Citation Nr: 21003884 Decision Date: 01/25/21 Archive Date: 01/25/21 DOCKET NO. 18-05 573 DATE: January 25, 2021 ORDER Entitlement to a rating in excess of 50 percent for a major depression disorder (depression), is denied. Entitlement to a rating in excess of 10 percent prior to April 22, 2015, for low back strain (low back disability), is denied. Entitlement to a rating in excess of 10 percent from September 1, 2015 to February 11, 2019, for low back strain (low back disability), is denied. Entitlement to a rating in excess of 20 percent from February 11, 2019, for low back disability, is denied. Entitlement to a rating in excess of 20 percent from April 20, 2015 and onward, for radiculopathy of left lower extremity, is denied. Entitlement to an initial compensable rating prior to April 18, 2017, for a scar associated with the lumbar spine, is denied. Entitlement to an initial compensable rating from April 18, 2017, but no earlier, for a scar associated with the lumbar spine, is granted. Entitlement to an initial rating in excess of 10 percent since April 18, 2017, for a scar associated with the lumbar spine, is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities, is denied. FINDINGS OF FACT 1. During the appeal period, the Veteran’s depression more nearly approximated occupational and social impairment with reduced reliability and productivity due to such symptoms as: depressed mood, chronic sleep impairment, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. 2. Prior to April 22, 2015, the Veteran’s service-connected low back disability was manifested by forward flexion of the lumbar spine of 90 degrees, with pain occurring at 70 degrees, at worst. 3. From September 1, 2015 to February 11, 2019, the Veteran’s low back disability was manifested by forward flexion of the lumbar spine of 80 degrees at worst. 4. From February 11, 2019, the Veteran’s low back disability has been manifesting by forward flexion of the lumbar spine of 55 degrees at worst. 5. The Veteran’s radiculopathy of left lower extremity approximated a moderate incomplete paralysis throughout the entire appeal period. 6. Prior to April 18, 2017, the Veteran’s scar associated with his low back disability was linear and not painful or unstable. 7. Resolving all reasonable doubt in favor of the Veteran, his lumbosacral area scar has manifested with symptoms of pain from April 18, 2017. 8. From April 18, 2017, the Veteran’s scar associated with his low back disability has been noted as linear and painful, but not unstable. 9. The Veteran’s service-connected disabilities have not precluded him from securing or maintaining substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 50 percent for depression 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 (DC) 9434. 2. The criteria for a rating in excess of 10 percent prior to April 22, 2015 (a temporary total rating was in effect from April 22, 2015 to September 1, 2015), a rating in excess of 10 percent from September 1, 2015 to February 11, 2019, and a rating in excess of 20 percent from February 11, 2019, for low back disability, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5237. 3. The criteria for a rating in excess of 20 percent from April 20, 2015 for radiculopathy of the left lower extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.124a, DC 8520. 4. The criteria for an initial compensable rating from prior to April 18, 2017, for a scar associated with a service-connected low back disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.16, 4.118, DCs 7804, 7805. 5. The criteria for a rating of 10 percent, but no higher, from April 18, 2017, for a scar associated with a service-connected low back disability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.16, 4.118, DCs 7804, 7805. 6. The criteria for a rating in excess of 10 percent from April 18, 2017, for a scar associated with a service-connected low back disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.16, 4.118, DCs 7804, 7805. 7. 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, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from July 1979 to July 2001. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from August 2015 and July 2017 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that in December 2015, the Veteran submitted a Notice of Disagreement (NOD) with the August 2015 rating decision that awarded a 100 temporary total rating for his low back disability from April 22, 2015 to August 31, 2015 and a 10 percent rating from September 1, 2015. The rating decision also granted service connection for lumbosacral area scar rated noncompensable from April 22, 2015, and an increased rating to 20 percent from April 20, 2015 for radiculopathy of left lower extremity. For the low back disability, the Board notes that in order to address the procedural development presented in this case and the stage ratings on appeal, the Board will address the issues as entitlement to an increased rating in excess of 10 percent prior to April 22, 2015 and from September 1, 2015 to February 11, 2019, and entitlement to an increased rating in excess of 20 percent from February 11, 2019. Increased ratings Ratings are based on a schedule of reductions in earning capacity from specific injuries or combination of injuries. The ratings shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations. 38 U.S.C. § 1155. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. 1. Entitlement to an increased rating for depression. The Veteran seeks a rating in excess of 50 percent for his depression. The appeal period before the Board begins on April 18, 2017, the date of the claim for service connection. The Veteran appealed for a higher initial rating. The Veteran’s depression has been rated at 50 percent, under the General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130, DC 9434. Under DC 9434, a 50 percent rating is warranted for 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; difficulty in establishing and maintaining effective work and social relationships. Id. 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 a work-like setting); inability to establish and maintain effective relationships. Id. 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 inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. The rating of psychiatric disorders is ultimately based upon their resultant level of occupational and social impairment. 38 C.F.R. § 4.130; Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117-18 (2013). The evaluation, however, is symptom-driven, meaning that the symptomatology should be the fact-finder’s primary focus in determining the level of occupational and social impairment. Id. at 116-17. This includes consideration of the frequency, severity, and duration of those symptoms. 