Citation Nr: 18154845 Decision Date: 12/03/18 Archive Date: 11/30/18 DOCKET NO. 15-28 467 DATE: December 3, 2018 ORDER Entitlement to service connection for right index finger disability is denied. Entitlement to service connection for a back disability is denied. Entitlement to service connection for a respiratory disorder is denied. Entitlement to service connection for a kidney disability is denied. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and depression is denied. Entitlement to a total disability rating based upon individual unemployability due to service connected disabilities is denied. FINDINGS OF FACT 1. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of paronychia, or any other right index finger disability for VA purposes. 2. The preponderance of the evidence is against finding that the Veteran’s back disability is due to a disease or injury in service, to include specific in-service event, injury, or disease. 3. The preponderance of the evidence is against finding that the Veteran’s respiratory disorder is due to a disease or injury in service, to include specific in-service event, injury, or disease. 4. The preponderance of the evidence is against finding that the Veteran’s kidney disability is due to a disease or injury in service, to include specific in-service event, injury, or disease. 5. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and depression. 6. Throughout the relevant period, the Veteran was not unable to secure and follow a substantially gainful occupation as a result of his service-connected disability. CONCLUSIONS OF LAW 1. The criteria for service connection for a right index finger disability are not met. 38 U.S.C. §§ 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for a back disability are not met. 38 U.S.C. §§ 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 3. The criteria for service connection for a respiratory disorder are not met. 38 U.S.C. §§ 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 4. The criteria for service connection for a kidney disability are not met. 38 U.S.C. §§ 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 5. The criteria for service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and depression are not met. 38 U.S.C. §§ 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 6. Entitlement to a TDIU is not warranted. 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 1960 to April 1962. Service Connection A veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in line of duty in active service. 38 U.S.C. §§ 1131. 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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for a disease shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred in-service. 38 C.F.R. § 3.303(d). Service connection for chronic disease may be granted if manifest to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “Chronic.” When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. 3.303(b). Service connection for a recognized chronic disease can also be established through continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303(b), 3.309. Lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). However, the lack of contemporaneous medical evidence can be considered and weighed against a Veteran’s lay statements. Id. Further, a negative inference may be drawn from the absence of complaints or treatment for an extended period. Maxson v. West, 12 Vet. App.453, 459 (1999), aff’d sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). The ordinary meaning of the phrase “engaged in combat with the enemy,” as used in 38 U.S.C. § 1154(b), requires that a veteran have participated in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality. The issue of whether any particular set of circumstances constitutes engagement in combat with the enemy for purposes of section 1154(b) must be resolved on a case by case basis. See VAOPGCPREC 12 99 (October 18, 1999). The Board will address the credibility of the Veteran’s assertions but finds that he did not engage in combat and that his claimed disabilities did not result from him engaging in combat with the enemy. The Veteran was not in an air crew nor was he ashore in a hostile area. Therefore, the combat provisions of 38 U.S.C. § 1154(b) are not applicable. Under applicable criteria, VA shall consider all lay and medical evidence of record in a case with respect to benefits under laws administered by VA. In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Entitlement to Service Connection for Right Index Finger Disability The Veteran contends that he is entitled to service connection for a right index finger disability. See September 2013 Report of General Information. The Veteran’s service treatment records (STRs) are associated with the claims file. April 1961 STRs reflect that the Veteran sought medical attention for pain in the tip of his index finger. July 1961 STRs reveal that the Veteran had a minor infection on the tip of his first finger on the right hand. The Veteran completed a Report of Medical History at separation in February 1962. He denied bone, joint or other deformity and neuritis. His separation examination determined that his upper extremities were normal. May 1990 Social Security Administration (SSA) records reflect that the Veteran was able to pinch, hold, grasp and manipulate with his fingers, and there were no limitations. The Veteran underwent a VA examination in June 2015. The Veteran reported that from time to time he grew two fingernails on his right index finger, leading to infections. He reported that this occurred in April and July 1961, while in service. The Veteran