Citation Nr: 21002890 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 17-41 102 DATE: January 19, 2021 ORDER A rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is denied. An initial rating in excess of 10 percent for degenerative disc disease of the lumbar spine is denied. A total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is denied. FINDINGS OF FACT 1. For the entire appeal period, the Veteran’s PTSD is manifested by psychiatric symptomatology resulting in occupational and social impairment with reduced reliability and productivity, without more severe manifestations that more nearly approximate occupational and social impairment with deficiencies in most areas or total occupational and social impairment. 2. For the entire appeal period, the Veteran’s degenerative disc disease of the lumbar spine is manifested by forward flexion limited to, at most, 70 degrees and a total combined range of motion of the thoracolumbar spine limited to, at most, 170 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without muscle spasm or guarding resulting in abnormal gait or abnormal spinal contour, ankylosis, intervertebral disc syndrome (IVDS) with incapacitating episodes having a total duration of at least two weeks, or associated objective neurological abnormalities other than sciatica of the right and left lower extremities as of March 15, 2019. 3. The Veteran’s service-connected disabilities do not render him unable to secure or follow a substantially gainful occupation consistent with his education and work history. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 50 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. 2. The criteria for an initial rating in excess of 10 percent for degenerative disc disease of the lumbar spine have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5243. 3. The criteria for a TDIU have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1963 to January 1993. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from rating decisions issued in March 2012 and May 2013 by a Department of Veterans Affairs (VA) Regional Office. In April 2019, the Veteran and his spouse testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In August 2019, the Board remanded the case and it now returns for further appellate review. The Board observes that, subsequent to the issuance of the most recent supplemental statement of the case in August 2020, additional evidence, to include updated VA treatment records and VA examination reports, has been received. While the Veteran has not waived Agency of Original Jurisdiction (AOJ) consideration of such newly received evidence, the Board finds that no prejudice results to him in proceeding with a decision at the present time as such newly received evidence is irrelevant to the issues on appeal or include findings that are duplicative to those previously considered by the AOJ. 38 C.F.R. § 20.1305(c). Increased Rating Claims Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant’s favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods based on the facts found - a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. 1. Entitlement to a rating in excess of 50 percent for PTSD. The appeal period before the Board begins on August 30, 2011, the date VA received the Veteran’s claim for an increased rating for his PTSD, plus the one-year look back period. Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). For the entire appeal period, such disability is rated as 50 percent disabling pursuant to Diagnostic Code 9411, which provides that PTSD is evaluated under the General Rating Formula for Mental Disorders (General Rating Formula). In this regard, the General Rating Formula provides a 50 percent rating when there is occupational and social impairment with reduced reliability and productivity, due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is warranted when there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or work-like setting); and inability to establish and maintain effective relationships. A 100 percent rating is warranted when there is total occupational and social impairment due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of closest relatives, own occupation, or own name. The United States Court of Appeals for the Federal Circuit has held that the evaluation under 38 C.F.R. § 4.130 is “symptom-driven,” meaning that “symptomatology should be the fact-finder’s primary focus when deciding entitlement to a given disability rating” under that regulation. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-117 (Fed. Cir. 2013). The symptoms listed are not exhaustive, but rather “serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating.” Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). In the context of determining whether a higher disability evaluation is warranted, the analysis requires considering “not only the presence of certain symptoms, but also that those symptoms have caused occupational and social impairment in most of the referenced areas” - i.e., “the regulation...requires an ultimate factual conclusion as to the Veteran’s level of impairment in most areas.” Vazquez-Claudio, 713 F.3d at 117-118; 38 C.F.R. § 4.130, Diagnostic Code 9411. Further, when evaluating a mental disorder, the Board must consider the “frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran’s capacity for adjustment during periods of remission,” and must also “assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner’s assessment of the level of disability at the moment of the examination.” 