38 C.F.R. § 4.126(a); Vazquez-Claudio, 713 F.3d at 117. Significantly, however, the symptoms enumerated in the rating criteria are merely examples of those that would produce such level of impairment; they are not exhaustive, and VA is not required to find the presence of all, most, or even some of the enumerated symptoms to assign a particular evaluation. Id. at 115; Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002). Turning to the evidence of record, the Veteran initially underwent a psychiatric VA examination in June 2017. With regards to the Veteran’s social functioning, he reported that he has been married for 33 years. He also reported that he has two brothers and sisters, one child, and three grandchildren. He had problems with aggression in 1985 but reported currently being passive. As for occupational impairment, the Veteran reported that since his separation from service he has worked as an information technology security consultant and that he is currently employed in retail on part-time basis. During the examination, the Veteran’s primary complaints were mood swings and problems with concentration. The examiner reported that the following symptoms were present: depressed mood, chronic sleep impairment, disturbances of motivation and mood, and difficulty in adapting to stressful circumstances, including work or worklike setting. The examiner noted that the Veteran was oriented to person, time, place, and situation. His motor status was normal, and his thought process was organized. His speech was coherent, and mood and affect were appropriate. The Veteran had a cooperative attitude. His memory was intact, and judgment and insight were fair. He reported no suicidal ideations. The examiner opined that the Veteran’s depression manifested in occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during period of significant stress, and symptoms are controlled by medication. The Veteran reported taking medication as prescribed. The Veteran underwent another psychiatric VA examination in April 2019. With regards to social functioning, the Veteran reported that he and his wife have had marital discord issues. However, he also reported mostly engaging in social activities, to include going to the movies and dining out. The Veteran reported speaking to his siblings on weekly basis and staying in contact with his former military friends. As to employment, the Veteran reported being unemployed since November 2018. He stated that he had “challenges” with managerial staff, and he was replaced with another consultant. At the examination, the examiner described the following symptoms: depressed mood, anxiety, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. The examiner noted that the Veteran was cooperative and respectful throughout the assessment. He was dressed appropriately, and his hygiene and grooming were within normal limits. During the session, the Veteran maintained good eye contact and tracked questions and conversations well. The examiner further reported that the Veteran was oriented to person, place, time and situation. His mood was euthymic and his affect congruent with the mood. The Veteran’s speech was coherent and normal in rate and volume. He presented no signs of unusual thought processes, delusional qualities or flights of ideas. The Veteran demonstrated no evidence of impairments with immediate or remote memory. His attention and concentration were within normal limits. The examiner noted a history of intermittent passive suicidal ideations. However, the Veteran denied any history of active suicidal or homicidal behavior, or current intent. He also denied any auditory and visual hallucinations. The examiner concluded that the Veteran’s symptoms present occupational and social impairment with reduced reliability and productivity. The Veteran received ongoing VA treatment for his depression. VA treatment records during the appeal period are generally consistent with the symptoms endorsed by the Veteran during the June 2017 and April 2019 VA examinations. The records during that time frame show that the Veteran appeared well-groomed. The Veteran had good insight, cooperative attitude and logical thought process. He was oriented to time, place, and person. The Veteran’s speech, attention and concentration were within normal limits. He presented no evidence of psychomotor agitation or retardation. A February 2019 VA treatment record shows that the Veteran reported engaging in his interests and spending time with an old friend. While a January and April 2019 VA treatment records show that the Veteran reported a brief symptom of suicidal ideations and struggling with it at times, he stated that “[he] never really gave it any traction.” As evidenced with his VA treatment records, the Veteran otherwise consistently denied any suicidal or homicidal ideations throughout the appeal period. He also denied any delusions and hallucinations. The Veteran’s VA treatment records reflect his reports of marital and family relationships being affected due to self-distancing and withdrawal. However, the records do not show an inability to establish or maintain effective relationships. The Board finds that the Veteran’s depression has been properly evaluated at 50 percent throughout the appeal period. The Veteran’s depression has been manifested by symptoms such as depressed mood, chronic sleep impairment, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. Further, the Board notes that the April 2019 VA examiner reported occupational and social impairment with reduced reliability and productivity due to the Veteran’s symptoms, rather than occupational and social impairment with deficiencies in most areas. The Veteran’s symptoms have not more nearly approximated the criteria for a rating in excess of 50 percent at any time, and the evidence is not evenly balanced. As noted, throughout this appeal period, the Veteran was alert, well-oriented, and well-groomed. While the Veteran reported a brief instance of suicidal ideations, he discarded the idea and it did not cause any occupational and social impairment. In addition, the Veteran did not exhibit illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; spatial disorientation; or neglect of personal appearance and hygiene. In terms of occupational impairment, it is acknowledged that on one occasion the examiner noted that the Veteran experienced difficulty in adapting to stressful circumstances, including work or worklike setting. Nonetheless, the Veteran’s disability picture overall consistently shows symptoms more nearly approximating the assigned 50 percent rating. Although the Veteran reports that his symptoms, to include depressed mood, affected his occupational functioning because of his tendency to self-isolate, the evidence does