told the examiner that he had monthly flare-ups, manifested by pain and swelling. The examiner stated that the Veteran had recurrent paronychia (inflammation of tissue surrounding a nail) of the right index finger. Following an examination, review of the claims file, and history provided by the Veteran, the examiner determined that the Veteran’s right finger disability was less likely than not incurred in or caused by service. She explained that double nail growth was the result of trauma or congenital. Trauma was not documented in the Veteran’s STRs. She also reported that other than the Veteran’s 1961 treatment, there were no other records reflecting that the Veteran continued to suffer from recurrent infections or need for incision and drainage. VA obtained an additional opinion from the June 2015 examiner regarding the Veteran’s finger in January 2018. The VA examiner explained that she determined that the Veteran had recurrent paronychia because that is what he was treated for in April 1961 and July 1961. She stated that there was no evidence of infection or paronychia during the June 2015 VA examination and no evidence of an infection in any of his VA treatment records. She stated that the Veteran did not currently have recurrent paronychia, but that it was an acute condition which occurred twice in service and then resolved. There are no additional medical records which reflect that the Veteran suffered from or was treated for paronychia, or that he was treated for any other medical conditions affecting his right finger. Though the Veteran states that he has double nail growth, it does not appear that this condition has caused any infections or issues since 1961. Double nail growth, on its own, is not considered a disability for VA purposes. The Board has considered the Veteran’s lay statements, but they are outweighed by the substantial medical evidence in the claims file. As discussed above, the lack of contemporaneous medical evidence can be considered and weighed against a Veteran’s lay statements. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). The Board finds the June 2015 and January 2018 VA opinions to be of greatest probative value. The examiner noted the Veteran’s entire medical history regarding his right finger, examined the Veteran, and concluded that he did not have paronychia at any time during his claim. She provided sufficient rationale with her conclusions and considered the Veteran’s lay statements. In this case, although the Veteran was treated for paronychia in service, the evidence does not show he has been treated for or complained of any medical ailments regarding his right trigger finger since 1961. As with all claims for service connection, in the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). For the foregoing reasons, the preponderance of the evidence of record is against a finding that the Veteran has paronychia, or any other right finger disability recognized by VA. The benefit of the doubt doctrine is therefore not for application and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 2. Entitlement to Service Connection for a Back Disability The Veteran contends that he is entitled to service connection for a back disability. The Veteran’s STRs do not reflect any treatment for or complaints of back pain. On his February 1962 Report of Medical History, the Veteran denied arthritis, or the use of a back brace. The corresponding examination determined that his spine was normal. He denied any other illness or injuries other than those listed on his examination. The Veteran sustained an injury to his back in August 1977, and subsequently needed surgery for a herniated lumbar disc with nerve root irritation. See September 1980 private treatment record. April 1990 SSA records reflect that the Veteran had back surgery due to a work-related injury. May 1996 SSA records reflect that the Veteran complained of low back pain which was determined to be likely related to his previous back surgery. In March 2009 the Veteran submitted a claim for service connection for his back disability, stating that his disability began in June 1978. The Veteran attended a VA examination in June 2015. The Veteran reported that he twisted his back while in service and did not seek medical treatment. The Veteran has degenerative arthritis of the spine. Following an examination, review of the claims file, and history provided by the Veteran, the examiner determined that the Veteran’s back disability was less likely than not related to service. She considered that the Veteran’s military duties included light weapons infantry. She explained that the Veteran’s STRs fail to document any treatment for or complaints of back pain. She determined that while it was in the realm of possibility that back pain could be secondary to infantry duties, there was no medical evidence to support this notion, and the term “at least as likely as not” did not mean within the realm of medical possibility. VA obtained an additional opinion from the June 2015 examiner regarding the Veteran’s back in January 2018. The examiner noted the Veteran’s contention that he twisted his back in service. She stated that because he denied any back injury or pain at separation, any injury sustained would have been acute and resolved. She noted that the medical records indicate that the Veteran’s 1977 work injury was severe and led to his unemployability. The examiner concluded that the Veteran’s current back condition was a direct result of the 1977 injury and not related to any 1961 twisting injury. The Board finds the June 2015 and January 2018 VA opinions to be of greatest probative value. The