38 C.F.R. § 4.126(a). For the entire appeal period, the Veteran’s PTSD is rated as 50 percent disabling, which contemplates psychiatric symptomatology resulting in occupational and social impairment with reduced reliability and productivity. Therefore, to warrant a higher rating, the evidence must show that such disability resulted in psychiatric symptomatology that more nearly approximates occupational and social impairment with deficiencies in most areas or total occupational and social impairment. With respect to the Veteran’s symptomatology during the appeal period, the record reflects reports of depressed mood, anxiety, irritability, suspiciousness, chronic sleep impairment, impairment of memory, panic attacks weekly or less often, disturbances of mood and motivation, hypervigilance, and exaggerated startle response. Notably, the evidence does not demonstrate obsessional rituals which interfere with routine activities; impairment in speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control; spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or work-like setting); and inability to establish and maintain effective relationships, the symptoms reflective of a higher rating of 70 percent. The Board notes that the record reflects reports of “occasional suicidal ideation.” In Bankhead v. Shulkin, 29 Vet. App. 10 (2017), the United States Court of Appeals for Veterans Claims (Court) held that the language of the general rating formula “indicates that the presence of suicidal ideation alone...may cause occupational and social impairment with deficiencies in most areas.” However, as recognized by the Court, VA must engage in a holistic analysis in assessing the severity, frequency, and duration of the signs and symptoms of a veteran’s service-connected psychiatric disability, and their resulting social and occupational impairment. In this regard, the evidence reflects that, while the Veteran reported occasional suicidal ideation, he also denied any plan or intent due to protective factors that included his wife, grandchildren, religious beliefs, supportive relationships, future orientation, and responsibility towards family, and the VA examiners did not find him to be a danger for self-harm. Additionally, while the Veteran reported obsessional rituals, such as strict vigilance with respect to home security and avoidance of certain numbers, the evidence, to include his own statements, do not show that such recurrent practices interfere with routine activities. Furthermore, as will be discussed below, the Board finds that the nature, frequency, duration, and severity of the Veteran’s suicidal ideation and obsessional rituals does not result in occupational and social impairment in most areas. Specifically, in regard to the impact such psychiatric symptomatology has on the Veteran’s social functioning, an October 2011 VA examination report indicates that he had a very good relationship with his wife, spent time with his children, and was close to his grandchildren. Although the Veteran reported becoming more antisocial, he nevertheless still traveled to Biloxi to gamble and went to church every other Sunday. In April 2013, a VA examiner found the Veteran’s PTSD symptoms were not severe enough to interfere with social functioning. Also at such time, the Veteran reported enjoying going to the casinos with his wife, being in contact with his children, and spending time with his two grandchildren. On VA examination in March 2017, the Veteran again reported having a very good relationship with his wife and stated that he had a better relationship with his wife’s family than his own. He also reported spending most of his time on the computer, playing games and watching the stock market. On VA examination in September 2018, the Veteran reported enjoying spending time at home and, although he had to rely on his wife of 14 years to help him remember the names of people, he did report participating in social situations. A May 2019 VA treatment record indicates the Veteran went to Japan to visit his grandchildren in March 2019, and a September 2019 VA examination report reflects that the Veteran indicated that, while he did not have a relationship with one of his daughters and described himself as a loner, he reported that his marital relationship was very good and he maintained a good relationship with his other daughter. With respect to the impact the Veteran’s psychiatric symptomatology has on his occupational functioning, an October 2011 VA examiner summarized the level of impairment resulting from the Veteran’s mental health diagnoses, the symptoms of which overlapped, as occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. The Veteran reported that after spending 30 years in the military, he had obtained a doctorate and held part-time teaching jobs until retiring in 2004. A March 2013 VA treatment record indicates the Veteran spent all day on the computer investing in the stock market. In April 2013, the VA