Citation Nr: 21061305 Decision Date: 10/01/21 Archive Date: 10/01/21 DOCKET NO. 17-17 038A DATE: October 1, 2021 ORDER Entitlement to a total disability rating for compensation based on individual unemployability due to service-connected disabilities (TDIU) is denied. FINDING OF FACT The preponderance of the evidence is against a finding that the Veteran is unable to secure or follow substantially gainful employment as a result of her service-connected disabilities. CONCLUSION OF LAW The criteria for entitlement to TDIU have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from August 2010 to May 2013. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2015 rating decision issued by a Regional Office (RO) of VA. The matter of TDIU was raised in relation to an existing increased rating claim, pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009). This matter was previously denied by the Board in a March 2020 decision. The Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). In February 2021, the Veteran and the Secretary of VA (parties) entered a Joint Motion for Partial Remand (Joint Motion), relating to the issue of TDIU, which vacated and remanded the matter for readjudication for failure to provide an adequate statement of reasons and bases for its denial. The Joint Motion was granted by the Court the following week. Specifically, the parties within the Joint Motion stated that the Board failed to discuss relevant evidence resulting from a medical opinion by Dr. Heather Henderson-Galligan, who concluded that the Veteran's posttraumatic stress disorder (PTSD) symptoms prevented her from sustaining any form of substantially gainful employment since she stopped working in November 2015. The parties stated the Board did not discuss Dr. Henderson-Galligan's statements that the Veteran would become angry at least once per month under the normal pressures and criticisms of a job and would not stay focused for at least seven of eight hours per day more than three days per month. Dr. Henderson-Galligan noted the Veteran's endorsement of symptoms that could be problematic around children, such as persistent delusions or hallucinations. Dr. Henderson-Galligan also noted that the Veteran's symptoms would cause multiple difficulties with her employment, ultimately preventing employability. Additionally, the parties stated that the Board failed to address both the economic and non-economic components under 38 C.F.R. § 4.16 when considering TDIU, as required by Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). Total disability will be considered to exist where there is present any impairment of mind and body that is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is unable to secure or follow a substantially gainful occupation because of service-connected disabilities, provided that the Veteran meets the schedular requirements. Specifically, if there is only one such disability, the disability shall be ratable at 60 percent or more; if there are two or more disabilities, there shall be at least one disability that is ratable at 40 percent or more and enough additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). The Veteran is service-connected for PTSD with a 70 percent disability rating from February 10, 2015; a right ankle strain with tenosynovitis with a 10 percent disability rating from May 2, 2013, and a 20 percent disability rating from February 10, 2015; and migraines with a 30 percent disability rating from February 10, 2015, and a 10 percent disability rating from February 28, 2020. Based upon the above, the Veteran's combined disability rating during the relevant period is 80 percent from February 10, 2015. As such, the Veteran's service-connected disabilities meet the schedular criteria for a TDIU rating. "Substantially gainful employment" is that employment "which is ordinarily followed by the nondisabled to earn their livelihood with earnings common to the particular occupation in the community where the veteran resides." Moore v. Derwinski, 1 Vet. App. 356, 358 (1991). "Marginal employment shall not be considered substantially gainful employment." 38 C.F.R. § 4.16. In determining whether a veteran can secure and follow a substantially gainful occupation, the Court in Ray v. Wilkie directed the Board to consider the following factors: (1) the veteran's history, education, skill, and training; (2) whether the veteran has the physical ability (both exertional and non-exertional) to perform the type of activities required by the occupation at issue; and (3) whether the veteran has the mental ability to perform the activities required by the occupation at issue. 31 Vet. App. 58, 73 (2019). In determining whether unemployability exists, consideration may be given to the Veteran's level of education, special training, and previous work experience, but not to her age or to any impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. The responsibility for making the ultimate TDIU determination is placed on the adjudicator and not a medical examiner. See Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013). A medical examiner's role is limited to describing the effects of disability upon the person's ordinary activity. See Floore v. Shinseki, 26 Vet. App. 376, 381 (2013). The Veteran is competent to testify as to facts she personally observed or described; this includes recalling what she personally felt, saw, smelled, heard, or tasted. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Veteran has alleged that her combined service-connected disabilities have prevented her from being able to secure and follow substantially gainful employment since November 2015, when she stopped working a security job at a casino. