Citation Nr: 20031878 Decision Date: 05/06/20 Archive Date: 05/06/20 DOCKET NO. 96-09 211 DATE: May 6, 2020 ORDER Service connection for hypertension, including as the result of undiagnosed illness or secondary to a service-connected disability, is denied. A total rating based on individual unemployability due to service-connected disability (TDIU) prior to July 7, 2002, based on posttraumatic stress disorder (PTSD) alone, is denied. FINDINGS OF FACT 1. Hypertension was not evident during the Veteran’s first period of service or until many years thereafter and is not shown to have been caused by any in-service event. 2. Hypertension clearly and unmistakably preexisted the Veteran’s second period of service and was not aggravated therein. 3. Hypertension is not proximately due to or aggravated by a service-connected disease or injury. 4. Prior to July 7, 2002, service connection was in effect for PTSD, rated 50 percent disabling. 5. The Veteran reported that he had four years of college education and work experience in sales and as a bus driver. 6. Prior to July 7, 2002, the disability associated with the Veteran’s PTSD alone was not shown to be of such severity as to render him unable to secure or follow a substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 2. The criteria for TDIU based solely on the Veteran’s PTSD prior to July 7, 2002, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 3.340, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1955 to March 1959 and from December 1990 to May 1991. He also had service in the Naval Reserve that included several periods of active duty for training (ACDUTRA) and inactive duty training (INACDUTRA). This case has a very long and complicated appellate history, with the initial denial of service connection for hypertension being in July 1994. Entitlement to TDIU was denied in an October 2002 rating decision. One or, both of these issues were previously before the Board at various and different times. Decisions issued by Board in December 2000, June 2004, January 2008, March 2011, February 2012, and, most recently, in May 2016 were remands that returned one, or both, of the issues to the Agency of Original Jurisdiction (AOJ) for additional development. Service connection for hypertension was denied by the Board in a June 2003 decision. That decision was appealed to the United States Court of Appeals for Veterans Claims (Court) and, in a January 2004 Joint Motion for Remand (JMR), the June 2003 decision was vacated and remanded by the Board. Following the numerous remands of the issues that followed the JMR, the case is finally before the Board for appellate consideration. The Veteran testified at several hearings during the pendency of this appeal. In October 1999, he testified before a Veterans Law Judge (VLJ) who is no longer a member of the Board. He testified before a Decision Review Officer at the Regional Office in February 2005. Finally, he testified before the undersigned VLJ at a videoconference Board hearing in March 2020. Transcripts of these hearings have been associated with the claims folder. Entitlement to service connection for hypertension The Veteran contends that service connection should be established for hypertension. During the Board hearings, including before the undersigned in March 2020, the Veteran stated that he believed his hypertension was first diagnosed in the early 1990s and that he believed this was related to his service in the Persian Gulf. Alternatively, the Veteran has contended that his hypertension is related to his service-connected PTSD. As noted at the outset, the Veteran had two periods of active duty separated by a long period of service with the reserves. As will be explained in greater detail below, his hypertension postdated the first period of service, predated his second period of service and was not aggravated therein, and is not shown to be related to a service-connected disability. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). 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. With chronic disease shown as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. If a condition, as identified in 38 C.F.R. § 3.309(a), noted during service is not shown to be chronic, then generally, a showing of continuity of symptoms after service is required for service connection. 38 C.F.R. § 3.303(b). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Where a veteran who served for ninety days or more during a period of war (or during peacetime service after December 31, 1946) develops certain chronic diseases, such as hypertension, to a degree of 10 percent or more within one year from separation from service, such diseases may be presumed to have been incurred in service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. See 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Service connection may also be granted for disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). “When aggravation of a veteran’s non-service-connected condition is proximately due to or the result of a service-connected condition, such veteran shall be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation.” Allen v. Brown, 7 Vet. App. 439 (1995). Active military, naval, or air service includes any period of active duty for training (ACDUTRA) during which the individual concerned was disabled or died from a disease or injury incurred in or aggravated in line of duty, or any period of inactive duty training (INACDUTRA) during which the individual concerned was disabled or died from injury incurred in or aggravated in line of duty. 38 U.S.C. § 101(21), (24); 38 C.F.R. § 3.6(a), (d); Biggins v. Derwinski, 1 Vet. App. 474, 477-78 (1991). Presumptive periods do not apply to ACDUTRA or INACDUTRA. Id. Therefore, consideration of 38 C.F.R. §§ 3.307 and 3.309 (presumptive service connection for certain chronic diseases) for the periods of ACDUTRA or INACDUTRA is not appropriate. ACDUTRA is, generally, full-time duty in the Armed Forces performed by reserves for training purposes. 