examiner determined the Veteran’s PTSD symptoms were not severe enough to interfere with occupational functioning, and further found there was nothing in the evaluation of the Veteran that would suggest his symptoms of PTSD would preclude him from obtaining and maintaining gainful employment. Based on his current level of functioning, the VA examiner opined the Veteran appeared capable of sedentary, flexibly scheduled employment with limited stress and/or responsibility and limited/minimal interaction with staff and/or customers, if applicable. The Veteran again stated that he last worked in 2004 as a professor teaching a satellite course one night per week, which he had done for nine months. Prior to that job, he had worked part-time as a teacher. The March 2017 VA examiner repeated the October 2011 VA examiner’s finding that the Veteran’s PTSD (now diagnosed as other specified trauma and stressor related disorder) resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. Notably, however, the VA examiner opined the Veteran’s PTSD alone appeared mild, whereas his depression, a separate mental health diagnosis, appeared to be the most impairing. The VA examiner further opined that the Veteran’s PTSD and depressive symptoms, together, would result in occasional reduction in productivity and reliability in a stressful work setting where high productivity was required as a result of problems with irritability, fatigue, impaired sleep, anxiety, and anhedonia. In September 2018, the VA examiner summarized the level of impairment resulting from the Veteran’s mental health diagnoses as occupational and social impairment due to mild or transient symptoms which decreased work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medication. Following psychiatric examination of the Veteran in September 2019, the VA examiner found the Veteran’s PTSD and unspecified depressive disorder, contributing equally, resulted in occupational and social impairment with reduced reliability and productivity. Finally, a December 2019 VA treatment record reflects the finding that the Veteran’s PTSD was moderate in severity and resulted in impairment both social and occupational functioning. Upon review, the Board notes the record shows the Veteran consistently reported a good relationship with his wife and one of his daughters, and enjoyed spending time with his grandchildren. Although he did not report many friendships during the appeal period, the record does not show severe isolation or entire avoidance of social situations so as to warrant a higher rating based on impaired social functioning. Additionally, none of the VA examiners found the Veteran’s PTSD resulted in occupational and social impairment in most areas. In fact, all examiners other than the September 2019 VA examiner, who opined that the severity of the impairment caused by the Veteran’s psychiatric symptomatology met the criteria for the currently assigned 50 percent rating, found that such disability resulted in a lesser degree of occupational and social impairment. The Board is cognizant of the Veteran’s reports that he had to retire from teaching due to neurocognitive issues, which he associates with his service-connected PTSD. However, in December 2019 a VA psychiatrist found the Veteran’s subjective report of memory difficulties were not supported by valid objective evidence and his claimed memory problems were not related to his service-connected PTSD. Here, the Board affords the VA examiners’ determinations significant probative value with respect to the effects of the Veteran’s PTSD on his occupational and social functioning as they were based on psychological evaluations of the Veteran during the appeal period and consideration of his own contemporaneous lay statements of his symptoms in light of the rating criteria. In the instant case, the Board relies upon the competent medical evidence with regard to the specialized evaluation of functional impairment, symptom severity, and details of clinical features of his PTSD, particularly considering the medical expertise required to delineate the symptomatology and resulting impairment specifically attributable to the Veteran’s multiple psychiatric diagnoses. Therefore, in consideration of the totality of the nature, frequency, duration, and severity of the Veteran’s psychiatric symptomatology, the Board finds that such results in no more than occupational and social impairment with reduced reliability and productivity throughout the period on appeal. Consequently, a rating in excess of 50 percent is not warranted. 2. Entitlement to an initial rating in excess of 10 percent for degenerative disc disease of the lumbar spine. The instant appeal stems from August 30, 2011, the date service connection was awarded for the Veteran’s degenerative disc disease of the lumbar spine. The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. In Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011), the Court held that, although pain may cause a functional loss, “pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system.” Rather, pain may result in functional loss, but only if it limits the ability “to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance.” Id., quoting 38 C.F.R. § 4.40. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § 4.59 requires that “[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint.” Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the Diagnostic Code under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). The Veteran’s back disability is evaluated under Diagnostic Code 5243, which pertains to IVDS, and provides that such disability is evaluated under either the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula) or the Formula for Rating IVDS Based on Incapacitating Episodes (IVDS Rating Formula), whichever method results in the higher evaluation when all disabilities are combined. See 38 C.F.R. § 4.25 (combined ratings table). The IVDS Rating Formula provides a 10 percent evaluation when there are incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months and a 20 percent evaluation when there are incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent evaluation is warranted when there are incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent evaluation is warranted when there are incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. Note (1) provides that an incapacitating episode is a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a. Ratings under the General Rating Formula are made with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. Such provides for a 10 percent rating where forward flexion of the thoracolumbar spine is greater than 60 degrees but not greater than 85 degrees; or combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is assigned where forward flexion of the thoracolumbar spine is greater than 30 degrees but no greater than 60 degrees; the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. Finally, a 100 percent rating is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a. Such criteria also include the following Notes: Note (1): Any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be separately evaluated under an appropriate diagnostic code. Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner’s assessment that the range of motion is normal for that individual will be accepted. Note (4): Round each range of motion measurement to the nearest five degrees. Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. In the instant case, the medical evidence does not reflect IVDS with incapacitating episodes having a total duration of at least two weeks at any time during the pendency of the appeal. In this regard, in March 2013, a VA examiner found that, although the Veteran had IVDS of the thoracolumbar spine, he had not experienced any incapacitating episodes over the past 12 months due to IVDS. In particular, despite the Veteran reporting flare-ups that occurred approximately two to three times per month after sudden twisting or lifting a heavy object, he denied seeking medical care for such episodes. On VA examination in March 2017, the VA examiner recorded that the Veteran did not have IVDS of the thoracolumbar spine. The remainder of the evidence, to include the Veteran’s lay testimony and treatment records, does not reflect incapacitating episodes for which physicians prescribed bedrest so as to warrant a higher rating under the IVDS Rating Formula. Additionally, the evidence does not demonstrate forward flexion limited to 60 degrees, a combined range of motion of the thoracolumbar spine limited to 120 degrees, or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour so as to warrant a higher rating under the General Rating Formula. Specifically, in March 2013, it was noted that the Veteran had functional impairment in the form of less movement and pain on movement; however, his forward flexion of the lumbar spine was limited to, at most, 80 degrees and he had a total combined range of motion of 195 degrees, with no additional loss following repetitive-use testing. Additionally, while he reported flare-ups, he described such only as increased pain, rather than a further reduction in limitation of motion. Further, he did not exhibit symptoms of guarding or muscle spasms, and there was no ankylosis. The March 2017 VA examination report reflects forward flexion limited to, at most, 70 degrees and a total combined range of motion of 170 degrees, with no additional loss following repetitive-use testing. Additionally, while he reported flare-ups, he described such only as increased pain, rather than a further reduction in limitation of motion. Furthermore, there was no pain on weight-bearing, could be examined on nonweight-bearing, and passive range of motion could not be performed without risk of injury or perceived injury, and the examination was medically consistent with the Veteran’s statements describing functional loss with repeated use over time and was, in fact, conducted during a flare-up and there was no limitation of functional ability in light of such factors due to pain, weakness, fatigability, or incoordination. Further, the Veteran did not have guarding or muscle spasm of the thoracolumbar spine, and there was no ankylosis. Based on the foregoing, the Board finds a rating in excess of 10 percent is not warranted under the General Rating Formula for the Veteran’s back disability. Further, the evidence does not demonstrate objective neurologic abnormalities associated with the Veteran’s back