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against a finding that the Veteran is unable to secure or follow substantially gainful employment due to her service-connected disabilities. The reasons follow. The Veteran has reported suffering from migraine headaches since her separation from service. During an August 2015 VA examination, she stated that bright lights could trigger headaches and that there was little radiation of pain. She stated that sleep made her headaches better. She stated that she noticed some "dry heaving" during some episodes and treated her headaches with ibuprofen. The Veteran described she experienced pulsating or throbbing head pain on both sides of her head, and that she experienced nausea and sensitivity to light. She reported that typical head pain lasted less than one day and that she had characteristic prostrating attacks of migraine headache pain once every month and non-migraine headache pain once every two months. It was noted that she did not have frequent prostrating and prolonged attacks of migraine or non-migraine headache pain. A November 2015 VA treatment record shows that the Veteran denied experiencing headaches. In October 2016, she again denied experiencing headaches. A February 2017 VA treatment record indicated that the Veteran reported that she experienced bad headaches, which she associated with Nexplanon placement two years previously. The Veteran stated that she felt that her headaches were well managed with ibuprofen and she did not desire any other treatments. She requested that the Nexplanon be removed. Later that month, she was seen for removal of the Nexplanon and reported having no headaches. In May 2017, she reported hitting her head while getting into the back of a big truck and immediately had neck pain and headache. She was treated at the emergency room and reported only a dull ache, which was "tolerable." A private October 2017 Disability Benefits Questionnaire (DBQ), submitted by Dr. Richard Wagner, documented that the Veteran reported having more than one prostrating attack of migraine headache pain in a month accompanied with nausea and vomiting, light and sound sensitivity, disturbed concentration, and sensory changes. She stated the attacks lasted up to four hours and required her to lie down in a dark environment for relief. The examiner wrote that the Veteran had characteristic prostrating attacks of migraine headache pain more frequently than once per month, and non-migraine headache pain once every two months. Dr. Wagner stated that the Veteran had very frequent prostrating and prolonged attacks of migraine headache pain, but not non-migraine headache pain. Dr. Wagner noted that the Veteran had to leave work early one to two times per month and that she would have difficulty maintaining substantially gainful employment due ot the amount of work missed and would require unscheduled breaks to lie down for relief. Dr. Wagner stated that he found the Veteran's headaches were debilitating and impacted daily life including the ability to maintain gainful employment. The severity of symptomology described by Dr. Wagner is not consistent with the evidence of record or the Veteran's demonstrated functional capabilities. As stated, the Veteran has denied headaches in numerous treatment records. She has generally recorded normal neurological findings on physical examination. She has required only conservative treatment and stated that her headaches are well managed with ibuprofen, while rejecting any additional treatment. As discussed further herein, the Veteran's most recent employment doing security in 2020 was performed five days per week for five to six months, and the Veteran did not record excessive absences or require having to leave work early. While the Veteran's headaches may cause the Veteran some limitations, the record does not support that they preclude the Veteran from employment. Additionally, Dr. Wagner relied primarily on the Veteran's lay statements in assessing her condition. The Veteran's lay statements are addressed in greater detail later in this decision. A November 2017 VA treatment record indicated that the Veteran was evaluated for sleep paralysis and that she denied having headaches. In April 2018, during a gynecologist consultation, she again denied experiencing headaches. Treatment records throughout the relevant period routinely described the Veteran as well appearing, fully alert and oriented, and in no acute distress with intact cognitive functioning. During an August 2019 VA examination, the Veteran reported that bright lights could trigger headaches and that sleep made her headaches better. She stated that she experienced nausea and "dry-heaving" during some episodes. She noted that going to the gym regularly decreased the frequency of attacks. The examiner indicated that she experienced nausea, sensitivity to light, and changes in vision associated with headaches. The duration of head pain was less than one day, and she had prostrating attacks of headache pain once every two months. The examiner indicated that the Veteran did not have very prostrating attacks of headache pain productive of severe economic inadaptability. It was estimated that she lost two to four weeks of work time due to migraines, and she reported that she sometimes had to leave work early due to migraine pain and symptoms. In April 2021, the Veteran's former supervisor stated that the Veteran worked at a racetrack in Aurora, Colorado, from April 2020 until September 2020, when the racetrack closed. The Veteran worked a reported 32 hours per week, two days per week in the security building and three days per week in the "test barn." The former employer wrote the Veteran was allowed to bring her service dog on the two days that she worked in the security building. The supervisor