Citation Nr: 18154388 Decision Date: 11/29/18 Archive Date: 11/29/18 DOCKET NO. 16-10 215 DATE: November 29, 2018 ORDER Entitlement to service connection for hypertension, including as secondary to service-connected ischemic heart disease (IHD) with atrial fibrillation, is denied. Entitlement to service connection for erectile dysfunction (ED), including as secondary to IHD is denied. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is denied. FINDINGS OF FACT 1. The Veteran’s hypertension did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury, event, or disease. The Veteran’s hypertension is neither proximately due to nor aggravated beyond its natural progression by his service-connected IHD with atrial fibrillation or other service-connected disability. 2. The Veteran’s ED is neither proximately due to nor aggravated beyond its natural progression by his service-connected IHD with atrial fibrillation, and is not otherwise related to an in-service injury, event, or disease. 3. The weight of the evidence shows that the Veteran’s service-connected disabilities do not prevent him from obtaining and maintaining substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for establishing service connection for hypertension, including as secondary to service-connected IHD with atrial fibrillation, have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. 2. The criteria for establishing service connection for ED, including as secondary to service-connected IHD with atrial fibrillation, have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. 3. The criteria for a TDIU have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16, 4.18, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from November 1966 to August 1970. This case comes to the Board of Veterans’ Appeals (Board) on appeal from an Agency of Original Jurisdiction (AOJ) decisions dated in June 2012 and August 2012. Service Connection Service connection is granted if it is shown the Veteran suffers from disability resulting from an injury sustained or a disease contracted in the line of duty during active military service, or for aggravation during service of a pre-existing condition beyond its natural progression. 38 U.S.C. §§ 1110, 1131, 1153; 38 C.F.R. §§ 3.303, 3.306. Evidence of continuity of symptomatology from the time of service until the present is required where the chronicity of a chronic condition manifested during service either has not been established or might reasonably be questioned. 38 C.F.R. § 3.303 (b); see also Walker v. Shinseki, 708 F.3d 1331, 1340 (Fed. Cir. 2013) (holding that only conditions listed as chronic diseases in § 3.309(a) may be considered for service connection under 38 C.F.R. § 3.303 (b)). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303 (d). Generally, to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). The nexus element may be fulfilled by (1) a nexus opinion or (2) competent and credible evidence showing that the veteran has experienced frequent and persistent symptoms of the disease since service. 38 U.S.C. § 1154 (a); 38 C.F.R. §§ 3.303 (a), (d); see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Service connection may be established for disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310 (a). Further, a disability that is aggravated by a service-connected disability may be service connected to the degree that the aggravation is shown. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when: (1) a layperson is competent to identify the medical condition, (e.g., a broken leg, separated shoulder, pes planus (flat feet), varicose veins, the tinnitus (ringing in the ears), etc.), (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Where a Veteran served continuously for 90 days or more during a period of war, or during peacetime service after December 31, 1946, and cardiovascular-renal disease, including hypertension, becomes manifest to a degree of 10 percent within one year from date of termination of such service, such disease shall be presumed to have been incurred in or aggravated by service, even though there is no evidence of such diseases during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary. The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. 1. Entitlement to service connection for hypertension, claimed as secondary to IHD The Veteran contends that his current hypertension is secondary to his service-connected heart condition (IHD with atrial fibrillation). See his June 2011 claim and March 2016 substantive appeal. The question for the Board is whether the Veteran has a current disability that was incurred in or aggravated by active service, or is proximately due to or the result of, or was aggravated beyond its natural progress by a service-connected disability. The evidence reflects that the Veteran has a current diagnosis of hypertension. See April 2012 VA examination report. For VA purposes, hypertension is defined as diastolic blood pressure that is predominantly 90 mm or greater, or systolic blood pressure that is predominantly 160 mm or greater with a diastolic blood pressure of less than 90 mm. 