disability, aside from his service-connected sciatica of the bilateral lower extremities as of March 15, 2019, the propriety of which was separately evaluated in the January 2020 Board decision. Specifically, the March 2013 and March 2017 VA examinations revealed no evidence of radiculopathy of the bilateral lower extremities or other neurologic abnormalities, to include bowel or bladder impairment. Consequently, the Board finds that the Veteran’s back disability is manifested by forward flexion limited to, at most, 70 degrees and a total combined range of motion of the thoracolumbar spine limited to, at most, 170 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without muscle spasm or guarding resulting in abnormal gait or abnormal spinal contour, ankylosis, IVDS with incapacitating episodes having a total duration of at least two weeks, or associated objective neurological abnormalities other than sciatica of the right and left lower extremities as of March 15, 2019. Thus, a rating in excess of 10 percent is not warranted at any time during the pendency of the appeal. Other Considerations In making its determinations in this case, the Board has carefully considered the Veteran’s contentions with respect to the nature of his service-connected disabilities at issue and notes that his lay testimony is competent to describe certain symptoms associated with these disabilities. The Veteran’s history and reported symptoms have been considered, including as presented in the medical evidence discussed above, and has been contemplated by the disability ratings that have been assigned. Moreover, the competent medical evidence offering detailed specific findings pertinent to the rating criteria is the most probative evidence when evaluating the pertinent symptoms of the service-connected disabilities at issue. As such, while the Board accepts the Veteran’s testimony concerning matters that he is competent to address, the Board relies upon the competent medical evidence with regard to the specialized evaluations of functional impairment, symptom severity, and details of clinical features of the service-connected conditions at issue. The Board has also considered whether staged ratings under Hart, supra, and Fenderson, supra, are appropriate for the Veteran’s PTSD and back disability; however, finds that his symptomatology has been stable throughout the appeal period. Therefore, assigning staged ratings for such disabilities is not warranted. Further, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the increased rating claims adjudicated herein. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). In reaching the foregoing determinations, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran’s claims of entitlement to a rating in excess of 50 percent for his PTSD and an initial rating in excess of 10 percent for his back disability. Consequently, the benefit of the doubt doctrine is inapplicable in such regard, and the Veteran’s claims for increased ratings must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 3. Entitlement to a TDIU. In his April 2012 Veteran’s Application for Increased Compensation Based on Unemployability (VA Form 21-8940), the Veteran reported that he became too disabled to work in May 2003 due to his service-connected PTSD, gout with joint involvement and left ureterolithiasis (gout), hypertension, coronary artery disease (ischemic heart disease (IHD)), and diabetes mellitus, type II. Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that if there is only one such disability, such disability shall be ratable as 60 percent or more, and if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). Unlike the regular disability rating schedule, which is based on the average work-related impairment caused by a disability, “entitlement to a TDIU is based on an individual’s particular circumstances.” Rice v. Shinseki, 22 Vet. App. 447, 452 (2009). Therefore, when adjudicating a TDIU claim, VA must take into account the individual veteran’s education, training, and work history. Hatlestad v. Derwinski, 1 Vet. App. 164 (1991) (level of education is a factor in deciding employability); Friscia v. Brown, 7 Vet. App. 294 (1994) (considering Veteran’s experience as a pilot, his training in business administration and computer programming, and his history of obtaining and losing 19 jobs in the previous 18 years); Beaty v. Brown, 6 Vet. App. 532 (1994) (considering Veteran’s 8th grade education and sole occupation as a farmer); Moore v. Derwinski, 1 Vet. App. 356 (1991) (considering Veteran’s master’s degree in education and his part-time work as a tutor). Age may not be considered as a factor when evaluating unemployability or intercurrent disability, and it may not be used as a basis for a total disability rating. 38 C.F.R. § 4.19. There must be a determination that the service-connected disabilities are sufficient to produce unemployability without regard to advancing age or a non-service-connected disability. 