38 C.F.R. § 3.6(c)(1). A pre-existing disorder will be considered to have been aggravated by active military service when there is an increase in disability during service, unless there is clear and unmistakable evidence (obvious and manifest) that the increase in disability is due to the natural progress of the disorder. 38 U.S.C. § 1153; 38 C.F.R. § 3.306 (a), (b). Aggravation of a pre-existing condition may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. 38 U.S.C. § 1153; 38 C.F.R. § 3.306(b). In order to prevail on the issue of service connection, there must be medical evidence of current disability; medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and medical evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. See Hickson v. West, 12 Vet. App. 247 (1990). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and an evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1990); 38 C.F.R. § 3.303(a). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When all of the evidence is assembled, 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 fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The Board has reviewed all of the evidence in the Veteran’s claims file, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Hence, the Board will summarize the relevant evidence where appropriate and the analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim. Hypertension is defined as persistently high arterial blood pressure with suggested threshold levels starting at 140 mm/Hg systolic and 90 mm/Hg diastolic. Dorland’s Illustrated Medical Dictionary, 799 (27th ed. 1988). Note (1) to Diagnostic Code 7101 recognizes the disability of hypertension when the diastolic blood pressure is predominantly 90mm or greater, and isolated systolic hypertension when the systolic blood pressure is predominantly 160mm or greater with a diastolic blood pressure of less than 90mm. 38 C.F.R. § 4.104. Review of the record shows that service treatment records (STRs) during the Veteran’s first period of active duty showed no complaints or manifestations of hypertension. On separation examination in February 1959, his blood pressure reading was 120/80. On Naval Reserve enlistment examination in May 1977, the Veteran’s blood pressure reading was 140/90. On annual physical examination in February 1978, blood pressure readings of 142/104, 142/110, and 136/96 were recorded. The diagnosis was mild hypertension. Additional STRs, including examinations in February 1980 and September 1981 continued to demonstrate elevated blood pressure readings. On the latter examination, the diagnosis was hypertension, on medication. Based on the foregoing, the Veteran’s hypertension is not demonstrated to have manifested during his first period of service or within one year of his separation from that period of service. During the hearing before the undersigned, the Veteran testified that he believed that his hypertension first manifested in approximately 1994, but clearly, his hypertension was diagnosed many years earlier and many years prior to his entry into his second period of active duty. As noted above, the record shows that the Veteran first manifested an elevated blood pressure reading in 1977 and was diagnosed with hypertension in 1978. He was noted to be on medication in 1981. Medical records from the Naval Reserves show that the Veteran was hospitalized in August 1986 for complaints of substernal discomfort that had awakened him. The Veteran was noted to have atrial fibrillation. Diagnoses included essential hypertension. A review by the Commander of the naval reserve force found that the Veteran’s injury, illness, or disease was not incurred or aggravated while performing active or inactive duty for training. Regarding his second period of active duty, the STRs show that the Veteran was noted to have hypertension on an eye examination in February 1991. Post active duty reserve records show diagnoses of hypertension in January 1992 and August 1992. On VA examination in December 1992, it was noted that the Veteran was on medications utilized for treatment of hypertension. A VA examination in January 1993 included a medical history that he had been hypertensive since 1980. Additional treatment records continue to demonstrate a diagnosis of hypertension. In a February 2004 statement, the Veteran’s treating physician indicated that the Veteran had been treated for several disorders, including hypertension. It was opined that it was at least as likely as not that the Veteran’s medical conditions were directly related to his Gulf War service or secondarily related to a condition related to Gulf War service. No rationale for the opinion was provided. A general medical examination was conducted by VA in December 2005. At that time, the Veteran’s medical history included hypertension, with the diagnoses including coronary artery disease, status post myocardial infarction. In an addendum, the examiner opined that the “medical conditions listed in this patient’s examination report [could] be exacerbated by PTSD but [were] not likely due to or the results of PTSD.” An examination was conducted by VA in March 2009. At that time, the pertinent diagnosis was hypertension. The examiner noted that this condition was not caused by PTSD, had occurred before military service and is not an undiagnosed illness. No specific rationale was provided. On VA examination in July 2011, it was reported that the Veteran’s hypertension was diagnosed in 1984 when he suffered a myocardial infarction. The examiner rendered an opinion that the Veteran’s hypertension clearly and unmistakably existed prior to service and clearly and unmistakably was not aggravated beyond its natural progression by an in-service injury, event, or illness. The rationale was that there was no evidence of a worsening