did not recall the Veteran having excessive absences or needing to leave work early and stated that there were no issues with the Veteran's employment reported to him. In June 2021, M.W., who the Veteran babysat for in the summer of 2018, submitted a statement indicating that the Veteran would miss work due to migraines and anxiety. She reported that the Veteran worked 20 to 40 hours per week, four to six hours at a time. She stated that the Veteran missed work "due to her migraines, but mostly her anxiety." She stated that the Veteran would have a migraine once per week but could mostly manage her symptoms while babysitting by taking a nap or adjusting the lighting. She stated that the Veteran gets overwhelmed and stressed easily, particularly in public or in interactions with strangers. M.W. wrote the Veteran was able to travel with the family, including by airplane. M.W. stated that the Veteran was not able to handle a full-time work schedule, but that she loved the Veteran and would allow her to babysit again, if needed. As to the Veteran's right ankle disability, the Veteran has required only intermittent, conservative treatment during the period on appeal. She has not required inpatient or emergency treatment, and she has maintained independence in her activities of daily living. VA treatment records dated in September 2014 and December 2014 indicated that the Veteran's gait was normal. In January 2015, her gait was noted to be steady. A February 2015 VA treatment record indicated that the Veteran's right ankle strain was unchanged and that she remained active but could not run. During an August 2015 VA examination, the Veteran stated that she had to stand for four to five hours at work. The Veteran reported that pain improved after her initial right ankle injury but that she had less strength in the joint. She stated that her right ankle felt weak and that she was unable to plantar flex the right foot enough to activate the brake while driving. She also stated that her symptoms increased after standing more than 8 hours and that she was unable to run or jump due to pain. The Veteran stated that she occasionally used a cane for locomotion. In terms of impact on occupational tasks, the examiner stated that the Veteran experienced right ankle pain and swelling after standing four to five hours at work and that she used ice and rest afterwards or was unable to get her foot into her shoe the next day because of swelling. She stated that with walking, her right ankle would get very sore and that she could not chase anyone at work and had to call someone else to do it. She also stated that driving to and from work was difficult. A September 2015 VA treatment record shows the examiner documented that the Veteran had an antalgic gait but was fully weightbearing. In November 2015, her gait was normal and steady. Her gait was also noted to be normal in December 2015, October 2016, February 2017, November 2017, June 2018, and August 2019. In 2017 and 2018, the Veteran reported exercising three to four times per week, going to the gym, lifting weights, and doing cardiovascular exercises. Treatment records during the relevant period routinely described the Veteran as well appearing and in no acute distress. The report of an August 2019 VA examination indicated that the Veteran stated that she had improvement of right ankle pain, range of motion, and strength with personal training and ankle rehabilitation. She stated that her right ankle pain was a five out of 10 in severity and increased to seven to eight out of 10 after going to the gym. The Veteran reported that she occasionally used a right ankle brace during workouts. Regarding functional impact, the Veteran reported that she had increased pain going up stairs, walking the children to parks, walking uphill, and with picking up and carrying small children. She stated that she noted increased swelling in her ankles by the end of the workday. The examiner noted that there was no objective evidence of pain with passive range of motion testing and when the joint was used in non-weight bearing. Later in the same month, the Veteran reported pain relating to a nonservice-connected left knee disability. Still, she reported that she continued to work out, including "running, jumping." In 2020, she was reported to be capable of working 32 hours per week, 5 days per week, doing security at a racetrack. The Veteran has reported that her most significant limitations result from her PTSD and associated insomnia. A February 2015 VA treatment record noted that the Veteran's assessment included depression, military sexual trauma, and PTSD. She reported that she felt she was not doing well and was no longer seeing a mental health provider but was taking her medications. She stated that she felt that equine therapy was the most helpful for her. In June 2015, she reported that she was doing well and taking medication as needed. The report of an August 2015 VA examination shows that the Veteran reported that she lived with two roommates and that they got along well. She indicated that one of her roommates was her boyfriend and that they also got along well. She stated that she did not have any other friends but saw her father and grandparents once a week. She stated that she worked in a casino during the graveyard shift as a security guard. Before that, she worked in a retail store, but did not get along with her manager well. She stated that she went through 12 jobs when she first got out of service and did not do well at customer service. She reported that she graduated from high school and had just started college for business administration. The examiner documented that the Veteran's symptoms involved depressed mood; anxiety; suspiciousness; panic attacks that