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1). Hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. Id. A Veteran is presumed in sound condition when examined and accepted for service, except for defects or disorders noted at entrance to service, or where clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed prior thereto and was not aggravated by such service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304 (b). Only such conditions as are recorded in examination reports are to be considered as noted. 38 C.F.R. § 3.304 (b). The disorder need not be currently symptomatic, but only noted on entrance. Verdon v. Brown, 8 Vet. App. 529, 535 (1996). A pre-existing injury or disease will be considered to have been aggravated during service when there is an increase in disability during service, unless there is a specific finding that the increase in disability is due to the natural progression of the disease. 38 U.S.C. § 1153; 38 C.F.R. § 3.306 (a). Service treatment records show that on entrance medical examination in November 1966, the Veteran's blood pressure was 136/84. In a concurrent report of medical history, the Veteran reported that he had a history of high or low blood pressure. The reviewing examiner stated that the Veteran had high blood pressure, was obese and had no treatment for the condition. His blood pressure was 132/82 in December 1966. Subsequent service treatment records are negative for complaints, treatment, or diagnosis of hypertension or elevated blood pressure. In an August 1970 report of medical history at separation, the Veteran denied a history of high or low blood pressure. On separation medical examination in August 1970, hypertension was not diagnosed. The Board finds that, although the November 1966 report of medical history completed at the time of the service entrance examination shows that the Veteran reported a history of a high blood pressure, and the examiner added a handwritten notation that he had a history of high blood pressure without treatment, pre-existing hypertension was not clinically demonstrated, diagnosed, or “noted” on the associated November 1966 entrance examination report. History provided by the Veteran of the pre-service existence of conditions recorded at the time of the entrance examination, does not, in itself, constitute a notation of a preexisting condition. 38 C.F.R. § 3.304 (b)(1); Paulson v. Brown, 7 Vet. App. 466, 470 (1995); Crowe v. Brown, 7 Vet. App. 238, 246 (1995). The Board finds that a diagnosis of hypertension was not “noted” or clinically demonstrated on his entrance medical examination, and there is no clear and unmistakable evidence demonstrating that hypertension both existed prior to service and was not aggravated by such service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304 (b). Hence, he is presumed to have been in sound condition as to this disease on entry into service. His service treatment records are entirely negative for a diagnosis of hypertension. Post-service medical records are negative for hypertension for decades after service. A May 2008 private medical record from Deaconess Health System reflects that the Veteran had a history of hypertension in the past and was on anti-hypertensive medication a couple of years ago. He took those medications for a couple of years and then had some problems with low blood pressure and a slow heart rate, so the medication was discontinued. On examination, blood pressure was 110/72. The diagnostic impression was paroxysmal atrial fibrillation with symptoms, history of hypertension (presently his blood pressure was under decent control), history of colitis, and hypothyroidism. Private medical records from S.T., MD dated in June 2008 show that the Veteran was diagnosed with atherosclerotic heart disease, angina, systemic hypertension, mild obesity, atrial fibrillation, sick sinus syndrome status post pacemaker placement, irritable bowel syndrome, and hypercholesterolemia on statin therapy. In a June 2011 IHD Disability Benefits Questionnaire (DBQ), Dr. T. diagnosed status post coronary artery bypass graft (CABG), coronary artery disease, atrial fibrillation, hyperlipidemia and hypertension. VA medical records dated since June 2011 reflect treatment for multiple medical problems, to include heart disease. Hypertension was not diagnosed on examination in July 2011, at which time his blood pressure was 108/74, and no hypertensive medication was being taken. On cardiology consult in August 2011, his blood pressure was 110/65. The physician indicated that there was no history of hypertension. The preponderance of the evidence is against finding that hypertension began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a), (d). The Veteran’s service treatment records are completely silent as to any findings of or treatment for hypertension during his military service. The first post service diagnosis of this condition was in 2006, 40 years after his separation from military service, and the weight of the competent and credible evidence does not link this condition to his military service. The record shows that the Veteran served in the Republic of Vietnam during the Vietnam Era. Therefore, he is presumed to have been exposed to an herbicide agent during service. However, hypertension is not included in the list of diseases presumptively related to exposure to herbicide agents. See 38 C.F.R. § 3.309 (e). Moreover, while IHD is presumptively related to exposure to herbicide agents, hypertension is expressly excluded from the definition of IHD. Id. at Note 2. The next question for the Board to consider is whether the Veteran has hypertension that is proximately due to or the result of, or was aggravated beyond its natural progress by his service-connected IHD with atrial fibrillation. The Board concludes that, while the Veteran has a current diagnosis of hypertension, the preponderance of the evidence is against finding that the Veteran’s hypertension is proximately due to or the result of, or aggravated beyond its natural progression by service-connected disability. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). On VA examination in April 2012, the examiner noted that the Veteran had a history of hypertension dating back to 2005 or 2006, and referenced the May 2008 private medical record discussed above. He noted that the Veteran was diagnosed with IHD in May 2008, and subsequently began taking blood pressure medication. The examiner opined that the Veteran’s hypertension predated his diagnosis of coronary artery disease/IHD, and therefore it was not proximately due to and/or the result of IHD. By a letter dated in October 2012, N.A., MD, the Veteran’s primary care physician, stated that he had treated the Veteran for several years. He indicated that the Veteran had IHD and had been on medication for hypertension. He also had hypothyroidism, hypercholesterolemia, and ED. Dr. A. stated that his hypertension could be related to atherosclerosis which is a part of vascular disease. He opined that it is more likely that hypertension contributes to IHD. On VA examination in January 2016, the examiner opined that the Veteran’s hypertension is less likely as not (less than 50/50 probability) proximately due to or aggravated beyond normal progression by his service-connected coronary artery disease. The rationale was that coronary artery disease does not cause hypertension. The diagnosis of hypertension was made in 2006 and coronary artery disease was found in 2008. Hypertension was not listed in the Veteran's VA medical problem list at his first visit to a VA clinic in June 2011, although multiple other medical problems were listed, and he was not taking medication for hypertension. The Board finds that the October 2012 opinion by Dr. A. that hypertension “could be” related to atherosclerosis and vascular disease is equivocal, and expressed in speculative language, and therefore does not provide the degree of certainty required for medical nexus evidence. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). He also opined that it was more likely that hypertension contributed to IHD. This second statement, which is not speculative, weighs against the claim. Dr. A. did not provide a rationale for his opinions. The April 2012 and January 2016 VA examiners collectively opined that the hypertension predated the service-connected IHD, and was less likely to be proximately due to IHD. The January 2016 VA examiner further opined that Veteran’s hypertension was not aggravated by service-connected IHD, observing that he did not need medication for it as recently as 2011. While the Veteran believes his hypertension is proximately due to or the result of, or aggravated beyond its natural progression by service-connected IHD with atrial fibrillation, he is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the April 2012 and January 2016 VA medical opinions. Dr. A.’s opinion that it is more likely that hypertension contributes to IHD is also more probative than the Veteran's lay statement, in light of his medical training. The Board finds that the VA medical opinions constitute highly probative evidence against the Veteran’s claim of service connection for hypertension, and outweigh the Veteran’s lay opinion. The VA examination reports are based on current examination results, the Veteran’s reported history, and a review of the medical records, including examinations during and after service. This fact is particularly important, in the Board’s judgment, as the references make for a more convincing rationale. See Bloom v. West, 12 Vet. App. 185, 187 (1999) (the probative value of a physician’s statement is dependent, in part, upon the extent to which it reflects “clinical data or other rationale to support his opinion”). See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (factors for assessing the probative value of a medical opinion include the thoroughness and detail of the opinion). The weight of the evidence does not show that the Veteran’s hypertension became manifest to a compensable degree within the first year after discharge from service, and there is no probative medical opinion of record showing that the Veteran’s current hypertension is etiologically related to service or a service-connected disability. In sum, the Board finds the Veteran is not shown to have hypertension that was incurred in or aggravated by service or a service-connected disability. Accordingly, the claim must be denied. In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable in the instant appeal. Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert, supra. 