Citation Nr: 20028045 Decision Date: 04/22/20 Archive Date: 04/22/20 DOCKET NO. 15-17 782 DATE: April 22, 2020 ORDER Entitlement to service connection for a respiratory disability is denied. Entitlement to service connection for a stomach disability, to include gastrointestinal disabilities, is denied. Entitlement to service connection for diabetes mellitus, type II, is denied. Entitlement to an initial rating greater than 10 percent for left foot hammer toes is denied. Entitlement to an initial rating greater than 10 percent for right foot hammer toes is granted. Entitlement to a total disability rating based on individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that a respiratory disability began during active service or is otherwise caused by service. 2. The preponderance of the evidence is against finding that a stomach / gastrointestinal disability began during active service or is otherwise caused by to service. 3. Diabetes mellitus, type II, was not manifest in service or within one year of separation from service and was not otherwise caused by the Veteran’s active service, to include as due to herbicide exposure. 4. The Veteran’s left foot hammer toes involved all the toes of the foot, without claw foot. 5. The Veteran’s right foot hammer toes involved all the toes of the foot, without claw foot. 6. The evidence does not demonstrate that the Veteran’s service-connected disabilities prevented him from securing or following a substantially gainful occupation. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a respiratory disability have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2019). 2. The criteria for entitlement to service connection for a stomach disability, to include gastrointestinal disabilities, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for entitlement to service connection for diabetes mellitus, type II, have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2019). 4. The criteria for entitlement to an initial rating greater than 10 percent for left foot hammer toes have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5282 (2019). 5. The criteria for to an initial rating greater than 10 percent for right foot hammer toes have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5282. 6. The criteria for entitlement to TDIU have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 3.400, 4.16(a) (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service as a wheeled vehicle mechanic in the United States Army from August 1966 to November 1967. The Veteran passed away in January 2019. The appellant is the Veteran’s surviving spouse, and in August 2019 the RO found that the appellant was eligible for substitution as to the Veteran’s ongoing claims. In an April 2018 Board determination, in addition to the above issues the Board remanded the issue of entitlement to an increased rating greater than 30 percent for bilateral pes planus. In a November 2019 rating decision, the RO granted an increased rating of 50 percent, effective June 26, 2012, for the bilateral pes planus. This is the maximum rating available under Diagnostic Code 5276 and in the decision the RO indicated that this was the maximum benefit available and constituted a complete grant of the claim. The Board agrees, as it is the maximum rating available under the applicable Diagnostic Code and encompassed the entire appellate time period. The Board will address entitlement to a total disability rating based on individual unemployability below. Neither the Veteran nor her representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) As such, further discussion of this issue is not warranted, and the issue is not in appellate status. On January 15, 2020, the appellant’s representative requested copy of the file and a 90 day extension. A copy was provided in correspondence dated February 4, 2020. The electronic file shows that the representative was granted electronic access to the file since at least November 2019. No additional evidence or argument have been received and further delay is not warranted. Service Connection Service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110 (2012). 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.” Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). 1. Entitlement to service connection for a respiratory disability The Veteran and now the appellant contend that he had a respiratory disability due to his active service, to include his July 1967 motorcycle accident. The Veteran’s service treatment records do not include complaints, treatment, or diagnosis of a respiratory disability. In his November 1967 Report of Medical Examination at discharge, the Veteran had a normal examination of the lungs and chest, but in a contemporaneous Report of Medical History (labeled as November 1968) he reported a history of shortness of breath and pain or pressure in the chest. The Veteran explained that he had intermittent episodes of shortness of breath and a pressure sensation since a July 1967 motorcycle accident. That said, the Veteran believed he was in good health. A January 1968 VA medical examination report included a finding of a normal respiratory system. In July 1989, a chest x-ray showed grossly clear lung fields. In May 2005, January 2006, May 