Citation Nr: 21000274 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 11-15 098A DATE: January 5, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder is denied. Entitlement to a total disability rating based upon unemployability due to service-connected disabilities (TDIU) is denied. FINDINGS OF FACT 1. An acquired psychiatric disorder did not manifest in service, was not aggravated by service, and is not otherwise attributable to service. 2. The evidence of record does not show that the Veteran is unable to obtain or maintain substantially gainful employment as a result of service-connected disabilities. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for acquired psychiatric disorder have not been met. 38 U.S.C. § 1101, 1110, 1131, 1137, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2019). 2. The criteria for entitlement to a TDIU have not been met. 38 U.S.C. § §§ 1155, 5103A, 5107 (2012); 38 C.F.R. § §§ 3.102, 3.340, 3.341, 4.16, 4.18, 4.19 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from August 1970 to June 1971. These matters come before the Board of Veterans’ Appeals (Board) on appeal from multiple rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). In December 2017, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of that proceeding has been associated with the Veteran’s claims file. In April 2018, the Board reopened the Veteran’s claim and remanded it to afford the Veteran a VA examination. In December 2018, the Board remanded the claim for further development because the VA examiner did not consider all the evidence to which the Board called attention. In August 2019, the RO issued a supplemental statement of the case that continued to deny service connection for an acquired psychiatric disorder and for a TDIU. The Veteran submitted a written statement continuing to disagree with the decision. He also submitted a notice of disagreement (VA Form 10-182) opting into the Appeals Modernization Program adjudication process and selecting direct review by the Board. In December 2019, the Board erroneously issued a decision under the legacy adjudication process. The Veteran appealed the decision to the U.S. Court of Appeals for Veterans Claims (Court), challenging the use of the legacy system. In April 2020, the Court vacated the decision and remanded the appeal for compliance with a Joint Motion for Remand. The parties required the Board to explain whether it had jurisdiction to review the claims under the legacy or AMA system. In June 2020, the Veteran’s representative reversed course contending that the legacy system should be used because the Veteran did not check a specific box on the Form 10-182 opting out of the legacy system even though the form clearly indicated a desire for AMA direct review. The representative used the opportunity to submit new evidence. In July 2020, the Board remanded the claims to resolved conflicts in the medical evidence. The Veteran’s counsel submitted a brief dated October 26, 2020, which was associated with the Veteran’s claims file on that same day. This brief consisted of argument and included a copy of a consultant’s report. The RO issued a second Supplemental Statement of the Case (SSOC) on November 10, 2020. Pursuant to an email request from counsel, the Board has granted an extension through November 20, 2020. On December 8, 2020, the Veteran’s representative submitted an additional brief addressed directly to the Board. The brief contained additional argument but no new evidence. On December 21, 2020, the RO inappropriately issued another SSOC and offered another 30 days to respond. The Board finds that further delay is not warranted. The Veteran clearly desired the appeal to be adjudicated in the legacy system. No new evidence has been received. The Veteran has had the opportunity and has submitted argument which will be considered, and has requested expedited action as the Veteran has had a terminal illness. The Board has again reviewed the evidence or record comprehensively. Although the Board has an obligation to provide reasons and bases to support a decision, there is no requirement to discuss, in detail, all the evidence submitted by or on behalf of a Veteran or an appellant. See Gonzales v. West, 218 F. 3d 1378, 1380-81 (Fed. Cir. 2000). The analysis below focuses on the most salient and the most relevant evidence about what this evidence shows, or fails to show, about the issue on appeal. The Veteran must not assume that the Board has overlooked pieces of evidence that are not discussed explicitly. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the Veteran or appellant). Remand Compliance These matters were last remanded for additional development in July 2020. The Board finds that there has been substantially substantial compliance with remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that a remand confers on the claimant, as a matter of law, the right to compliance with the remand order); see also D’Aries v. Peake, 22 Vet. App. 97, 105 (2008); Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (holding that substantial, rather than strict, compliance with remand directives is required). In summary, the Board directed the RO to obtain any outstanding private and VA mental health treatment records. Upon receipt of such, the Board directed a VA addendum opinion and telehealth consultation with a VA psychologist to reconcile the contradictory psychological findings in the VA mental examination reports of record and the May 2020 private psychologist-consultant’s opinion. The Veteran cited the following Board remand directive. [T]he VA psychiatrist or psychologist should keep in mind that the Veteran is competent to report his symptoms and history. Such reports, including those of continuity of symptomatology and functional limitations, must be acknowledged and considered in formulating any opinion. If the psychiatrist or psychologist rejects the Veteran’s reports, she/he must provide an explanation for such rejection. The examiner should note any points of agreement or disagreement with the consultant’s evaluation. In October 2020, the counsel wrote that, [The VA psychologist’s] exam in not in compliance with the Board’s remand directives in its July 2, 2020 decision. Specifically Judge Francis stated, ‘The VA [psychiatrist] or psychologist should keep in mind that the Veteran is competent to report his symptoms and history.’ See October 26, 2020 Appellate Brief, p. 1 (underscored italics in original). To bolster this contention, counsel quoted a paragraph in the August 2020 VA psychologist’s opinion. infra However, counsel failed to mention an extensive discussion in the August 2020 VA psychologist’s opinion and telehealth consultation, in which this psychologist discussed the Veteran’s extensive lay contentions concerning his psychological history, to include an account of total absence of psychological treatment records during active duty service and allegation concerning the reason for such. According to the VA psychologist, [T]oday, the [Veteran] was clearly aware there are no documents in service treatment records, service personnel records, private treatment records, or VA records that support his claim [that] he sought treatment immediately after service. [The Veteran’s] explantation was unconvincing: ‘My records have been altered and redacted all the way down the line . . . I don’t think they (service treatment records) mention […] the lack of puberty—that’s what caused me all these problems.’ As for VA records [, the Veteran stated]: ‘The VA, they (sic) stole all my records. All my records from my first four years at the VA were ‘taken out […] They (sic) do that—because they (sic) don’t want you to be able to file a compensation and pension claims.’ See August 31, 2020 C&P Exam, p. 7. Counsel also contended that the August 2020 VA psychologist, [f]ailed to accept [the Veteran’s] history of military sexual trauma (MST) and symptomatology to service at face value. Instead, [the psychologist] in violation of Judge Francis’ remand instruction, improperly discredited [the Veteran’s] history of MST and symptoms back to his time in service due to lack of contemporaneous evidence. Accordingly, by failing to accept [the Veteran’s] testimony, the psychologist did not comply with Judge Francis’ remand instruction. See October 26, 2020 Appellate Brief, p. 1 (underscored italics added). As noted above, the remand directive states that the Veteran is “competent to report his symptoms and history.” The Board required the examiner to consider the Veteran’s statements and testimony but not that the examiner must find the Veteran’s testimony to be “internally consistent, facial plausible, and consistent with other evidence submitted on behalf of the [the Veteran].” Caluza v. Brown, 7 Vet. App. 498, 511 (1995). The examiner was asked to form a medical opinion based on his review of all the evidence including the Veteran’s statements. Counsel also insists that the August 2020 VA psychologist failed to comply with remand directive by not reconciling the contradictory psychological findings in the VA mental examination reports of record (as noted above) and the May 2020 private psychologist-consultant’s opinion. Here, counsel argues that the August 2020 VA psychologist omitted aspects of the consultant’s report, to include one of the consultant’s diagnoses. Again, returning to the August 2020 VA psychologist’s opinion. [I] do not believe the private psychologist’s report should be given preferential weight in determining the matter of service connection. There are several problems with [this psychologist-consultant’s] conclusions: The psychologist’s opinion [that] the Veteran was harassed, sexually victimized, and denied medical care for a serious injury in service is based entirely on his 90-minute phone interview with the [Veteran]. His opinion [that] the [Veteran] became depressed and anxious and first sought treatment for his symptoms, within months of [discharge from] service, is similarly based entirely on [the psychologist-consultant’s] phone interview. His opinion [that] the [Veteran] first attempted suicide is based entirely on his phone interview. [This psychologist-consultant’s] opinion was [that] the [Veteran’s] testimony was valid and reliable was based upon [the psychologist-consultant’s] impression that the [Veteran] seemed genuine on the day of the exam, and that [in-service] traumas were described in detail. [However,] [the psychologist-consultant’s] opinions did not consider any of the [Veteran’s] conflicting testimony about when symptoms, suicide attempts, and treatment started. [Likewise, the psychologist-consultant’s] conclusions did not consider that there is no record of any treatment prior to 1975, four years after [the Veteran’s separation from] service. [Likewise, the psychologist-consultant’s] conclusions did not take into account that service records contain no evidence of the traumatic events [that] the [Veteran] described (records shown only that he had a ‘[fracture of the] left tibia in basic training—ok now [;] [stress fracture—[summer] 1970’. […] [Likewise, the psychologist-consultant’s] conclusions did not take into account the Veteran’s denial of mental health symptoms, nor any history of such, on his separation exam. [Likewise, the psychologist-consultant’s] conclusions did not take into account [that] the [Veteran] admitted [upon the instant psychometric interview] that there are no records supporting his claim that symptoms and treatment started immediately after service. [And,] there was no psychological testing performed by the private [psychologist-consultant]. See August 31, 2020 C&P, pp. 7-8 (emphases added). Indeed, one would be hard-pressed to discern that the August 2020 VA psychologist did not frame the private consultant-psychologist’s opinion around its marked deficiencies. Even though counsel argues that the VA psychologist did not include one of this consultant’s diagnoses, the VA psychologist brought into question the very bases from which all of the consultant’s diagnoses were derived. As the record shows, the private consultant-psychologist’s diagnoses were wholly derived from one telephonic encounter and an “impression” that the Veteran] “seemed genuine on the day of the exam, and that [in-service] traumas were described in detail.” The Board finds that there has been substantial compliance with the remand instructions and will proceed with evaluation and assignment of credibility and probative weight to the evidence below. Service Connection The Veteran contends that an acquired psychiatric disorder (portrayed at times throughout the course of these proceeding as posttraumatic stress disorder (PTSD) related to military sexual trauma (MST), and varying inflections of depressive disorder) was incurred in, or aggravated by, or otherwise attributable to, active duty service. Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also include statements conveying sound medical principles found in medical treatises. It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159 (a)(2). This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). If the evidence is competent, the Board must then determine if the evidence is credible. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). After determining the competency and credibility of evidence, the Board must then weigh its probative value. In this regard, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. See Caluza, supra. In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. In order to establish service connection on a direct basis, the record must contain competent evidence of: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F. 3d 1163, 1167 (Fed. Cir. 2004). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F. 3d 1039, 1043 (Fed. Cir. 1994). If a claim is based on in-service personal assault, evidence from sources other than the veteran’s service records may corroborate the veteran’s account of the stressor incident. Examples of such evidence include but are not limited to records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; tests for sexually transmitted diseases; and statements from family members, roommates, fellow service members, or clergy. Evidence of behavior changes following the claimed assault is one type of relevant evidence that may be found in the sources. Examples of behavior changes that may constitute credible evidence of a stressor include but are not limited to request for transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavioral changes. 38 C.F.R. § 3.304(f)(3). Evidence and Analysis Acquired psychiatric disorder The March 1971 Discharge Report of Medical History, which bears the signatures of both the Veteran and a military clinician, discloses that the Veteran had not had and did not have (upon discharge): 1) frequent trouble sleeping; 2) frequent or terrifying nightmares; 3) depression or excessive worry; 4) loss of memory or amnesia; 5) nervous trouble of any sort; 6) any drug or narcotic habit; or 7) an excessive drinking habit. In the associated Discharge Report of Medical Examination, a clinician provided normal clinical evaluations of both the Veteran’s neurological and psychiatric status. Otherwise, service treatment records (STRs) do not show complaints, symptoms, treatment, or a diagnosis of a psychiatric disorder. The examiner also noted that the Veteran was under the body weight standard. The STRs show that the Veteran had sustained a stress fracture of the left tibia while running during basic training. In April 1971, a clinician evaluated an X-ray which showed that the fracture was healing. VA treatment records from December 1975 to March 1978 include, respectively: a hospital diagnosis of anxiety reaction; inpatient treatment for benzodiazepine overdose (attributed to depression and suicidal gesture); and a second hospital admission for benzodiazepine abuse (attributed to depressive