Citation Nr: 21003183 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 17-02 386 DATE: January 19, 2021 ORDER Entitlement to an initial rating in excess of 30 percent for unspecified anxiety disorder is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected unspecified anxiety disorder is denied. FINDINGS OF FACT 1. Throughout the appeal period, the severity, frequency, and duration of the Veteran’s unspecified anxiety disorder symptoms did not more closely approximate occupational and social impairment with reduced reliability and productivity. 2. Throughout the appeal period, the most probative evidence of record does not reflect that it was at least as likely as not that the Veteran was unable to secure or follow a substantially gainful occupation due solely to his service-connected unspecified anxiety disorder. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 30 percent for unspecified anxiety disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9413. 2. 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 had active service from May 1966 to May 1968. These matters come before the Board of Veterans’ Appeals (Board) on appeal from December 2015 (unspecified anxiety disorder) and March 2016 (TDIU) rating decisions issued by a Regional Office (RO) of the Department of Veterans Affairs (VA). The issues addressed herein, entitlement to an initial rating in excess of 30 percent for unspecified anxiety disorder and entitlement to TDIU, were initially before Board in January 2019, when the Board denied the claims. The Veteran appealed the January 2019 Board decision as to these denials to the United States Court of Appeals for Veterans Claims (Court), and in a September 2019 Memorandum Decision, the Court vacated the Board’s decision, and remanded these matters back to the Board for development consistent with the Memorandum Decision. Thereafter, the Board remanded these claims in March 2020. They now return for appellate review. 1. Entitlement to an initial rating in excess of 30 percent for unspecified anxiety disorder The Veteran contends a higher initial rating is warranted for his unspecified anxiety disorder. Specifically, his January 2016 notice of disagreement, as well as in January 2016 and April 2016 statements, the Veteran indicated a 70 percent rating (in conjunction with a grant of TDIU) or 100 percent evaluation was sought. Similarly, in a June 2019 statement to the Court, the Veteran reported a 70 percent rating (in conjunction with a grant of TDIU) was sought. Service connection for the Veteran’s unspecified anxiety disorder was granted effective April 24, 2015. As such the period for consideration is from April 24, 2015. Under the General Formula for Mental Disorders (General Formula), the Board must conduct a “holistic analysis” that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). The issue in this appeal is whether the Veteran’s symptoms with his service-connected unspecified anxiety disorder caused the level of impairment required for a disability rating of 50 percent or higher. However, the Board concludes that the Veteran’s symptoms did not cause the level of impairment required for a disability rating of 50 percent or higher. The Veteran’s symptoms more closely approximated the symptoms associated with a 30 percent rating, and resulted in a level of impairment that most closely approximated the level of impairment associated with a 30 percent rating. A noncompensable rating is assigned when a mental condition has been formally diagnosed, but symptoms are not severe enough to either require continuous medication, or to interfere with occupational and social functioning. A 10 percent rating is assigned when mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of occasional stress, or symptoms controlled by medication cause occupational and social impairment. A 30 percent rating is assigned when symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events), cause occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and normal conversation). A 50 percent rating is assigned when symptoms such 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; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; 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 a worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned for 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 inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name. Turning to the evidence of record, the Board recognizes the Veteran submitted private examination reports dated in June 2015 and October 2015, which each endorsed a diagnosis of PTSD. However, the December 2015 rating decision explicitly denied entitlement to service connection to PTSD. The Veteran did not submit a notice of disagreement as to the December 2015 rating decision’s denial of service connection for PTSD and new and material evidence was not received within the appeal period. As such, the Board finds that the December 2015 rating decision is final as to the denial of service connection for PTSD and PTSD symptomology is not for consideration. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 20.1103. In this regard, in January 2016 and April 2016 statements, the Veteran generally argued if the private diagnosis (apparently referencing the June 2015 and October 2015 examination reports which each endorsed a sole diagnosis of PTSD), was not adequate, the RO should have returned the reports to the private examiner to substantiate the diagnosis. However, neither the RO, nor VA generally, has the ability to contact a private examiner directly in order for the private examiner to provide an adequate examination report. Instead, VA has obtained VA examination reports which are adequate. Nonetheless, to the extent the June 2015 and October 2015 private examination reports generally documented the manifestations of the Veteran’s psychiatric symptomology and did not attempt to distinguish or attribute certain symptoms to the endorsed diagnosis of PTSD rather than the service-connected unspecified anxiety disorder, the Board will consider all findings of non-distinct symptomology as attributed to the Veteran’s service-connected unspecified anxiety disorder. Mittleider v. West, 11 Vet. App. 181, 182 (1998). In this regard, the September 2019 Memorandum decision concluded that the Board provided an inadequate statement of reasons or bases for assigning the October 2015 VA examination report more probative weight than the June 2015 and October 2015 private examination reports. Here, however, the Board will accept the June 2015 and October 2015 private examination reports to extent they each documented the Veteran’s psychiatric symptomology itself (although not to the extent they suggest more than occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks or the finding the Veteran was permanently disabled - as discussed below), and this documented psychiatric symptomology is discussed below. Nonetheless, the Board finds the level of impairment caused by the Veteran’s psychiatric symptomology more closely approximates the level associated with a 30 percent rating. In this regard, the June 2015 private examiner did not endorse any symptoms listed in the relevant rating criteria but did endorse unlisted symptoms of hypervigilance, avoidance of crowds, inability to have anyone behind him, that he noted the exits in a public place, lacked socialization, got into arguments easily, preferred to spend time alone, felt estranged from civilians, struggled to control his temper, thought about his personal safety, had problems going to sleep and staying asleep, had nightmares and night sweats, did not talk about his time in the military, avoided watching war movies, was saddened when he went to the VA Medical Center and saw wounded soldiers, reflected that he could have been a wounded warrior, startled easily, had an agitated mood, affect was restricted, and that he reexperienced the traumatic event (in February 1968, while he was stationed in Germany, he learned that his good friend was killed in Vietnam) as intrusive thoughts and nightmares. Additionally, an October 2015 private examination report also did not endorse any symptoms listed in the relevant rating criteria but did endorse unlisted symptoms. Specifically, that the Veteran wondered why he was sent to Germany when his good friend was sent to Vietnam and died there, that he thought about others in his unit who he lost (although it is unclear who this refers to), that he did not share his memories from the military with anyone, that he reported that his sleep was disturbed, specifically that he woke up sweaty and tried to ease back into sleep but was unsuccessful, that his mood went up and down, that he remained hypervigilant and constantly concerned about his personal safety, and that he preferred to be alone, and when he was around other people, he was hyperirritable. An October 2015 VA examination report also reported unlisted symptoms of recurrent, involuntary, and intrusive distressing memories of the traumatic event, and recurrent distressing dreams in which the content and/or affect of the dream were related to the traumatic event, which were more explicitly characterized as experiencing anxiety tied to periodic bouts of unwanted thoughts related to his friend’s death, and sleep disturbance. The October 2015 VA examination report also noted the Veteran’s mood was euthymic and his affect was stable. A November 2020 examination report also documented the Veteran reported an inability to relax when bored and also reported waking for a time two to three times a week. Also, in June 2015 statements, the Veteran reported, that in February 1968, while he was serving in Germany, he learned of the death of a hometown friend killed in action in Vietnam. He reported this event had resulted in nightmares, that it seemed he could not escape news stories and movies of war and wartime causalities, which led him to relieve his recounted stressor event (while he was stationed in Germany, he learned that his good friend was killed in Vietnam). He also reported that since this reported stressor he was very concerned with his personal safety, often withdrew from family and friends, and he often struggled with his temper. However, these unlisted symptoms, as discussed above, which were reported by the Veteran, endorsed in the June 2015 and October 2015 private examination reports, and endorsed in the October 2015 and November 2020 VA examination reports, are similar to symptoms of depressed mood, anxiety, suspiciousness, and chronic sleep impairment, which are contemplated by the assigned 30 percent rating. The Board also recognizes that the June 2015 private examination report noted additional unlisted symptomology, specifically the Veteran’s narrative was not always linear, that he had problems with concentration, and that he had difficulty focusing, which are similar to impaired abstract thinking, as contemplated by a 50 percent rating. However, impaired abstract thinking or similar symptomology is not demonstrated in any other evidence of record. Moreover, the October 2015 VA examination report, dated proximate to the June 2015 private examination report, found the Veteran’s attention and concentration were normal and documented he was able to was able to perform serial 7’s. Similarly, the November 2020 examination report documented the Veteran did not exhibit or report difficulties with his thought