2007, August 2008, March 2009, October 2009, and March 2010, the Veteran’s lungs were clear. In December 2010, the Veteran denied cough or shortness of breath. In January 2011, the Veteran denied any respiratory symptoms. On examination, the lungs were clear. In December 2012, the Veteran had clear lung fields with no crackles or wheezes. The Veteran was afforded a VA examination in March 2013. The examiner indicated that the Veteran did not currently have and had not had a diagnosis of a respiratory disability. The Veteran was noted to be a poor historian but stated that he had shortness of breath on exertion associated with chest pressure and dizziness for the past 2 to 3 years. The symptoms had occurred with walking one “New Jersey” block. The Veteran stated that in June 2010 a stress test had been stopped after 5 minutes due to epigastric pain that was relieved with belching and rest. The cardiologist had believed the issues were non-ischemic. In July 2012, however, the Veteran had sought emergency treatment and been diagnosed with congestive heart failure and discharged with medication. Following examination, the examiner concluded that it was less likely than not that the Veteran’s respiratory symptoms were incurred in or caused by service. The rationale noted that the cause of the Veteran’s shortness of breath on exertion had not been identified. The examiner did find it significant that in a November 1968 report of examination there was a notation of “intermittent episodes of shortness of breath & pressure sensation since the above incident.” That said, at the time of the current examination the Veteran reported that his current symptoms were of relatively recent onset. In July 2015 and September 2015, the Veteran’s lungs were clear. In September 2016, the Veteran’s lungs were clear and without wheezing, rales, and rhonchi. In March 2017, there were noted pulmonary nodules in the lungs, but on examination his lungs were clear and without wheezing, rales, or rhonchi. In December 2017, April 2018, August 2018, and January 2019, the Veteran’s lungs were clear. The Board concludes that he did not have a current diagnosis of a respiratory disability at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In reaching that conclusion, the Board has considered the case of Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), in which the Federal Circuit held that “pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability” if it “reaches the level of a functional impairment of earning capacity.” Id. at 1367-69. In this case, however, there is no indication that there was a functional impairment of earning capacity as a result of the Veteran’s subjectively decreased respiratory capacity. The difficulty is that the Veteran was noted to be a generally poor historian during VA examination and numerous treatment records noted that the Veteran’s lungs were clear or essentially clear. No medical professional found that the Veteran had a respiratory disability other than a pulmonary nodule and there is no indication that the nodule resulted in any functional impairment of earning capacity or that it was a residual of a 1967 motor vehicle accident. Again, the March 2013 VA examiner evaluated the Veteran and determined that, while he experienced subjective symptoms, he did not have a diagnosis of a respiratory disability. The evidence indicates, at most, that the Veteran experienced intermittent shortness of breath on exertion and chest pain with dizziness. While the Veteran and appellant believe his claimed symptoms were caused by his in-service motorcycle accident, this issue is medically complex and the lack of a continuity of ongoing symptoms from service renders the Veteran’s contentions not competent or probative. During the March 2013 VA examination, the Veteran indicated that the symptoms had been present for 2 to 3 years, which demonstrates that there is no continuity of symptomatology with his in-service reports at separation of intermittent episodes of shortness of breath and a pressure sensation since a July 1967 motorcycle accident. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the medical evidence of record. 2. Entitlement to service connection for a stomach disability, to include gastrointestinal disabilities The Veteran and now the appellant contend that he had a stomach / gastrointestinal disability due to his active service. The Veteran’s service treatment records do not include complaints, treatment, or diagnosis of a gastrointestinal disability. In his November 1967 discharge Report of Medical Examination, the Veteran had a normal examination of the abdomen and in a contemporaneous Report of Medical History he denied a history of frequent indigestion or stomach or intestinal trouble. A January 1968 VA medical examination report included a finding of a normal digestive system. In March 2009, the Veteran denied abdominal pain, constipation, diarrhea, or blood in the stool. In June 2010, the Veteran reported that 3 weeks previously he had sought treatment for abdominal pain. He stated that an obstructive series showed some fecal retention and that an abdominal ultrasound showed cholelithiasis and fatty liver. In September 2010, the Veteran complained of significant burping and heartburn. Previously