of hypertension due to service in the Gulf War; the Veteran stated that his blood pressure had been well controlled by medications; and moreover, there was no indication of a worsening of hypertension due to PTSD or any other service-connected condition. In an August 2011 addendum, the examiner opined that the hypertension was less likely than not incurred in or caused by a claimed in-service injury, event, or illness. The rationale was that there was no medical evidence to support a claim of aggravation or causation of the hypertension by PTSD or other mental health disorder. The examiner further stated that medically, a relationship between health disorders and hypertension (and other disabilities covered by the opinion) had not been established. An examination was conducted by VA in November 2014. After examination, the examiner rendered an opinion regarding whether hypertension was due to or incurred during active duty, or aggravated by active duty. The examiner opined that the condition was less likely than not incurred in or caused by a claimed in-service injury, event or illness. The rationale was that hypertension was not permanently aggravated by Gulf War service and had remained stable without changes in medication or renal status since onset. It was further noted that the Veteran was not treated for hypertension at this time and had not had any alteration of renal function or other condition that would reflect worsening of the condition and there was no evidence of aggravation due to his active duty. An examination was conducted by VA in July 2017. After examination, the examiner opined that, regarding hypertension, the condition was less likely than not proximately due to or the result of a service-connected condition. The rationale was that review of the Veteran’s medical records from 2000 to June 2017 showed only four days of mildly elevated blood pressure readings. The examiner observed that these one-day elevations had temporary causes that included not eating in the morning and not taking the medications in the morning. Overall, his blood pressure was at goal all of the years. In addition, the examiner opined that it was less likely than not that the Veteran’s hypertension was aggravated by a service-connected disability, including as a result of any medications utilized to treat service-connected disabilities. The examiner stated that the Veteran’s baseline disability level could be determined based on the medical evidence, noting that the readings had been on goal since 2000. Furthermore, there were only four single-day episodes of elevations that were temporary so that the current severity of the hypertension was not greater than the baseline. Review of the record shows that the Veteran did not manifest hypertension during his first period of service or within one year thereafter. Hypertension was first noted in the record in 1978. The record also does not demonstrate that the hypertension was related to any period of ACDUTRA or INACDUTRA with a specific finding to this effect made in 1986. Hypertension preexisted the Veteran’s second period of service and the record shows that this preexisting disability had not increased in severity during the second period of service. Finally, the only competent opinion regarding secondary service connection shows that hypertension was not proximately due to or aggravated by a service-connected disability. It is the responsibility of the Board to assess the credibility and weight to be given the evidence. See Hayes v. Brown, 5 Vet. App. 60, 69-70 (1993) (citing Wood v. Derwinski, 1 Vet. App. 190, 192-93 (1992)). The probative value of medical evidence is based on the physician’s knowledge and skill in analyzing the data, and the medical conclusion the physician reaches; as is true of any evidence, the credibility and weight to be attached to medical opinions are within the province of the Board. See Guerrieri v. Brown, 4 Vet. App. 467, 470-471 (1993). When reviewing such medical opinions, the Board may appropriately favor the opinion of one competent medical authority over another. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). However, the Board may not reject medical opinions based on its own medical judgment. Obert v. Brown, 5 Vet. App. 30 (1993); see also Colvin v. Derwinski, 1 Vet. App. 171 (1991). The weight of a medical opinion is diminished where that opinion is ambivalent, based on an inaccurate factual premise, based on an examination of limited scope, or where the basis for the opinion is not stated. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993); Sklar v. Brown, 5 Vet. App. 140, 146 (1993); Guerrieri, 4 Vet. App. at 470-71. In this case, the 2004 opinion rendered by the Veteran’s treating physician, which indicated that hypertension was among those disabilities that could be caused by the Veteran’s service-connected PTSD, did not include a rationale for the opinion. The later VA opinion in the record that addressed secondary service connection, in July 2017, was specific in the rationale regarding the reasons why there was no proximate causal connection or aggravation by PTSD, or any other service-connected disability, and the diagnosis of hypertension, that was first demonstrated of record in 1978. For these reasons, the Board finds the 2017 opinion more persuasive. While the Veteran believes his hypertension is related to an in-service injury, event, or disease, or to a service-connected disability, he is not competent to provide a nexus opinion in this case. This issue is also medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. For these reasons, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for hypertension, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Entitlement to TDIU prior to July 7, 2002 based on PTSD alone The claim of entitlement to TDIU has been remanded on several occasions. Most recently, in the Board’s May 2016 decision, the matter