38 C.F.R. §§ 3.340, 3.341, 4.16. The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. A high rating in itself is recognition that the impairment makes it difficult to obtain or keep employment. The ultimate question, however, is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether he or she can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Recently, in Ray v. Wilkie, 31 Vet. App. 58 (2019), the Court defined the term “unable to secure and follow a substantially gainful occupation” in § 4.16(b) to include two components: one economic and one noneconomic. The economic component means an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. The non-economic component includes consideration of the veteran’s history, education, skill, and training; whether the veteran has the physical ability to perform the type of activities required by the occupation at issue; and whether the veteran has the mental ability to perform the activities required by the occupation at issue. The instant appeal stems from the Veteran’s increased rating claims, which were received on August 30, 2011. For the entire appeal period, exclusive of the time period where a temporary total rating has been assigned from October 23, 2019, to February 1, 2020, the Veteran is service-connected for PTSD, evaluated as 50 percent disabling; gout, evaluated as 40 percent disabling; IHD, evaluated as 30 percent disabling; diabetes mellitus, type II, with erectile dysfunction, evaluated as 20 percent disabling; hypertension, evaluated as 10 percent disabling; back disability, evaluated as 10 percent disabling; and tinea cruris, evaluated as noncompensably disabling. As of March 15, 2019, the Veteran is also service-connected for sciatica of the right and left lower extremities, each evaluated as 10 percent disabling. Based on these ratings, the Veteran has a combined disability rating of 90 percent throughout the appeal period, exclusive of the period where a temporary total rating has been assigned, and meets the schedular requirements for consideration of a TDIU. With respect to his education, the record shows the Veteran completed his Doctorate of Arts in Education in 1996. As for his work history, he reports that he taught part-time at Troy State University from 1998 to 2001 and at the Naval War College from August 2002 to May 2003 following his retirement from a 30-year career in the military. On his VA Form 21-8940, the Veteran stated he was barely able to complete his last teaching commitment due to his service-connected gout, hypertension, IHD, diabetes mellitus, and PTSD and indicated that the side effects of the medications prescribed for such disabilities made it difficult to leave his home at times. Upon review of the evidence, however, the Board finds the Veteran’s service-connected disabilities do not render him unable to secure or follow a substantially gainful occupation consistent with his education and work history. As noted above, VA examiners determined the Veteran’s PTSD symptomatology resulted in no more than occupational impairment with reduced reliability and productivity at any point during the pendency of the appeal. In March 2017, a VA examiner determined the Veteran was capable of sedentary, i.e., seated, to light physical activity based on his service-connected conditions alone. Specifically, the VA examiner found the Veteran’s ability to work was not impacted by his IHD, hypertension, diabetes mellitus, type II, back disability, or gout. Likewise, a November 2020 VA examiner determined the Veteran’s diabetes mellitus, type II, did not impact his ability to work. However, following neurological examination that same month, a VA examiner did report that the Veteran’s sciatica of the bilateral lower extremities impacted his ability to stand and walk for extended periods of time, as he was easily fatigued. Nevertheless, the Board finds the Veteran’s education and work history do not preclude occupational positions that would permit him to sit whenever necessary to relieve any sciatic symptoms. Again, the Board also notes the Veteran’s reports that his PTSD resulted in neurocognitive deficits, to include difficulty with finding words and memory, that forced him to retire from teaching. However, the competent, medical evidence, as described above, does not indicate that such symptomatology is associated with a service-connected disability and, thus, the Board cannot consider such in its determination of entitlement to a TDIU. Here, the Board affords greater probative weight to the medical professionals’ opinions as they considered such reported symptoms, conducted a review of the Veteran’s medical records, and performed relevant physical and psychiatric examinations prior to reaching their conclusions. Moreover, even in consideration of the totality of the Veteran’s symptomatology and their resulting functional impairment, the Board finds that he retains the ability to perform the requisite physical and mental acts necessary to perform the occupational tasks consistent with his education and prior work history. In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine; however, the preponderance of the evidence does not show the Veteran’s service-connected disabilities, alone or in combination, render him unable to secure or follow a substantially gainful occupation consistent with his education and work history. As such, a TDIU is not warranted, and the Veteran’s claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. M. Celli, 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.