not demonstrate significant occupational impairment due solely to his depression symptoms. Additionally, the April 2019 VA examiner found the Veteran’s symptoms only cause occupational and social impairment with reduced reliability and productivity. The VA opinion is considered competent and highly probative as the examiner is skilled to render such assessments, based on the review of the claims file and conducted interviews and evaluations of the Veteran. The cumulative evidence of record shows that the Veteran’s overall level of occupational and social functioning is consistent with the moderate degree of impairment that is contemplated by a 50 percent rating. Thus, while the Board acknowledges that the Veteran’s disturbances in mood and motivation affect his occupational and social functioning, his depression symptoms alone do not cause significant occupational and social impairment such as that contemplated by the 70 or 100 percent rating criteria. As noted, the Board acknowledges the Veteran’s brief reports of suicidal ideations and difficulty in adapting to stressful circumstances, including work or worklike setting, which are symptoms enumerated in the 70 percent criteria. However, VA must engage in a holistic analysis in which it assesses the severity, frequency, and duration of the signs and symptoms, quantifies the level of occupational and social impairment caused by those symptoms, and assigns an evaluation that more nearly approximates that level of occupational and social impairment. See Bankhead v. Shulkin, 29 Vet. App. 10, 20 (2017). As such, while the Veteran has demonstrated symptoms of passive suicidal ideations, by the Veteran’s own account, he never gave those thoughts any “traction,” and his VA treatment reports, and examination reports do not frequently show suicidal ideation. Overall, his disability picture does not present other symptoms that amount to occupational and social impairment with deficiencies in most areas. In sum, the severity, frequency, and duration of the Veteran’s symptoms do not result in the level of occupational and social impairment contemplated by a rating in excess of 50 percent. There is no doubt to be resolved; a higher rating is not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3, 4.7; Hart v. Mansfield, 21 Vet. App. 505 (2007). 2. Entitlement to an increased rating for low back disability. The Veteran seeks higher ratings for his low back disability. As an initial matter, the Veteran was granted service connection for his low back disability in an April 2005 rating decision. VA received the Veteran’s claim for an increased rating due to his back surgery on April 20, 2015. The RO granted a temporary 100 percent disability rating for his low back disability effective from the date of the surgery, April 22, 2015. Subsequently, the RO assigned a 10 percent rating effective from September 1, 2015 (the first day of the month after the Veteran’s convalescence period ended per August 2015 VA examination), in an August 2015 rating decision. The Veteran timely appealed. Thus, the Board will address the beginning of the appeal period, April 20, 2014, one year prior to the date of receipt of the claim, and the period effective from September 1, 2015. Under the relevant laws and regulations, when evaluating joint disabilities rated on the basis of limitation of motion, VA must consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). “Although pain may cause a functional loss, pain itself does not constitute functional loss.” Mitchell v. Shinseki, 25 Vet. App. 32, 37 (2011) (emphasis in original). Painful motion is deemed to be limitation of motion and warrants the minimum compensable rating for the joint, even if there is no actual limitation of motion. 38 C.F.R. § 4.59; Lichtenfels v. Derwinski; 1 Vet. App. 484, 488 (1991). The provisions of 38 C.F.R. § 4.59 relating to painful motion are not limited to arthritis and must be considered when raised by the claimant or when reasonably raised by the record. Burton v. Shinseki, 25 Vet. App. 1 (2011). The Board must also consider whether VA examiners have elicited information concerning the “severity, frequency, duration, or functional loss manifestations” of such flare-ups. Sharp v. Shulkin, 29 Vet. App. 26 (2017). Disabilities of the spine (other than IVDS when evaluated on the basis of incapacitating episodes) are to be rated under the General Rating Formula for Diseases and Injuries of the Spine. 38 C.F.R. § 4.71a, DCs 5235-5243. These criteria are to be applied irrespective of whether there are symptoms such as pain (whether or not it radiates), stiffness, or aching in the affected area of the spine, and they “are meant to encompass and take into account the presence of pain, stiffness, or aching, which are generally present when there is a disability of the spine.” 68 Fed. Reg. 51, 454 (Aug. 27, 2003). Under the General Rating Formula, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine 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 warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine 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 assigned where forward flexion of the thoracolumbar spine is 30 degrees or less, or if there is favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine, while a 100 percent rating is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula. Additionally, any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under the appropriate diagnostic codes. Id. at Note (1). 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 normal combined range of motion of the thoracolumbar spine is 240 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. 38 C.F.R. § 4.71a, DC 5242, Note (2). Intervertebral disc syndrome (IVDS) is evaluated under either the General Rating Formula or under the IVDS Formula, whichever results in the higher evaluation when all disabilities are combined. 38 C.F.R. § 4.71a. An incapacitating episode is defined as 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, DC 5243, Note (1), Formula for Rating IVDS Based on Incapacitating Episodes. Under the IVDS Formula for intervertebral disc syndrome, a 10 percent disability rating is warranted when there are incapacitating episodes having a total duration of at least 1 week but less than 2 weeks during the past 12 months. A 20 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months. A 40 percent rating is warranted for incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. A maximum 60 percent rating is warranted for incapacitating episodes having a total duration of at least six weeks during the past 12 months is warranted. 