. 38 U.S.C. § 5107(b). TDIU 5. Entitlement to TDIU. The Veteran contends that he is unemployable due to service-connected disabilities including CAD, asbestosis, diabetes, and diabetic neuropathy. VA will grant a TDIU when the evidence shows that the Veteran is precluded, by reason of service-connected disabilities, from obtaining or maintaining “substantially gainful employment” consistent with his education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16; VAOPGCPREC 75-91; 57 Fed. Reg. 2317 (1992). A TDIU may be assigned where the schedular rating is less than total if the veteran has a single service-connected disability ratable at 60 percent or more, or has 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. §§ 3.340, 3.341, 4.16(a). The Veteran is in receipt of a combined schedular rating of 70 percent from June 29, 2007 and 80 percent from October 10, 2008. He does meet the schedular criteria for an award of TDIU as he does have a single disability ratable at 40 percent or more when the Board considers the full provisions of 38 C.F.R. § 4.16 which provide for circumstances when multiple disabilities may be considered a single disability, e.g. disabilities resulting from a common etiology or affecting a single body system. Thus, the Board must assess whether there are circumstances in this Veteran’s case, apart from any non-service connected conditions and advancing age, which would justify a total rating based on unemployability. Van Hoose v. Brown, 4 Vet. App. 361(1993); see also Hodges v. Brown, 5 Vet. App. 375 (1993). In this case, the Board finds that the Veteran is not unemployable as his service-connected disabilities do not cause a level of occupational impairment that prevents him from obtaining or maintaining substantially gainful employment. The record establishes that while the Veteran has some impairments to physical exertion related to service-connected disabilities, he is capable of performing work consistent with his educational and employment history. The Veteran reported on his March 2018 VA Form 21-8940 (“Veteran’s Application for Increased Compensation Based on Unemployability”) that he last worked full-time in May 2005 in escrow account research. His reported earlier jobs in similar fields such as a mortgage clerk, scanner operator, data convertor, and business broker. During the May 2017 VA peripheral nerves examination, the Veteran also reported that he obtained a bachelor degree in science and had completed some graduate courses in public administration budgeting and finance. The Board therefore finds that the Veteran’s work and education history is consistent with work that does not require a great deal of physical exertion or manual labor. The evidence also establishes that the Veteran can perform work that does not require heavy physical labor. As discussed above, the Veteran’s CAD and respiratory disability are no more than mild in severity and do not restrict his ability to sustain employment consistent with his educational and work history. The May 2017 VA examiner determined that the Veteran’s CAD only impaired his ability to perform heavy physical exertion and the respiratory examiner found there was no impairment to occupational activities from the service-connected lung disease. Similar conclusions were reached by VA examiners in August 2009; the Veteran’s diabetes was described as well-controlled, his hearing loss did not preclude the use of assistive technology or other communication strategies, and the Veteran’s heart disease manifested occupational impairment to physical activities such as mobility, lifting and carrying, and stamina. Thus, the competent medical evidence establishes that the Veteran is capable of performing work that is not physically demanding. The Board has considered the Veteran’s own statements, but finds that they also do not support an award of TDIU. Despite the Veteran’s contentions that he is unemployable due to service-connected disabilities, the Board notes that he has attributed his level of impairment to nonservice-connected conditions when providing a history for medical treatment purposes. For example, during the May 2017 VA cardiac examination, the Veteran reported that he was most restricted to walking due to nonservice-connected hip pain and severe low back pain. The Veteran has also characterized his lifestyle as active—he told his private pulmonologist in December 2013 that he volunteered three times a week at a VA hospital and reported to the May 2017 VA examiner that he volunteered with several major veterans’ organizations. The Veteran has also consistently reported that he is independent with respect to all activities of daily living. The Board finds that this lay evidence of the Veteran’s nonservice-connected disabilities and daily activities is consistent with a finding that he is not unemployable for work consistent with his educational and employment history. The Board therefore concludes that the weight of the evidence is against a finding of unemployability due to solely to service-connected disabilities. As the weight of the evidence is clearly against the claim, the benefit-of-the-doubt rule is   inapplicable and the claim must be denied. 38 U.S.C. § 5107(b); Gilbert, supra; 38 C.F.R. §§ 4.15, 4.16, 3.340, 3.341. M. H. HAWLEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Riley, Counsel