processes or perceptions. Thus, the Board finds the severity, frequency, and duration of these unlisted symptoms more closely approximate the symptoms contemplated by a 30 percent rating, which are less severe, less frequent, and shorter in duration than those contemplated by a 50 percent rating or higher rating. See 38 C.F.R. § 4.126. The October 2015 VA examination report did note the Veteran was somewhat poorly groomed and the November 2020 examination report also noted his clothes were somewhat stained and ill-fitting; however, these general descriptions do not rise to chronic neglect of personal appearance and hygiene, as contemplated by a 70 percent rating. Further, the listed symptom of neglect of personal appearance and hygiene was not endorsed by either VA examination report. Moreover, the June 2015 private examination, dated proximate to the October 2015 VA examination report, found the Veteran had normal dress. Thus, a higher rating based on these general descriptions is not warranted. Id. Moreover, the October 2015 and November 2020 VA examination reports show that the Veteran’s unspecified anxiety disorder was manifested by symptoms associated with a 30 percent rating of anxiety and chronic sleep impairment. No other listed symptoms were endorsed by any examiner. Further, the October 2015 and November 2020 VA examination reports each found the Veteran’s unspecified anxiety disorder resulted in symptomology not severe enough either to interfere with occupational and social functioning or to require continuous medication, which is indicative of a noncompensable rating, and which is lesser than the rating currently assigned. The October 2015 VA examination report further reported the Veteran did not report impairment in social or occupational functioning related to mental health problems but he did report experiencing some psychological distress tied to anxiety, sleep problems, and unwanted thoughts. The November 2020 VA examination report also noted the Veteran described a fairly constricted life, but that he denied that his anxiety prevented him from doing anything he would like to do. Conversely, the June 2015 private examination report found the Veteran’s PTSD symptoms had caused significant disturbances in all areas of his life and that the Veteran was considered to be permanently disabled. An October 2015 private examination report also noted the Veteran was considered to be permanently disabled. However, the October 2015 private examination report, signed by the same two examiners who also signed the June 2015 private examination report, noted, in part, the Veteran had to leave his job due to knee and shoulder pain, and further noted, that since he did not have work to distract, he thought more about his time in the military. As discussed below, the Board recognizes the Veteran retired in September 2014, which is proximate to the appeal period at issue. Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). Further, consistent with the October 2015 private examination report, the October 2015 VA examiner also documented that the Veteran stated that he last worked about six months ago, and indicated that he stopped working due to medical problems, and that his relationships with co-workers and supervisors through the years were characterized as mostly positive and productive. Similarly, the November 2020 VA examiner documented the Veteran reported he retired in 2014, as the work became too physically tasking. Thus, as discussed, the VA and private examiners consistently documented that the Veteran left his job due to physical disability rather than his service-connected unspecified anxiety disorder, which is relevant, as it reflects, proximate to the appeal period, the Veteran’s unspecified anxiety disorder did not interfere with his occupation. This weighs against a finding that the Veteran was permanently disabled due to his psychiatric symptomology, as generally documented in the June 2015 and October 2015 private examination reports, or that psychiatric symptoms caused clinically significant impairment in occupational, social and personal life beyond the degree contemplated by the 30 percent criteria. Accordingly, the record does not reflect the Veteran’s unspecified anxiety disorder resulted in occupational impairment consistent with an evaluation in excess of 30 percent. Additionally, the evidence of record does not reflect the Veteran’s unspecified anxiety disorder resulted in social impairment consistent with an evaluation in excess of 30 percent. Specifically, as discussed above, the June 2015 private examination report found the Veteran did not socialize and preferred to spend time alone. Also, in June 2015 statements, the Veteran reported, in part, that he withdrew from family and friends. However, the June 2015 private examination report and the Veteran’s June 2015 recollections, unlike the October 2015 and November 2020 VA examination reports, did not provide any specific details regarding the Veteran’s personal relationships for the Board to weigh and consider. In this regard, the October 2015 VA examiner documented that the Veteran reported he had two children, and described his relationship with his children as okay. The Veteran also reported that he remained socially active with girlfriends and friends. Similarly, the November 2020 VA examiner documented that the Veteran reported he currently had little contact with his two children; however, he got together with members of his large family to play spades. The November 2020 VA examiner also documented that the Veteran reported moved back to North Carolina to be close to his family of origin in 2014. Thus, as the October 2015 and November 2020 VA examiners provided a specific