38 C.F.R. § 4.71a, DC 5243. An incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome which requires bed rest prescribed by a physician and treatment by a physician. a. Prior to April 22, 2015 As previously noted, the Veteran’s low back disability claim was received on April 20, 2015, and the RO assigned a temporary total rating (100 percent) from April 22, 2015 to September 1, 2015. As such, the Board will focus its analysis on whether the Veteran’s rating of 10 percent for his low back disability was proper from April 20, 2014 to April 22, 2015. Based on the review of the evidence of record, the Board finds that the Veteran’s low back disability was properly rated at 10 percent prior to April 22, 2015. During this time period, the evidence does not demonstrate that the Veteran’s lower back disability was manifested by forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine 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. It is acknowledged that the Veteran’s private treatment records show that the Veteran begun to have recurrent symptoms in June 2014. See March 2015 private treatment record. The Veteran underwent MRI, epidural steroid injections and physical therapy. The Veteran reported buttock and left leg pain. He denied any pain in his back. The MRI of the lumbar spine showed evidence of lateral recess stenosis. On examination, muscle strength was normal and altered sensation in S1 area was noted. The Veteran requested to proceed with a surgical intervention. The Veteran reported his pain level from 6 out of 10 to 10 out of 10. See April 2015 private treatment record. The pain aggravating factors were bending/flexion, carrying, extension, twisting, sitting, standing, and walking. The Veteran reported tingling in his left foot. On examination, pain with motion was noted on active ROM. However, muscle strength was 5 out of 5, with the exception of 4 out of 5 in the left ankle. The Veteran was administered a transforaminal epidural injections to left L5 and S1 areas of his spine. A radiological examination of the lumbar spine showed severe degenerative disc disease in the L4-5 of the Veteran’s spine. See March 2015 private treatment record. Evidence of lumbar spine instability was not noted. While the reports document the Veteran’s complaints of pain and treatment received for his pain, the medical records do not show objective findings of a low back disability that is contemplated by a rating in excess of 10 percent. The evidence does not demonstrate increased impairment on flexion or other increased functional impairment, as contemplated by the criteria for the assignment of a 20 percent rating. Accordingly, the Board finds that the assignment of a higher rating prior to April 22, 2015, is not warranted. b. From September 1, 2015 to February 11, 2019 The Veteran underwent another VA examination in August 2015. The Veteran reported symptoms pertaining to his lumbar spine disability, including pain and numbness down his left leg. It was noted that he has had epidural steroid injections in the past. The Veteran had his second decompression surgery in April 2015. The first surgery helped to alleviate the Veteran’s symptoms by about 40 percent. The second surgery helped some but not significantly. The Veteran reported flare-ups during which his average pain level is 8 out of 10 without medication and 5 out of 10 with medication, with sharp intermittent pain in his left leg. He also reported constant numbness in his left extremity. The VA examiner assessed the Veteran’s ROM for forward flexion from 0 to 80 degrees, for extension from 0 to 10 degrees, for both right and left lateral flexion from 0 to 15 degrees, and for both right and left lateral rotation from 0 to 15 degrees. The examiner noted pain which caused functional loss was exhibited on all ROM assessments. The examiner found no evidence of localized tenderness or pain on palpation of the thoracolumbar spine. The Veteran was able to undergo repetitive use testing, and the examiner reported that there was no additional loss of function or ROM. The examiner found that the pain, weakness, fatigability or incoordination do not significantly limit the Veteran’s functional ability with flare-ups. No muscle spasms or guarding was found. The muscle strength testing found the Veteran to have 4 out of 5 for hip flexion on both the left and right side, and normal 5 out of 5 strength for all other muscle strength testing and he was not found to have muscle atrophy. The Veteran was found to have radiculopathy manifested by moderate numbness and pain in his left lower extremity. The Veteran was not found to have ankylosis or IVDS. The Veteran reported regularly utilizing a cane and occasionally a walker for his thoracolumbar spine disability. A review of the Veteran’s VA treatment records does not show any further limitations of the Veteran’s functional ability as it pertains to his lumbar spine disability, nor do they show any different findings pertaining to ROM of the Veteran’s thoracolumbar spine. See e.g. April 2016 VA treatment record. Upon review of the evidence of record, the Board finds that, after September 1, 2015 but prior to February 11, 2019, a rating in excess of 10 percent is not warranted. As noted during August 2015 VA examination, the Veteran’s ROM for forward flexion of the thoracolumbar spine was 80 degrees and his combined ROM was 230 degrees, which aligns with a 10 percent disability evaluation. A rating of 20 percent would require forward flexion of the thoracolumbar spine of greater than 30 degrees but not greater than 60 degrees, and a combined ROM of the thoracolumbar spine not greater than 120 degrees. The Veteran also did not have guarding or muscle spasm of the thoracolumbar spine, which is contemplated by the 20 percent rating. The Board has also considered whether a higher disability evaluation is warranted on the basis of functional loss due to pain, weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40 and 4.45 for the Veteran’s lumbar strain. See DeLuca, supra; see also Mitchell, supra. Nonetheless, the evidence shows that while the Veteran has been noted to have chronic pain, he did not report any functional loss to warrant a higher disability rating. Specifically, at August 2015 VA examination, the examiner noted that even though the examination was not conducted during flare-ups, pain, weakness, fatigability, or incoordination do not significantly limit his functional ability with flare-ups. Additionally, throughout the period on appeal, the Veteran’s lumbar spine disability has not been found to manifest by ankylosis or IVDS with any incapacitating episodes lasting for any sustained period, to include over a week during any 12-month period. As such, the Board finds that the preponderance of the evidence is against an assignment of a rating in excess of 10 percent prior to February 11, 2019. Accordingly, the benefit-of-the doubt doctrine does not