2. Entitlement to service connection for ED, including as secondary to IHD The Veteran contends that his current ED is secondary to his service-connected heart condition (IHD with atrial fibrillation). See his March 2016 substantive appeal. The question for the Board is whether the Veteran has a current disability that is related to service or is proximately due to or the result of, or was aggravated beyond its natural progress by service-connected disability. While the Veteran has a current diagnosis of ED, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a), (d). The Veteran’s service treatment records are completely silent as to any findings of or treatment for ED during his military service. The first post service diagnosis of this condition was decades after his separation from military service, and there is no competent and credible evidence linking this condition to his military service. The next question for the Board to consider is whether the Veteran has ED that is proximately due to or the result of, or was aggravated beyond its natural progress by his service-connected IHD with atrial fibrillation. The Veteran’s original claim of service connection for ED was received in June 2011, and the Veteran asserted that this condition is secondary to his heart condition. By a letter dated in October 2012, N.A., MD, the Veteran’s primary care physician, stated that he had treated the Veteran for several years. He indicated that the Veteran had IHD, hypertension, hypothyroidism, hypercholesterolemia, and ED. Dr. A. stated that ED could be related to atherosclerosis which is a part of vascular disease. He opined that atherosclerosis contributes to ED. On VA examination in January 2016, the Veteran reported that about 8 months after his CABG, he noticed ED. The examiner opined that the Veteran's ED is less likely as not (less than 50/50 probability) proximately due to or aggravated beyond normal progression by his service-connected coronary artery disease. The rationale was that coronary artery disease does not cause ED. Hypogonadism causes ED, and this was suspected and diagnosed by his VA treatment provider. The examiner also indicated that obesity and hypothyroidism are contributing factors for ED, and noted that he had decreasing levels of testosterone, which were related to hypogonadism. The examiner opined that the Veteran's ED is as likely as not attributable to possible age, hypogonadism, hypothyroidism, obesity and/or hyperlipidemia. Based upon a longitudinal review of the evidence of record, the Board concludes that the preponderance of the evidence is against finding that the Veteran’s ED is proximately due to or the result of, or aggravated beyond its natural progression by his service-connected IHD with atrial fibrillation. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310 (a). The January 2016 VA examiner opined that the Veteran’s ED is instead more likely due to/aggravated by attributable to possible age, hypogonadism, hypothyroidism, obesity and/or hyperlipidemia. The Board finds that the October 2012 opinion by Dr. A. that ED “could be” related to atherosclerosis and vascular disease is equivocal, and expressed in speculative language, and therefore does not provide the degree of certainty required for medical nexus evidence. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). Moreover, Dr. A. did not provide a rationale for his opinion, which reduces the probative value of his assertion that atherosclerosis contributes to ED. While the Veteran believes his ED is proximately due to or the result of, or aggravated beyond its natural progression by service-connected IHD with atrial fibrillation, he is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the January 2016 VA medical opinion. The Board finds that the VA medical opinion constitutes highly probative evidence against the Veteran’s claim of service connection for ED, and outweighs the Veteran’s lay opinion. The VA examination report is based on current examination results, the Veteran’s reported history, and a review of the medical records, including examinations during and after service. This fact is particularly important, in the Board’s judgment, as the references make for a more convincing rationale. See Bloom v. West, 12 Vet. App. 185, 187 (1999) (the probative value of a physician’s statement is dependent, in part, upon the extent to which it reflects “clinical data or other rationale to support his opinion”). See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (factors for assessing the probative value of a medical opinion include the thoroughness and detail of the opinion). The weight of the probative evidence does not show that the Veteran’s current ED is etiologically related to service or a service-connected disability. In sum, the Board finds the Veteran is not shown to have ED that was incurred in or aggravated by service or a service-connected disability. Accordingly, the claim must be denied. In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable in the instant appeal. Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert, supra. 