reaction) In March 1992, a VA provider noted the Veteran’s report of symptoms of insomnia since the age of 17, adding that he had had a history of depression including a suicide attempt at the age of 19 on over-the-counter (OTC) medication. Upon VA mental health examination in December 1993, a clinician provided an initial impression of alcohol dependence (intoxication); heroin dependence; marijuana abuse; cocaine abuse; tobacco dependence; homelessness; and adult situational reaction (attributed to the death of the Veteran’s mother). This clinician noted that the Veteran cried when he spoke about his mother and presented with a slow and intoxicated thought process, while emanating odors of alcohol. In August 1994, a VA clinician noted that the Veteran again indicated that he had a history of prior suicide attempts. The Veteran also endorsed treatment for his nerves in the 1970s. In January 1997, a clinician at state department of criminal justice facility noted that the Veteran claimed that he attempted to commit suicide through overdosing on a benzodiazepine 25 years earlier. To a great extent, a clinician at a hospital facility, indicated that same subjective endorsement of attempted suicide on January 1999. In this latter note, the clinician indicated that the Veteran claimed that he received outpatient treatment. February and April 2005 county records mention that the Veteran experienced depression and attempted suicide by benzodiazepine overdose when he was 19—after active duty service. In a July 2006 lay account, the Veteran wrote that upon separation from active service, he sought VA treatment for “a nervous condition and depression.” Moreover, he conveyed that he received psychiatric treatment on multiple occasions in the early 1970s for attempted suicide. In his own words, “[the] depression problem that [he has [had] since [he] left service has caused […] a lifetime of problems, which [has included] inpatient stays […] usually as a result of suicidal tendencies.” The Veteran also conveyed that he received “rough physical treatment” from his drill sergeant. The Veteran completed a questionnaire regarding exposure to Hepatitis C in which he denied any drug use or high-risk sexual activity. However, the Veteran did not describe an MST event in service. He did note that he had received orders for duty in Vietnam and was ready and willing to go. See July 14, 2006 VA 21-2138 Statement in Support of Claim. The Board also reviewed lay statements from the Veteran’s siblings. In pertinent part, the siblings reported that they observed changes in the Veteran’s behavior after his separation from active service. The siblings also indicated that the Veteran’s symptoms have worsened over time, emphasizing what the Veteran endorsed and what they observed. In a February 2008 lay account, the Veteran wrote that he bypassed normal military recruitment processes. The Veteran also wrote that he “had severe emotional problems that had not been brought to light in a formal manner.” Weighing less than 100 pounds and reportedly lacking pubic hair, the Veteran contended that he experienced “extreme psychological torture for 9 months.” Only at this point in time (over 36 years after the Veteran’s separation from active duty service) did the Veteran contend that he “endured only laughter, sexual harassment, [and] humiliation from his peers due to [his] underdeveloped [physique].” The Veteran did not explain how this constituted sexual harassment in any way. Further, Veteran advanced that he now could not function without “high volumes” of depressants and sleeping aids. Moreover, he stated that he has been in and out of mental health institutions and imprisoned on four occasions for alcohol-related offences. He attributed these events to the result of the “psychological destruction […] during [his] ordeal in the Army.” See February 15, 2008 NOD, pp. 1, 5 (respectively). The Veteran was afforded a VA psychological evaluation in July 2009. A VA psychologist reviewed the results of psychometric testing and opined as to the Veteran’s psychiatric profile. The Veteran’s VA problems list, according to this psychologist, includes depression, insomnia, substance abuse, borderline personality disorder, antisocial personality disorder, combination drug dependence, alcohol abuse, and an unspecified neurotic disorder. Psychometric Testing (Minnesota Multiphasic Personality Inventory II (MMPI II)) indicated that the Veteran may have attempted to endorse items in a manner to convey a favorable impression with regard to moral virtue and self-control. While this testing revealed a presence of severe psychopathology, it also revealed some symptom exaggeration. The examiner noted that the Veteran’s psychological distress appeared to limit his ability to maintain steady employment. This psychologist provided present diagnoses of major depressive disorder, recurrent moderate; polysubstance dependence reportedly in full remission; and personality disorder not otherwise specified with antisocial, borderline, and dependent features. At the December 2017 Board hearing, the Veteran and his witnesses, as reflected above, testified about the “humiliation” that the Veteran sustained during his period of active service. The Veteran also testified that he began being psychologists in 1972. As to his mental health diagnoses, the Veteran testified that the one thing that every mental health clinician stated is that the Veteran had major depressive disorder, severe, recurring, “sometimes” with psychosis. The Veteran’s witnesses recapitulated their lay impressions of the Veteran’s behavioral changes upon separation. There were also statements proffered as to the Veteran’s periods of homelessness and suicidality. Neither the Veteran nor his witnesses testified that MST occurred during active duty service including a situation in which the Veteran held down on the floor of the shower room by several African American soldiers from his barracks at Ft. Benning. In August 2018, the Veteran was afforded a VA mental disorders examination. A VA psychologist reviewed the claims file; considered the Veteran’s extensive subjective accounts; and conducted an examination. This psychologist indicated a current diagnosis of other specified personality disorder. The psychologist opined that review of the evidence of record discloses that the Veteran has exhibited a repetitive and persistent pattern of misconduct in which the rights of other people and age-appropriate societal norms and rules are violated. Moreover, the Veteran has engaged in serious violation of rules throughout his lifetime—as evinced through numerous arrests post-military service and multiple incarcerations and prison sentences (the most recent being from 2011 to May 2017). Furthermore, this psychologist found that the Veteran met the “full criteria” for substance use disorder, including alcohol use disorder. This disorder has contributed to many diagnoses, as noted in the record, as attributes of possible substance-induced mood disorder. As to current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, the psychologist diagnosed: 1) other specified personality disorder; 2) alcohol use disorder, severe, in sustained remission; and 3) unspecified depressive disorder. In an addendum, this psychologist opined that the Veteran’s personality disorder was less likely as not aggravated by events in service. Likewise, the psychologist opined that the Veteran’s alcohol abuse disorder (severe, in sustained remission) less likely as not first manifested in service or was caused by service. As a rationale for the former, the psychologist emphasized that personality disorders are diagnosed upon an evaluation of an individual’s long-term patterns of functioning and these personality features must be present by early adulthood. In this instance, the Veteran exhibited personality disorder characteristics by his teenage years and his consistent pattern of thoughts, feelings and behavior