he had sought treatment but been told that he was “ok.” In December 2010, the Veteran was seen for GERD and persistent abdominal discomfort. He denied abdominal pain, heartburn, or stool changes. On examination, bowel sounds were normal, but there was abdominal bloating. The assessment was GERD, and there was a suggestion that the Veteran should change his Metformin medication for diabetes. In February 2011, the Veteran indicated that when he started to run or walk 2 blocks he felt “acid reflux” and could not complete a stress test due to reflux-like symptoms. That said, the Veteran stated that his gastrointestinal symptoms had resolved after stopping Metformin for his diabetes but had heartburn-like discomfort with exertion. In June 2011, the Veteran denied any abdominal pain, but did report some bloating after meals. He did have diagnosed GERD but declined any treatment and would try over-the-counter medication. In December 2012, the Veteran denied abdominal pain, constipation, diarrhea, or blood in the stool. In April 2015, October 2015, January 2016, July 2016, and March 2017, the Veteran denied abdominal pain, nausea, vomiting, and diarrhea. In January 2019, the Veteran denied abdominal pain, black stools, or diarrhea. Thus, the Veteran had a diagnosis of GERD during the appellate period. The relevant question, therefore, is whether the Veteran had any stomach / gastrointestinal disability with its onset during service or otherwise was caused by service. The Board concludes he did not. The sole evidence of record supporting an association between the Veteran’s symptoms and his active service are his lay contentions. While the Veteran and appellant believe his claimed symptoms were related to his active service, this issue is medically complex and the lack of a continuity of ongoing symptoms from service renders the Veteran’s contentions not competent or probative. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The Veteran denied symptoms at the time of separation and during his 1968 examination abdominal examination was normal. The Veteran did not report any ongoing symptoms. Consequently, the Board gives low probative weight to his contentions. The appellant has not provided specific evidence or argument regarding the issue. There is no competent evidence linking the Veteran’s GERD or other stomach / gastrointestinal symptoms to his active service. 3. Entitlement to service connection for diabetes mellitus, type II The Veteran and now appellant contend that his diagnosed diabetes mellitus, type II, was due to exposure to Agent Orange during his service in South Korea. Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). The Veteran has a current diagnosis of diabetes mellitus, type II. A July 1989 treatment record noted a history of diabetes mellitus. A May 1990 VA examination report also noted that the Veteran had a history of diabetes mellitus. In June 2010, the Veteran reported that he was diagnosed with diabetes mellitus in 1970 after having polydipsia. As noted, the Veteran contends that his multiple myeloma is the result of exposure to Agent Orange during his service in Korea. With respect to service connection based on herbicide exposure, VA laws and regulation provide that a veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam war (i.e., January 9, 1962, to May 7, 1975), shall be presumed to have been exposed to an herbicide agent, unless there is affirmative evidence to the contrary. 38 U.S.C. § 1116(a)(3); 38 C.F.R. § 3.307(a)(6)(iii). Additionally, a veteran who, during active military service, served between April 1, 1968, and August 31, 1971, in a unit that, as determined by the Department of Defense, operated in or near the Korean DMZ (Demilitarized Zone) in an area in which herbicides are known to have been applied during that period, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to the contrary. 38 C.F.R. § 3.307(a)(6)(iv). The Department of Defense (DoD) has identified specific units it has cited that served in areas along the DMZ in Korea where herbicides were used between April 1, 1968 and August 31, 1972. 38 C.F.R. § 3.307(a)(6)(iv). If a veteran was exposed to an herbicide agent during active service, certain diseases, including diabetes mellitus, type II, will be presumed to have been incurred in service if manifest to a compensable degree within specified periods, even if there is no record of such disease during service. 38 U.S.C. § 1116(a)(2); 38 C.F.R. §§ 3.307(a)(6), 3.309(e). The Veteran did not have any service in the Republic of Vietnam. The evidence of record demonstrates that the entirety of the Veteran’s active service took place prior to April 1968 and that prior to such date there is no documented evidence of the use of herbicides in Korea. As such, the above presumptive provisions do not apply to the Veteran. There is also no competent lay or medical evidence that the Veteran was actually exposed to the designated herbicide agents in the course of his duties. The Board notes, that the Federal Circuit has held that a claimant is not precluded from establishing service connection for a disease averred to be related to herbicide exposure, as long as there is proof of direct causation. See Combee v. Brown, 34 F.3d 1039, 1043-1044 (Fed. Cir. 1994). The