occurred weekly or less often; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; chronic sleep impairment; mild memory loss, such as forgetting names, directions or recent events; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances, including work or a work-like setting; and inability to establish and maintain effective relationships. The examiner indicated that the Veteran was oriented to person, place and time, and that she appeared nervous and reported feeling anxious about talking about her trauma. She denied any thoughts, plans or intent to hurt herself. She reported having a significant romantic relationship and a supportive family. She also expressed passion about her future career. The diagnosis was PTSD. The examiner opined that the Veteran's symptoms were productive of occupational and social impairment with reduced reliability and productivity. An August 2016 VA treatment record shows that the Veteran reported insomnia, nightmares, and recent sleep paralysis. She stated that she wanted to get back on Ambien and have some paperwork signed for a service dog. It was noted that she was oriented, well-groomed, and ambulating independently. Her mood was euthymic, and her affect was slightly anxious. There was no suicidal or homicidal ideation. Thought process and content were within normal range. There was no psychosis. Another August 2016 record noted that the Veteran reported that going into public was difficult for her and she felt hypervigilant. She described experiencing nightmares with sleep paralysis. She indicated that she occasionally had flashbacks during the day. The Veteran stated that she babysat two days per week but that having a more regular job had been difficult for her given her hypervigilance. She stated that she sometimes had days where it was difficult for her to get out of bed but that it rarely lasted more than three days. She denied suicidal ideation. On mental status examination, she was oriented; her thought processes were linear, logical, and non-racing; her mood was anxious and her affect was congruent; her attention and concentration were intact; she did not experience any hallucinations, perceptions, delusions, or illusions; associations were intact; recent and remote memory was grossly intact; her insight was limited; and her judgement was fair. The psychiatrist indicated that the Veteran would likely benefit from medication, but that the Veteran would wait and consider. In September 2016, it was noted that the Veteran presented with a child whom she was babysitting. She endorsed ongoing symptoms consistent with anxiety and depression. It was also noted that her hypervigilance had increased her paranoia and fear of going out in public. The Veteran denied any symptoms of psychosis and there were no clinical indications of imminent danger to self or others. An August 2017 treatment note states that the Veteran's service animal has been very beneficial for her mood and anxiety. The Veteran sought an insomnia clinical consultation in January 2018. The following month, despite some continued fatigue, she reported that she was doing "really good," sleeping longer, and that it took her less time to fall asleep. A June 2018 VA treatment record indicated that the Veteran presented for a physical examination prior to starting a job as a camp counselor. The Veteran later stated that this was a week-long volunteer position for a church camp. An August 2018 private Disability Benefits Questionnaire (DBQ) completed by Dr. Heather Henderson-Galligan documented that the Veteran reported being isolated, withdrawn, detached, suspicious, anxious, and irritable. Dr. Henderson-Galligan wrote the Veteran had difficulty with trust and intimacy, being hypervigilant, and easily started. She documented the Veteran had diminished participation in social activities. Regarding employment, the Veteran reported working for 12, different menial labor joints in the fast-food industry for no more than a year and a half each. She stated that she had been unable to sustain substantially gainful employment since November 2015. Dr. Henderson-Galligan wrote the Veteran's PTSD symptoms included: depressed mood; anxiety; suspiciousness; panic attacks more than once a week; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; chronic sleep impairment; mild memory loss, such as forgetting names, directions or recent events; flattened affect; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances, including work or a work-like setting; and inability to establish and maintain effective relationships; obsessional rituals which interfered with routine activities; and persistent delusions or hallucinations. Dr. Henderson-Galligan opined that the Veteran's PTSD symptoms resulted in occupational and social impairment with deficiencies in most areas. She also opined that her symptoms prevented her from sustaining any form of substantial gainful employment activity since she stopped working in November 2015. As noted in the Joint Remand, Dr. Henderson-Galligan stated that the Veteran would become angry at least once per month and would not stay focused for at least seven or eight hours per day, more than three days expert month. Dr. Henderson-Galligan also noted the Veteran endorsed symptoms, such as persistent delusions and hallucinations, that would cause multiple difficulties with her employment, ultimately preventing employability. Dr. Henderson-Galligan, provided an addendum opinion in July 2021 after reviewing the updated evidence of record. She stated that her opinion continues to be that the Veteran's PTSD causes occupational and social impairment with deficiencies in most areas, such as work, and that her overall mental health symptoms are severe enough to prevent her from maintaining any