have been stable and consistent over time. As a rationale for the latter, the examiner underscored that Veteran’s evasiveness and deception of his substance and alcohol abuse history during evaluation. These behavioral ploys, according to the psychologist, did not concatenate findings in the medical evidence of records. This evidence shows that the Veteran was treated on an in-patient basis on at least three occasions for drug and alcohol cessation programming. Indeed, the examiner highlighted that this was indicative of far more that the “experimenting” or “trying” of substances which the Veteran endorsed. As to unspecified depressive disorder, the psychologist opined that the Veteran’s depression would appear most likely related to the Veteran’s post-military life. Here, the psychologist indicated stressors of chronic alcoholism with resulting occupational and social limitations due to arrests and prison sentences. Moreover, the evidence of record fails to disclose that the Veteran’s “poor interpersonal functioning” first manifested in service or was caused by service. In September 2018, the Veteran submitted a lengthy narrative account, entitled “Preemptive NOD.” In pertinent part, he critiqued the findings of the August 2018 VA examiner. He objected to the examiner’s use of descriptive language and implied incompetence. In this communication, the Veteran contended that he suffered military sexual trauma (MST); through graphic imagery, he conveyed multiple forms of abuse during active service (underscoring his physical frailty, prepubescent status, and racial tensions at his military facility). See October 3, 2018 NOD, pp. 12-15 (mislabeled as such). Upon review of the evidence of record, this was the first time that the Veteran articulated that he had suffered an MST. Other his lay contention of February 2008 (“endured only laughter, sexual harassment, [and] humiliation from his peers due to [his] underdeveloped [physique]”), this subjective endorsement of PTSD due to MST has not been made. As such, the issue of MST “emerged” almost 48 years after the Veteran’s active duty service. The Board observes that that the Veteran submitted additional lay statements in which he described the impropriety of the VA psychologist’s evaluation. Further, the Veteran articulated hostility at the way in which VA was handling his claim. The Board notes that these matters have been remanded for development on several occasions. The process of obtaining purported treatment records is lengthy as is the process of adjudication. The Board acknowledges the Veteran’s complaints; however, upon close scrutiny, VA has fulfilled its duty to assist according to applicable laws and regulations. As noted in the introduction, the Veteran has been provided extensive due process. VA treatment records subsequent to the September 2018 VA mental disorders examination reveal that the Veteran continued to avail himself of VA consultations and programming concerning mental health. These records also disclose that mental health clinicians advised the Veteran on the importance of being consistent with psychoactive medication protocols; on the importance of not overusing OTC medications for sleep due to potential paradoxical stimulating effects; and on the issues of cognitive distortions, potential triggers, and alternative behavioral paradigms to improve coping skills. In May 2019, the Veteran was afforded a VA mental disorders examination with a different VA psychologist. This psychologist performed an exhaustive review of the claims file; considered the Veteran’s many varied subjective representatives; and conducted evaluative protocols. As to present diagnoses, this psychologist provided cluster B personality traits and alcohol use disorder (in full remission as per the Veteran). The psychologist recapitulated both the objective medical evidence and subjective lay evidence in the record, from active service through the date of examination in detail. As to clinical findings, this psychologist opined that MMPI II testing revealed that the Veteran’s protocol was valid with some evidence of overreporting of psychological dysfunction which was indicated by a much larger than average number of infrequent responses. Nevertheless, results indicate a diagnosis within the depressive disorder is appropriate. Upon summation, the psychologist indicated that comprehensive review of the corpus of objective and subjective evidence of record led to an opinion that the Veteran’s substance abuse began after discharge from active service. Records indicate that the Veteran presented to VA at age 23 with an overdose of a benzodiazepine. Lay statements fail to disclose any indication of mental health issues prior to service. Moreover, the Discharge Reports of Medical Examination and Medical History, as discussed above, are wholly silent as to any noted mental health problems or issues. While the Veteran contended that he did not reach puberty until his early 20s, there is no indication of this in STRs. The psychologist continued by observing that the Veteran’s medical records divulge his earliest mental health/substance abuse treatment occurred well beyond his separation from service. Therefore, based upon this evidence of record and evaluation of the Veteran, he does not meet the DSM-5 criteria for posttraumatic stress disorder (PTSD). While the Veteran does meet the DSM-5 criteria for unspecified depressive disorder, this disorder is less likely as not related to, or the result of, any incidence of military service, including the Veteran’s subjective account of military sexual trauma. Furthermore, according to the psychologist, severe negative sequalae of alcohol use disorder and cluster B personality traits contribute to post-military life stress. In May 2019, the Veteran submitted a lay statement which expressed dismay at the May 2019 VA psychologist’s examination report. The Veteran, once again, provided an extensive critique of this professional’s clinical findings and analysis of evidence. The Veteran also prepared his own version of a psychological evaluation. Again, the Board acknowledges the Veteran’s lay lengthy disquisition of this report. In response to the Veteran’s proposed “declaration,” the undersigned Veterans Law Judge has read and considered all of the Veteran’s NODs and “preemptive NODs” which are of record. A review of contemporaneous VA progress notes discloses that the Veteran was prescribed medication to control symptoms of depression and sleep medication. Upon a psychiatric review in February 2020, a VA clinician indicated that the Veteran presented with appropriate mood as well as affect and articulated himself in clear speech. These notes also show that the Veteran was afforded supportive therapy and psycho-educational programming. The Veteran’s medications were monitored to ensure maximum efficacy. In June 2020, VA received a report from a private consultant-psychologist. This consultant wrote that he had reviewed the Veteran’s claims file. Additionally, the consultant indicated that he conversed with the Veteran for 90 minutes; however, this consultant did not indicate that he conducted any psychometric testing (viz, MMPI II). As noted above, this consultant indicated a 90-minute telephonic “mental status examination.” As a central premise the consultant wrote that he “believed” that the Veteran did not distort facts for any ulterior motive for benefit. In the words of the consultant, the Veteran was a “reliable historian.” The consultant indicated that the Veteran did not meet DSM-5 criteria for a personality disorder or a personality cluster, rather the Veteran met the DSM-5 criteria for posttraumatic stress disorder, service-connected (sic); major depressive disorder, recurrent, severe, service-connected (sic); and alcohol use disorder in sustained remission, secondary to service-connected (sic) posttraumatic stress disorder. Moreover, according to this consultant, the Veteran’s DSM-IV-TR