examiner noted the Veteran’s entire medical history regarding his back, examined the Veteran, and explained the likely etiology of his current back disability. She provided sufficient rationale with her conclusions. The Board has considered the Veteran’s lay statements but does not afford them any probative weight. Lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). However, the lack of contemporaneous medical evidence can be considered and weighed against a Veteran’s lay statements. Id. Further, a negative inference may be drawn from the absence of complaints or treatment for an extended period. Maxson v. West, 12 Vet. App. 453, 459 (1999), aff’d sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Additionally, the Board finds the Veteran’s statements regarding the onset and causes of his back disability are not credible and probative because they conflict with his own reports and the contemporaneous medical record. Here, the Veteran’s lay statements as to whether his back disability is related to service are outweighed by the other evidence of record. The preponderance of the evidence weights against finding that the Veteran’s back disability is related to service, and as such service connection is not warranted. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990); 38 C.F.R. § 3.102. 3. Entitlement to Service Connection for a Respiratory Disorder The Veteran contends that he is entitled to service connection for a respiratory disorder. The Veteran’s STRs reflect that the Veteran sought medical attention for bronchitis in October 1961. On his February 1962 Report of Medical History, the Veteran denied shortness of breath, chronic chough, asthma, or pain or pressure in the chest. The corresponding examination determined that his lungs and chest were normal. February 1962 diagnostic testing reflects that his heart and lungs were normal. July 1990 SSA records reveal that the Veteran had a cardiac catheterization in 1987, and that he experienced shortness of breath when he had chest pressure. In February 1992 and January 1993, the Veteran was treated for bronchitis and advised to stop smoking. The Veteran underwent a pulmonary function test in June 1992. He reported that he worked on strip mines for 20 years, as well as road construction. He stated that he smoked one to one and a half packs of cigarettes daily for 30 years, and had smoked up to five packs per day. May 1996 SSA records reflect that the Veteran had a history of occasional shortness of breath. September 2010 VA treatment records reflect that the Veteran’s breathing was irregular due to pneumonia. October 2010 VA treatment records reflect that the Veteran had issues breathing because of fluid in his lungs. The Veteran filed a claim for compensation for a respiratory disorder in August 2013. VA treatment records reflect that the Veteran denied shortness of breath six times between September 2013 and January 2015. Respiratory complaints appear in February 2016 VA treatment records following heart surgery, but shortness of breath was then denied in March 2016. July 2016 VA treatment records reflect that the Veteran denied experiencing shortness of breath, coughing, or wheezing. Weakness and shortness of breath appear in November 2016 VA treatment records. The Veteran was afforded a VA examination in January 2018. He told the examiner that he had shortness of breath and his heart was always pumping hard. He was not able to tell the examiner when he started experiencing shortness of breath, except that he has had this symptom for a long time. He reported occasional wheezing. The Veteran denied using any inhalers or breathing medications. When asked why he thought his shortness of breath was related to his active service, the Veteran responded that he did not know but thought it could be related to something he breathed in. The Veteran also told the examiner that his doctors told the Veteran that his breathing issues could be related to his heart disability, and not caused by a lung condition. Following an examination, the examiner determined that the Veteran had dyspnea on exertion secondary to his heart disability. She also stated that the Veteran had right pleural effusion, which was the result of fluid overload secondary to congestive heart failure. The examiner reviewed the claims file and took a verbal history from the Veteran. She determined that the Veteran’s in-service bronchitis was acute and resolved prior to separation. She pointed to the Veteran’s normal chest and lung X-ray at separation. Ultimately, the examiner determined that the Veteran did not have a respiratory or lung disability, but instead had shortness of breath and pleural effusion because of his heart disability. In conclusion, the examiner stated that although the Veteran believes he has a lung or respiratory condition, he actually has dyspnea on exertion and pleural effusion, secondary to his heart disease. Therefore, the examiner concluded that any respiratory condition was less likely than not related to service. The Board finds that the Veteran’s lay statements are outweighed by the January 2018 VA examiner’s opinion. Additionally, VA treatment records associated with the claims file do not contradict the VA opinion, and the Veteran reported that he was told his breathing problems could be related to his heart. The Board acknowledges the Veteran’s lay statements. However, the etiology and nature of respiratory disorders are complex medical matters beyond the expertise of a layperson. Jandreau v. Nicholson, 492 F. 3d 1372 (2007). As the January 2018 VA examiner’s opinion is considered credible and probative, it is entitled to significant weight and weighs against the claim. Entitlement to service connection is not warranted. