Citation Nr: 21001410 Decision Date: 01/08/21 Archive Date: 01/08/21 DOCKET NO. 15-41 156 DATE: January 8, 2021 ORDER Entitlement to service connection for left hand arthritis is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for residuals of a head injury is denied. Entitlement to service connection for a chronic bilateral eye disorder is denied. Entitlement to a compensable evaluation for tension headaches is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. The preponderance of the evidence of record is against finding that the Veteran has had left hand arthritis or any related disability at any time during or approximate to the pendency of the claim. 2. The Veteran’s hypertension was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. 3. The preponderance of the evidence of record is against finding that the Veteran has had a head injury or any related disability at any time during or approximate to the pendency of the claim. 4. The preponderance of the evidence is against finding that chronic bilateral eye disorder began during active service or is otherwise related to an in-service injury or disease. 5. During the appeal period, the Veteran experienced tension headaches with less frequent attacks. His tension headaches did not manifest in characteristic prostrating attacks averaging one in two months over the last several months. 6. The Veteran does not meet the schedular criteria for TDIU, and the criteria for referral on an extra-schedular basis are not met. CONCLUSIONS OF LAW 1. The criteria for service connection for left hand arthritis are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for service connection for residuals of a head injury are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for chronic bilateral eye disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for a compensable rating for tension headaches have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8100. 6. The criteria for a TDIU are not met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.3, 4.15, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1978 to November 1982. This matter comes before the Board of Veterans’ Appeals (Board) from July 2012 and March 2014 rating decisions from the Department of Veterans Affairs (VA) Regional Office (RO). This claim was previously remanded by the Board in October 2018 for further development, to include providing VA examinations and updating VA treatment records. The Board finds substantial compliance with the remand directives and therefore another remand is not necessary. Stegall v. West, 11 Vet. App. 268 (1998). Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the appellant or obtained on his behalf be discussed in detail. Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996). Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). 1. Entitlement to service connection for left hand arthritis The Veteran contends that he is diagnosed with left hand arthritis that is due to service. The Veteran has not asserted a specific injury or in-service event which caused his arthritis and has not indicated exactly when his arthritis symptoms began. Arthritis is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. However, the Board finds that the Veteran does not have a current diagnosis of left hand arthritis, or any related condition, presently or at any time during or proximate to the pendency of the appeal. Though November 2010 VA treatment records indicate an assessment of hand pain due to arthritis, this diagnosis appears to have been based on the Veteran’s reported symptoms as there is no imaging in file to support the diagnosis. Additionally, a November 2011 x-ray of both hands was normal. Private treatment records received from the Social Security Administration (SSA) dated 2013 to 2014 show osteoarthritis of the foot and ankle, but not hand. At an October 2013 SSA orthopedic examination, the Veteran reported being diagnosed with unspecified arthritis of bilateral hands after an x-ray earlier that year. He reported constant soreness, itching and cramping in both hands aggravated with lifting and alleviated with rubbing. He reported being given prescription ibuprofen for a short while but was not taking it at the time of the examination, had not seen a provider since diagnosis, and had no current treatment. Physical examination showed normal range of motion, grip strength, sensation, and reflexes. Though the examiner’s assessment was nonspecific arthritis, as no imaging was taken and the physical examination was normal, the assessment appears to be based on the Veteran’s reported symptoms. However, the Veteran’s reports of an x-ray showing bilateral hand arthritis is not consistent with contemporaneous medical records showing negative x-rays in November 2011. While the Veteran is competent to report experiencing symptoms of hand pain for many years, to the extent the Veteran’s contentions can be construed as claiming symptoms since separation from service, the Board finds the Veteran’s reports of continuity of symptomatology not credible. The Veteran’s reports are internally inconsistent with his reports in contemporaneous treatment records, which show that he initially reported the onset of hand pain as 2008, decades after the presumptive period. See November 2010 VA treatment records; Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). Additionally, service treatment records (STRs) are silent for any hand condition or injury. Further, while the Veteran asserts that the reported symptoms are a manifestation of arthritis, he is not competent to determine this as the Veteran has not demonstrated the necessary medical expertise. The issue is medically complex, as it requires the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The Board gives more probative weight to competent medical evidence, which establishes that there is no diagnosed disability. In the absence of proof of a current disability, there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223 (1992); Gilpin v. Brown, 155 F.3d 1353 (Fed. Cir. 1998) (service connection may not be granted unless a current disability exists). In this regard, the Board finds that the record provides no indication of a hand disability during the appellate period. The Veteran’s range of motion, sensation, strength and reflexes of his left hand are normal. The record does not reflect that he has had a functional disability, to include one caused by pain, of his left hand at any time period relevant to the appeal. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Here, because there is no diagnosis of current hand disability, service connection cannot be granted. Brammer, 3 Vet. App. 223. Accordingly, the Board finds that the preponderance of the evidence is against the claim, and the claim must be denied. 38 U.S.C. § 5107 (b) (2012); Gilbert, 1 Vet. App. at 55. 2. Entitlement to service connection for hypertension The Veteran contends that his hypertension is related to service. The Veteran has not asserted a specific injury or in-service event which caused his hypertension and has not indicated when his hypertension symptoms began. The Veteran has a current diagnosis of hypertension as evidenced by November 2010 VA treatment records. Hypertension is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. However, the disability was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. STRs are negative for any symptoms, findings or diagnosis of hypertension. VA treatment records show the Veteran was not diagnosed with hypertension until November 2010, decades after his separation from service and decades outside of the applicable presumptive period. Prior to November 2010, the Veteran had not been seen at the VA medical center since 2002, at which time his blood pressure was normal and he did not have a diagnosis of hypertension. While the Veteran is competent to report experiencing symptoms of high blood pressure for many years, the Veteran has not contended that he has experienced those symptoms since discharge from service or during the presumptive period. Further, contemporaneous treatment records show the onset of high blood pressure as November 2010, decades outside of the presumptive period See Buchanan, 451 F.3d at 1336-37. Service connection may still be granted on a direct basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s hypertension and an in-service injury, event or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303. While the Veteran believes his hypertension is related to service, he is not competent to provide a nexus opinion in this case. Jandreau, 492 F.3d at 1377, 1377 n.4. Consequently, the Board gives more probative weight to the competent medical evidence. The Board acknowledges that the Veteran has not been provided a VA examination. Generally speaking, for a VA examination to be warranted the evidence of record must “indicate” that a current disability “may be associated” with a Veteran’s military service or due to or aggravated by a service-connected disability. 38 U.S.C. § 5103A (d)(2); 38 C.F.R. § 3.159 (c)(4)(i); McLendon v. Nicholson, 20 Vet. App. 79 (2006). While this is a low evidentiary threshold; there still must be evidence indicating the existence of a current disability and possible association to military service, for example, medical evidence suggesting a possible nexus or credible evidence of ongoing complaints of pain or other symptoms capable of lay observation. See McLendon, 20 Vet. App. at 83. In this case, the evidence, as summarized above, does not indicate that the Veteran’s hypertension was associated to his military service. The Veteran does not indicate, and STRs do not show, any in-service injury, event or disease. Further, the Veteran has not indicated that he has had symptoms of hypertension since service or the presumptive period thereafter. Considering the evidence of record, the Board finds that the criteria outlined in McLendon are not met. See 38 C.F.R. § 3.159 (d). In sum, the Board finds that the preponderance of the evidence is against this service connection claim, and the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 3. Entitlement to service connection for residuals of a head injury The Veteran has contended that he was hit over the head with a wine bottle in service and that his nerves have been affected ever since. The Board notes that the Veteran is currently service connected for anxiety disorder (claimed as nerves, body shaking, and depression) which is evaluated as 50 percent disabling. In a March 2014 VA examination report for mental disorders, the Veteran reported that a junior enlisted soldier hit him on the head with a wine bottle. This examination did not diagnose traumatic brain injury (TBI). His service treatment records do not document any head injuries; however, the Veteran’s military personnel records indicate that he was discharged due to solicitation. An October 2015 DBQ completed by private physician Dr. H.H-G., and February 2018 DBQ completed by private physician Dr. R.W., noted there was no TBI diagnosis. A March 2020 VA examination indicated there was no diagnosis of TBI. The examiner indicated that there were no findings in the STRs of a TBI, head injury or concussion during service, and no physical findings of a TBI on prior VA examinations or upon present examination. The Veteran submitted four lay statements from friends and family attesting to personality and mood changes immediately after discharge from service, and memory problems beginning over the past few years. See April 2018 Correspondence and November 2020 Buddy Statement. These statements do not discuss any head injuries or TBI specifically. To the extent these statements can be considered evidence of possible manifestations of a head injury, none of the Veteran’s friends or family are competent to determine these symptoms are manifestations of a head injury as they have not demonstrated the necessary medical expertise. The issue is medically complex. Jandreau v. Nicholson, 492 F.3d at 1377, 1377 n.4. In the absence of proof of a current disability, there can be no valid claim for service connection. Brammer, 3 Vet. App. 223; Gilpin, 155 F.3d 1353. The Veteran has not submitted any medical evidence that shows he has a current head injury disability. In this regard, the Board finds that the record provides no indication of a head injury disability during the appellate period. Here, because there is no diagnosis of current head injury disability, service connection cannot be granted. Id. Accordingly, the Board finds that the preponderance of the evidence is against the claim, and the claim must be denied. 