Citation Nr: 20042014 Decision Date: 06/19/20 Archive Date: 06/19/20 DOCKET NO. 14-25 670 DATE: June 19, 2020 ORDER Entitlement to a total disability rating based on individual unemployability (TDIU) is denied. FINDING OF FACT The preponderance of the evidence shows the Veteran’s service-connected disabilities did not render him unable to secure or follow substantially gainful employment, consistent with his education and work experience. CONCLUSION OF LAW The criteria for entitlement to a total disability rating based on individual unemployability (TDIU) have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.16. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1962 through June 1974 and from August 1984 through April 1995. This appeal comes before the Board of Veterans’ Appeals (Board) from a March 2012 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In May 2017, the Veteran testified before the undersigned Veterans Law Judge (VLJ), and a transcript of that hearing has been associated with the claims file. In a June 2018 decision, the Board denied this claim. The Veteran appealed to the United States Court of Appeals for Veterans Claims (CAVC), and a joint motion for remand (JMR) was granted by the CAVC in July 2019, which vacated the June 2018 decision, in part, to obtain outstanding VA treatment records. In December 2019, the Board remanded to obtain the identified records. As those records have been obtained and associated with the claims file, the Board finds that there has been substantial compliance with the remand directives. Stegall v. West, Vet. App. 268, 270-71 (1998). Other than the VA treatment records, there has been no additional evidence submitted or identified by the Veteran, nor any additional statements from him, while the case was in remand status. The parties also agreed in the July 2019 JMR that the Board failed to adequately explain its rejection of a private physician’s opinion and instructed the Board to address the issue of entitlement to a TDIU for the entire period on appeal. The JMR specifically stated that the Board incorrectly found entitlement to a TDIU moot for the periods in which the Veteran had a 100 percent combined rating (October 20, 2010, to January 31, 2011; July 6, 2012, to October 31, 2013; and from April 14, 2014 to present), and explained that during the entire appeal period, the Veteran “would be entitled to a 60 percent combined rating if his PTSD rating was set aside”—in other words, “that, if Appellant’s PTSD by itself warranted a TDIU, he would be entitled to SMC.” See 38 U.S.C. § 1114(s). In July 2010, the Veteran filed his Application for Increased Compensation based on Unemployability. In that application, he stated he had stopped working July 6, 2008 due to his radiculopathy, neck, frostbite, and PTSD. The Board will not address whether any of the evidence prior to July 2010 was sufficient to reasonably raise an inferred claim for TDIU because the parties agreed in the JMR that “[t]he period on appeal begins in July 2010, which is the month in which the Appellant filed his claim for a TDIU.” The Veteran had a combined 100 percent rating for the periods October 20, 2010, to January 31, 2011; July 6, 2012, to October 31, 2013; and from April 14, 2014 to present. As for the remaining periods on appeal since July 2010, the Veteran met the schedular basis under 38 C.F.R.§ 4.16(a), with a combined rating of 90 percent. Initially, with regards to the first combined 100 percent rating period (October 20, 2010, to January 31, 2011), the Board notes that the Veteran was awarded a total temporary disability rating (100 percent) for surgical or other treatment necessitating convalescence for his service-connected cervical spine degenerative disc disease. As the Veteran was in receipt of a total disability rating, he was in receipt of the maximum benefit allowed under law. See e.g. Bradley v. Peake, 22 Vet. App. 280, 294 (2008). Furthermore, the Board notes that the Veteran was in receipt of special monthly compensation throughout this period under 38 U.S.C. § 1114, subsection (s) and 38 C.F.R. § 3.350(i). Accordingly, even considering Bradley, entitlement to a TDIU for this time period was moot, as the Veteran was in receipt of a total rating plus SMC. In addressing entitlement to a TDIU for the remainder of the appeal period (beginning July 2010), the Board will proceed its analysis in the following order: (1) whether the Veteran is entitled to a TDIU (based on all service-connected disabilities) throughout the entire appeal period, but excluding the periods in which the Veteran has a combined 100 percent rating, and (2) whether the Veteran’s service-connected PTSD alone, entitles him to a TDIU throughout the periods where the Veteran has a combined 100 percent rating (but excluding October 20, 2010, to January 31, 2011, because he already had SMC). VA will grant TDIU benefits when the evidence shows that the Veteran is precluded, by reason of his service-connected disabilities, from obtaining and maintaining any form of gainful employment consistent with his education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. Under 38 C.F.R.§ 4.16(a), if there is only one service-connected disability, the disability must be rated at 60 percent or more to qualify for schedular TDIU. If there are two or more service-connected disabilities, there must 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). In this case, the Veteran has met the schedular requirements for a TDIU for the entire period on appeal. Special Monthly Compensation (SMC) is available when a veteran has a service-connected disability rated as total and has additional service-connected disabilities independently ratable at 60 percent or more. 38 U.S.C. § 1114(s). The U.S. Court of Appeals for Veterans Claims (Court/CAVC) held in Bradley v. Peake, 22 Vet. App. 280 (2008), that there could be a situation where a veteran has a schedular total rating for a particular service-connected disability, and could establish entitlement to a TDIU for another service-connected disability in order to qualify for special monthly compensation (SMC) under 38 U.S.C. § 1114(s) by having an “additional” disability of 60 percent or more (“housebound” rate). See 38 U.S.C. § 1114(s). Thus, Bradley made it such that even with the assignment of a total schedular rating, the issue of TDIU was not necessarily moot. Thus, when a veteran is entitled to a TDIU for a single disability, that 100 percent rating can be the basis for entitlement to SMC. Bradley, 22 Vet. App. at 294. Neither the Veteran nor his representative has raised any specific issues with the duty to notify. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”). With regards to his June 2011 VA examination, the Veteran contended its adequacy, specifically arguing that the examiner’s opinion was based on a rating more favorable to VA than to the Veteran as the examiner opined the Veteran could maintain sedentary work. See May 2017 Board hearing testimony. A presumption of regularity is applied to all manner of VA processes and procedures. Miley v. Principi, 366 F.3d 1343, 1346-47 (Fed. Cir. 2004) (“The presumption of regularity provides that, in the absence of clear evidence to the contrary, the court will presume that public officers have properly discharged their official duties.”); Rizzo v. Shinseki, 580 F.3d 1288, 1292 (Fed. Cir. 2008) (applying the presumption of regularity to VA examination). Clear evidence is required to rebut the presumption of regularity. Miley, 366 F.3d at 1347. Here, the Board finds that the presumption of regularity has not been rebutted. The VA examination report included specific, objective clinical findings, and there was no indication that such findings were inaccurate or biased in any way. Moreover, the exam was consistent with the other medical evidence of record. The examiner considered the Veteran’s pertinent history and functional impairments, and conducted a thorough clinical evaluation of the Veteran. Therefore, to the extent that the Veteran contends that this VA examination report included erroneous, incomplete, or biased findings, the Board finds that the presumption of irregularity has not been rebutted, as there is not “clear evidence” of irregularity. The Board finds