was bifurcated and TDIU was granted from July 7, 2002. The matter related to whether TDIU prior to that date based upon disability associated with the Veteran’s PTSD alone might be awarded was remanded for further development of the evidence. Specifically, it was instructed that the case be referred to the VA Under Secretary for Benefits or the VA Director of the Compensation and Pension Service for an opinion regarding whether the Veteran might be eligible for TDIU based on PTSD alone for the period from the effective date of the award in October 1994 to July 7, 2002. Total disability ratings for compensation may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. When these percentage standards are not met, consideration may be given to entitlement on an extraschedular basis, taking into account such factors as the extent of the service-connected disability, and employment and educational background. It must be shown that the service-connected disability produces unemployability without regard to advancing age. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 3.340, 3.341, 4.16, 4.19. Marginal employment shall not be considered substantially gainful employment. Marginal employment generally shall be deemed to exist when a veteran’s earned annual income does not exceed the amount established by the U. S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. Marginal employment may also be held to exist, on a facts found basis (included but not limited to employment in a protected environment such as a family business or sheltered workshop) when earned annual income exceeds the poverty threshold. Consideration shall be given in all claims to the nature of the employment and the reason for termination. 38 C.F.R. § 4.16. In his June 2002 application for TDIU, the Veteran indicated that he had been working part time as a driver for the City of Huntsville since 1994. He stated he was physically disabled by surgeries, having had nine over the past three years. He reported having four years of college education and additional education in advanced sales training and management. Prior to July 7, 2002, the Veteran’s PTSD was rated 50 percent disabling. A report of a May 1994 Persian Gulf neuropsychological evaluation shows that the Veteran had been married for 30 years and that his relationship was described as stable. He had worked in sales for the past 20 years as a manufacturer’s agent. The last 10 years had been with the same company. He had been involved with direct sales, but had recently had difficulty with paperwork and difficulty with traveling. He worked on a limited basis training his replacement and would fully retire in December. The Veteran reported having some difficulties with anxiety and depression that resulted in him seeing a psychiatrist for the past two years. On examination, attention and spontaneous speech were said to be within normal limits. Memory testing showed scores that were within average range. The Veteran reported more physical problems than normal, with the profile suggesting an augmentation of physical complaints due to emotional distress. There was no indication of significant PTSD symptoms. The Veteran was considered to have significant psychological distress with strong focus on somatic complaints. Depression was considered moderate in degree and there was mild anxiety evident. In a July 2000 VA Persian Gulf psychological evaluation, it was noted that the Veteran had previously been evaluated in 1994 and the current results were to be compared with those findings. The summary and impressions were that the Veteran was cooperative with the examiner and effort was good. Neuropsychological tests were within, or exceeding, the estimated high average levels. Scores on tests of visual memory and visuospatial-constructional skills were higher than those noted in 1994, which could possibly be attributed to successful treatment of sleep apnea. Physically, rapid fine motor skills had worsened and he was now significantly impaired. This was noted to be probably attributable to a worsening of the conditions affecting the nerves of the arms and hands due to cervical radiculopathy and forearm surgeries. Verbal memory, language, reasoning and attentional skills were intact. The Veteran was observed to have a dysphoric affect and hypophonic speech, but there were not found to be significant difficulties with cognitive or behavior self-regulation. Scores on the depressive inventory indicated moderate depression without recent suicidal ideation. PTSD scores were below the cutoff for combat-related PTSD. As before, there was little evidence of a neuropathological condition and there was no evidence of a significant decline in cognitive functioning that would indicate a progressive neurological condition. The Veteran continued to have complaints of difficulties with memory and attention that were likely related to interference from anxiety, depression, and chronic sleep as a contributing factor. The diagnoses were dysthymic disorder and pain disorder associated with both psychological factors and general medical condition. In a June 2001 psychiatry clinic note, the Veteran reported that he had been doing quite well and was neither depressed nor having much in the way of anxiety until he ran out of his medication. After this, he had had difficulty sleeping, felt anxious and agitated. He had just renewed his medication. He also complained of right shoulder disability and had been found to have a torn rotator cuff with subsequent surgery. He noted that he had been employed as a shuttle bus driver for the city and stated he would be able to return to work in the next few days after his doctor released him following the right shoulder surgery. He was to continue with his psychiatric medication and appeared to be doing well with this regimen. An October 2001 VA psychiatric clinic note shows a diagnosis of dysthymic disorder and chronic