38 U.S.C. § 5107 (b) (2012); Gilbert, 1 Vet. App. at 55. 4. Entitlement to service connection for a chronic bilateral eye disorder The Veteran contends that his chronic bilateral eye disorder is related to service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of bilateral cataracts, occluded puncta, and pterygium, and evidence shows that he reported having defective and blurred vision in service, the preponderance of the evidence weighs against finding that the Veteran’s diagnoses began during service or is otherwise related to an in-service injury, event, or disease. His April 1978 enlistment examination noted that he had defective vision. In a May 1979 record, the Veteran also reported having blurred vision. He was given spectacles in service. In an August 1999 VA treatment record, the Veteran reported that his girlfriend threw lye into his eye several years earlier. The Veteran later reported this incident impaired his vision. See October 2013 SSA Orthopedic Examination. In November 2010 VA treatment records, the Veteran reported watery eyes for some time and was diagnosed with dry eye syndrome. The Veteran also reported this issue in January 2015 VA treatment records. During a March 2014 VA examination, the examiner found that the Veteran had mild cataracts in both eyes and mildly enlarged cup to disc ratio in both eyes. The Veteran reported floaters starting approximately one year prior. However, no medical opinion was provided with the examination. The examiner opined that she suspected a large portion of his reported visual difficulty is functional or non-organic in nature, as she did not see any reason for significantly decreased visual function on examination. January 2015 VA treatment records show diagnoses of bilateral epiphora, bilateral complete punctal occlusion due to traumatic/chemical exposure, and bilateral blurred vision. In October 2011 he reported he could not see at night. In May 2016 he was diagnosed with bilateral pterygium, which he had removed prior to November 2017. The March 2020 VA examination noted diagnoses of bilateral cataracts, occluded puncta, and pterygium. The examiner opined that none of the conditions preexisted service and were not incurred in or caused by service. Regarding cataracts, the examiner opined that the blurred vision mentioned in the May 1979 service record was refractive in nature and corrected with spectacles. Cataracts are well known, medically and generally, to be part of the natural aging process. His cataracts are clinically consistent in appearance to age related cataracts. Regarding occluded puncta and pterygium, the examiner opined that there was no mention of the conditions in STRs, and that both conditions clinically appear to have possibly been caused by scarring secondary to lye being thrown into the eyes post-service. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). VA treatment records show the Veteran was not diagnosed with occluded puncta and pterygium until after the 1984 lye exposure. The Veteran was not diagnosed with cataracts until May 2014, decades after separation from service. While the Veteran is competent to report having experienced symptoms of a chronic eye disability since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of any of his currently diagnosed conditions. The issue is medically complex. Jandreau, 492 F.3d at 1377, 1377 n.4. Further, though the Veteran believes his eye conditions are related to service, he is not competent to provide a nexus opinion regarding this issue as it is medically complex and the record does not show that he has the medical training or credentials to make such a determination. Id.; see also Kahana v. Shinseki, 24 Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the March 2020 VA examination. Accordingly, as the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 55. Increased Rating The VA’s Schedule for Rating Disabilities is used to determine disability ratings once a disability is service-connected. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. In the Rating Schedule, Diagnostic Codes (DC) are assigned to specific disabilities. These DCs designate percentage ratings based on the average functional impairment of the Veteran due to a service-connected disability. 38 C.F.R. §§ 3.321, 4.10. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran’s entire history is to be considered when assigning disability ratings. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). A claimant may experience multiple distinct degrees of disability that may result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). The following analysis is therefore undertaken with consideration of the possibility that different ratings may be warranted for different time periods. 5. Entitlement to a compensable evaluation for tension headaches The Veteran contends that his tension headache disability warrants a compensable rating. A May 2014 rating decision granted service-connection for tension headaches with an initial noncompensable disability rating effective June 12, 2013. The Veteran’s tension headaches are evaluated under Diagnostic Code (DC) 8100, which addresses migraine headaches. 