that this report adequately addressed the nature and severity of the Veteran’s service-connected disabilities. See generally Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). While the Veteran may disagree with the conclusions the examiner reached (and argue his claim accordingly), that does not render the exam or the opinions inadequate. Therefore, the Board finds that there is no duty to provide another examination or medical opinion. As noted above, the Veteran filed a TDIU claim in July 2010, asserting that his radiculopathy, residuals of frostbite to his bilateral feet, cervical spine degenerative disk disease, and PTSD made him totally unemployable. On that VA 21-8940 form, he indicated that he completed both a Bachelor of Arts and a Master of Divinity, and stated that he left his last job due to his service-connected disabilities. The Veteran reported to the Social Security Administration (SSA) that his duties as a pastor were to visit the sick in the hospital, perform funerals, preach sermons, counseling, meet with the different boards of the church, study in preparation for the Sunday service, execute contracts for building and banking, sign checks for the church, prepare programs, teach other pastors, and teach at the school. Whether the Veteran is entitled to a TDIU throughout the entire appeal period, but excluding the periods in which the Veteran has a combined 100 percent rating (ie. July 6, 2012, to October 31, 2013; and from April 14, 2014 to the present) From July 10 to October 20, 2010 At the time of the Veteran’s TDIU application, he was service connected for left upper extremity radiculopathy (non-dominant) associated with degenerative disk disease of the cervical spine (rated as 60 percent disabling), posttraumatic stress disorder (PTSD) (rated as 30 percent disabling), diabetes mellitus type II (rated as 20 percent disabling), right foot residuals of frostbite (rated as 20 percent disabling), diabetic retinopathy (rated as 10 percent disabling), hypertension (rated as 10 percent disabling), left foot residuals of frostbite (rated as 10 percent disabling), cervical spine degenerative disk disease (rated as 10 percent disabling), post-operative residuals of left inguinal hernia (rated as noncompensable), urethritis and prostatitis (rated as noncompensable), and erectile dysfunction (rated as noncompensable), for a combined total disability rating of 90 percent. Accordingly, the Veteran met the schedular requirements for the entire period prior to October 20, 2010. First, with regards to service-connected PTSD, the Veteran was afforded a VA examination in September 2009. At the time, he was not seeking treatment for his PTSD. The Veteran reported that he felt depressed for approximately three to four days a week and had lost interest in his hobbies. He reported thoughts of death approximately three times a week, but had no suicidal plans, intentions, or actions. The Veteran had excellent relationships with his children, and a good relationship with his wife, but had experienced some conflict with her due to his irritability. He maintained excellent contact with friends and family. He reported being tired during the day due to constant sleep disruption, and that his fatigue limited his activities such as household duties. The examiner opined the Veteran appeared to be experiencing mild impairment due to his symptoms involving impairment in social functioning with respect to his marriage, and his PTSD symptoms, when present, were transient and moderate at most. The examiner also opined that the Veteran’s PTSD symptoms manifested as occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks due to his PTSD signs and symptoms, but with generally satisfactory functioning, routine behavior, self-care, and conversation normal. The examiner provided a rationale explaining that the Veteran had reported various occasions involving outbursts and irritability while working as a minister, occasional intrusive thoughts that have mildly disrupted him during socialization and work, and instances over the past two years where he ducked for cover after hearing loud sounds unexpectedly. However, the Veteran reported that he had “retired” from work due to age/duration of his job; he did not allege he left his position due to any PTSD symptoms. The Veteran also made statements as to his last job during the course of outpatient treatment prior to the VA examination. A November 2008 VA outpatient record indicated he had worked as a minister for over 30 years until he was “laid off” in July 2008 for being “outspoken.” A later November 2008 VA outpatient record indicates that he was “relieved of his church” and had not been assigned to another. The Veteran was denied vocational rehabilitation assistance following an April 2009 assessment. At the time, the Veteran reported having several medical issues that significantly impacted his previous two periods of employment. He reported he could sit for three hours without moving, but could only walk or stand for 30 minutes to one hour out of an eight-hour work day. He also listed several self-prescribed restrictions to reaching forward, reaching overhead, fingering, feeling, grasping, bending, stooping, crouching, crawling, climbing, balancing and kneeling. Records from the Social Security Administration (SSA) reflect that, although he had always used inappropriate language, the Veteran had no problems with his employers prior to being diagnosed with a meningioma and an associated seizure disorder. [Moreover, the Veteran himself reported to SSA in March 2014 that he had stopped working due to seizures and a brain tumor.] The record also contains a January 2006 letter informing the Veteran he had 60 days’ notice to vacate the pulpit due to a less than desirable relationship between the Veteran and the trustee board, a deteriorating relationship with his congregation, and the loss of insurance coverage for all of the church’s properties, including its vans. The Board concludes that prior to October 20, 2010, the Veteran’s service-connected PTSD did not render him totally unemployable. Although the Veteran reported that he had some irritability and outbursts that interfered with his occupation as a pastor, the VA examiner opined that the Veteran’s PTSD symptoms, which were noted to be only occasionally present and transient, were at most moderate in severity. That conclusion was supported by the Veteran’s statements as to how his PTSD symptoms affected him at work. Although the Board acknowledges that the Veteran was asked to step down from his church in 2006 due to deteriorating relationships with the trustees and his congregation, the Board notes that even if the declining relationships were due to his irritability and outbursts associated with his PTSD, those symptoms occurred approximately four years prior to his claim for entitlement to a TDIU. While certainly relevant to his job history, it does not necessarily follow that the same level of impairment remained in 2010. The September 2009 VA examiner considered the Veteran’s reported irritability and outbursts while at work and determined that those symptoms caused only occasional and transient occupational impact, but the Veteran was generally able to function normally. Moreover, the Veteran moved to a different church after 2006 and led another congregation. While he reportedly lost that job for being “outspoken,” the word “outspoken” does not necessarily encompass difficulties because of PTSD symptoms. Accordingly, the Veteran’s moderate and transient PTSD symptoms did not render him totally unemployable prior to October 20, 2010. The Veteran’s cervical spine degenerative disk disease similarly did not render the Veteran totally unemployable. A January 2010 VA examination noted the Veteran reported numbness in his left upper extremity and he had been diagnosed with cervical stenosis. However, physical evaluation reflected his cervical spine had full range of motion. The Veteran was afforded a VA examination to determine the severity of his cervical spine degenerative disk disease in April 2010. He reported experiencing symptoms of pain, stiffness, weakness, lack of endurance, incapacitation, and that he was unable to turn his neck to the left. Specifically, his