3. Entitlement to a TDIU is denied. The Veteran contends that he is unable to work due to his service-connected disabilities. He filed a claim for a TDIU in June 2011, along with his original service connection claims. A total disability rating for compensation may be assigned, where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, 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 the combined rating must be 70 percent or more. 38 C.F.R. § 4.16 (a). It is the established policy of VA 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, in the case of veterans who are unemployable by reason of service-connected disabilities, but who fail to meet these schedular percentage standards, the case should be submitted to the Director, Compensation Service, for extraschedular consideration. 38 C.F.R. § 4.16 (b). During the rating period on appeal, the Veteran’s service-connected disabilities are anxiety disorder (rated 50 percent disabling from June 21, 2011), IHD with atrial fibrillation (rated 30 percent disabling from August 31, 2010), and scar (rated noncompensable from August 31, 2010). The Veteran had a combined disability rating of 30 percent from August 31, 2010, and a combined disability rating of 70 percent from June 21, 2011. Thus, he has met the schedular criteria for a TDIU pursuant to 38 C.F.R. § 4.16 (a) since June 21, 2011, and did not meet the criteria prior to that date. Records on file show that the Veteran was employed on a full-time basis until February 25, 2011, when he retired. To receive a TDIU, the Veteran’s service-connected disabilities, alone, must be sufficiently severe to cause unemployability. Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). The United States Court of Appeals for Veterans Claims (Court) clarified in Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993), that the disability rating, itself, is recognition that industrial capabilities are impaired. According to 38 C.F.R. § 4.1, the degrees of disability specified in the Rating Schedule are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. Thus, the record must reflect some factor that takes a particular case outside the norm in order for a claim for individual unemployability benefits to prevail. In making this determination of employability, consideration may be given to the Veteran’s level of education, special training, and previous work experience, but not to his age or impairment caused by any disabilities that are not service connected. 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16, 4.19. See also Hodges v. Brown, 5 Vet. App. 375 (1993); Blackburn v. Brown, 4 Vet. App. 395 (1993). Substantially gainful employment is defined as work which is more than marginal and which permits the individual to earn a living wage. Moore v. Derwinski, 1 Vet. App. 356 (1991). See also Faust v. West, 13 Vet. App. 342 (2000). The ultimate determination of whether a Veteran is capable of substantial gainful employment rests with the VA adjudicator, not a medical examiner. See Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013) (citing 38 U.S.C. § 5103A (d)(1)) (the VA adjudicator has the ultimate responsibility for a TDIU determination and VA is not required in every case to obtain a single medical opinion regarding the combined impact of all service-connected disabilities). Private medical records from the Heart Group dated in 2010 and 2011 reflect that the Veteran denied any symptoms, exercised daily 7 days per week and 4-5 miles daily, and worked as a probation officer. In June 2011, Dr. T. stated that the Veteran had no symptoms related to IHD. In a June 2011 IHD Disability Benefits Questionnaire (DBQ), Dr. T. diagnosed status post coronary artery bypass graft (CABG), coronary artery disease, atrial fibrillation, hyperlipidemia and hypertension. He opined that the Veteran’s IHD did not impact his ability to work. In a June 2011 VA Form 21-8940 (Veteran’s Application for Increased Compensation Based on Unemployability), the Veteran did not fill in the boxes as to when his disability affected full-time employment or when he last worked full-time. He said his service-connected conditions prevented him from securing or following any substantially gainful occupation. He stated that he worked as a probation officer from December 1989 to February 2011. He did not list any other employment. He said he left his last job because of his disability, and did not receive disability retirement benefits. He said he had not tried to obtain employment since he became too disabled to work. He reported that he had a bachelor of science in education. Information from the Veteran's former employer dated in June 2011 reflects that the Veteran worked as a probation officer (chief over four counties) on a full-time basis from December 1989 to February 25, 2011. The employer indicated that he had job-related stress which impacted his cardiovascular conditions, and that the Veteran took early retirement due to job stress. The employer stated that the Veteran's stress negatively affected his physical health specifically his heart. The employer stated that the Veteran received monthly retirement benefits. On VA psychological examination in April 2012, the examiner opined that the Veteran's anxiety disorder was manifested by occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medication. The Veteran reported that he worked in a machine shop as a teenager, attended