apply, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, supra. c. After February 11, 2019 The Veteran underwent an updated VA examination in July 2019. The Veteran reported continuous pain and spasms in lumbosacral area. He reported numbness, tingling and radiating pain in left foot. The Veteran also reported experiencing sudden, sharp pain more prevalent on the left and cramping in his left lower extremity. The Veteran was noted to experience moderate to severe flare-ups that are alleviated with minimizing movement, applying heat, taking pain medication, and resting. The examiner assessed the Veteran’s ROM for forward flexion from 0 to 55 degrees, for extension from 0 to 30 degrees, for right lateral flexion from 0 to 25 degrees, for left lateral flexion from 0 to 30 degrees, and for both right and left lateral rotation from 0 to 30 degrees. The examiner noted pain which caused functional loss and was exhibited on all ROM assessments. The examiner found no evidence of localized tenderness or pain on palpation of the thoracolumbar spine. The Veteran was able to undergo repetitive use testing, and the examiner reported that there was no additional loss of function or ROM. The examiner found that pain contributed to functional loss over time. The functional impact of the Veteran’s condition was noted as reduced capacity for tasks that require lifting, walking, standing, repeated bending, or ambulating over uneven terrain. The examiner also found that pain and lack of endurance would significantly limit the Veteran’s functional ability with flare-ups, but was not able to describe the loss in terms of ROM, stating that, after reviewing the Veteran’s records and subjective complaints and using own medical knowledge and expertise, there is insufficient basis to estimate ROM for each plane of motion. The Veteran was found to have muscle spasms or guarding of the thoracolumbar spine. However, muscle spasm was noted not to result in abnormal gait or spinal contour. The muscle strength testing found the Veteran to have 5 out of 5 strength for hip flexion on both the left and right side, and normal 5 out of 5 strength for all other muscle strength testing and he was not found to have muscle atrophy. The Veteran was found to have decreased sensation to light touch on his left lower extremity, and normal sensation to light touch on his right lower extremity. The Veteran was also found to have radiculopathy manifested by moderate numbness, pain, and paresthesias and/or dysesthesias in his left lower extremity. He was not found to have ankylosis or IVDS. The Veteran reported regularly utilizing a cane for his lumbar spine disability. The Veteran’s VA treatment records after February 11, 2019 show that his back symptoms are “tolerable.” See August 2019 VA medical record. The Veteran consistently reported chronic back pain and daily medication regimen. See e.g. September 2019 VA medical record. He also reported experiencing muscle spasms and cramping in his back. See August 2019 VA medical record. However, there is no evidence of any other symptoms or objective findings consistent with a 40 percent or higher rating. Thus, the Board finds that the preponderance of the evidence is against a rating in excess of 20 percent for the Veteran’s low back disability after February 11, 2019. As noted during July 2019 VA examination, the Veteran’s ROM for forward flexion of the thoracolumbar spine was 55 degrees and no ankylosis was noted, which aligns with a 20 percent disability evaluation. A rating of 40 percent would require forward flexion of the thoracolumbar spine of 30 degrees or less, or ankylosis of the entire thoracolumbar spine. In addition, while the Veteran was noted to have guarding or muscle spasm, it was not noted to result in abnormal gait or spine contour, which is required for a 20 percent disability rating. As the evidence of record does not show any reports of incapacitating episodes, no consideration was given to assigning rating under the Formula for IVDS. The Board has also considered whether repetitive motion or flare-ups resulted in additional functional loss due to symptoms such as pain, swelling, weakness, fatigue, or incoordination. As demonstrated during the examinations, the Veteran had pain on motion, but there is no indication that the pain resulted in additional functional loss, to include a greater loss of flexion, so as to warrant a higher rating. The Board finds that such factors do not result in functional loss more nearly approximating ankylosis, including unfavorable ankylosis. As such, there is no evidence that the Veteran’s spine is fixed in position or ankylosed. The Board recognizes that the Veteran believes that he is entitled to higher ratings. However, the Veteran’s lay evidence regarding his symptoms is outweighed by the competent and credible medical evidence that evaluates the extent of impairment due to his low back disability. Layno v. Brown, 6 Vet. App. 465, 470 (1994). In this regard, the Board notes that the VA examiners and treating medical professionals have the training and expertise necessary to administer the appropriate tests for a determination of the type and degree of the impairment associated with the Veteran’s complaints. For these reasons, greater evidentiary weight is placed on the examination findings as to the type and degree of his low back disability impairment. Based on the foregoing, the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 20 percent after February 11, 2019 for his low back disability. In reaching this conclusion, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, supra. Thus, the claim must be denied.   3. Entitlement to a rating in excess of 20 percent from April 20, 2015 and onward, for radiculopathy of left lower extremity. The Veteran seeks a higher rating for radiculopathy of his left lower extremity. The Veteran’s radiculopathy is currently rated as 20 percent disabling under DC 8520, paralysis of the sciatic nerve. Under DC 8520, mild incomplete paralysis is rated 10 percent disabling, moderate incomplete paralysis is rated 20 percent disabling, moderately severe incomplete paralysis is rated 40 percent disabling, and severe incomplete paralysis (with marked muscular atrophy) is rated 60 percent disabling. An 80 percent rating is warranted where there is complete paralysis and “the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost.” Turning to the evidence of record, the Veteran underwent a VA examination for his low back disability in August 2015. The examiner noted radiculopathy of left lower extremity. The examination report shows moderate constant pain, severe intermittent pain, and moderate numbness. The examiner noted that the Veteran has objective pain and numbness in his left leg. Muscle strength was 4 out of 5 throughout