pain was a level of seven out of ten daily, and flare ups of pain were an eight to nine out of a scale of ten. He experienced a flare up approximately once a week. Range of motion testing reflected the following results: forward flexion to 45 degrees, extension to 30 degrees, right and left lateral flexion to 15 degrees, right lateral rotation to 50 degrees, and left lateral rotation to 45 degrees limited by pain. An August 2010 private medical record reflected the Veteran’s cervical spine demonstrated mild limitation of range of motion with posterior left cervicothoracic pain on all motions without crepitation. There was no evidence of tenderness to palpation, swelling, instability, abnormal muscle tone, or atrophy. Private treatment records from September and October 2010 noted the Veteran’s cervical spine had moderate limitation of range of motion with posterior cervical pain on all motions. There was no evidence of crepitation, tenderness, or swelling, and his paraspinal muscle tone was within normal limits. Prior to October 20, 2010, there is no evidence in the record indicating that the Veteran’s cervical spine disability rendered him unable to work. Although the April 2010 VA examination report reflected the Veteran had left lateral rotation to 45 degrees and was limited by pain, his private treatment records from August through October 2010 noted that his limitation of range of motion was at worst moderate. Moreover, VA treatment records from November 2009 noted the Veteran still drove, and, as will be discussed below, there is evidence he continued to drive for the entire period on appeal. As the evidence reflects the Veteran had, at worst, moderate limitation of motion of his cervical spine and he was still able to drive (that is –able to turn his neck/spine sufficient to drive despite his claims he could not), his cervical spine disability did not impair his ability to obtain and maintain substantial gainful employment. With regards to his left upper extremity radiculopathy, the Board notes the Veteran was in receipt of a 60 percent disability rating based on severe symptoms. A December 2009 VA treatment record noted the Veteran had muscle wasting of his left deltoid and weakness throughout his left upper extremity. Muscle strength testing reflected the Veteran’s deltoid strength was reduced throughout the left upper extremity with 4-/5 recorded for the deltoid, and 4/5 for the biceps and triceps. However, a January 2010 VA treatment record noted the Veteran’s extremities had no muscle atrophy. The January 2010 treatment record noted the Veteran had decreased strength of 4-/5 in the left deltoid, 4/5 in the bicep, and 4/5 in the infraspinatus, but otherwise had full motor strength throughout. He had numbness in his left dorsal hand and finger, but his sensation was otherwise intact. The Veteran was afforded a VA examination to assess the severity of his left upper extremity radiculopathy in April 2010. Physical examination reflected the Veteran’s deep tendon reflexes and strength were normal and equal throughout his left upper extremity. There was no evidence of muscle atrophy, hypertrophy, or loss of tone. There is a private treatment record from August 2010 indicating the Veteran reported numbness in his thumb, index finger, and long finger. Physical examination reflected the Veteran maintained full range of motion of his left upper extremity without any noted muscle atrophy, tenderness, neurocirculatory deficit, or instability. Muscle strength was normal except for decreased strength of 4/5 noted in the Veteran’s triceps. Reflexes were absent in the left upper extremity. September and October 2010 private treatment records reflected essentially the same neurological testing results as were recorded in August, except the Veteran demonstrated full muscle strength in his left upper extremity. The Veteran’s left upper extremity radiculopathy did not render the Veteran totally unable to obtain or maintain substantially gainful employment. The Board notes that during his March 2017 Board hearing, he testified that there was a period of time that he could not lift his left arm. However, VA treatment records reflect that the Veteran had only mild muscle weakness prior to April 2010, and essentially normal muscle strength from April 2010 through October 20, 2010. Additionally, there is no evidence of muscle atrophy or wasting during the period on appeal. Although the Veteran experienced numbness in his left dorsal hand and finger, these mild symptoms did not prevent him from working. The Veteran was noted to be right-hand dominant, and his left upper extremity weakness and numbness would not prevent his ability to write, prepare sermons, execute contracts for the church, or sign checks on behalf of the church. There is no evidence in the record that his left upper extremity radiculopathy prevented him from engaging in his duties as a pastor, or pursuing similar work. The Veteran’s service-connected residuals of frostbite to his bilateral feet, diabetes, and hypertension similarly did not render him unable to obtain or maintain substantially gainful employment. Although the April 2010 VA examination did not specifically address the Veteran’s cold injuries to his feet, a foot examination revealed no painful motion, edema, weakness, instability, or tenderness. He could heel-to-toe walk and had normal sensation to the bilateral lower extremities. There was no functional limitation to standing or walking. The Veteran reported in May 2010 that his feet had begun to get progressively more painful and numb, but he felt like the changes were due to his diabetes. The Veteran’s treating physician submitted a letter dated July 2010 noting the Veteran had painful feet and toenails, onychocryptosis, onychomycosis, and tinea pedis. However, the physician did not link these toenail changes and tinea pedis to his residuals of cold injuries. Moreover, even if the toenail and skin changes were related to his bilateral feet residuals of cold injuries, the physician did not opine that the changes caused functional impairment or impacted the Veteran’s ability to work. In May 2009, the Veteran submitted information concerning his application for vocational rehabilitation, and that included letters from Dr. Surratt recommending that he retire due to “stress” because it made his other medical problems worse such as hypertension, diabetes, and a seizure disorder. Dr. Surratt opined that if the Veteran were to continue working, the stress would worsen, and further suggested that he quit working in order to maintain his physical health. The Board acknowledges that he is service-connected for his hypertension and diabetes, although not for a seizure disorder. However, the fact remains that the contemporaneous medical evidence at that time did not support finding that his hypertension and/or diabetes substantially impacted his ability to work. Notably, there was no evidence in the record indicating the Veteran’s diabetes or hypertension prevented him from obtaining or maintaining employment. The record is silent for any evidence the Veteran’s hypertension caused functional impairment. Although it was consistently noted to have been out of control or not well controlled, there is no evidence it caused any functional impairment or negatively impacted his ability to work. Similarly, while the Veteran’s diabetes was frequently noted to be poorly controlled, even with insulin and medication, he was never instructed to restrict his activities. In a July 2010 letter, the Veteran’s private physician noted he was an insulin dependent diabetic with neuropathy and was unable to reach and care for his own toenails. The physician also noted the Veteran reported difficulty with shoe wear and irritation. While the Veteran’s diabetes may cause some amount of occupational impairment, the inability to reach and care for his toenails would not prevent him from gaining or maintaining employment. Additionally, the Veteran reported difficulty with shoe wear and irritation, but the record contains no evidence that he was unable to wear shoes. Thus, in light of these findings, the Board finds that these private opinions do not alone lead to a conclusion that his service-connected hypertension and diabetes would