form of substantial gainful employment. Dr. Henderson-Galligan stated that this has been the case since at least when the Veteran stopped working in November 2015, despite various work attempts since that time. She stated that her opinion is supported by the medical records, Social Security earnings statement, and statements from the Veteran's past supervisor and employer. The Board notes that, in the Joint Motion, the parties agreed that the 2018 findings of Dr. Henderson-Galligan were relevant to the Veteran's ability to care for children, specifically as it pertains to her ability to stay focused, and ability to cope with workplace pressures involved with caring for children. However, the Board finds that Dr. Henderson-Galligan's assessments are largely inconsistent and refuted by the more probative evidence of record. For example, the record does not show that the Veteran left her full-time employment in November 2015 due to her service-connected disabilities, but instead that she stopped working after running out of leave during recovery from breast augmentation surgery, a nonservice-connected condition. This does not support Dr. Henderson-Galligan's finding that the Veteran's PTSD precluded her from substantially gainful employment beginning in November 2015. Additionally, Dr. Henderson-Galligan's assessment relied heavily on findings that the Veteran is unable to sustain concentration and would become angry, impacting her ability to work. She also noted the Veteran to experience persistent delusions or hallucinations. However, mental status examinations of record routinely recorded the Veteran to be fully alert and oriented with a linear, logical thought process, intact attention and concentration, intact memory, no perceptual abnormalities, limited insight, fair judgment, and a normal mood and affect. The Veteran has also noted that she reads as a hobby. These findings are not reflective of significant limitations in concentration and attention that would preclude employment. Treatment records also reflect the Veteran to be cooperative and pleasant with appropriate behavior and do not document anger impacting her ability to interact appropriately. Examples of these findings occurred in August 2016, February 2017, April 2017, July 2017, August 2017, October 2017, January 2019, June 2019, August 2019. Although the Veteran has reported occasional hallucinations of monsters in her room, these are associated with sleep paralysis, which would not be an issue while the Veteran is working. The Veteran has much more predominantly denied hallucinations, delusions or any perceptual abnormalities. Similarly, Dr. Henderson-Galligan indicated the Veteran had an inability to establish and maintain effective relationships, but this is contradicted by the record which shows that the Veteran is now married but reported being single in 2019. This would demonstrate the Veteran's ability to establish and maintain an effective relationship. Furthermore, the record shows that the Veteran was able to work 32 hours per week, five days per week, for five to six months at a racetrack in 2020. The Veteran stopped this employment only because the racetrack closed. Her supervisor stated that the Veteran only brought her service dog to work two days per week and that he was unaware of any work problems or excessive absences. The Veteran demonstrated the ability to sustain concentration and work with others, outside the home, without noted problems, and predominantly without her service dog, five days per week. Dr. Henderson-Galligan did not discuss this work or provide a reason as to why the Veteran would be capable of this work, but not a 40-hour or full-time work schedule, when providing her addendum opinion that the Veteran is unable to sustain substantially gainful employment. For all the reasons discussed herein, the opinions of Dr. Henderson-Galligan are of reduced probative value. While the parties agreed in the Joint Motion that Dr. Henderson-Galligan's findings could impact the Veteran's ability to work with kids, the June 2021 statement from M.W., for whom the Veteran babysat in 2018, stated that her family loved the Veteran and she would allow her to babysit her children again, if needed. Additionally, as to the Veteran's earnings since November 2015 being indicative of no more than marginal employment, this is not probative evidence to support an award of TDIU. Minimal earnings or part-time work do not demonstrate that the Veteran was not capable of full-time work, or that the Veteran was precluded from gainful employment due to service-connected conditions. In this instance, the record demonstrates that the Veteran stopped working after undergoing breast augmentation surgery in November 2015 and that she did not have enough leave at work to allow her to keep her job through her recovery. An August 2019 VA examination report documents that the Veteran was living with her grandparents, who both had health problems, and that she helped them with chores. She indicated that she had a good relationship with them. She noted that she had broken up with her boyfriend two years previously and had no subsequent romantic relationships. She indicated that she reads, watches Netflix, helps her grandparents with yardwork, goes to the gym, video chats with one friend each week, but had no friends locally due to her distrust of others. She stated that she enjoyed camping. She further stated that she worked the night shift as a security guard at a casino but felt overwhelmed being around too many people and quit after having surgery without sufficient leave to recover from the surgery. She stated that she had no other employment. She stated that she attended online college for two semesters and got good grades but admitted