discussion of the Veteran’s personal relationship, this evidence is more probative the general findings that the Veteran did not socialize and preferred to spend time alone or that he withdrew from family and friends. Accordingly, the record does not reflect, proximate to the appeal period, the Veteran’s unspecified anxiety disorder resulted in social impairment consistent with an evaluation in excess of 30 percent. In January 2016 and April 2016 statements, the Veteran referenced Global Assessment of Functioning (GAF) scores. While the Veteran believes that he is entitled to a higher rating on the basis of GAF scores, “[a]n adjudicator is not permitted to rely on evidence that the American Psychiatric Association itself finds lacking in clarity and usefulness.” Golden v. Shulkin, 29 Vet. App. 221, 225 (2018). Furthermore, the Board recognizes the Veteran’s assertions that his unspecified anxiety disorder warrants a higher evaluation and these endorsements are admissible and have been taken into consideration. See Layno v. Brown, 6 Vet. App. 465, 469-71 (1994). However, the Veteran has not been shown to have the requisite knowledge or training to be deemed competent to identify a specific level of disability of his unspecified anxiety disorder according to the rating criteria. Jandreau v. Nicholson, 492 F. 3d 1372, 1376-77 (Fed. Cir. 2007). Such competent evidence concerning the nature and extent of the Veteran’s unspecified anxiety disorder has been provided by clinical records, including October 2015 and November 2020 VA examination reports, associated with the claims file and these medical findings directly address the criteria under which the Veteran’s unspecified anxiety disorder is evaluated. The Board finds these clinical records to be competent, objective, and probative evidence of record, and are therefore accorded greater weight than the Veteran’s subjective complaints of symptomatology for his unspecified anxiety disorder. Additionally, in a June 2019 statement to the Court, the Veteran also argued that if he had been lucky and had his case reviewed by a different Veterans’ Law Judge, his claim may have been granted, and also he cited to a prior Board decision for another veteran. In this regard, the Veteran is assured the Board strives for consistency in adjudication of claims. Indeed, the undersigned Veterans Law Judge is not the same Veterans Law Judge who issued the January 2019 decision, but each separately arrived at same determination, albeit with some new evidence in this case. Further, each Board decision is based on review of the evidence of record in a particular claims file and, accordingly, has no precedential value toward adjudication of appeals by other claimants, such as this Veteran, who may appear to be similarly placed. See 38 C.F.R. § 20.1303. Thus, based on the reasons and bases discussed, the preponderance of the evidence weighs against finding that the severity, frequency, and duration of the Veteran’s symptoms resulted in the level of impairment required for a 50 percent or higher rating. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Accordingly, entitlement to an initial rating in excess of 30 percent for unspecified anxiety disorder is denied. 2. Entitlement to a TDIU The Veteran contends entitlement to a TDIU is warranted. In a June 2019 statement to the Court, he indicated that extraschedular consideration for his TDIU claim was warranted but did not provide any further reasoning. Entitlement to a TDIU has been raised as part and parcel of the Veteran’s disagreement with the initial rating assigned for his unspecified anxiety disorder, for which service connection was awarded effective from April 24, 2015. As such the period for consideration is from April 24, 2015. Rice v. Shinseki, 22 Vet. App. 447 (2009). A total disability rating 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 the result of service-connected disabilities. See 38 U.S.C. § 1155; 38 C.F.R. § 4.16. To meet the schedular requirements, there must be one disability ratable at 60 percent or more, or, if more than one disability, at least one disability ratable at 40 percent or more and a combined disability rating of 70 percent. 38 C.F.R. § 4.16(a). Nevertheless, it is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. Rating boards are to refer to the Director of the Compensation Service for extraschedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities but who fail to meet the percentage requirements of 38 C.F.R. § 4.16(a). 38 C.F.R. § 4.16(b). The United States Court of Appeals for Veterans Claims (Court) interpreted “unable to secure and follow a substantially gainful occupation” under 38 C.F.R. § 4.16(b) and also noted 38 C.F.R. § 4.16 uses the phrases “substantially gainful employment” and “substantially gainful occupation” and found these phrases were synonymous.” Ray v. Wilkie, 31 Vet. App. 58, 62 (2019) (footnote 4, citing Ortiz-Valles v. McDonald, 28 Vet. App. 65, 70 (2016)). The Board notes that 38 C.F.R. § 4.16(a) requires a Veteran to be unable to secure or follow a substantially gainful occupation, rather than secure and follow it, but finds the Court’s analysis in Ray is applicable to the Board’s analysis here. Thus, the phrase unable to secure or follow a substantially gainful occupation contains both economic and noneconomic components. Id. 