prevent him from working. Rather, the letters from Dr. Surratt amounted to speculation about the Veteran’s potential future physical condition – that if the Veteran stopped working, his medical problems “should get significantly better.” That is simply not tantamount to opining that the Veteran’s disabilities prevented him working. Dr. Surratt also did not differentiate between the Veteran’s service-connected (hypertension and diabetes) and nonservice-connected (seizure disorder) conditions, and their respective impact on his ability to work. The fact remains that Dr. Surratt’s letters are but one piece of evidence and must be weighed against the other evidence of record. The Board has done so, and as discussed above, the other contemporaneous medical evidence about the severity of his hypertension and diabetes is more persuasive than Dr. Surratt’s letters as to their effect on the Veteran’s ability to maintain employment. Although the April 2009 vocational rehabilitation assessment determined that the Veteran could not work on a regular full time or part time basis and was not feasible for employment (based on the Veteran’s self-reported physical limitations and testing of his cognitive impairments (in which it was found that his speed of processing information was delayed and his academic skills were not consistent with what would be expected of an individual with his level of educational training, despite his college level training)), the Board notes that evaluation considered the Veteran’s vocational abilities based on a combination of both his service-connected and nonservice-connected disabilities. Accordingly, it cannot be relied on to determine that only the Veteran’s service-connected disabilities preclude substantial gainful employment. Furthermore, the examiner attributed the Veteran’s cognitive impairment to residuals of his meningioma or a combination of his medications. However, the examiner did not determine which of the Veteran’s medications could cause his cognitive impairments, and the Board cannot determine (on its own initiative) that it was the medications taken solely for his service-connected disabilities. Finally, the severity of the Veteran’s symptoms recorded in the April 2009 vocational assessment are not consistent with the Veteran’s symptoms noted during his many VA examinations from 2010, all detailed above. Accordingly, the Board does not find the April 2009 vocational assessment and the examiner’s determination that the Veteran could not work to be an accurate representation of the occupational impact caused solely by his service-connected disabilities. Finally, at no point has the Veteran asserted, and there is no evidence to support, that his diabetic retinopathy, urethritis and prostatitis, or erectile dysfunction caused occupational impairment or impacted his ability to work. The combined occupational impact of the Veteran’s transient and moderate PTSD symptoms, moderate limitation of motion of the Veteran’s cervical spine, left upper extremity (non-dominant arm) radiculopathy with normal to mildly decreased muscle strength and full range of motion, residuals of bilateral foot cold injuries, diabetes, and hypertension did not render the Veteran totally unable to obtain or maintain substantially gainful employment. The Veteran’s PTSD symptoms were noted to be transient, and although it was noted he had a deteriorating relationship with his church in 2006, the Veteran was able to work until 2008. Similarly, while the Veteran had some limitation of range of motion of his neck, he continued to drive throughout the period on appeal, indicating that his cervical spine disability did not negatively impact his ability to work, as he could turn his head enough to drive safely. While a cervical spine condition could arguably affect an ability to engage in strenuous physical activity, that is not the Veteran’s job history, so the effect on his usual occupation as a pastor would be mild, at best. Finally, the Veteran’s residuals of cold injuries to his bilateral feet did not result in limitations to walking or standing, and his hypertension and diabetes did not limit his daily activities beyond difficulty with shoe wear and irritation. In summary, the Veteran’s service-connected disabilities, both individually and combined, did not prevent the Veteran from obtaining or maintaining substantial gainful employment throughout this period. There is no evidence in the record that he was totally unable to perform his duties as a pastor or in a similar job. The Veteran had an advanced educational history and his job history included many skills and experience that would transfer to another occupation. While the Veteran’s service-connected disabilities may have made work more difficult, he was not unable to obtain or maintain substantial gainful employment throughout this period. February 1, 2011 through July 5, 2012 Effective February 1, 2011 through July 5, 2012, the Veteran was service connected for left upper extremity radiculopathy (rated as 60 percent disabling), PTSD (rated as 30 percent disabling), diabetes (rated as 20 percent disabling), right foot residuals of frostbite (rated as 20 percent disabling), left foot residuals of frostbite (rated as 10 percent disabling), diabetic retinopathy (rated as 10 percent disabling), hypertension (rated as 10 percent disabling), degenerative disk disease of the cervical spine (rated as 10 percent disabling), urethritis and prostatitis (rated as noncompensable), post-operative residuals of left inguinal hernia (rated as noncompensable), and erectile dysfunction (rated as noncompensable) for a combined total disability rating of 90 percent. The Veteran’s PTSD was increased to 50 percent disabling effective May 31, 2011, but that increase did not impact his combined overall total rating. The Veteran has not asserted, and there is no evidence to suggest, that his diabetic retinopathy, urethritis and prostatitis, and erectile dysfunction negatively impact his ability to work. Thus, the Board will focus its analysis on his other service-connected disabilities. The Veteran underwent a VA examination for his service-connected PTSD in December 2010. He reported that he had been unemployed as a pastor since 2009 and stopped working as the Bishop was breaking the laws of the church and he was not assigned an appointment. His relationship with his wife was not going well, but he maintained relationships with his children. He reported that he got along with people in general, but had disagreements with how bishops were running the church. Mental status examination reflected the Veteran was well-groomed and cooperative, his mood was euthymic with full and reactive affect and frequent joking. His attention, memory, and judgment were within normal limits. The Veteran reported that he visited homeless people who lived under bridges in the cold weather and took them to Waffle House. In May 2011, the Veteran was afforded another VA examination to evaluate the severity of his PTSD. He reported that he could not seem to hold a job and was in the middle of a divorce. He also reported experiencing stress, flashbacks, and memory trouble. The Veteran asserted that his wife had not been giving him the kind of support he needed from her. He reported he got along well with three of his children, but had a poor relationship with his fourth child. The examination showed that the Veteran was fully oriented, well groomed, friendly, and cooperative, with mood euthymic with congruent, appropriate affect. His thought processes were somewhat circumstantial, speech had regular rate and rhythm, but was somewhat over-elaborative. The Veteran’s attention, memory, and judgment appeared to be within normal limits. The examiner opined the Veteran’s PTSD symptoms manifested as occasional decrease in work efficiency with intermittent periods of inability to perform occupational tasks due to PTSD signs and symptoms, but he was generally functioning satisfactorily with routine behavior, self-care, and normal conversation. In doing so, the examiner explained that the Veteran presented some reports of mild memory impairment, irritability, and sleep disruption, which could affect social, interpersonal, and occupational interactions. There is also a chaplain