38 C.F.R. § 4.124a, DC 8100. Under DC 8100, a noncompensable rating is warranted for migraines with less frequent attacks. A 10 percent rating is warranted for migraines with characteristic prostrating attacks averaging one in 2 months over the last several months. A 30 percent rating is warranted for migraines with characteristic prostrating attacks occurring on an average once a month over the last several months. A 50 percent rating is warranted for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. A 50 percent rating is the highest schedular rating under DC 8100. The rating criteria of DC 8100 are considered successive, meaning that a claimant cannot fulfill the criteria of the higher rating without fulfilling those of the next lower rating. Johnson v. Wilkie, 30 Vet. App. 245, 252 (2018). The phrase “characteristic prostrating attacks” is used in the criteria corresponding to 10 percent and 30 percent ratings under DC 8100 to describe the nature and severity of migraines, but it is not defined in the regulation. Pursuant to Dorland’s Illustrated Medical Dictionary 1531 (32d ed. 2012), prostration is defined as “extreme exhaustion or powerlessness.” Thus, the phrase “characteristic prostrating attacks” is understood to describe migraine attacks that typically produce extreme exhaustion or powerlessness. The rating criteria for a 50 percent rating contain several undefined phrases. The descriptive phrase “very frequent” connotes a frequency at least greater than once a month, as is required by the rating criteria corresponding to a lesser 30 percent rating. Johnson, 30 Vet. App. at 253. The phrase “completely prostrating” generally means that the migraines attack must render the veteran entirely powerless. Id. The completely prostrating attacks must also be “prolonged,” which is defined as “to lengthen in time: extend duration: draw out: continue, protract.” Id. (internal citation omitted). Lastly, the 50 percent rating criteria requires that the very frequent completely prostrating and prolonged attacks be “productive of severe economic inadaptability.” Productive can be read as having either the meaning of “producing” or “capable of producing,” and, with regard to severe economic inadaptability, nothing in DC 8100 requires that the claimant be completely unable to work in order to qualify for a 50 percent rating. Pierce v. Principi, 18 Vet. App. 440, 445-46 (2004). The Board concludes that for the entire period on appeal, the Veteran has had headaches with less frequent attacks, none of which are prostrating, corresponding to the criteria for noncompensable rating under DC 8100. At the March 2014 VA examination the Veteran endorsed headache pain on one side of the head with sensory changes, tremors, and dizziness lasting less than one day. The attacks were not prostrating. In the December 2019 Board remand, the Board found that a 2015 private evaluation report indicated possible worsening of the Veteran’s headaches and ordered an updated VA examination be obtained. In March 2020 the Veteran reported to a VA examination, indicating painful tension headaches without prostrating attacks or associated symptoms like nausea. He endorsed headaches lasting less than one day, which cause difficulty concentrating and focusing on work related tasks. The examiner noted a worsening in his condition. In a March 2020 psychiatric VA examination, the Veteran reported his headaches occurred every other day and lasted a few hours. A November 2020 statement from friend M.B. reveals at least once weekly headaches relieved by rest. Though the record indicates that the Veteran at times must lie down to relieve his migraine, this does not indicate that he experiences prostrating attacks, as the phrase “characteristic prostrating attacks” is understood to describe migraine attacks that typically produce extreme exhaustion or powerlessness. There is no evidence of extreme exhaustion or powerlessness. In sum, there is no evidence of prostrating attacks. Accordingly, the Board concludes that the Veteran has had tension headaches with less frequent attacks and no prostrating attacks, occurring on average 15 times per month, corresponding to the criteria for a noncompensable rating under DC 8100. The Veteran does not have migraines with characteristic prostrating attacks averaging one in 2 months over the last several months to warrant a 10 percent rating. Accordingly, as the preponderance of the evidence is against the claim for a compensable rating, the benefit of the doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 55. 6. Entitlement to a total disability rating based on individual unemployability (TDIU) In an August 2017 supplemental statement of the case, the RO found that the issue of entitlement to a TDIU had been raised by the October 2015 private medical opinion by Dr. H.H-G. Rice v. Shinseki, 22 Vet. App. 447 (2009). Dr. H.H-G. opined that the Veteran’s anxiety disorder prevents him from working. TDIU may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more and there is an additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 3.340, 3.341, 4.16(a). In this case, the Veteran’s combined disability rating is 50 percent for anxiety disorder and tension headaches. 38 C.F.R. §§ 4.25, 4.26. Thus, he does not meet the schedular criteria set forth in Section 4.16(a). However, even when the rating percentage requirements are not met, entitlement to TDIU benefits may be nonetheless considered when the veteran is unable to secure and follow a substantially gainful occupation due to service-connected disabilities. 