college, served in the Navy, and then finished college. He taught school for several years, worked in the oil fields for 11 years, and became a probation officer in 1989. He worked as a probation officer until February 2011 when he retired at age 65. He felt stressed by having to use a computer more at work but was otherwise handling the job even after his heart surgery. Currently he was involved with his church where he was involved in Sunday School and as a lay minister. He liked to garden and working around the house, and restored old furniture. He was not currently receiving treatment for psychiatric symptoms. His main symptom was irritability for a number of years, which worsened upon dealing with a heart condition. The examiner opined that the Veteran was not unemployable due to his psychiatric symptoms. On VA hypertension examination in April 2012, the examiner stated that the Veteran had a history of hypertension since 2006, and a diagnosis of IHD in 2008, and continued to work until 2011. He observed that the Veteran worked as a probation officer for 21 years, and his heart problems were diagnosed in 2008. He did fairly well after pacemaker placement and bypass procedure in 2008, was off work during his recuperation from surgery, and then continued to work for another 2-3 years and eventually retired in February 2011 when he turned 65. No other significant time was lost from work. Moreover, the Veteran currently had essentially normal exertional capacity and normal left ventricular functioning. The examiner opined that although the Veteran's heart problems did impact his ability to work, currently, the Veteran's coronary artery disease/IHD would less likely as not render the Veteran unable to secure and/or maintain substantially gainful employment. On VA examination in August 2013, a cardiac functional assessment reflects that the lowest level of activity at which the Veteran experienced dyspnea and fatigue was at 5-7 METs (metabolic equivalent), consistent with activities such as golfing (without cart), mowing lawn (push mower), and heavy yard work (digging). In an August 2015 IHD DBQ, Dr. J.M. diagnosed myocardial infarction and CABG, both treated in 2008. He indicated that a cardiac functional assessment reflects that the lowest level of activity at which the Veteran experienced fatigue was at 5-7 METs, consistent with activities such as golfing (without cart), mowing lawn (push mower), and heavy yard work (digging). No other heart symptoms were noted. The probative evidence of record reflects that the Veteran's service-connected anxiety disorder produces no more than a moderate level of occupational and social impairment, and that his other service-connected disabilities do not prevent him from obtaining or maintaining substantially gainful employment. VA and private examiners have opined that he has a METs level consistent with mowing the lawn or heavy yard work, and the Veteran's statements to treating providers show that he volunteers at his church, exercises daily and performs yard work and work around the house. The Board finds that there is little probative value in his employer’s statement, to the effect that job stress affected his heart and reduced his ability to work, as the employer is not shown to be competent to provide a medical opinion as to the effect of job stress on his heart. Moreover, the employer’s statement is outweighed by the competent medical opinion by the April 2012 VA examiner who observed that the Veteran successfully returned to his job for 3 years after his heart condition was diagnosed and treated, only retiring upon reaching retirement age. The Board finds that the preponderance of the evidence does not show that the Veteran’s service-connected disabilities have rendered him unable to secure or follow a substantially gainful occupation throughout the rating period on appeal. The evidence shows that the Veteran has a bachelor’s degree, and varied work experience as a teacher, machine shop employee, oil field worker, and probation officer over several counties. The VA medical opinions regarding the functional effects of the Veteran’s service-connected disabilities are highly probative, and weigh against the claim. The Board concludes that the findings during VA treatment and examination to be more probative than the lay statements by the Veteran and his employer regarding the effect of his service-connected disabilities on his occupational functioning. During the period prior to February 25, 2011, a TDIU is not warranted as the Veteran was employed on a full-time basis. During the period from that date until June 21, 2011, he did not meet the schedular criteria for a TDIU. In light of the foregoing evidence, which does not show that the Veteran is unemployable as a result of his service-connected disabilities, including during that period, the Board finds that extraschedular referral under 38 C.F.R. § 4.16 (b) is not warranted. The most probative evidence of record does not show that the Veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities alone. The claim for entitlement to a TDIU is denied. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107 (b) (2012); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. L. Wasser, Counsel