general note from September 2011, documenting the Veteran’s positive affect and mood, appearing relaxed and calm, with positive outset (ie. “I am grateful for the medical team that performed the surgery and the support I received while I was in rehab. I am visiting church’s [sic] in the community outside of my faith tradition and being prayerful as I look to God for spiritual guidance”). The Board finds that the Veteran’s PTSD did not make him unable to work throughout this period. His attention, memory, insight, and judgment were within normal limits during both his December 2010 and May 2011 VA examinations. Although he reported disagreements with the way bishops were running the church, there is no indication that his PTSD prevented him from being a pastor, or engaging in similar work. During the December 2010 examination, the Veteran reported that he still maintained some of his pastoral duties through charity work when he would approach the area’s most vulnerable individuals and take them for a hot meal at Waffle House. Furthermore, despite having a poor relationship with his wife, the Veteran maintained relationships with his children and reported that he got along with people in general. Certainly his demeanor would support that conclusion, as noted by the chaplain in September 2011 (positive affect and mood, relaxed and calm). The May 2011 VA examiner noted the Veteran’s thought processes were somewhat circumstantial and his speech somewhat over elaborative, but there is no evidence the Veteran’s “somewhat” non-linear thought processes or overelaborate speech negatively impacted his ability to work. The examiner opined that the Veteran’s self-reported irritability, memory impairment, and sleep disturbance “could” affect his occupational interactions, but did not opine that the Veteran’s symptoms totally prevented occupational interactions. With regards to the Veteran’s left upper extremity radiculopathy, a February 2011 VA treatment record reflected he presented with reduced strength of 4+/5 in the infraspinatus and 5-/5 in the deltoid, which was improved from before. His arm strength was otherwise normal. A June 2011 VA treatment record noted the Veteran had radicular pain and weakness, but it had improved after his spinal fusion. Neurological examination indicated the Veteran had no gross motor or sensory deficits. In May 2012, it was noted the Veteran had weakness in his left-hand grip, but the medical record contains no documented results of neurological testing. The Veteran was afforded a VA examination to evaluate the severity of his service-connected residuals of frostbite injuries, cervical spine, and upper extremity radiculopathy in June 2011, during which time he reported that he could eat, shower, walk, and drive independently and was independent in his activities of daily living such as dressing, eating, toileting, and showering. The Veteran was ambulatory without assistance and wore glasses, but his gross vision was unimpaired. His driving was limited by his seizure disorder, but none of his service-connected disabilities. The Veteran’s foot examination reflected his flexion was within normal limits and there was no evidence of weakness, instability, tenderness, rashes, ulcerations, or skin necrotic changes. No functional limitation with standing or walking was noted. There was onychomycosis of the right great toe. The Veteran reported that he had episodic feelings of ants-like sensation in both feet, worse with walking. On occasion, the sensation was present at rest. Elevation and use of a whirlpool relieved the sensation somewhat. There was no weakness or fatigability in his feet, he wore regular shoes, and did not use assistive devices or orthotics. Turning to the Veteran’s cervical spine and left upper extremity radiculopathy, the Veteran reported that his October 2010 surgery was successful, and helped with the pain and numbness in his left arm. There were no periods of bed rest prescribed by a physician and no interference with daily activities. There was some stiffness noted on physical examination, but no weakness. Range of motion testing reflected the following results: forward flexion to 35 degrees, extension to 25 degrees, right and left lateral flexion to 15 degrees, right lateral rotation to 50 degrees, and left lateral rotation to 45 degrees. The Veteran’s range of motion was limited by stiffness and discomfort. Neurological testing reflected the Veteran had normal deep tendon reflexes and strength testing to gravity and resistance was within normal limits for his age. His sensation to pinprick and light touch was normal. The examiner opined that the Veteran’s left upper extremity radiculopathy had resolved, as the Veteran demonstrated normal clinical presentation and there were no objective findings of radiculopathy. The examiner opined that the Veteran’s service-connected residuals of frostbite injuries to his bilateral feet, cervical spine degenerative disk disease, and left upper extremity radiculopathy would not impede his ability to engage in sedentary work. The evidence does not suggest that the Veteran’s left upper extremity radiculopathy, cervical spine degenerative disk disease, or residuals of cold injuries to his bilateral feet prevented him from obtaining or maintaining substantial gainful employment. The Veteran’s left upper extremity weakness was noted to be mild in February 2011, and he demonstrated no neurological deficits or decreased sensation during the June 2011 VA examination. While there was an indication of some weakened grip strength in July 2012, there were no results of neurological testing noted in the medical record. Although the Veteran continued to experience some weakness in the left upper extremity following his cervical spine fusion, he is right-hand dominant and would not have been prevented from engaging in his normal duties as a pastor. The Veteran’s cervical spine disability also did not impact his ability to work. His range of motion was limited, but he was still able to dress himself and drive, and he did not report any difficulty with activities of daily living. Similarly, the Veteran’s residuals of bilateral foot frostbite injuries were noted to have resolved and he was not limited in walking or standing. Again, while physical conditions such as the cervical spine and the feet could prevent strenuous physical activity, there is no persuasive evidence showing they interfered with the Veteran’s usual occupation as a pastor. The record does not contain any evidence the Veteran’s hypertension or diabetes negatively impacted his ability to work. Although he continued to take medications to treat both his hypertension and diabetes, and was insulin dependent, physicians never instructed him to limit his activities. The Board notes that the Veteran consistently reported that he did not work because he did not agree with how bishops were running the church, and that he stopped working because the bishops were breaking church law. Moreover, a November 2010 pastoral care note reflected the Veteran was trying to decide whether to pursue a career in the chaplaincy or focus on his other gifts and offer support to his family. Accordingly, there is evidence that the Veteran believed he was capable of maintaining his career as a pastor, despite his service-connected disabilities, although he was contemplating pursuing other options. He did not report leaving his job because of his disabilities. In summary, from February 1, 2011 through July 5, 2012, the Veteran’s service-connected disabilities, taken on their own or combined, did not prevent him from obtaining or maintaining substantial gainful employment. November 1, 2013 through April 13, 2014 Throughout this period, the Veteran was service-connected for PTSD (rated as 50 percent disabling), diabetes (rated as 20 percent disabling), right foot residuals of frostbite (rated as 20 percent disabling), left foot residuals of frostbite (rated as 20 percent disabling), urethritis and prostatitis (rated as 20 percent disabling), diabetic retinopathy (rated as 10 percent disabling), hypertension (rated as 10 percent disabling), degenerative disk disease of the cervical spine (rated as 10 percent disabling), right lower extremity peripheral neuropathy (rated