Veteran’s service treatment records do not include complaints of diabetes mellitus or associated symptoms. His November 1967 Report of Medical Examination prior to separation included negative albumin and sugar in the Veteran’s urine and a contemporaneous Report of Medical History included his denial of a history of sugar or albumin in the urine. Again, the Veteran does not contend that he had problems associated with diabetes mellitus in service, but that he developed diabetes mellitus more than one year after separation from service due to in-service herbicide exposure. As noted above, the Veteran has reported a diagnosis of diabetes mellitus in 1970. It is unclear from the record when associated symptoms began; however, the Veteran has not reported symptoms during or in the year following his separation from service. The Board concludes that the evidence does not establish that the Veteran had exposure to Agent Orange or other herbicide agents in service. The Veteran has not provided any specific argument regarding in-service herbicide exposure during his time in the Republic of Korea and, as mentioned above, the DoD has not found any evidence of herbicide use in Korea during the Veteran’s time there. The Veteran served for a total of about 3 months at Camp Casey, about 11 miles from the Demilitarized Zone, in the occupation of vehicle mechanic. The nature and circumstances of this service are not consistent with any possible contact with herbicide agents. There is no lay or medical evidence to suggest that the Veteran’s diabetes mellitus was incurred in service or is otherwise related to service. The Veteran does not claim to have experienced symptoms in service or in the year following separation from service and there is no medical evidence to suggest any link to service. In summary, the Veteran’s service treatment records show no complaints of or symptoms consistent with diabetes mellitus and he has not reported the onset of symptoms in service or in the year after separation from service. The evidence does not demonstrate in-service exposure to Agent Orange or other herbicide agents contemplated in 38 C.F.R. §§ 3.307 and 3.309. No medical professional has ever attributed the Veteran’s diabetes mellitus to his service. Based on the foregoing, service connection on a direct basis is not warranted. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule does not apply, and the claim for service connection must be denied. See 38 U.S.C. § 5107(b) (2012); see generally Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001). Increased Rating 4. Entitlement to an initial rating greater than 10 percent for left foot hammer toes 5. Entitlement to an initial rating greater than 10 percent for right foot hammer toes Disability evaluations are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2019). Separate DCs identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2019). Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3 (2019). The Veteran’s entire history is reviewed when making a disability determination. See 38 C.F.R. § 4.1 (2019). VA must consider whether the Veteran is entitled to “staged” ratings to compensate when his or her disability may have been more severe than at other times during the course of his or her appeal. The evaluation of the same disability under various diagnoses, known as pyramiding, is generally to be avoided. 38 C.F.R. § 4.14 (2019). The critical element in permitting the assignment of several ratings under various DCs is that none of the symptomatology for any one of the disabilities is duplicative or overlapping with the symptomatology of the other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). The Veteran’s right and left hammer toes were assigned separate 10 percent ratings under DC 5282. The Veteran and now the appellant contend that the ratings did not accurately reflect the severity of his condition. The Veteran was afforded a VA examination in March 2013. The examiner noted diagnoses of bilateral hammer toes. The hammer toes affected all of the toes on each of the feet. The Veteran did not have hallux valgus, hallux rigidus, pes cavus / claw foot, or malunion or nonunion of the tarsal bones. The Veteran also reported an injury to the right heel in a 1967 motorcycle accident, but the examiner was unable to detect any residuals. The Veteran used over-the-counter insoles. X-rays showed arthritis of the bilateral feet. The hammer toes affected the Veteran’s ability to work. His usual occupation was as a designer of air conditioning (AC) systems. The Veteran had his own business, which he closed in 2010 after a bad business venture. He tried working at Lowes in November and December 2012 but had to quit due to foot pain. The Veteran was afforded a VA foot contract examination in January 2019. The Veteran reported hammer toes from service, with current achy bilateral foot pain. The pain had worsened in the past 18 months. He was unable to walk or stand without difficulty. Under DC 5282, a 10 percent rating contemplates hammer toe on all toes unilaterally without claw foot. This is the highest rating possible under DC 5282, and as such, a higher rating is not warranted as a matter of law for the Veteran’s bilateral hammer toe disabilities. Additionally, as DC 