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. Id. The non-economic component requires a determination as to a veteran’s ability to secure and follow such employment and includes consideration of the veteran’s history, education, skill, and training, consideration of the veteran’s physical ability with possible relevant factors including the veteran’s limitations as to lifting, bending, sitting, standing, walking, climbing, grasping, typing, and reaching, as well as audio and visual limitations, and consideration of the veteran’s mental ability, including his limitations as to memory, concentration, ability to adapt to change, handle workplace stress, get along with coworkers, and demonstrate reliability and productivity. Id. However, these factors are not a checklist, but, rather, discussion of these factors is only necessary when they are raised by the evidence. Id. With consideration of these factors, as discussed below, the evidence of record does not reflect the Veteran is prevented from securing or following a substantially gainful occupation due to his service-connected unspecified anxiety disorder. Turning to the economic component, in the Veteran’s VA Form 21-8940, Veteran’s Application for Increased Compensation based on Unemployability, dated in December 2015, he reported that he last worked full-time and became too disabled to work in September 2014. During the October 2015 VA examination, the Veteran reported, in part, that he last worked about six months ago. Also, of record is a May 2020 VA Form 21-4192, Request for Employment Information in Connection with Claim for Disability Benefits, from the Veteran’s former employer which documented that he last worked in September 2014. Thus, the record reflects the Veteran was employed proximate to the appeal period, but has not been employed during the appeal period at issue. Turning to the non-economic component, specifically as to the Veteran’s education and employment, in the VA Form 21-8940, Veteran’s Application for Increased Compensation based on Unemployability, dated in December 2015, the Veteran reported he had four years high school education, and that he previously worked at janitor from 2004 to 2014. During the October 2015 VA examination, the Veteran reported, in part, he entered the military with a high school diploma, and following his discharge, he was employed in a variety of jobs, including construction, day labor, and farm work. During the November 2020 VA examination, the Veteran reported after separating from service, he worked in construction, as a truck driver, and at other odd jobs, and from 2004 to 2014, he worked as a janitor at a school. Also, of record is a May 2020 VA Form 21-4192, Request for Employment Information in Connection with Claim for Disability Benefits, from the Veteran’s former employer, which reflects the Veteran performed custodial work from July 2004 to September 2014. The Veteran is service-connected for unspecified anxiety disorder, rated as 30 percent disabling from April 24, 2014 and his combined evaluation for compensation mirrors his unspecified anxiety disorder rating. Therefore, the Veteran does not meet the schedular criteria for a TDIU at any time during the appeal period. 38 C.F.R. § 4.16(a). After careful consideration, the Board finds there is no plausible evidence of record that the Veteran’s service-connected unspecified anxiety disorder has prevented him from securing and following substantially gainful employment. As such, referral for consideration of entitlement to a TDIU on an extraschedular basis is also not warranted under 38 C.F.R. § 4.16(b). Specifically, the October 2015 and November 2020 VA examination reports found the Veteran’s unspecified anxiety disorder resulted in symptomology not severe enough either to interfere with occupational and social functioning or to require continuous medication, which is not indicative any interference with employment. Additionally, the November 2020 VA examiner also found the Veteran had no job related difficulties secondary to service connected mental health issues. However, as discussed above, a June 2015 private examination report found the Veteran’s PTSD symptoms had caused significant disturbances in all areas of his life and that he was considered to be permanently disabled. An October 2015 private examination report also noted the Veteran was considered to be permanently disabled. However, the October 2015 private examination report, signed by the same two examiners who also signed the June 2015 private examination report, noted, in part, the Veteran had to leave his job due to knee and shoulder pain, thus it is unclear whether the Veteran was found to be “permanently disabled” in the private examination reports, from, at least, in part, a knee and/or shoulder disability. Further, the phrase “permanently disabled” utilized in the private examination reports was not defined in these reports and is not the correct standard for a TDIU. Thus, for these reasons, the private examination reports lack probative value in terms of the TDIU claim. Further, as discussed above, the record reflects the Veteran was employed, from July 2004 to September 2014, as a janitor at a school. Specifically, a May 2020 VA Form 21-4192, Request for Employment Information in Connection with Claim for Disability Benefits, received from the Veteran’s former employer, reflected the Veteran was not working due to regular retirement. Further, in the May 2020 VA Form 21-4192, the Veteran’s former employer did not indicate the Veteran had lost time during 12 months preceding last date of employment due to disability or that any concessions had been made to the Veteran by reason of age or disability. Additionally, as to the Veteran’s unspecified anxiety disorder, as discussed above, an October 2015 VA examiner documented that the Veteran reported relationships with co-workers and supervisors through the years were characterized as mostly positive and productive, which is not indicative interference with employment. In this regard, the September 2019 Memorandum Decision specifically concluded that