as 10 percent disabling), left lower extremity peripheral neuropathy (rated as 10 percent disabling), tinnitus (rated as 10 percent disabling), left upper extremity radiculopathy (rated as noncompensable), post-operative residuals of left inguinal hernia (rated as noncompensable), erectile dysfunction (rated as noncompensable), and anterior neck surgical scar (rated as noncompensable), for a combined total disability rating of 90 percent. The Veteran’s left upper extremity radiculopathy rating was raised to 20 percent disabling effective December 12, 2013, but that did not impact his overall combined rating. In July 2013, the Veteran was afforded a VA examination for his hypertension, cold injuries to his bilateral feet, diabetes, male reproductive disability, urethritis and prostatitis, cervical spine disability, and diabetic neuropathy. During that time, he was alert and oriented during the exam, demonstrated appropriate comprehension, and provided coherent answers, and his memory, attention, concentration, and executive functions appeared intact. The Veteran’s hypertension evaluation reflected he took three medications to manage the disability. His diastolic blood pressure was not predominantly 100 or more, and three blood pressure readings taken during the examination were recorded as 165/84, 163/84, and 189/104. The examiner opined that the Veteran’s hypertension did not impact his ability to work. As for the Veteran’s diabetes, the examiner noted his condition was managed by restricted diet and he was prescribed oral hypoglycemic agents. However, his diabetes did not require regulation of activities as part of his medical management. The Veteran visited his diabetic care provider for episodes of ketoacidosis or hypoglycemic reactions less than twice a month, and he had never been hospitalized for complications due to his diabetes. There was noted progressive loss of weight due to diabetes, but no loss of strength. The examiner determined the Veteran was symptomatic of diabetic peripheral neuropathy in the bilateral lower extremities. The examiner noted symptoms of mild intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness to the bilateral lower extremities. Neurological examination reflected normal strength of the bilateral upper and lower extremities. Deep tendon reflexes were normal in the upper extremities, but reduced in the bilateral lower extremities. Sensation of the lower extremities was normal to light touch at the knee/thigh and ankle/lower leg, but was decreased at the foot/toes. Position sense of the bilateral lower extremities was normal, but the Veteran had decreased vibration sensation and cold sensation. There was no evidence of muscle atrophy. The examiner opined the Veteran had mild incomplete paralysis of the sciatic nerve due to diabetic peripheral neuropathy bilaterally. The examiner also opined that the Veteran’s bilateral peripheral neuropathy caused difficulty in ambulation due to sensation of pins and needles in the plantar aspect of both feet. The examiner attributed all of the Veteran’s tingling sensation while walking to his peripheral neuropathy, rather than to his bilateral residuals of cold injuries to the feet. Evaluation of the Veteran’s urethritis and prostatitis reflected the Veteran experienced daytime voiding at intervals between one and two hours, and nighttime awakening to void two times a night. He experienced slow or weak stream and decreased force of stream, but the symptoms of obstructive voiding were not marked. The examiner opined that the Veteran’s urethritis and prostatitis did not impact his ability to work. Finally, the examiner evaluated the Veteran’s cervical spine disability. The Veteran reported experiencing marked relief of his cervical spine symptoms following his October 2010 spinal fusion. The Veteran did not report experiencing flare ups. Range of motion testing reflected the following results: forward flexion to 35 degrees, extension to 25 degrees, right lateral flexion to 30 degrees, left lateral flexion to 25 degrees with pain at 25 degrees, right lateral rotation to 50 degrees, and left lateral rotation to 45 degrees with pain at 45 degrees. There was no evidence of tenderness to palpation, but the Veteran did experience pain on movement and guarding or muscle spasm that did not result in abnormal gait or spinal contour. Neurological evaluation reflected normal strength and deep tendon reflexes of the bilateral upper extremities, and the sensory examination was normal bilaterally. The examiner noted there was no evidence of radiculopathy. The examiner opined that the Veteran’s cervical spine disability impacted his ability to work because he had limited head turning and pain to the left and hardware in place following his cervical spine fusion. In a December 2013 letter, the Veteran’s private physician noted that the Veteran continued to experience moderate cervical radiculopathy of the left upper extremity, which was confirmed by EMG and nerve conduction tests in November 2013. The Veteran also had underlying general polyneuropathy and a mild median neuropathy of the left wrist. However, a VA treatment record from January 2014 noted the Veteran had 5-/5 strength of his left deltoid and infraspinatus, but otherwise his left upper extremity appeared fairly well intact. The Veteran underwent VA examination for assessing the severity of his cervical spine and left upper extremity radiculopathy in April 2014. The Veteran reported occasional neck pain during certain motions. He also reported intermittent radicular symptoms to the bilateral upper extremities. Range of motion testing reflected forward flexion to 50 degrees with pain beginning at 35 degrees, extension to 25 degrees with pain beginning at 25 degrees, right lateral flexion to 20 degrees with pain beginning at 20 degrees, left lateral flexion to 35 degrees with pain beginning at 25 degrees, right lateral rotation to 50 degrees with pain beginning at 50 degrees, and left lateral rotation to 60 degrees with pain beginning at 60 degrees. The Veteran experienced functional loss due to pain and subjective reports of tightness. There was no evidence of tenderness, muscle spasm, or guarding. Neurological testing reflected normal strength, deep tendon reflexes, and sensation to light touch. The Veteran reported mild intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness, but the examiner noted these symptoms were not confirmed by neurological examination. The examiner opined that the Veteran’s cervical spine disability and radiculopathy did not impact his ability to work because physical examination revealed no swelling or spasm, and there were no findings of radiculopathy despite the reported intermittent radicular symptoms noted, and the Veteran’s well-healed left anterior surgical scar was of no current clinical significance. The Veteran was afforded a VA examination to evaluate his tinnitus in April 2014, and during that time, the examiner noted his condition impacted his work based on the Veteran’s report that it was distracting and caused confusion. After reviewing all records, the Board finds that the Veteran’s physical disabilities did not prevent him from obtaining or maintaining substantial gainful employment. Neither the July 2013 nor the April 2014 VA examiners opined that the Veteran’s service-connected disabilities prevented him from working. Most significantly, the Veteran had difficulty turning his head to the left, and experienced difficulty walking due to a pins and needles sensation in his feet. There is no evidence the Veteran’s hypertension or urethritis and prostatitis impacted his ability to work. Additionally, although his diabetes was treated with restricted diet and medications, it was not treated with restriction in activities. Although neurological testing reflected the Veteran had mild bilateral impartial paralysis of his sciatic nerve due to peripheral neuropathy, his reported symptoms of pins and needles while walking did not prevent him from working. It was noted he had difficulty toe walking, heel walking, and heel-to-toe walking, but he was capable of performing those actions. The Veteran’s cervical spine degenerative disk disease also did not impact his ability to work. Although he experienced limitation