his left lower extremity. Deep tendon reflexes were absent in the left ankle. Light touch was normal in his feet and toes. The Veteran had no muscle atrophy and no trophic changes. The Veteran underwent a VA examination for his radiculopathy of left lower extremity in July 2019. The examination revealed moderate, constant pain and moderate paresthesias and/or dysesthesias in the lower left leg. No intermittent pain was noted. The examiner noted moderate numbness and muscle strength, which was 5 out of 5 throughout his left lower extremity. The Veteran had no muscle atrophy and no trophic changes. Deep tendon reflexes were hypoactive in the left knee. Light touch was decreased in his left foot and toes. The examiner concluded that the Veteran had radiculopathy of lower left extremity that resulted in moderate incomplete paralysis. The examiner indicated that the Veteran’s radiculopathy does not result in functional impairment in his left lower extremity. The Board finds that the Veteran’s symptoms throughout the entire appeal period do not warrant an assignment of a rating in excess 20 percent. The Board acknowledges that severe intermittent pain was noted in August 2015. However, the evidence of record overall establishes that the Veteran’s radiculopathy of the left lower extremity has been productive of no more than moderate impairment. The same examination report dated in August 2015 also describes the Veteran’s impairment as moderate numbness and moderate pain. Other findings were normal. Additionally, findings in July 2019 show no more than moderate impairment. In fact, after examination, the examiner characterized the disability as moderate. In sum, the Board finds that a rating higher than 20 percent is not warranted as the Veteran’s radiculopathy of the left lower extremity has at no point during the appeal period more nearly approximated moderately severe impairment. At no time was radiculopathy of his left lower extremity described as moderately severe or severe by the examiners, nor does the Board find that the probative and persuasive evidence of record support a higher rating. Accordingly, the claim must be denied. 4. Entitlement to an initial compensable rating from April 22, 2015, and in excess of 10 percent from February 11, 2019, for a scar associated with the lumbar spine. The Veteran seeks higher initial ratings for a scar associated with his low back disability. Scars are rated under 38 C.F.R. § 4.118, schedule of ratings for disorders of the skin, under DC 7801, 7802, 7804, and 7805. Effective August 13, 2018, the rating criteria for skin disabilities were revised. See 73 Fed. Reg. 32, 592 (July 13, 2018). As this appeal was pending on August 13, 2018, the revised criteria are applicable, but only for the period beginning August 13, 2018. Under the version of the Schedule for Rating Disabilities in effect prior to August 2018, scars were rated under DCs 7800 to 7805. DC 7800 applied scars or disfigurement of the head, face, or neck. DC 7801 applied to burn scars or scars due to other causes, not of the head, face, or neck, that are deep and nonlinear. A minimum 10 percent rating was assigned for an area(s) of at least 6 square inches (30 sq. cm.) but less than 12 sq. inches (77 sq. cm.). A deep scar was associated with underlying soft tissue damage. DC 7802 applied to burn scars or scars due to other causes, not of the head, face, or neck, that are superficial and nonlinear. A 10 percent rating was assigned for area(s) of 144 sq. inches (929 sq. cm.). DC 7804 pertains to unstable or painful scars. A 10 percent evaluation is assigned for one or two scars that are unstable or painful. A 20 percent evaluation is assigned for three or four scars that are unstable or painful. A 30 percent evaluation is assigned for five or more scars that are unstable or painful. Note (1): an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2): If one or more scars are both unstable and painful, 10 percent is added to the evaluation that is based on the total number of unstable or painful scars. Note (3): Scars evaluated under diagnostic codes 7800, 7801, 7802, or 7805 may also receive an evaluation under Diagnostic Code 7804, when applicable. DC 7805 applies to limitation of function of the affected part and specifically provides: Evaluate any disabling effect(s) not considered in rating provided under diagnostic codes 7800-04 under an appropriate diagnostic code. Under the post-August 2018 rating criteria, DCs 7800, 7804 and 7805 remain the same. DC 7801 was amended to state that burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are associated with underlying soft tissue damage, in an area or areas of at least 6 square inches (39 sq. cm.) but less than 12 square inches (77 sq. cm.) will be assigned a 10 percent rating. Notes (1) and (2) were amended, but not in a manner that is pertinent to this particular case. DC 7802 was amended to state that burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage in an area or areas of 144 square inches (929 sq. cm.) or greater will be assigned a 10 percent rating. Notes (1) and (2) were amended, but not in a manner that is pertinent to this particular case. The Veteran’s scar was rated noncompensable from April 22, 2015, under DC 7805, and 10 percent disabling from February 11, 2019, under DC 7804. Turning to the evidence of record, the Veteran’s scar was examined when he underwent a VA examination for his low back disability in August 2015. The examiner noted a scar in the S1 area of his back. The scar was reported as vertical and 9 centimeters in length, but not painful or unstable. He was assigned a noncompensable rating for his scar effective April 22, 2015. In his Statement in Support of Claim, received on April 18, 2017, the Veteran reported that the scar in his lumbosacral area is “numb, sore, hard/tight and mushy/unstable.” In addition, during his June 2017 VA examination for the Veteran’s service-connected depression, the examiner noted reports of “the nerve pain cause[ing] weirdness in the scar area.” Subsequently, the Veteran underwent a VA examination for his lumbosacral area scar in July 2019. The Veteran reported having a scar on his back from lumbar spine decompression surgeries in May 2006 and April 2015. The scar was reported on the posterior trunk, measuring 4.5 centimeters in length. The scar was noted as painful with superimposed, sharp pain, but it was not noted as unstable. The examiner noted that the Veteran’s scar does not result in limitation of function; nor does it impact his ability to work. The RO assigned a 10 percent rating from February 11, 2019, based on the examination results showing one painful scar. In order to warrant a higher rating under DC 7804 after February 11, 2019, there would need to be three or four