to cheating. She left the program after determining that she did not enjoy it. The Veteran reported experiencing ongoing difficulty leaving home and stated that she goes to the grocery store at night. She stated that she had an easier time leaving home with a trusted other and had a service dog in training. She had no history of suicide attempts or psychiatric hospitalizations. She stated that she is not prescribed psychotropic medication and is not engaged in continued psychotherapy. The Veteran's PTSD symptoms included: anxiety; chronic sleep impairment; mild memory loss, such as forgetting names, directions or recent events; impaired judgment; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; and difficulty in adapting to stressful circumstances, including work or a work-like setting. The examiner opined that her symptoms were productive of occupational and social impairment with reduced reliability and productivity. A separate August 2019 VA treatment record indicated that the Veteran had a history of anxiety, depression, insomnia, and sleep paralysis. It was noted that her symptoms had improved, and she reported feeling better. A PTSD screening was negative. In December 2019, a VA physician reviewed the evidence of record to assess the Veteran's functional limitations and ability to function in an occupational environment. The doctor stated that, due to the chronicity of the Veteran's complaints, she should avoid activities that involve ladders, stair climbing, walking on uneven terrain or repetitive squatting or kneeling activities that would place increased biomechanical stress source through the ankle joint. He stated that the Veteran should also avoid lifting in excess of 20 pounds. The doctor stated that limitations with respect to her headaches are minimal, but she should avoid activities with exposure to loud noises or flashing lights, and there may be times where she will need to leave work because of headaches. Relating to her mental health disorders, the doctor stated that she should avoid occupational activities that involve interpersonal interactions with customers and minimize interpersonal interactions with coworkers. She would do best at work that did not require higher level executive function or require significant concentration and memory. She would be better suited for job duties that are more routine and repetitive such as light to moderate assembly. While these findings are generally probative and consistent with the evidence of record, they do not indicate the Veteran to be precluded from all forms of substantially gainful employment. The Board clarifies that the Veteran is capable of some interpersonal interaction but has difficulty in public spaces or with crowds. She has demonstrated the ability to effectively work at a racetrack where she has stated she "had to interact with people all the time," has served as a nanny with the mother stating that she loved the Veteran and would allow her to babysit for her family again and has consistently been described as cooperative and pleasant with appropriate behavior. She has also volunteered to work a week-long church trip in 2018. Thus, the record reflects that the Veteran is able to socially function and engage appropriately but has difficulty in certain environments. As stated, M.W. provided a statement in June 2021, stating that the Veteran could not handle a full-time work schedule as a babysitter. She stated that the Veteran gets overwhelmed and stressed easily, particularly in public or in interactions with strangers. She also indicated that the Veteran would miss work, primarily due to her anxiety. While M.W. is competent to report her observations, her statement relates only to the Veteran's ability to perform her duties as a babysitter for her family, which involves a multitude of unique factors, and involved air travel and being responsible for children in public. M.W. noted that she loved the Veteran and would allow her to babysit again. The Veteran submitted a statement in July 2021, in which she summarized her relevant work history since service and the difficulties she encountered relating to her service-connected disabilities. The Veteran stated that she has high anxiety in public places, particularly in crowded areas, but that she does okay at home in her "comfort zone." She also stated that maintaining a five-day work schedule is impossible due to her migraines and that she can't handle leaving her house five days per week or being around people 40 hours per week. The Veteran reported that she is easily overwhelmed. She reported that she experiences fatigue from lack of sleep, and pain in her ankle with prolonged physical activity. She stated that she does not go anywhere without her service dog. As to her 2020 employment working security at a racetrack, the Veteran reported that she only worked 22 hours per week and needed a mental health day every one to two weeks, despite her part-time work schedule. As to the Veteran's lay statements, they are of reduced credibility due to inconsistencies with the evidence of record. For example, the Veteran reported that she cannot maintain a five-day work schedule and that she only worked 22 hours per week at the racetrack. However, a statement from the Veteran's supervisor stated that she maintained a five-day work schedule, 32 hours per week. She stated that she took a mental health day every one to two weeks, but the supervisor stated that he did not recall the Veteran to have excessive absences, and no issues were reported him in relation to the Veteran. The Veteran reported that she does not go anywhere without her service dog, but the supervisor's statement specifically indicated that the Veteran brought her service dog to work only two days per week, when