of motion (especially when turning his head to the left), there is no evidence that his limitation of motion prevented him from fulfilling his duties as a pastor or other similar work. Similarly, the Veteran’s left upper extremity radiculopathy did not prevent him from working. Although a November 2013 EMG and nerve conduction test confirmed the existence of radiculopathy, physical evaluations were absent for any objective symptoms. Neither the July 2013 nor the April 2014 VA examinations found any physical evidence of decreased strength, absent deep tendon reflexes, or loss of sensation. The April 2014 examiner noted the Veteran reported intermittent symptoms of radiculopathy, but was presently asymptomatic. There is no evidence the Veteran’s left upper extremity radiculopathy presented with objective symptoms, or even that the Veteran’s subjectively reported mild symptoms prevented him from performing his duties as a pastor or engaging in similar work. Finally, the Veteran’s PTSD did not prevent him from engaging in substantial gainful employment. His mental health treatment records from April 2014 show that he only had mild psychiatric condition and that he has made a significant progress toward treatment goals; and he was found to have cooperative, calm conduct; good eye contact; alert, oriented, euthymic, appropriate affect; appropriate speech; logical and goal directed thought processes; grossly intact memory, good insight and judgment. The Veteran was afforded a VA examination to evaluate the severity of his PTSD in May 2014. During that time, he reported he did not get along with his wife, but was beginning to see that he was the problem in his marriage. He also reported that he would wake up in the morning and watch TV, but spent most of his day sleeping due to the amount of medications he took. The Veteran fixed his own meals and tended to himself. He had not been to church lately and was not in community organizations, but continued to spend informal time with homeless veterans and occasionally took them to Waffle House. The Veteran reported that he had to retire from his position within the church after he developed a meningioma which led to a seizure disorder. His mental status examination reflected the Veteran was fully oriented, neatly groomed, and cleanly dressed. His speech was normal in rate, rhythm, and volume. His thought process was logical, but he needed frequent redirection to stay on task with regard to the interview, and he desired to discuss past experiences rather than present symptoms and situations. The Veteran’s mood presented as depressed and angry with the VA for decreasing his compensation in the past, and his affect was congruent. There was no observable impairment in attention, concentration, or memory, and his insight, judgment, and impulse control were intact. The Veteran reported that he had one to two good days per week, and he felt better when he helped other people. He provided subjective reports of impaired memory. The examiner opined the Veteran’s PTSD manifested as occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although he was generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. Accordingly, the Board finds that the Veteran’s PTSD did not prevent him from working. He reported difficulty getting along with his wife, but there is no evidence his irritability with his wife prevented him from establishing relationships with other people, as evidenced by his personal volunteer work spending time with homeless veterans, and his report that he felt better on days that he helped other people. As such, there is no evidence that the Veteran’s PTSD prevented him from working around others or performing his duties as a pastor such as preaching, counseling, and teaching. Additionally, the Veteran has consistently stated that he stopped working due to his meningioma and seizure disorder, not his PTSD or other physical symptoms. With regards to his physical disabilities, the Board is cognizant of his May 2017 Board hearing testimony, that he has limitation as to weight lifting more than 15 to 20 pounds, and that he experiences an occasional symptom of his right leg giving out while climbing ladders. However, the Board again underlines that the Veteran’s duties as a pastor (as reported by the Veteran to SSA) were to visit the sick in the hospital, perform funerals, preach sermons, counseling, meet with the different boards of the church, study in preparation for the Sunday service, execute contracts for building and banking, sign checks for the church, prepare programs, teach other pastors, and teach at the school. None of these enumerated duties indicate the Veteran was engaging in heavy lifting or ladder climbing (or similar strenuous physical labor) while fulfilling his duties. The Board also acknowledges that Veteran’s son testified during the May 2017 Board hearing that it took the Veteran a lot of time to bathe and get ready in the morning, including dressing himself. However, those reported symptoms are not consistent with the objective symptoms and level of disability the Veteran demonstrated prior to April 14, 2014. Additionally, the Board notes that the Veteran testified that he retired and moved to a smaller church as a result of his seizure disorder and meningioma, not as a result of any conflict he had at his original church or any other symptoms reportedly due to service-connected conditions. The Board finds that the Veteran’s service-connected disabilities did not make him unable to secure or follow a substantially gainful occupation. There is no indication in the record that his service-connected disabilities, on their own, prevent him from participating in any kind of work. Although the Veteran has some tingling sensation in his feet that causes difficulty walking/standing, problems with irritability due to his PTSD, and limited cervical spine range of motion, these symptoms alone do not make him unable to work. He remains capable of fulfilling the duties of a pastor including teaching, preparing sermons, studying, counseling, preaching on Sundays, and all clerical duties associated with running a church, or engaging in similar activities in another position. Accordingly, entitlement to a TDIU prior to October 20, 2010, effective February 1, 2011 through July 5, 2012, and effective November 1, 2013 through April 13, 2014 is not warranted. As the preponderance of the evidence is against entitlement to a TDIU, the benefit-of-the doubt doctrine is not applicable. See 38 U.S.C.§ 5107(b); 38 C.F.R.§§ 3.102, 4.3; Gilbert, 1 Vet. App.at 53-56. Whether the Veteran’s service-connected PTSD alone, entitles him to a TDIU throughout the periods where the Veteran had a combined 100 percent rating (July 6, 2012, to October 31, 2013; and from April 14, 2014 to the present) The Board has further considered, per the JMR’s instructions, whether the Veteran’s service-connected PTSD alone, entitles him to a TDIU throughout the periods where the Veteran had a combined 100 percent rating, but finds such not to be the case. Thus, there is no basis for entitlement to SMC(s) throughout these periods, and TDIU remains denied. July 6, 2012, to October 31, 2013 The Veteran’s psychiatric VA treatment records from November 2012 revealed that he was mentally oriented to own ability, and despite his report of frustration and anger over the way he was treated in the military during a March 2013 VA mental health session (ie. racial barriers he faced in the military as a chaplain), he was otherwise consistently found (to include during the March 2013 treatment session) to be: cooperative, calm, adequately groomed, appropriately attired, alert, oriented, logical, goal directed, good insight/judgment, dysphoric/sad mood, with grossly intact memory functions and appropriate speech (see January 2013, March 2013, April 2013, September 2013 VA treatment records). He also consistently denied hallucinations or homicidal thoughts throughout those treatment sessions. Although his April 2013 mental health treatment notes contained the Veteran’s report of continued symptoms of poor sleep and nightmares related to dead children and innocent people who were killed, as well as his struggle finding purpose of life issues, there was no indication that