scars that are unstable or painful. As the record shows only one painful scar, a rating higher than 10 percent is not warranted. However, the Board finds that the Veteran is entitled a 10 percent rating prior to February 11, 2019. As noted, the evidence of record shows that the Veteran has reported numbness, soreness, tightness, and instability associated with the low back scar in his Statement in Support of Claim, which was received on April 18, 2017. Further, the contemporaneous medical records show reports of pain in the scar area. See June 2017 VA examination. As such, the Board finds that there is competent and credible evidence showing that the Veteran’s symptoms more nearly approximated the criteria for a 10 percent rating on April 18, 2017, the date of receipt of the statement. However, a compensable rating under DC 7805 is not warranted prior to April 18, 2017. In fact, the Veteran’s low back scar was not painful or unstable at the August 2015 VA examination. The evidence indicates that the Veteran’s symptoms did not more nearly approximate a 10 percent rating until receipt of his April 18, 2017 statement. As such, when resolving doubt in the Veteran’s favor, a higher rating from the date of receipt of the Veteran’s statement, but no earlier, is warranted. The Board notes that evaluation under DC 7800 is not appropriate because the scar is not of the head, face, or neck. Evaluation under the former DC 7801 or DC 7802 is not appropriate as the scar is not nonlinear. Evaluation also is not warranted under the revised criteria of DC 7801 or DC 7802 as the scar does not meet the minimum area coverage requirements. As such, resolving doubt in favor of the Veteran, the evidence is in favor of a 10 percent rating for his low back scar from April 18, 2017. However, the preponderance of the evidence weighs against the assignment of a compensable rating for a scar of the lumbar spine prior to April 18, 2017 and since February 11, 2019. 5. Entitlement to a TDIU. A claim for TDIU is raised by the evidence of record. See February 2019 VA Form 21-8940 (VA 21-8940) (asserting that the Veteran’s service-connected disabilities render him unable to secure or follow any substantially gainful occupation). Rice v. Shinseki, 22 Vet. App. 447, 453 (2009). For the reasons that follow, the Board finds that the Veteran’s service-connected disabilities do not render him unable to obtain or maintain a substantially gainful occupation. Total disability ratings for compensation may be assigned when a veteran is unable to secure and follow a substantially gainful occupation.  See 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. In reaching such a determination, the central inquiry is “whether the Veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability.” See Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993); also see Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993) (the ultimate question is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether he can find employment). Additionally, entitlement to a TDIU is based on an individual’s particular circumstances. 38 C.F.R. § 4.16; Ray v. Wilkie, 31 Vet. App. 58, 72 (2019). Thus, in adjudicating a TDIU claim, VA must consider the individual veteran’s education, training, and work history, but not his or her age or the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. The phrase “unable to secure and follow a substantially gainful occupation” in 4.16 has both an economic and a noneconomic component.  Ray, supra. The economic component means an occupation earning more than marginal income outside of a protected environment. Id.  The noneconomic component concerns whether the Veteran is able to “secure or follow” gainful employment.  Id.  In determining whether a Veteran can secure and follow a substantially gainful occupation, in addition to the Veteran’s history, education, skill, and training, the Board should consider whether he or she “has the physical ability (both exertional and nonexertional) to perform the type of activities (e.g., sedentary, light, medium, heavy, or very heavy) required” to work in a substantially gainful occupation, and “whether the Veteran has the mental ability to perform the activities required” to work in a substantially gainful occupation.  Id.  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, this disability shall be ratable at 60 percent or more; 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).   When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant.  38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990).  In pertinent part, the Veteran is service-connected for: (1) major depression associated with low back strain, rated at 50 percent from April 18, 2017; (2) left lower extremity radiculopathy associated with low back strain, rated at 10 percent from February 23, 2006, and 20 percent from April 20, 2015; (3) low back strain, rated at 10 percent from September 1, 2015, and 20 percent from February 11, 2019; (4) right knee meniscal tear with degenerative arthritis, rated at 20 percent from February 12, 2019; (5) left knee meniscal tear with degenerative arthritis, rated at 20 percent from February 12, 2019; (6) lumbosacral area scar, rated at 10 percent from February 11, 2019; (7) anemia, rated noncompensable from February 27, 2004. The Veteran’s combined evaluation is 70 percent from February 11, 2019 and 80 percent from February 12, 2019. The schedular percentage criteria for a TDIU are met from February 11, 2019. The Board notes that while the Veteran’s combined evaluation was 100 percent from April 22, 2015 to September 1, 2015, the record shows that he was gainfully employed during that timeframe. See VA 21-8940. Thus, the crux of this case rests upon whether the Veteran is unable to secure or follow a substantially gainful occupation by reason of his service-connected disabilities after February 11, 2019. Turning to the evidence of record, the Veteran’s military occupational specialty (MOS) was a sonar technician. See DD Form 214. The Veteran primarily worked as an information technology consultant/SAP security analyst since his separation from active service. See May 2019 VA Form 21-4138 (VA 21-4138); VA 21-8940. He has also worked as a part-time computer repairman in retail. See June 2017 VA examination. With regards to the Veteran’s education level, he has a high school diploma. Id. While the Veteran has no additional education or training, the Board finds that he has the proficiency to work in an office-like setting, performing administrative or clerical work because of his extensive experience in the information technology field. As to the Veteran’s contentions, he asserts that his ability to secure and maintain gainful employment has been severely impacted by chronic back and