she was working in the security building. The other three days of work, while working in the "test barn," the Veteran did not bring her service dog to work. The Veteran's 2021 TDIU application states that she attended one year of college, in 2014. A 2019 VA examination documents the Veteran reported attending two semesters of college from 2015 to 2016, which is after 2014. Additionally, the Veteran has reported cheating on her online college coursework. Whether intentional or otherwise, these inconsistencies and findings serve to reduce the overall probative value of the Veteran's lay statements. Although the Veteran has submitted multiple research articles relating to the effects of PTSD on veterans, they do not consider the specific facts of this case or the Veteran's functional abilities and, thus, are not probative as to the Veteran's TDIU claim. Furthermore, the record contains a statement from the Veteran's former manager from her employment at Domino's in 2013. The manager stated that the Veteran's mental health problems caused concentration difficulties, that the Veteran struggled completing tasks, that the Veteran had to be sent home because of emotional issues at least twice per week, and that she required extra breaks. The Board notes that her employment at Domino's occurred prior to the relevant period and that she maintained employment doing security at a casino for nearly a year and half thereafter before quitting at the time of her November 2015 surgery. As such, the manager's statement is not probative as it relates to the Veteran's functional abilities during the period on appeal. The preponderance of the evidence is against a finding that the Veteran's service-connected disabilities have prevented the Veteran from securing or following substantially gainful employment during the relevant period. Although the Veteran suffers from a range of psychiatric and physical symptoms, she has demonstrated a high functional capacity that shows she is capable of performing substantially gainful employment. The Veteran was able to maintain a 32-hour, five-day work schedule from April to September 2020 at a venue that required the Veteran to routinely interact with others. During this time, she had her service dog with her only two days per week. The Veteran left this employment only because the racetrack she worked at closed. The Veteran has routinely been found to have intact cognitive functioning and has been described as pleasant and cooperative with appropriate behavior. She has maintained independence in her activities of daily living and reported that she is not prescribed psychotropic medication or engaged in ongoing mental health counseling. Despite her ankle disability, the Veteran was able to maintain her part-time job working security, has reported going to the gym three to four times per week lifting weights and doing cardiovascular exercise, and helping her grandparents with yardwork. She has reported that her headaches are well-controlled with the use of ibuprofen. As such, the weight of the evidence indicates that the Veteran's service-connected disabilities do not preclude her from substantially gainful employment. Regarding the Veteran's education, training, skills, and work history, the record reflects that the Veteran attended two semesters of online college, but that she left the program because she did not enjoy it. She has denied any additional skills or training experience. The Veteran has had a diverse work history since her separation from service. She has reported working as a nanny, doing security for a casino and a racetrack, working in multiple positions in retail as a cashier, and as a cook/manager at Domino's. The Veteran reported that she did not do well in customer service while working in retail, but the record reflects that she is able to interact appropriately and her problems relate to being around crowds or in public spaces. Overall, the Veteran's diverse work history and education record demonstrate a capacity for learning, training, and adaptability that would not be hindered by her service-connected disabilities. These attributes would facilitate the Veteran's transition to a separate line of work that the Veteran can perform. As to the Veteran's physical ability to perform substantially gainful employment, the Board acknowledges that the Veteran's disabilities limit her ability to perform heavy exertional activities. Additionally, the Veteran should avoid jobs that would routinely expose her to flashing lights or loud noises due to her migraine symptoms. However, the record shows that the Veteran has maintained the ability to perform a wide range of physical activities that show that she is not physically precluded from full-time employment. She has demonstrated independence in her activities of daily living, the ability to ambulate independently, and to engage in activities such as regular exercise and weightlifting, as well as driving, working as a security guard, and doing yardwork. Additionally, the Veteran has reported that her headaches are well-managed with the use of ibuprofen. She has required only conservative treatment for her physical disabilities and has not required emergency or inpatient treatment. For all these reasons, the totality of the evidence shows that the Veteran is capable of performing work at least at the "light" exertional level with a restriction from work that would expose the Veteran to loud noises or flashing lights. The Department of Labor's Dictionary of Occupational Titles (DOT) defines light work as exerting up to 20 pounds of force occasionally (i.e., up to one-third of the time), and/or 10 pounds of force frequently (i.e., from one-third to two-thirds of the time), and/or a negligible amount of force constantly