5282 specifically governs the evaluation of the Veteran’s hammer toe disabilities, the Board is prohibited from assigning a separate higher rating under another DC for the Veteran’s right and left foot hammertoes. Copeland v. McDonald, 27 Vet. App. 333, 337 (2015) (“[W]hen a condition is specifically listed in the Schedule, it may not be rated by analogy”). However, the presence of a listed condition does not preclude an analogous rating for an associated unlisted foot condition under other DCs. Scott v. Wilkie, 920 F.3d 1375, 1379 (Fed. Cir. 2019). Disabilities of the foot are rated under DCs 5276 through 5284. As noted above, the Veteran recently was assigned a maximum 50 percent rating under DC 5276 for bilateral pes planus. As such, further consideration of a rating under DC 5276 is not necessary. The Veteran’s right and left foot disabilities otherwise were not shown to be characterized by weak foot, claw foot, metatarsalgia, hallux rigidus, hallux valgus, or malunion or nonunion of the tarsal or metatarsal bones. Accordingly, the DCs pertaining to those disabilities are not applicable in the instant case. See 38 C.F.R. § 4.71a, DCs 5277, 5278, 5279, 5280, 5281, 5283 (2019). The Board has considered all potentially applicable provisions of 38 C.F.R. Parts 3 and 4, regardless of whether they have been raised by the Veteran. In this case, the Board finds no provision upon which to assign a rating greater than 10 percent under DC 5282 for either the right or left hammer toes. Furthermore, the Board concludes that in light of the consistent symptomatology during this appellate period and the absence of the necessary criteria for a higher rating at any point on appeal, that staged ratings are not for application. TDIU 6. Entitlement to TDIU 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. 38 C.F.R. § 4.16 (2019). 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.” 38 C.F.R. §§ 3.340(a)(1), 4.15 (2019). Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the Veteran is 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, such disability shall be ratable as 60 percent or more and if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). Where these percentage requirements are not met, entitlement to benefits on an extraschedular basis may be considered when the Veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities, and consideration is given to the Veteran’s background, including his employment and educational history. 38 C.F.R. § 4.16(b). The Board does not have the authority to assign an extraschedular total disability rating for compensation purposes based on individual unemployability in the first instance. Bowling v. Principi, 15 Vet. App. 1 (2001). In determining whether unemployability exists, consideration may be given to the Veteran’s level of education, special training, and previous work experience, but it may not be given to his or her age or to any impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19 (2019). For a veteran to prevail on a claim for a TDIU rating, the record must reflect some factor, which takes this case outside the norm. The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. A high rating in itself is recognition that the impairment makes it difficult to obtain or keep employment, but the ultimate question is whether the veteran is capable of performing the physical and mental acts required by employment, not whether he can find employment. Van Hoose v. Brown, 4 Vet. App. 361 (1993). In this case, the Board notes that the Veteran’s service-connected disabilities included bilateral pes planus, rated as 50 percent disabling; right and left hammer toes, each rated as 10 percent disabling; and scars to the right thigh, right foot, and right ankle, each rated as noncompensably disabling. The combined disability rating is 70 percent. As such, the Veteran has met the schedular criteria for TDIU for the entire appellate time period. In his June 2012 TDIU claim, the Veteran stated that he had last worked full-time in September 2010 when he had been self-employed in “design and build” work. His education included mechanical engineering. In August 2012, the Veteran indicated that his service-connected right foot and ankle disabilities prevented him from lifting and walking and prevented him from working. A March 2013 scar examination report of the right lower extremity included the examiner’s finding that there was no observable scar on the right foot or ankle by either the examiner or a nurse and that the Veteran was unable to identify the location of the scar and was not sure which foot was involved. A March 2013 pes planus examination report documented bilateral foot pain that was accentuated with use. There was pain with manipulation of the feet, but no calluses caused by the flatfeet. There was tenderness of the plantar surface of both feet. There was marked deformity of the bilateral feet and he used other-the-counter shoe inserts. The pes planus affected the Veteran’s ability to work. His usual occupation was as a designer of AC systems. The Veteran had his own business, which he closed in 2010 after a bad business venture. He tried working at Lowes in November and December 2012 but had to quit due to foot pain. Social Security Administration records