Board provided an inadequate statement of reasons or bases for its TDIU determination. Specifically, that the Board found that the Veteran’s work history from 2004 to 2014 was probative of its decision to deny TDIU, but failed to adequately explain why this employment before the appeal period was relevant to its determination and remand was required for the Board to provide an adequate statement of reasons or bases. Thus, the Board is providing the following reasoning. First, the Veteran’s work history, albeit prior the appeal at issue, is proximate to the appeal period, and thus is relevant. See Romanowsky, 26 Vet. App. at 294. Specifically, the record reflects the Veteran retired in September 2014, and the appeal period for consideration is from April 24, 2015, which is a temporal gap of several months. Second, although the Veteran reported during the October 2015 private examination, that since he did not have work to distract, he thought more about his time in the military, there is no evidence which specifically reflects the severity of the Veteran’s service-connected unspecified anxiety disorder symptomology has fluctuated over time. In this regard, the October 2015 and November 2020 VA examination reports, dated over five years apart, provided consistent symptomology. Thus, although no evidence is of record dated during the period when the Veteran was last employed, as the evidence reflects his symptomology has not fluctuated over the appeal period, it tends to reflect his symptomology is likely generally consistent with the symptomology when he was employed. Moreover, in June 2015 statements, the Veteran generally described his symptomology onset in February 1968, while he was serving in Germany, when he learned of the death of a hometown friend of killed in action in Vietnam and since that time he had struggled, and recounted his symptoms such as nightmares, reliving the experience due news stories and movies, being concerned with his personal safety, withdrawing from family and friends, and he struggling with his temper. As such, the evidence tends to reflect that the Veteran’s current symptomology is likely consistent with the symptomology experienced since the event in February 1968, including when he was employed in July 2004 to September 2014, and thus, would not preclude employment. Further, the record also reflects the Veteran retired from his last job due to physical non service-connected disabilities, which, rather than his service-connected unspecified anxiety disorder, prevented his ability to continue work with his former employer. Specifically, as discussed above, the October 2015 private examination report, noted, in part the Veteran had to leave his job due to knee and shoulder pain. Similarly, an October 2015 VA examiner also documented that the Veteran indicated that he stopped working due to medical problems, and a November 2020 VA examiner documented the Veteran reported he retired in 2014, as the work became too physically tasking. However, the Veteran is not service connected for any physical disabilities, to include of either knee and/or shoulder, and such disability is not for consideration. Accordingly, this evidence weighs against the claim for a TDIU. Having considered the medical and lay evidence of record, the Board finds the Veteran’s service-connected unspecified anxiety disorder, did not preclude him from securing or following a substantially gainful occupation consistent with his education and vocational background. In terms of the occupational economic component, as discussed above, the Board has found the Veteran was not employed proximate to the appeal period but not during the appeal period. However, in terms of the non-economic component, the limitations documented as resulting from the Veteran’s service-connected unspecified anxiety disorder are not reflective of limitations that would preclude him from securing or following a substantially gainful occupation consistent with his education and vocational background, in particular, with his prior usual occupation in custodian work. Instead, as discussed, the evidence reflects the Veteran retired from his prior job due to non service-connected physical disabilities. While the Veteran believes he is unable to secure and follow a substantially gainful occupation due to his service-connected unspecified anxiety disorder, he not competent to provide an opinion in this case. The issue is medically complex, as it requires specialized medical education. See Jandreau, 492 F. 3d at 1376-77. Therefore, it is outside the competence of the Veteran in this case because the record does not show he has the medical training or credentials to make such a determination. Consequently, the Board gives more probative weight to the competent medical evidence, to include the November 2020 VA opinion. Further, the Veteran, during the November 2020 examination report, denied that his anxiety prevented him from doing anything he would like to do. In consideration of the evidence, the Board finds that there is no plausible evidence that the Veteran’s service-connected unspecified anxiety disorder precludes him from securing or following a substantially gainful occupation, consistent with his educational and vocational history. Therefore, referral to the Director, Compensation Service, for extraschedular consideration is not warranted. 38 C.F.R. § 4.16(b). As the preponderance of the evidence is against the claim for entitlement to a TDIU, the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3; Gilbert, 1 Vet. App. at 55-57. Accordingly, entitlement to a TDIU is denied. M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Espinoza, 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.