such symptoms or behaviors seeking purpose and meaning in life led to, or manifested to, the level of him losing any motivation to work or impacting his ability to work. In fact, throughout this period, to include during the April 2013 VA mental health treatment session, the Veteran was noted to be goal directed and at a low risk level, especially considering that he had good coping skills, supportive relationships, responsibility toward family, spiritual support/beliefs (see January 2013, March 2013, April 2013, September 2013 VA treatment records); furthermore, he was consistently found to present only mild symptoms of PTSD, and was noted to have made significant progress toward treatment goals in all of those treatment sessions. After reviewing all records, the Board finds that the Veteran’s service-connected PTSD did not make him unable to secure or follow a substantially gainful occupation. There is no indication in the record that his PTSD alone, prevented him from participating in any kind of work. Although the Veteran has some mood affect (constricted in the sad range) and irritability due to his PTSD, these symptoms alone do not make him unable to work, the Board points out that he was consistently found to have structured and goal directed thoughts, good insight and judgment, and grossly intact memory function. The Board reiterates that the Veteran’s duties (per the Veteran’s report) as a pastor were to visit the sick in the hospital, perform funerals, preach sermons, counseling, meet with the different boards of the church, study in preparation for the Sunday service, execute contracts for building and banking, sign checks for the church, prepare programs, teach other pastors, and teach at the school. He remains capable of fulfilling the duties of a pastor including teaching, preparing sermons, studying, counseling, preaching on Sundays, and all clerical duties associated with running a church. Thus, the Board finds that PTSD did not prevent him from engaging in substantial gainful employment throughout this period. From April 14, 2014 to the present The Veteran underwent a VA examination to evaluate the severity of his PTSD in May 2014. During that time, he reported not having been to church lately and not being involved in community organizations, as well as spending most of his day sleeping due to the amount of medications he took. However, he reported continuously spending informal time with homeless veterans and occasionally took them to Waffle House. The Veteran also reported that he had to retire from his position within the church after he developed a meningioma which led to a seizure disorder. He was found to be fully oriented, neatly groomed, and cleanly dressed; speech normal in rate, rhythm, and volume; thought process logical, but requiring frequent redirection to stay on task with regard to the interview, and it was noted that he desired to discuss past experiences rather than present symptoms and situations. The Veteran’s mood presented as depressed and angry with the VA for decreasing his compensation in the past, and his affect was congruent. There was no observable impairment in attention, concentration, or memory, and his insight, judgment, and impulse control were intact. The Veteran reported that he had one to two good days per week, and he felt better when he helped other people. He provided subjective reports of impaired memory. The examiner opined the Veteran’s PTSD manifested as occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although he was generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. His VA mental health treatment records consistently documented the Veteran’s presentation of cooperative and calm behavior; good psychomotor retardation; alert orientation; appropriately attired manner; sad/dysphoric mood and appropriate affect; denial of hallucinations; appropriate speech, logical and goal directed, with memory functions grossly intact; good insight and judgment, history of good coping skills and supportive relationships, future oriented, responsibility toward family, spiritual support/beliefs. See August 2014, November 2014, November 2016 VA treatment records; see also January 2015, May 2015, January 2016 VA treatment records; see also September/October 2014 and June 2016 pastoral care/mental health follow-up sessions (in which the Veteran again presented a positive affect and mood, expressing gratitude for the emotional support he has been receiving from family that has been decreasing his anxiety and relaying a thought of potentially exploring and applying at the local medical center to earn two clinical pastoral units that would allow him to be eligible to work in VA chaplaincy). Similarly, during June and July 2019 social work risk assessments, besides the Veteran’s one-time report of experiencing some memory issues (in June 2019), the Veteran was again found to be open, engaged, oriented to time, place, person, situation, clean/neat in appearance, appreciative and positive affect, and he denied suicidal and/or homicidal ideation, plan, or intent. See also June 2019 pastoral care note (in which the Veteran was noted to have a delightful presentation and expressed his desire to seek spiritual direction on his understanding of his calling from God to serve as a chaplain). Furthermore, throughout all the treatment sessions, he was consistently found to present only mild symptoms of PTSD, and was noted to have made significant progress toward treatment goals. The Board is cognizant of the Veteran’s testimony during his May 2017 Board hearing that his PTSD impacted his work because he could not get along with anyone. However, he also testified during that time that he had conflicts at work because bishops were putting people in the wrong slots for the wrong reasons. His son also testified that the Veteran was temperamental at work because he was well educated, and others working in the church did not want to make sound choices when it came to finances. Thus, it is apparent from his testimony that while the Veteran’s PTSD symptoms may have made it difficult for him to work, they did not prevent him from working, and his conflicts arose from situations independent of any psychiatric symptoms he had. Regardless, the probative weight of his testimony is outweighed by the treatment notes which consistently report him as cooperative, calm, etc., but which also reflect his own belief that he could, in fact, continue to work, as he expressed a desire to perhaps work as a VA chaplain. Clearly if he “could not get along with anyone,” common sense dictates his treatment records would not describe him as calm and cooperative and positive, nor would he desire to engage in an occupation similar to his prior one where he would have to continuously engage with others. Since April 14, 2014, the Veteran’s service-connected PTSD did not render him totally unemployable. Although the Veteran once reported some memory issues, his treatment records consistently show that his memory is grossly intact. Despite presenting sad/dysphoric mood at times, he consistently manifested positive affect/attitude regarding life perspectives, and he was consistently found to be fully oriented, neatly groomed, and cleanly dressed; speech normal in rate, rhythm, and volume; and logical thought process. Furthermore, even though the Veteran reported not participating in community organizations or attending church lately during his VA examination, the Board highlights that the Veteran reported he continued spending informal time with homeless veterans consistently and occasionally taking them to Waffle House. After reviewing all records, the Board finds that PTSD alone did not render the Veteran unemployable at any point from July 6, 2012, to October 31, 2013; and from April 14, 2014. As the preponderance of the evidence is against entitlement to a TDIU, the benefit-of-the doubt doctrine is not applicable. See 38 U.S.C.§ 5107(b); 38 C.F.R.§§ 3.102, 4.3; Gilbert, 1 Vet. App.at 53-56. Having determined that he is not warranted TDIU based on PTSD alone, there is also no basis for him to warrant a SMC(s) throughout these periods. MICHELLE L. KANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Lee 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.