obtained in March 2014 showed that the Veteran had two years of education after high school. He reported working f, from 1980 to 2010 in construction and had owned his own business. SSA awarded disability benefits for lumbar spine, arm and leg joint disabilities, and for diabetes. A physician noted the following limitations that would impair work: walking for less than 2 hours, no ladder climbing or working at heights, and maximum lifting of 10 pounds due to angina, diabetes and peripheral artery disease. There was no mention of the feet. An October 2018 Examination for Housebound Status or Permanent Need for Regular Aid and Attendance indicated that he had no upper extremity restrictions, but that he had impaired coordination while walking and weakness and numbness in the lower legs. He also had decreased range of motion in the neck and lower back. The Veteran was confined to his home most of the time. He was able to leave the home for medical care and for shopping for groceries. The Veteran was afforded a VA foot contract examination in January 2019. The Veteran reported bilateral pes planus from service, with current achy bilateral foot pain. The pain had worsened in the past 18 months. He was unable to walk or stand without difficulty. There was functional loss due to excess fatigability, pain on movement, pain on weight-bearing, disturbance of locomotion, interference with standing, and lack of endurance. The Board concludes that the Veteran’s service-connected disabilities, singly or in combination, did not render him unable to secure and follow a substantially gainful occupation. In reaching that conclusion, the Board acknowledges that the Veteran had not worked other than for a few months during the appellate time period. The Veteran attributed the unemployment to a combination of his service-connected foot disabilities. It is clear from the record that the Veteran’s bilateral foot disabilities made jobs requiring significant physical labor, such as extensive standing or walking, impossible. The question remains, however, whether the Veteran’s service-connected disabilities would preclude employment in less physically demanding jobs. There is no lay or medical evidence to suggest that the Veteran’s heart or bilateral lower extremity peripheral neuropathy disabilities would affect his ability to perform job duties that were not physically demanding, such as filing or work on a computer. The Veteran’s most recent extensive work background was in designing AC systems. He reported during his March 2013 pes planus examination that he closed his business due to a bad business venture. The Veteran’s reports during VA examinations demonstrate problems with extensive standing, walking, and other similar activities, but do not indicate that his actual job was precluded by his foot disabilities. Instead, the Veteran reported that he shut down his business due to a bad business venture. The Veteran’s educational background was in mechanical engineering and there is nothing to suggest that he could not have found another job within such an industry that did not require extensive standing, walking, or other difficulties involving the feet. As a construction business owner, the Veteran had personnel, logistics, scheduling, and business financial management experience. The Board recognizes that the October 2018 housebound examination report indicated that the Veteran had difficulty leaving his home due to weakness and numbness in the lower extremities. Numbness was never a symptom attributed to the Veteran’s service-connected pes planus, hammer toe, or scar disabilities. The October 2018 examination report noted a diagnosis of arthritis of the back and peripheral neuropathy disabilities, which also would have attributed to any lower extremity coordination problems. VA outpatient records showing medical leading to the Veteran’s death cited cancer of the thyroid and brain as extremely limiting function. In any case, there is nothing to suggest that any lower extremity problems attributable solely to the Veteran’s service-connected disabilities were of such severity that they could not have been accommodated by any number of employers in the mechanical engineering field not requiring regular walking or standing, to include (based on the Veteran’s own representations) his own self-employment in designing AC systems. Thus, the most probative evidence of record demonstrates that the Veteran’s service-connected disabilities did not preclude him from multiple areas of employment. The Board acknowledges that the Veteran’s service-connected disabilities had some effect on his occupational impairment. However, the combined schedular ratings during the appellate time period recognize the industrial or commercial impairment resulting from his disabilities. Nevertheless, for the reasons and bases set forth above, the preponderance of the evidence is against finding his service-connected disabilities were of such severity so as to preclude his participation in any form of substantially gainful employment. As such, the benefit of the doubt doctrine is inapplicable, and the claim must be denied. See 38 U.S.C. § 5107(b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. J. Houbeck, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.