38 C.F.R. § 4.16 (b). To that end, the central inquiry in determining whether a TDIU is warranted 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 a veteran’s level of education, special training, and previous work experience, but advancing age and the impairment caused by nonservice-connected disabilities are not for consideration in determining whether such a total disability rating is warranted. See 38 C.F.R. §§ 4.16, 4.19; Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). In the first instance, such cases are submitted to the Director, Compensation Service, for extra-schedular consideration. At the March 2014 psychiatric VA examination, the examiner opined that given the Veteran’s report of daily alcohol abuse and crack cocaine use one to two times per week, it is likely that these substances are mostly responsible for his occupational and social impairment. The anxiety disorder likely plays a secondary role in his social and occupational impairment. At the March 2014 headaches VA examination, the Veteran reported retiring in 2007 due to high blood pressure and myalgias. He also reported his headaches impair concentration at work. As above, an October 2015 private medical opinion by Dr. H.H-G. opined that anxiety disorder prevents the Veteran from maintaining substantially gainful employment. A May 2017 VA opinion addressed the October 2015 private opinion. The examiner opined that the October 2015 opinion ignored the impact of the Veteran’s substance abuse on his employability. The examiner further opined that the March 2014 VA examination should be deemed more credible than the October 2015 private opinion because it fully addressed the Veteran’s substance abuse issues. A February 2018 psychiatric DBQ completed by private physician by Dr. R.W. opined that the Veteran cannot sustain stress from work or engage in gainful work due to anxiety disorder, and ongoing alcohol and cocaine use self-medication are most likely secondary and aggravating factors which cannot be differentiated from the Veteran’s mental health problems. Additionally, the Veteran’s persistent tension headaches continue with increased symptoms and, in combination with his substance abuse and psychiatric conditions, are severe enough to preclude him from sustaining substantial, gainful employment activity. The March 2020 psychiatric VA examination opined that the Veteran’s occupational and social impairments are caused by alcohol dependence, not anxiety or stimulant use. As the veteran describes his anxiety as mild and his stimulant use as occasional, his occupational and social impairments are caused by dependence on alcohol and are significant. He is unable to drive owing to a DUI and has been unable to hold a job for more than nine months due to alcohol-related declines in productivity and motivation. The probative value of medical opinion evidence is based on the medical expert’s personal examination of the patient, the physician’s knowledge and skill in analyzing the data, and the medical conclusion that the physician reaches. Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Whether a physician provides a basis for his or her medical opinion goes to the weight or credibility of the evidence in the adjudication of the merits. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). Other factors for assessing the probative value of a medical opinion are the physician’s access to the claims folder and the thoroughness and detail of the opinion. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000); Nieves-Rodriguez, 22 Vet. App. 295. Regarding the October 2015 private opinion, the Board finds this opinion to be of little weight as it did not address the impact of the Veteran’s well documented substance abuse on his employability. Id. Additionally, though the February 2018 private opinion addressed the Veteran’s polysubstance abuse, the Board notes that the Veteran is not service connected for polysubstance abuse. In regard to this question of TDIU, the Board finds that it does not have jurisdiction of questions of secondary service connection. As the opinion indicated his polysubstance abuse was a contributing factor to his unemployability, the Board finds the opinion to be of little probative weight as it relates to the TDIU question currently before the Board. Here, the March 2014, May 2017, and March 2020 opinions were provided by VA medical professionals who possess the necessary education, training, and expertise to provide the requested opinions. Additionally, the opinions are shown to have been based on a review of the Veteran’s record and are accompanied by sufficient explanations as to why the Veteran’s service-connected disabilities do not cause him to be unemployable. The Board thus places more probative weight on the March 2014, May 2017, and March 2020 opinions. The Board is aware that, in the March 2020 VA examination, the Veteran reported he was receiving SSA disability benefits since getting hit by a car in 2014 or 2016, fracturing his pelvis. SSA records received in April 2014 and April 2018 indicate the Veteran was denied disability benefits in 2014. The documents received by SSA in 2018, after the incident for which the Veteran claims to have been in receipt of SSA disability benefits, do not discuss a fractured pelvis. Further, VA treatment records dating through 2020 do not indicate a fractured pelvis or any complaints related thereto. Accordingly, the Board finds the Veteran’s statement that he is in receipt of SSA disability benefits is not credible. In sum, the Veteran does not meet the schedular criteria for a TDIU, and the evidence of record does not reflect some factor that takes his case “outside the norm” of any other veteran rated at the same level. Van Hoose, supra. In addition, considering the VA examination of record and the discussion of symptomology contained therein, the Board finds the evidence weighs against a finding that the service-connected disabilities of anxiety and tension headaches prevent substantially gainful employment.   On this basis, referral to the Director for extra-schedular consideration is not warranted. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K.L. Blevins, Associate 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.