to lift, carry, push, pull, or otherwise move objects. According to the DOT's definition, when walking or standing are involved to a significant degree, the job is classified as light even when the weight lifted is negligible. A job is also classified as light when it involves sitting most of the time with a degree of pushing and pulling of arm and/or leg controls, or when the job requires working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible. The Board finds no prejudice to the Veteran in considering the definition for purposes of deciding this claim. The treatment record does not indicate the Veteran's service-connected disabilities to limit her beyond the restrictions of light work, as evidenced by her past work doing security, her independence in activities of daily living, her gym routine, and her reports that regular exercise has improved her headaches. Accordingly, the weight of the evidence shows that the Veteran is physically capable of performing substantially gainful employment. As to the Veteran's mental ability to perform substantially gainful employment, the Board acknowledges the Veteran has reported a range of symptoms, including anxiety, hypervigilance, paranoia, social isolation and withdrawal, fatigue, some limited judgment and insight, and mild concentration and memory deficits. Despite this, the Veteran has maintained a high level of functional abilities. Mental status examinations of record routinely recorded the Veteran to be fully alert and oriented with a linear, logical thought process, intact attention and concentration, intact memory, no perceptual abnormalities, limited insight, fair judgment, and a normal mood and affect. Treatment notes also regularly describe the Veteran as polite and cooperative with appropriate behavior. The Veteran has recently gotten married, was able to volunteer for a week-long church trip, regularly goes to the gym, and maintained employment at the racetrack through the summer of 2020 where she "had to interact with people all the time." The Veteran has denied any current prescriptions for psychotropic medication or ongoing mental health counseling. Accordingly, the Veteran's psychiatric condition can be accommodated by restricting the Veteran from work that would require her to have routine face-to-face interaction with the public or require her to work in crowds. The Veteran should work in a controlled environment. Additionally, the Veteran should avoid positions that require supervisory duties or executive decision-making or require a degree or advanced training prior to employment. Such limitations would help to alleviate concerns over her anxiety and social issues, as well as any minor cognitive deficits, and difficulties managing stress. As such limitations would not preclude the Veteran from work, the weight of the evidence shows that the Veteran is mentally capable of performing substantially gainful employment. Based on the above assessment of the Veteran's physical and mental abilities with consideration of her education, training, skills, and work history, the Board finds that the Veteran is capable of work that would result in income at the level of substantially gainful employment. For example, the preponderance of the evidence is against a finding that the Veteran's service-connected disabilities preclude her from jobs that can be performed at home, such as a telemarketer, where the employee makes calls and reads a script, which does not require extensive training or experience, and would require minimal exertional activity. Similarly, a customer service agent interacts with customers to handle complaints, process orders, and answer questions. These positions can often be performed from home, while seated, in a controlled environment, without face-to-face public interaction or work in crowds. While the Veteran has reported not doing well in customer service in the past, her prior experience was in retail while working as a cashier in public spaces. The evidence supports that the Veteran could succeed in a position that can be performed where she is physically removed from the public, possibly at home. Additionally, the Veteran's service-connected disabilities would not preclude her from jobs that involve data entry. With data entry, the Veteran is primarily responsible for entering data into a system. These jobs can usually be done from home, in the Veteran's "comfort zone," without significant training. Similarly, these occupations require very little exertional effort and can be performed in a controlled environment without face-to-face public interaction or work in crowds. The jobs listed above would not require supervisory duties or executive decision-making and would not expose the Veteran to loud noises or flashing lights to trigger her migraine symptoms. These occupations would use the basic computer skills that the Veteran has demonstrated that she possesses from her online schooling experience. These examples are not exhaustive but are merely illustrative of potential occupations that the Veteran could perform. This is evidence against a finding that the Veteran is precluded from all forms of substantially gainful employment due to the service-connected disabilities. For all these reasons, the Board finds the preponderance of the evidence is against a finding that the Veteran is precluded from securing or following all forms of substantially gainful occupation due to her service-connected disabilities. As the probative evidence of record weighs against the Veteran's claim, there is no reasonable doubt to be resolved, and the claim of entitlement to a TDIU rating is denied. A. P. SIMPSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Wonderling, 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.