assessment and global assessment of functional score (psychometric clinical criteria which VA no longer employs) show that the Veteran met the criteria for a 100 rating for total occupational impairment beginning on June 10, 1971. As noted above, the Veteran was afforded a VA examination via approved video telehealth in August 2020. A VA psychologist reviewed the entirety of the claims file; considered the Veteran’s lay accounts of his psycho-medical history; and conducted a psychometric video telehealth evaluation. This psychologist provided a current diagnosis of unspecified depressive disorder. Upon a comprehensive discussion of the evidence of record, the psychologist provided a diagnostic summary. This psychologist indicated that he did not have enough information about the Veteran’s pre-service developmental history to diagnose a personality disorder with confidence. Here, the psychologist noted that “personality disorder” by definition has an onset that can be traced “at least’ to adolescence or early adulthood—according to DSM-5 criteria. However, the psychologist opined that he agrees with previous VA examiners and treating providers that the Veteran’s adult behavior is suggestive of defects or pathological trends in the Veteran’s personality structure. As to the Veteran’s present diagnosis of unspecified depressive disorder, the psychologist opined that upon review of the totality of evidence, to include findings from the instant psychometric video telehealth evaluation, it was less likely than not incurred in, caused by, or aggravated by, active duty service. The psychologist opined that the evidentiary record supports that the Veteran’s current unspecified depressive disorder had more likely than not originated after the Veteran’s service. As noted above, there is no evidence of depression in the record prior to the mid-1970s—some four years after discharge. Here, the psychologist added that it is not clinically reasonable, despite testimony from the Veteran (and his siblings), as this testimony is not consistent with statements that the Veteran made to other mental health providers. The psychologist provided an extensive evidence-based rationale for this negative nexus opinion, part of which has already been discussed. Otherwise, the Veteran conveyed that he was held on the floor by several soldiers and sexually mistreated. As a result of this alleged MST and the Veteran’s service-connected leg injury, the Veteran stated that he became anxious and depressed. The Veteran attributed all of his mental health symptoms to alleged MST and a leg injury. The Veteran further conveyed that VA prescribed several benzodiazepines “right after service.” And, the Veteran claimed that his first suicide attempt occurred 5 or 6 months later. A review of the evidence of record, according to the psychologist, discloses that treatment for depression began in 1992—2 decades after service. The Veteran did attempt suicide in 1972 and the Veteran’s siblings reported that they observed changes in the Veteran’s behavior immediately after discharge in 1971. Upon a thorough review of the psycho-medical evidence, the psychologist reported that the Veteran’s mental health symptoms, including suicidal ideations and attempts, did not begin immediately after service as the Veteran now contends, but only in the mid-1970s, years after discharge. As noted above, the Veteran was clearly aware that there are no documents in service treatment records, service personnel records, private treatment records, or VA records that support his claim that he sought treatment immediately after service. The Veteran contended, without any supporting evidence, that his records had been altered and redacted “all the way down the line,” conveying that VA does not want Veterans to file claims. The psychologist provided an extensive inventory of behavioral observations and noted that the Veteran had long history of arrests and incarcerations. As to the opinion of the June 2020 consultant, the psychologist noted that he, as well as earlier VA examiners, believe that the “overall evidentiary record” supports that the Veteran suffers from a depressive disorder. The only question is whether there is sufficient evidence to link the Veteran’s current diagnosis of unspecified depressive disorder to service. Of this, this psychologist opined that there is insufficient competent evidence to draw such an etiological connection. The Board may favor the opinion of one competent medical examiner over that of another as long as an adequate statement of reasons and bases is provided. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). An evaluation of the probative value of medical opinion evidence is based on the medical expert’s examination of the patient, the examiner’s knowledge and skill in analyzing the data, and the medical conclusion reached. The credibility and weight to be attached to such opinions are within the province of the Board as adjudicators. See Guerrieri v. Brown, 7 Vet. App. 467 (1993). Greater weight may be placed on one practitioner’s opinion over another depending on factors such as reasoning employed and whether or not and the extent to which they reviewed prior clinical records and evidence. See Gabrielson v. Brown, 7 Vet. App. 36 (1994). Furthermore, the probative weight of a medical opinion may be reduced if the examiner fails to explain the basis for an opinion. See Sklar v. Brown, 5 Vet. App, 140 (2003). Here, the Board assigns far greater probative weight to the August 2020 VA psychologist’s evaluation. This VA psychologist reviewed the entirety of the claims file; considered the Veteran’s lay accounts of his psycho-medical history; and conducted a psychometric video telehealth evaluation. And, this psychologist supported his negative nexus opinion with an holistic evidence-based rationale—to include psycho-medical evidence of record; extensive lay evidence; and psychometric findings from the video telehealth evaluation. Unlike the June 2020 private psychologist-consultant, this clinician did not base his findings, opinions, and evidentiary assessment wholly on the “belief” that the Veteran did not distort facts for any ulterior motive. Indeed, the VA psychologist pointed out inconsistencies in the Veteran’s lay accounts of his psychological trauma throughout the decades (as noted by other VA mental health clinicians discussed above) and did not concur in the consultant’s assessment that the Veteran was a reliable historian. Following the Board’s remand, the VA psychologist indicated that the current diagnosis of unspecified depressive disorder is apposite to the Veteran’s acquired psychiatric disorder—directly responsive to the Board’s July 2020 remand directive. Here, the Board must emphasize that the July 2020 remand addresses an “acquired psychiatric disorder”—not posttraumatic stress disorder; major depressive disorder; or/and alcohol use disorder in sustained remission, secondary to posttraumatic stress disorder. (Hence, the Veteran’s representative’s contention that the August 2020 VA psychologist “did not even address [the psychologist-consultant’s PTSD diagnosis” shows noncompliance with the Board’s July 2020 remand directives is unsustainable. See October 26, 2020 Appellate Brief, p.1.). In October 2020, the private psychologist-consultant submitted an addendum letter as a response to the August 2020 VA psychologist’s video telehealth evaluation report. In pertinent part, this consultant wrote that the VA psychologist failed to address the Veteran’s claimed posttraumatic stress disorder; the VA psychologist provided an inaccurate current diagnosis according to DSM-5 criteria; and the VA psychologist misconstrued the consultant’s report. The Board acknowledges this consultant’s letter; however, for reasons articulated above, assigns diminished probative weight to it. The consultant’s point of the Veteran’s “unwavering and consistent narrative” is simply not reflected in decades of lay