knee pain, anxiety, depression, sleep apnea and PTSD. See VA 21-4138. As noted, when analyzing whether or not TDIU is warranted, impairment caused by nonservice-connected disabilities is not to be considered. See 38 C.F.R. §§ 3.341, 4.16. As such, the Board will not address the Veteran’s contentions with respect to disabilities that are not currently service-connected, to include anxiety, sleep apnea and PTSD. With regards to the Veteran’s low back disability, the Veteran underwent a VA examination in February 2019. The examiner concluded that the Veteran’s back disability impacts his ability to work. Specifically, the examiner noted that the Veteran has a reduced capacity for tasks that require prolonged lifting, standing or walking for longer than 15-20 minutes, repeated bending or ambulating over uneven terrain. Next, as to the Veteran’s bilateral knee disabilities, the Veteran underwent a VA examination in February 2017. The examiner concluded that the Veteran’s conditions impact his ability to perform occupational tasks. Significantly, the examiner noted that the Veteran is limited in running, kneeling, crawling, squatting, prolonged standing, prolonged walking, and high impact activities. In this case, the Board acknowledges that the Veteran’s low back and bilateral knee disabilities substantially impact his ability to perform physically challenging work and work requiring prolonged standing and walking. Nonetheless, the evidence does not show that these disabilities, or the Veteran’s other service-connected disabilities, preclude him from obtaining and retaining substantially gainful employment, such as sedentary employment in an office-like setting. The Veteran has work experience in the information technology field and the record does not show that his low back and bilateral knee disabilities would prevent him from working in an office setting, where physical exertion would be minimal. The Veteran’s other service-connected disabilities would not impact his ability to perform administrative or clerical tasks. For example, with respect to the Veteran’s contentions that he is unable to work due to his service-connected depression, as noted, the Veteran underwent psychiatric VA examinations in June 2017 and April 2019. As the schedular percentage criteria for a TDIU are met from February 11, 2019, the Board will focus its analysis on the April 2019 VA examination. Notably, the Veteran asserts that during his April 2019 examination he did not discuss the impact that decreased focus and concentration have on his job performance. See VA 21-4138. Nonetheless, the Board observes that the examiner reported that the Veteran’s attention and concentration were within normal limits. The examiner further reported the Veteran’s pertinent symptoms to include depressed mood, mild memory loss, anxiety, chronic sleep impairment, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. However, as to the occupational impact, the examiner concluded that the Veteran’s depression symptoms merely amount to occupational and social impairment with reduced reliability and productivity. As discussed in the prior section, the VA opinion is considered competent and highly probative because the examiner is skilled to render such assessments, based on the review of the claims file and conducted interviews and evaluations of the Veteran. Similarly, while the Veteran reported “challenges” between him and managerial staff, a supplemental June 2019 VA opinion noted that the Veteran does not have trouble with authority or anger. The examiner described the Veteran’s functional impairment as follows: difficulty attending to tasks and maintaining concentration due to depression and pain; isolation from others at work or having little interest or motivation; and potential fatigue due to sleep problems from pain and depression. Additionally, the Veteran’s VA treatment records show that he has a cooperative attitude, his thought process is logical and goal oriented, and his attention and concentration are within normal limits. See January 2019 VA treatment record. The Veteran’s treatment records also show that “[h]e is still looking for jobs with some progress in this area.” Id. Thus, as the objective, persuasive evidence substantiates the supplemental June 2019 VA opinion, the Board finds the VA opinion more probative. Based on the foregoing, the Board finds that the Veteran’s depression would not completely preclude employment in an office-like setting. While the evidence of record shows that the Veteran experiences depressed mood, disturbances in motivation, and difficulty in establishing and maintaining effective work relationships, he has been able to maintain substantially gainful employment through November 2018. See April 2019 VA examination; VA 21-8940. Moreover, even though the Veteran currently meets the TDIU schedular criteria, awarding a TDIU would not serve its intended purpose as the Veteran has been able to maintain gainful full-time employment for many years, despite the severity of his service-connected disabilities, including his depression. While the Veteran reported part-time employment from July 2016 to November 2018, the Board does not find that this employment constituted marginal employment. On his January 2019 VA 21-8940, the Veteran reported that he worked approximately 30 hours per week and made $1,800 per month, which equates to annual income of approximately $21,600. As this amount is more than the poverty threshold for one person, the Board finds that such employment was not marginal. In addition, this position was the Veteran’s secondary employment from August 2017. See VA 21-8940. Thus, any occupational impairment as a result of the Veteran’s depression symptoms has been and remains at most mild. Lastly, although the Veteran reported issues with being irritable, negative and overly emotional, work in an office-like setting would likely provide the ability to control and limit such symptoms with proper accommodation of an isolated work environment. See VA 21-4138. The fact that reasonable accommodations may be necessary to allow the Veteran to perform his work is not the equivalent of unemployability. As such, the Board finds that the Veteran’s service-connected disabilities do not prevent him from obtaining and maintaining substantially gainful employment. In sum, the evidence of record does not show that the Veteran’s service-connected disabilities would preclude employment in an office-like setting. The preponderance of the evidence is against the claim for a TDIU. As such, the benefit of the doubt doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Accordingly, a TDIU is not warranted. C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Kuzniar, 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.