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990); 38 C.F.R. § 3.102. For these reasons, the claim is denied. 4. Entitlement to Service Connection for a Kidney Disability The Veteran contends that he is entitled to service connection for a kidney disability. The Veteran’s STRs do not reflect any treatment for or complaints of a kidney disability. On his February 1962 Report of Medical History, the Veteran denied kidney stones or blood in urine, he did not report any kidney issues. The corresponding examination did not note any kidney issues. Mild renal failure first appears in June 2006 VA treatment records, nearly 44 years following separation. The Veteran has end-stage renal disease and is on hemodialysis. See August 2017 VA treatment records. The Board recognizes that the Veteran has not been afforded VA examination for his kidney conditions. A medical examination or medical opinion is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but: (1) contains competent evidence of a current diagnosed disability or persistent or recurrent symptoms of a disability; (2) establishes that an event, injury, or disease occurred in service or certain diseases manifested during an applicable presumptive period for which the claimant qualifies; and (3) indicates that the disability or symptoms may be associated with the established event, injury or disease in service or with another service-connected disability. McClendon v. Nicholson, 20 Vet. App. 79 (2006). VA must consider lay evidence but may give it whatever weight it concludes the evidence is entitled to and mere conclusory generalized lay statement that service event or illness caused the claimant’s current condition is insufficient to require the Secretary to provide an examination. Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). The Board finds that the standards of McClendon are not met in this case. The evidence of record fails to show that there is any relationship between the Veteran’s renal disease and his service. Other than the vague and generalized claim of entitlement to service connection, there is no other evidence of onset or cause by service. Thus, the Board finds that a VA examination for a kidney disability is not warranted. While the Board recognizes that the Veteran has a kidney disability, there is no credible and probative evidence in the claims file to suggest that his kidney disability is related to service. Additionally, the Veteran has not offered any theories as to how this disability is related to service. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990); 38 C.F.R. § 3.102. For these reasons, the claim is denied. 5. Entitlement to Service Connection for an Acquired Psychiatric Disorder, to include Posttraumatic Stress Disorder (PTSD) and Depression The Veteran filed a claim for entitlement to service connection for PTSD in August 2013. He noted that he believed that he was discharged from the Army unjustly and was worried about that. There are particular requirements for establishing service connection for PTSD in 38 C.F.R. § 3.304(f) that are separate from those for establishing service connection generally. Arzio v. Shinseki, 602 F.3d 1343, 1347 (Fed. Cir. 2010). Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125 (a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304 (f) and 38 C.F.R. § 4.125 (requiring PTSD diagnoses to conform to the DSM-IV/V). If the evidence establishes that the Veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the Veteran’s service, the Veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f)(1). See also 38 U.S.C. § 1154(b) and 38 C.F.R. § 3.304(d) (pertaining to combat Veterans). A finding that the Veteran engaged in combat with the enemy, however, requires that the Veteran participated in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality, and does not apply to veterans who served in a general “combat area” or “combat zone” but did not themselves engage in combat with the enemy. See VAOPGCPREC 12-99 (October 18, 1999). The Veteran was stationed in Germany from April 1961 to April 1962, and he did not receive any combat awards. He did not serve in combat and did not engage with an enemy. Effective July 13, 2010, 38 C.F.R. § 3.304(f) was amended to reduce the evidentiary burden of establishing a stressor when it is related to a fear of hostile military or terrorist activity. See 75 Fed. Reg. 39843 -01 (July 13, 2010), codified at 38 C.F.R. § 3.304(f)(3). The amendment provides that, if a stressor claimed by a veteran is related to the veteran’s fear of hostile military activity, and a VA psychiatrist or psychologist confirms that the claimed stressor is adequate to support a diagnosis of PTSD, a veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor, as long as the claimed stressor is consistent with the places, types, and circumstances of the veteran’s service and there is no clear and convincing evidence to the contrary. Id. “Fear of hostile military activity” is defined to mean that a veteran experienced, witnessed, or was confronted with an event or circumstance that involved actual or threatened death or serious injury, or a threat to the physical integrity of the veteran or others, and the veteran’s response to the event or circumstance involved a psychological or psycho-physiological state of fear, helplessness, or horror. Id. The occurrence of an event alleged as the “stressor” upon which a PTSD diagnosis is based (as opposed to the sufficiency of the alleged event to cause PTSD) is an adjudicative determination, not a medical