pain syndrome associated with psychological factors. At that time, the Veteran complained of severe headaches that were thought to be related to his neck. The Veteran stated he was having strange dreams, which were believed to represent some degree of communicative problems. In September 2002, he related that he had had long standing sleep difficulties as well as recurrent and “frustrating” dreams. Objectively, he was well-groomed, alert, and spoke in a clear voice. His mood was mildly depressed, and he appeared to have a slightly anxious and slightly dejected affect. His thought processes were goal directed and he was able to maintain basic concentration. He denied having clear-cut suicidal or homicidal ideation or plans at the immediate present. He did voice some feelings of hopelessness. He denied having clear cut paranoid or grandiose delusions at present as well as auditory or visual hallucinatory phenomena. He appeared to have some insight into the nature of his situation and concerns and to have basic judgement skills. The diagnoses were PTSD, chronic pain disorder associated with medical and psychological factors, and dysthymic disorder. In an April 2003 letter, the Veteran’s former supervisor indicated that the Veteran had worked as a shuttle driver for the City of Huntsville Public Transit Division from May 1994 to July 2002. During this time, he had been unable to maintain a full-time work schedule and had frequent absences due to illness, often described as being due to severe pain. The Veteran resigned from his regular part-time position, stating that his physical condition made it impossible for him to consistently operate his schedule. He continued to work as an on-call driver until his resignation from employment on July 7, 2002. His supervisor noted that the Veteran would be missed in that he was a skilled driver whose customers were very fond of. Pursuant to the Board’s remand, VA requested an opinion from the Director of Compensation Service (Director) as to whether prior to July 7, 2002, the Veteran’s PTSD alone would have rendered him eligible for TDIU. It was noted that the Veteran had been awarded a combined 100 percent rating as a result of all his service-connected disabilities and that a finding of TDIU based only on PTSD symptoms would allow for an award of special monthly compensation benefits. In a February 2019 response, the Director indicated concurrence with the RO recommendation to deny entitlement to TDIU based on PTSD, with pain disorder, depression and anxiety alone on an extra-schedular basis. The rationale was that the available evidence did not show any emergency room visits, inpatient treatment, or intensive outpatient treatment for the time period under review, from October 1994 to July 7, 2002. As such, TDIU on an extraschedular basis due solely to PTSD during this time was not established. At the March 2020 Board hearing, the Veteran testified that he was precluded from work from 1994 due to his disabilities. He related that he had problems driving long distances required for his employment as a salesman in that he frequently had to stop to walk around to “keep everything fluid.” He stated he would have back and leg pain as well as “ferocious headaches” and neuropathy. He also reported that his service-connected sleep apnea contributed to the fatigue that made it difficult for him to maintain employment. For a veteran to prevail on a claim for a total compensation rating based on individual unemployability, the record must reflect some factor which takes his case outside of the norm. The sole fact that he 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 and keep employment. The 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). The Board has reviewed the evidence of record prior to July 7, 2002 and finds no basis for entitlement to TDIU based solely on the Veteran’s psychiatric disability. The psychiatric evaluations show that his anxiety was controlled while he was taking his medications and his depression was described as moderate in nature. Significantly, he was able to maintain part-time employment as a bus driver that does not meet the criteria for marginal employment in that it was not in a protected environment such as a family business or sheltered workshop. The Veteran’s former supervisor also described his ability to interact with people in such a way that he was missed when he was forced to retire due to physical disabilities. Moreover, the evidence as outlined above, shows that prior to July 7, 2002, the challenges that the Veteran faced in his employment stemmed primarily from physical limitations. As an example, he reported in 1994 that traveling for work was difficult. His former supervisor also reported that the Veteran was frequently absent from his shuttle bus employment due to severe pain and eventually resigned from his regular part-time position as a result of his physical condition. At the March 2020 Board hearing, the Veteran described his back and knee pain, headaches, neuropathy, and sleep apnea as having more impact on his employment than PTSD. While the Board does not wish to minimize the nature and extent of the Veteran’s overall limitations due to his service-connected disabilities, and indeed would point out that prior to July 7, 2002, he had a combined 100 percent disability rating as a result of all his service-connected disabilities, the question presently before the Board is whether prior to July 7, 2002, the Veteran’s service-connected psychiatric disability alone rendered him unable to secure or follow a substantially gainful occupation. For the reasons explained above, the Board finds that it did not. In conclusion, the preponderance of the evidence is against the Veteran’s claim for TDIU based solely on PTSD symptoms prior to July 7, 2002, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Joseph P. Gervasio 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.