evidence. And, the fact that VA has invested “an exorbitant amount of time, money, and resources to repeatedly (sic) evaluate the Veteran’s acquired psychiatric disorder claim” is part of VA’s duty to assist under the Veterans Claims Assistance Act (VCAA) of 2000. See 38 U.S.C. § 5103A. The consultant’s implication that these “costly and repetitive” examinations somehow warrants a grant of service connection has not basis in law but rather an appropriate effort to assist the Veteran with multiple competent medical assessments and opinions. In December 2020, counsel submitted a letter with attached exhibits. In pertinent part, counsel now contended that the August 2020 VA psychologist’s comprehensive report, as discussed above should be assigned “no weight.” As a basis for this argument, counsel advances that this VA psychologist “failed to accept the Veteran’s stated history of MST and symptomatology (sic) dating back to service at face value and as competent.” Moreover, according to counsel, this “failure [violated] the Board’s remand [directives], improperly discredited the Veteran’s history of MST and symptoms back to his time in service due to a lack of direct and contemporaneous evidence. As the point of the Board’s July 2020 Remand directives have again become central to counsel’s argument, the Board will again explain why counsel’s contention cannot be supported. [T]he VA psychiatrist or psychologist should keep in mind that the Veteran is competent to report his symptoms and history. Such reports, including those of continuity of symptomatology and functional limitations, must be acknowledged and considered in formulating any opinion. If the psychiatrist or psychologist rejects the Veteran’s reports, she/he must provide an explanation for such rejection. The examiner should note any points of agreement or disagreement with the consultant’s evaluation. As noted above, a lay person, such as the Veteran, is competent to report discernable symptoms—what is discerned with his/her senses if touch, smell, sight, hearing. Additionally, a Veteran in highly circumscribed circumstances, may be competent to report some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. See Jandreau, Kahana, both supra. Nowhere does the Board’s remand directive state explicitly, or even suggest, that the Veteran’s “competence” subsumes either consistency or credibility. Possessing the competence to report does not mean that such reporting has been internally consistent, facially plausible, and consistent with other evidence submitted on behalf of the Veteran. See Caluza, supra. The August 2020 VA psychologist did specifically state that, [T]he Veteran told this writer that on one occasion he was held down on the floor of the shower room by several African American soldiers from his barracks at Ft. Benning, one man telling him ‘let me show you what a man looks like’ (after ridiculing [the Veteran] for his small stature. “They tried to rub it in my face—the guy was flapping his peter (penis) on my cheek.” This only stopped when ‘I started screaming as loud as I could’, at which time they let [the Veteran] up and ‘backed away’, though still laughing at [the Veteran]. See August 31, 2020 C&P Exam, supra. Moreover, this psychologist did state, quite unambiguously that, [M]y opinions are based on the fact that there is no marker or direct evidence of MST in [the Veteran’s] service records, nor is there evidence of mental health complaints, diagnoses, or treatment in service or for several years thereafter, Without such evidence, I cannot confidently state that his [current] unspecified depressive disorder is at least as likely as no due to service. [… This] does not mean [that] this writer knows that MST did not occur; that the Veteran was not harassed by his sergeant and others; that his care proper and timely; [or] that he was depressed in evidence. See id. The August 2020 VA psychologist clearly considered and discussed the Veteran’s stated history of MST and symptomatology (sic) dating back to service at face value. As to “acceptance of such at face value,” the psychologist underscored the dearth of either contemporaneous or chronologically-close supporting evidence. As noted above, if a claim is based on in-service personal assault, evidence from sources other than the veteran’s service records may corroborate the veteran’s account of the stressor incident. Examples of such evidence include but are not limited to records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; tests for sexually transmitted diseases; and statements from family members, roommates, fellow service members, or clergy. Evidence of behavior changes following the claimed assault is one type of relevant evidence that may be found in the sources. Examples of behavior changes that may constitute credible evidence of a stressor include but are not limited to request for transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavioral changes. See 38 C.F.R. § 3.304(f)(3). Again, according to the August 2020 psychiatrist, [T]here is no evidence to support [the Veteran’s] claim of treatment at the Houston VA within a few short months of separating service. Records sent to the Evidence Intake Center in November 2019 from the Houston VA indicate ‘a thorough search of [its] records system both electronic and archived’ found no evidence if treatment prior to 1975, four years after [separation from] service. This writer, too, could find no evidence of VA, state, or private treatment prior to December 1975. The earliest treatment in [VA’s electronic records] was a December 1975 treatment note [which noted that] the Veteran was ‘very depressed and asking for help’ and [indicating] a diagnosis of anxiety reaction. See August 31, 2020 C&P Exam, supra. And, as already noted above (and repeated with emphasis in response to counsel), the Veteran posited a reason for these purportedly missing psychological treatment records [T]oday, the [Veteran] was clearly aware there are no documents in service treatment records, service personnel records, private treatment records, or VA records that support his claim [that] he sought treatment immediately after service. [The Veteran’s] explantation was unconvincing: ‘My records have been altered and redacted all the way down the line... I don’t think they (service treatment records) mention […] the lack of puberty—that’s what caused me all these problems.’ As for VA records [, the Veteran stated]: ‘The VA, they (sic) stole all my records. All my records from my first four years at the VA were ‘taken out […] They (sic) do that—because they (sic) don’t want you to be able to file a compensation and pension claims.’ See id. Here, the August 2020 VA psychologist did strive to locate any evidence suggestive of the MST factors noted above in the evidence of record on or around the Veteran’s period of active duty service. However, there was absolutely no confirming evidence other than the Veteran and relative’s statements indicative of such (to include records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; tests for sexually transmitted diseases; and statements from family members, roommates, fellow service members, or clergy) prior to December 1975. Furthermore, short of the Veteran’s lay account articulated over 4 decades later, there is no evidence of behavior changes following the claimed assault (request for transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavioral changes). Veteran’s counsel insists that the Veteran’s lay accounts of MST/PTSD have been improperly discounted due to the absence of contemporaneous treatment records. Here, the Board respectfully does not agree. Nowhere does the August 2020 VA psychologist “discount” the Veteran’s lay contentions, the psychologist merely opined that there is no evidence whatsoever to suggest MST—as described in 38 C.F.R. § 3.304(f)(3). Moreover, once again, the Board does not find the Veteran to lacks the competence to report a contention; however, the Board finds that for years the Veteran has presented prevaricating internally inconsistent lay accounts. See Caluza, supra. Therefore, the Board finds that the comprehensive report of the August 2020 psychologist is not predicated upon incorrect factual bases; to the contrary, the Board observes that the August 2020 VA psychologist’s exhaustive recitation of both objective and subjective factual evidence is thorough and anything but predicated upon inaccurate factual premises and, as such clearly distinguishable from what counsel argues. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (A medical opinion based on an inaccurate factual premise has no probative value.); see also Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012) (“If the opinion is based on an inaccurate factual premise, then it is correct to discount it entirely.”) (citing Reonal). As to legal bases, counsel apparently conceives of an examiner as an adjudicator, clearly an erroneous understanding of the VA appeals process. Counsel also argues that the August 2020 psychologist and the other mental health examiners of record should be discounted because these VA psychologists lacked the qualifications to conduct MST evaluations. Here, counsel cites VHA Directive 1603 (attached exhibits) to support this argument. As noted above, the Veteran’s first lay subjective endorsement of MST dates from September 2018—almost 48 years after the Veteran’s separation from active duty service. The only psychologists who “dealt” with the Veteran’s subjective lay endorsement of MST were the psychologists who prepared the May 2019 and August 2020 VA opinions. Counsel’s exhibit 2, VHA Directive 1603 (March 1, 2019), which rescinds VHA Directive 1603 (November 15, 2016) states that certification to perform general Compensation and Pension exams includes mandatory courses for providers the following specialized examinations: (1) Post-Traumatic Stress Disorder examinations (VA 5497), (2) Initial Mental Health Disorder examinations (VA 5522), (3) Musculoskeletal examinations (VA 5516), and (4) Traumatic Brain Injury examinations (VA 9238). Both Dr. K.’s May 2019 report and Dr. D’s August 2020 report are drafted in formats of VA Progress Notes; there is absolutely no indication in the body of these reports that either psychologist was conducting a VA 5497 examination. As to counsel’s argument that neither Dr. K. nor Dr. D. completed training on MST, the Board observes that VHA Directive 1603 does state that a DMA MST training course is mandatory. Nevertheless, single downloaded copies of Dr. K.’s and Dr. D.’s Clinician C&P certifications is not analogous to VA’s proprietary TMS course completion tool. All VA employees are required to complete TMS courses and information as to the completion of these courses is confidential. Indeed, this is protected private information, accessible only to a VA employee and his/her chain of command. For counsel to declaim that Dr. K.’s examination should “carry no weight” based upon a document culled from a VA website is unsustainable. Not only does confidential TMS data not support counsel’s conclusory assertion, but also this begs the question of whether the private psychologist-consultant, who conducted a telephonic interview, has received analogous formal MST training and certifications. If so, counsel has failed to provide any information indicative of such training. Although, as the this TMS data is confidential, it would be most unlikely that counsel could—at least legally—replicate such VA-specific proprietary data. Furthermore, to “discount” Dr. D.’s opinion on this basis in favor of the private consultant’s June 2020 90-minute “conversation” with the Veteran is unsupportable legally, as discussed extensively above. See Owens, Guerrieri, Gabrielson, Sklar, all supra. Once again, the Board notes that Dr. K. provided current diagnoses of cluster B personality traits and alcohol use disorder (in full remission as per the Veteran). As to clinical findings, Dr. K. opined that MMPI II testing revealed that the Veteran’s protocol was valid with some evidence of overreporting of psychological dysfunction which was indicated by a much larger than average number of infrequent responses. Nevertheless, results indicate a diagnosis within the depressive disorder is appropriate. Dr. K. noted that the Veteran’s lay statements fail to disclose any indication of mental health issues prior to service. Moreover, the Discharge Reports of Medical Examination and Medical History, as discussed above, are wholly silent as to any noted mental health problems or issues. While the Veteran contended that he did not reach puberty until his early 20s, there is no indication of this in STRs. Dr. K. continued by observing that the Veteran’s medical records divulge his earliest mental health/substance abuse treatment occurred well beyond his separation from service. Therefore, based upon this evidence of record and evaluation of the Veteran, the does not meet the DSM-5 criteria for posttraumatic stress disorder (PTSD). While the Veteran does meet the DSM-5 criteria for unspecified depressive disorder, this disorder is less likely as not related to, or the result of, any incidence of military service, including the Veteran’s subjective account of military sexual trauma. Furthermore, according to the psychologist, severe negative sequalae of alcohol use disorder and cluster B personality traits contribute to post-military life stress. Other than the Veteran’s subjective endorsement of MST, Dr. K.’s evaluation focalized upon the results of a clinical interview and that objective MMPI II testing that revealed that the Veteran’s protocol was valid with some evidence of overreporting of psychological dysfunction which was indicated by a much larger than average number of infrequent responses. Dr. D.’s comprehensive findings need not be repeated; the Board only notes that they were comprehensive and wholly responsive to the Board’s Remand directives. The Veteran and his witnesses contend that an acquired psychiatric disorder (to include depression, polysubstance abuse, and, from September 2018, military sexual trauma) was incurred in, or aggravated by, or otherwise attributable to, active service. However, as lay persons, these parties lack the specialized education and expertise in psychology or psychiatry to render such an etiological opinion. See Jandreau, supra. As such, the Board assigns diminished probative weight to this body of lay contentions. As noted above, the Veteran’s lay statements, narrative accounts, and contentions have been internally inconsistent. This further diminishes the probative weight of this lay evidence mightily. See Caluza, supra. The Board assigns substantial probative weight to the August 2020 VA psychologist’s video telehealth report. This skilled clinician reviewed the entirety of the claims file; considered the Veteran’s lay accounts of his psycho-medical history; and conducted a psychometric evaluation. Further, this psychologist opined that the evidentiary record supports that unspecified depressive disorder more likely than not originated after the Veteran’s service. According to this clinician, there is no evidence of such in the evidence prior to the mid-1970s—some four years after discharge. Here, the psychologist added that it is not clinically reasonable, despite testimony from the Veteran (and his siblings) as this testimony is not consistent with statements that the Veteran made to other mental health providers. Moreover, this psychologist supported his negative nexus opinion with a holistic evidence-based rationale—to include psycho-medical evidence of record; extensive lay evidence; and psychometric findings from the video telehealth evaluation. The Board observes that the current disability prong for establishing service connection is present for an acquired psychiatric disorder (“unspecified depressive disorder”). See Shedden, supra. Nevertheless, the record