determination. Zarycki v. Brown, 6 Vet. App. 91, 98 (1993). In regard to the Veteran’s stressor, the Veteran reported that he witnessed a soldier being shot in the back. See a statement from the Veteran dated March 2014. The Veteran did not report the date, time, place or circumstances of the event and the claimed stressor is not consistent with the places, types, and circumstances of the Veteran’s service. In July 2014, the RO made a formal finding that there was a lack of information to verify the Veteran’s claimed stressor, and the Veteran has yet to provide sufficient details regarding that stressor. As the Court stated in Wood v. Derwinski, “[t]he duty to assist is not always a one-way street. If a Veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence.” 1 Vet. App. 190, 193, reconsidered, 1 Vet. App. 406 (1991); see also Wamhoff v. Brown, 8 Vet. App. 517 (1996). In this instance, the Veteran should have aided in the development of his claim by describing his in-service stressors and providing more information. In fact, in March 2014, VA informed him of the types of evidence he needed to submit in order to substantiate his claim. Because the Veteran failed to provide details about his in-service stressor, VA was unable to recognize the occurrence of any in-service stressors. In April 2014 correspondence, the Veteran stated that in fact, his in-service stressor was notice from his wife that she wanted a divorce while he was stationed in Germany. He reported that after he received this information he became intoxicated and went AWOL for one evening. He said that it was due to this incident that he left the army. This reported stressor does not meet the criteria for PTSD. Not only is there no verified stressor, it also does not appear that the Veteran has a mental health diagnosis. The Veteran’s STR’s are associated with the claims file. His February 1962 separation examination determined that he was psychologically normal. The Veteran explicitly denied depression or excessive worry, memory loss, or nervous trouble of any sort. Following an episode where the Veteran went AWOL, he underwent a psychiatric examination in March 1962. He was oriented to time, person and place and expressed himself without difficulty. He was not delusional and denied hallucinations. The Veteran’s memory was adequate. He expressed that he no longer wanted to be in service. The examiner determined that the Veteran’s motivation for further military service was hampered by emotional instability. In December 2001, the Veteran received a mental health consult because he was having nightmares following a motor vehicle accident in November 2001. See December 2001 VA treatment records. January 2002 VA treatment records reflect that the Veteran had a positive screening for depression. He had been involved in a motor vehicle accident in which the other driver was killed. He had negative depression screens annually from March 2003 to August 2013. No depression, anxiety, or mental illness was evident during February 2014, August 2014, October 2014, and February 2015 VA treatment. The Veteran was provided a VA psychological examination in June 2015. The Veteran reported that what bothers him the most from his service is the incident in which he went AWOL. He denied any mental health treatment while in service, he also denied treatment following separation. After examination of the Veteran and consideration of his medical history, the VA examiner declined to diagnose the Veteran with an acquired psychiatric disorder. The examiner noted that while the Veteran reported having nightmares of his time in the military, the incidents do not reach criterion A stressors of being life threatening or out of the normal experiences to be considered traumatic. Moreover, the one incident that may be considered traumatic doesn’t cause him undo anxiety resulting in re-experiencing, avoidance or hyperarousal behaviors. Also, the other emotional symptoms that he reported were within a range that he has never sought treatment or intervention. The VA obtained an additional opinion in January 2018. The examiner performed a thorough review of the Veteran’s claims file. He stated that the Veteran did not meet the diagnostic criteria for a mood disorder, to include depression. He acknowledged that the Veteran had one positive screening for depression in January 2002, but explained that the positive screening did not mean that the Veteran was diagnosed with depression. He went on to explain that the Veteran did not receive any mental health treatment and explicitly denied symptoms of depression several times following the positive January 2002 screening. He also explained that the positive depression screen was not because of the Veteran’s service, but instead resulted from a car accident in which the other driver died. The examiner determined that any depressive feelings appeared to resolve prior to the Veteran submitting his claim for service connection for an acquired psychiatric disorder in August 2013. As noted above, service connection requires a showing of a current disability. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). A current disability is shown if the claimed condition is demonstrated at the time of the claim or while the claim is pending. McClain v. Nicholson, 21 Vet. App. 319 (2007). In the absence of proof of a present disability (and, if so, of a nexus between that disability and service), there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Court has held that the requirement for service connection that a current disability be present is satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim even though the disability resolves prior to the Secretary’s adjudication of the claim. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); see also Romanowsky v. Shinseki, 26 Vet. App. 289, 321 (2013) (held that when the record contains a recent diagnosis of disability prior to a veteran filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency). For the foregoing reasons, the preponderance of the evidence of record is against a finding that the Veteran has an acquired psychiatric disorder. The benefit of the doubt doctrine is therefore not for application and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102 6. Entitlement to a Total Disability Rating based upon Individual Unemployability due to Service Connected Disabilities The Veteran contends that he is unable to secure or maintain substantially gainful employment due to his service-connected disability. VA treatment records reflect that he drove a truck for 40 years and stopped working sometime in 2010. See October 2010 VA treatment records. 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. See 38 C.F.R. § 4.16. A finding of total disability is appropriate “when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation.” See 38 C.F.R. §§ 3.340(a)(1), 4.15. TDIU may be assigned where the schedular rating is less than total and it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of either (1) a single service-connected disability ratable at 60 percent or more, or (2) two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is a 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). For the purposes of determining rating level, disabilities resulting from a common etiology or affecting a single body system are considered a single disability. 38 C.F.R. § 4.16(a). When two or more disabilities are treated as one, the ratings for those disabilities are combined using the combined ratings table. 38 C.F.R. § 4.25. If a sufficient rating is present, then it must be at least as likely as not that the Veteran is unable to secure or follow a substantially gainful occupation as a result of that disease. See 38 C.F.R. § 4.16(a). The central inquiry is, “whether the Veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability.” Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). The issue is not whether the Veteran can find employment generally, but whether the Veteran is capable of performing the physical and mental acts required by employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Consideration may be given to the Veteran’s education, special training, and previous work experience, but not to his age or to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19; see also Van Hoose, 4 Vet. App. at 363. The Veteran is service-connected for bilateral hearing loss, which has been evaluated as 50 percent disabling. In this case, the Veteran does not meet the threshold requirements for the entire period on appeal. When the schedular TDIU requirements are not met, as in this case, entitlement to a TDIU on an extraschedular basis may still be granted. See 38 C.F.R. § 4.16(b). In this regard, the Board notes that neither the Agency of Original Jurisdiction (AOJ) nor the Board is authorized to assign an extraschedular TDIU in the first instance under 38 C.F.R. § 4.16(b). See Wages v. McDonald, 27 Vet. App. 233 (2015). 38 C.F.R. § 4.16(b) states that “rating boards should submit to the Director, Compensation Service, for extra-schedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities, but who fail to meet the” schedular TDIU requirements. Accordingly, the issue before the Board is more specifically whether referral to the Director of Compensation Service for consideration of an extraschedular TDIU is warranted. September 1980 private treatment records reflect that the Veteran would have trouble working due to his nonservice-connected back disability. In a December 1999 application for disability through SSA, the Veteran did not report any trouble hearing and did not list hearing as a reason for his unemployability. He stated that his heart disability, back disability, high blood pressure, blood clots and poor circulation were the reasons he was unable to work. The Veteran is not service-connected for any of those conditions. In March 2004, the Veteran reported that he was unable to work because of his age and the medication he took for his medical conditions. See March 2004 Application for Increased Compensation Based on Unemployability. During a July 2015 VA examination, the Veteran reported that his hearing loss made it difficult to hear his wife and children and that he had to keep the volume high on his television. Significantly, the Veteran has not made any definitive statements that he was unemployable due to his hearing loss during the appeal period. Furthermore, there is otherwise no suggestion that the Veteran has been unable to obtain or maintain gainful employment due to his hearing loss. The determinative issue in this case is whether the Veteran is unable to secure and follow a substantially gainful occupation by reason of his service-connected hearing loss disability. Upon review, the Board finds that the Veteran was not unable to secure and follow a substantially gainful occupation by reason of his hearing loss disability. The Board finds that the symptomatology of the Veteran’s hearing loss disability is not of such severity to render him unable to secure and follow a substantially gainful occupation. As such, referral to the Director of Compensation Service for consideration of an extraschedular TDIU is not warranted. J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Fitzgerald, Associate Counsel