is bereft of evidence which establishes any competent, internally consistent service incurrence or predicate. Again, the Board assigns negligible probable weight to the Veteran’s lay statements, narrative accounts, and contentions—which have been internally inconsistent and prevaricating. See Caluza, supra. The Board, once again, places significant weight on the normal clinical evaluations noted in the Veteran’s March 1971 Discharge Report of Medical Examination, where findings showed normal clinical evaluations of both the Veteran’s neurological and psychiatric statuses. Moreover, the Veteran’s associated March 1971 Discharge Report of Medical History disclosed that the Veteran had not had and did not have: 1) frequent trouble sleeping; 2) frequent or terrifying nightmares; 3) depression or excessive worry; 4) loss of memory or amnesia; 5) nervous trouble of any sort; 6) any drug or narcotic habit; or 7) an excessive drinking habit. As noted above, each of these respective Reports bear the Veteran’s signature. The Board assigns considerable probative weight to these reports, in which the Veteran himself played a contributory role. Therefore, the preponderance of the evidence is against the Veteran’s acquired psychiatric disorder service connection claim (in all its myriad permutations); there are no doubts to be resolved. See 38 U.S.C. § 5107(b); Gilbert, supra. Entitlement to a TDIU Initially, the Board notes that the Appeals Management Center (ARC), upon a September 17, 2018 Administrative Review, did not recommend entitlement to a TDIU on an extraschedular basis. Specifically, the ARC wrote: There is no consistent evidence [to show] that the Veteran is unable to secure gainful employment due to his service-connected [disability]. [And] the totality of the evidence does not support that the Veteran’s service-connected [disability] [is] so exceptional or unusual as to tender the use of the rating schedule. See September 17, 2019 VA Memo, p. 2. Upon de novo review, the Board concurs with the ARC Administrative review not to recommend entitlement to a TDIU on an extraschedular. Nevertheless, the Board assesses the possibility of granting a TDIU in a schedular basis. The Veteran contends that his service-connected disability has rendered him unable to obtain and maintain gainful employment. In order to establish entitlement to a TDIU due to service-connected disabilities, there must be impairment so severe that it is impossible for the average person to follow a substantially gainful occupation. See 38 U.S.C. § § 1155; 38 C.F.R. § §§ 3.340, 3.341, 4.16. In reaching such a determination, the central inquiry is “whether the veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability.” Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Consideration may be given to the veteran’s level of education, special training, and previous work experience in arriving at a conclusion, but not to his age or to the impairment caused by nonservice-connected disabilities. See 38 C.F.R. § §§ 3.341, 4.16, 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). “Substantially gainful employment” is that employment “which is ordinarily followed by the nondisabled to earn their livelihood with earnings common to the particular occupation in the community where the veteran resides.” Moore (Robert) v. Derwinski, 1 Vet. App. 356, 358 (1991). “Marginal employment shall not be considered substantially gainful employment.” 38 C.F.R. § § 4.16(a) The regulatory scheme for a TDIU provides both objective and subjective criteria. Hatlestad, supra; VAOPGCPREC 75-91 (Dec. 27, 1991) 57 Fed. Reg. 2317 (1992). The objective criteria, set forth at 38 C.F.R. § § 3.340(a)(2), provide for a total rating when there is a single disability or a combination of disabilities that results in a 100 percent schedular evaluation. Subjective criteria, set forth at 38 C.F.R. § § 4.16(a), provide for a TDIU when, due to service-connected disability, a veteran is unable to secure or follow a substantially gainful occupation, and has a single disability rated 60 percent or more, or at least one disability rated 40 percent or more with additional disability sufficient to bring the combined evaluation to 70 percent. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). In exceptional circumstances, where the veteran does not meet the aforementioned percentage requirements, a total rating may nonetheless be assigned upon a showing that the individual is unable to obtain or retain substantially gainful employment. 38 C.F.R. § § 4.16(b). The Veteran is service-connected for residuals of a stress fracture of the left proximal third tibia, rated at 10 percent disabling effective from December 16, 2009. Therefore, the Veteran does not meet the schedular requirements for entitlement to a TDIU. See 38 C.F.R. § § 4.16(a). A review of the evidence of record shows that the Veteran earned a general equivalency diploma (GED) in 1973. The Veteran has indicated that he has worked as an industrial electrician from January 2001 to January 2010. The evidence of record does not reveal that the Veteran’s termination of employment in January 2010 was due to service-connected residuals of a stress fracture of the left proximal third tibia. The Veteran DD Form 214 discloses that the Veteran’s military occupational specialty (MOS) was a mechanic maintenance apprentice, indicative of a related civilian occupation of an automobile mechanic. As discussed above, the competent medical evidence of record (the VA examiner’s objective psychometric findings), in which the Board place substantial probative weight, does indicate that service-connected residuals of a stress fracture of the left proximal tibia present functional impacts by limiting standing and walking because of left knee pain. Whereas in lay accounts, the Veteran endorsed functional limitations imposed: by weakness in the knees and ankles; stiffness in the knees; instability in the knees; abnormal motion in that “the knees and ankle do not move together”; and an inability to stand or walk for even 15 minutes. This evidence does make it clear that the Veteran does have some functional impact as to standing and walking. Nevertheless, there is no competent evidence of record that states that this identified functional limitation due to the Veteran’s one service-connected disability precludes substantially gainful employment in light of the Veteran’s actual or specific education and occupational history. See Withers v. Wilkie, 30 Vet. App. 139 (2018). Other that the Veteran’s and his witnesses’ (siblings’) subjective accounts, there is no showing that the requisite duties of industrial electricians necessitate full-time standing or walking and “reliance” upon the left knee. Stated another way, the technical skill set of an industrial electrician can be deployed in ways that do not require extensive standing or walking. Rewiring disconnected electrical components and electrical work on mobile industrial devices are viable options in today’s marketplace. While it could perhaps be argued the Veteran’s limited standing and walking would preclude industrial electrician jobs at sites under construction, it is highly questionable whether that Veteran lacks basic electrician skills that would allow him to obtain substantial gainful employment with his years of expertise working in a field. The Veteran’s extensive knowledge and experience in this occupational field and other more general businesses could be employed in work scheduling, planning and ordering materials and in associated administrative work that does not require extended walking or standing and allows for periodic breaks. Accordingly, the preponderance of evidence is against granting entitlement to a TDIU. As such, the benefit of doubt doctrine is not for application in this case. See 38 U.S.C. § § 5107; Gilbert, supra. J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. J. Komins, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.