Citation Nr: 21062543 Decision Date: 10/07/21 Archive Date: 10/07/21 DOCKET NO. 16-39 234 DATE: October 7, 2021 ORDER Entitlement to service connection for a right ankle disorder is denied. Entitlement to service connection for a left ankle disorder is denied. Entitlement to service connection for a skin disorder (other than pseudofolliculitis barbae (PFB)) is denied. Entitlement to a rating in excess of 30 percent for major depressive disorder is denied. FINDINGS OF FACT 1. A right ankle disorder did not manifest during active service and is not otherwise related to service. 2. A left ankle disorder did not manifest during active service and is not otherwise related to service. 3. A skin disorder (other than PFB) did not manifest during active service and is not otherwise related to service. 4. The evidence demonstrates that the Veteran's service-connected major depressive disorder is manifested by no more than occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a right ankle disorder have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. 2. The criteria for entitlement to service connection for a left ankle disorder have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. 3. The criteria for entitlement to service connection for a skin disorder (other than PFB) have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. 4. The criteria for entitlement to a rating in excess of 30 percent for major depressive disorder have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.130, Diagnostic Code 9434. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a Veteran who served on active duty from July 1970 to April 1972, including service in the Republic of Vietnam. He had military reserve service from January 1975 to December 1979. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2014 rating decision by the New Orleans, Louisiana, Regional Office (RO) of the Department of Veterans Affairs (VA). In April 2021, the Veteran testified at a personal hearing before the undersigned Veterans Law Judge. A copy of the transcript of that hearing is of record. The Board, in pertinent part, denied entitlement to service connection for pseudofolliculitis and remanded the remaining issues on appeal for additional development in June 2021. It was additionally noted that the Veteran's statements at his April 2021 hearing may be construed as raising a claim for entitlement to total disability rating based upon individual unemployability due to service-connected disability (TDIU). The United States Court of Appeals for Veterans Claims (Court) has held that a claim for a TDIU is a rating theory and not a separate claim for benefits. See Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). The Board found the TDIU matter was more appropriately addressed as part of the increased rating issue on appeal. Although entitlement to a TDIU was not specifically addressed in an August 2021 supplemental statement of the case, the available record is sufficient for an adequate determination upon appellate review. The Veteran has not asserted, and the evidence does not indicate, that he is unemployable due to either his combined service-connected disabilities or any specific service-connected disability other than major depressive disorder. He is shown to have been provided an appropriate 100 percent schedular rating for his service-connected residuals of prostate cancer for the period from March 1, 2019, to May 1, 2021. See Harper v. Wilkie, 30 Vet. App. 356, 359-60 (2018). Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Service connection connotes many factors but basically it means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 C.F.R. § 3.303(a). In the case of a veteran who engaged in combat with the enemy in active service with a military, naval, or air organization of the United States during a period of war VA shall accept as sufficient proof of service-connection of any disease or injury alleged to have been incurred in or aggravated by such service satisfactory lay or other evidence of service incurrence or aggravation of such injury or disease, if consistent with the circumstances, conditions, or hardships of such service, notwithstanding the fact that there is no official record of such incurrence or aggravation in such service. 38 U.S.C. § 1154(b); 38 C.F.R. § 3.304(d). Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). The term "disability" for VA compensation purposes refers to the functional impairment of earning capacity rather than the underlying cause of the impairment and it is noted that pain alone may be a functional impairment. See Saunders v. Wilkie, 887 F.3d 1356, 1364-68 (Fed. Cir. 2018). Certain chronic diseases, including arthritis, are subject to presumptive service connection if manifest to a compensable degree within one year from separation from service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Chloracne or other acneform disease consistent with chloracne, if manifest to a degree of 10 percent or more within a year after the last date of exposure, for an herbicide exposed veteran may be presumed service connected. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6), 3.309. Veterans diagnosed with an enumerated disease who, during active service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307(a)(6)(iii). Even though a disease is not included on the list of presumptive diseases, a nexus between the disease and service may nevertheless be established on the basis of direct service connection. Stefl v. Nicholson, 21 Vet. App. 120 (2007). When a claimed disability is not included as a presumptive disability, direct service connection may nevertheless be established by evidence demonstrating that the disability was in fact incurred during service. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Under 38 C.F.R. § 3.303(b), an alternative method of establishing the second and third Shedden element is through a demonstration of continuity of symptomatology if the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309(a). Arthritis is a qualifying chronic disease. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The Board has the authority to discount the weight and probity of evidence in light of its own inherent characteristics and its relationship to other evidence. Madden v. Gober, 125 F.3d 1477 (Fed. Cir. 1997). VA may favor one medical opinion over another, provided an adequate basis is provided. Owens v. Brown, 7 Vet. App. 429 (1995). It is the policy of VA to administer the law under a broad interpretation, consistent with the facts in each case, with all reasonable doubt to be resolved in favor of the claimant. 38 C.F.R. § 3.102. 1. Entitlement to service connection for a right ankle disorder. 2. Entitlement to service connection for a left ankle disorder. The Veteran contends that he has right and left ankle disorders with occasional swelling since active service. He states that he sustained ankle injuries walking through the jungle in Vietnam. He does not recall any specific right or left ankle injury in service, but recalls experiencing swelling and receiving medic treatment. He notes that the medics often did not record such treatments and that VA had informed him that additional service treatment records were unavailable. The Veteran's stressor involving combat events, rocket and mortar attacks, in Vietnam was conceded. His status as a combat veteran for VA compensation purposes is established. Service treatment records are negative for complaint, diagnosis, or treatment for an ankle disorder. He denied having or having ever had a history of joint problems or lameness in his May 1976 report of medical history. A May 1976 reserve service examination revealed a normal clinical evaluation of the lower extremities. Similar reports and findings were provided in reserve service records dated in January 1979. In March 2001, the Veteran reported that he sustained an open left tibia fracture in a 1985 motor vehicle accident (MVA). A July 2003 report noted chronic left ankle swelling following a fracture/scar with no evidence of right leg swelling. VA examination in July 2021 included a diagnosis of bilateral ankle strain. It was noted that the Veteran reported his ankle problems began in 1973 with injuries sustained from walking in the jungle during duty. He complained of pain and swelling in the left ankle and reported that his ankle problems had worsened. X-ray studies revealed no acute osseous abnormalities and no evidence of degenerative changes. Testing revealed no evidence of ankle joint instability. The examiner found it was less likely that the ankle disorders were incurred in or caused by the claimed in-service injury, event, or illness. As rationale for the opinion, it was noted that service treatment records were silent for evidence of a right or left ankle condition and that relevant records revealed left ankle swelling due to an MVA. Based upon the evidence of record, the Board finds that right and left ankle disorders were not manifested during active service and that the preponderance of the evidence fails to establish that a present disability is etiologically related to service. There is no competent evidence demonstrating arthritis to either knee joint, so presumptive service connection consideration is not warranted. He is a combat veteran for compensation purposes and his statements as to having sustained ankle injuries in Vietnam are, to some extent, consistent with the circumstances of his service. It is noted, however, that the Veteran denied having any joint problems in reports of medical history dated in May 1976 and January 1979 and examinations at that time revealed no clinical abnormality of the lower extremities. The overall record demonstrates that no chronic ankle problems existed during or immediately after service. The July 2021 VA examiner's opinion is persuasive and based upon adequate rationale. The examiner is shown to have reviewed of the evidence of record and to have adequately considered the credible lay statements and reported symptom manifestation history of record. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). The Veteran's personal reports of inservice symptomatology were duly considered. Consideration has also been given to the Veteran's personal assertions that he has right and left ankle disorders as a result of active service. However, while lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the specific issues in this case fall outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The disabilities at issue are not conditions that are readily amenable to lay diagnosis or probative comment regarding etiology. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). In conclusion, the Board finds service connection for right and left ankle disorders is not warranted. When all the evidence is assembled VA is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether a preponderance of the evidence is against the claim in which case the claim is denied. Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). The preponderance of the evidence is against the right and left ankle claims. 3. Entitlement to service connection for a skin disorder (other than PFB). The Veteran contends that he has a skin disorder (other than PFB) involving the lower extremities due to environmental or herbicide agent exposure during service in Vietnam. He testified in April 2021 that he experienced a rash to the lower extremities during service that started worsening approximately 10 to 15 years earlier. He recalled his lower extremities had itched after he had walked in water. He described having itching and swelling about the ankles that he had treated with creams or gels for approximately 10 years. The Veteran had one year of active service in the Republic of Vietnam. He is presumed to have been exposed to an herbicide agent during service in Vietnam. Service treatment records are negative for complaint, diagnosis, or treatment for a skin disorder (other than PFB). He denied having or having ever had a history of skin diseases in his May 1976 report of medical history. A May 1976 reserve service examination revealed a normal clinical evaluation of the skin. Similar reports and findings were provided in reserve service records dated in January 1979. VA treatment reports including dated in July 2001 noted the Veteran complained of dry skin to the back and shoulders without opinion as to etiology. Reports show he was subsequently prescribed a lotion to apply twice per day. VA examination in April 2014 included a diagnosis of stasis dermatitis. It was noted the Veteran reported current treatment for stasis dermatitis with topical steroids. The examiner noted a depigmented area to the left shin. An August 2021 VA medical opinion found it was less likely that the claimed skin condition was incurred in or caused by the claimed in-service injury, event, or illness. The examiner stated that it was highly unlikely that an individual of the age of the Veteran while in service would have had stasis dermatitis. It was noted he did not have stasis dermatitis in 1976 or 1979 and that the disorder was a skin manifestation of a vascular/venous condition. While the exact etiology of his stasis dermatitis was not reported in the available records, it was not caused by environmental exposures, including Agent Orange, it was not present in service, and it was not present as late as 1979. The examiner stated the first evidence of the disorder was in or around May 2013 and was associated with obesity and age but may be attributed to other conditions. The Veteran's stasis dermatitis was found to have less likely had its nexus in service or to be due to service, including Agent Orange exposure. It was further reiterated it was not a topical condition but was caused an internal vascular compromise, and that any dermatologic condition caused by exposure to an environmental agent such as Agent Orange would be evident at the time of exposure or proximate to it. Based upon the evidence of record, the Board finds that a skin disorder (other than PFB) was not manifested during active service and that the preponderance of the evidence fails to establish that a present disability is etiologically related to service. There is no competent evidence demonstrating chloracne or other acneform disease consistent with chloracne, so presumptive service connection consideration as an herbicide exposed veteran is not warranted. It is noted that the Veteran denied having a history of skin diseases in reports of medical history dated in May 1976 and January 1979 and examinations at that time revealed no clinical abnormality of the skin. The overall record demonstrates that no chronic skin problems existed during or immediately after service. The August 2021 VA examiner's opinion is persuasive and based upon adequate rationale. The examiner is shown to have reviewed of the evidence of record and to have adequately considered the credible lay statements and reported symptom manifestation history of record. Consideration has also been given to the Veteran's personal assertions that he has a skin disorder as a result of active service. However, the disability at issue is not a condition that is readily amenable to lay diagnosis or probative comment regarding etiology. The Board finds service connection for a skin disorder is not warranted. The preponderance of the evidence is against the Veteran's claim. 4. Entitlement to a rating in excess of 30 percent for major depressive disorder. The Veteran contends that an increased rating is warranted for his service-connected major depressive disorder. In statements and testimony provided in support of his claim he reported having trouble sleeping, experiencing nightmares, and not being able to tolerate crowds. He reported having been terminated from employment in 2018 and expressed skepticism as to the official reduction in staff reason provided. His request for an increased rating was received by VA in September 2013. Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. This Rating Schedule is primarily a guide in the rating of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and their residual conditions in civil occupations. 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. For the application of this schedule, accurate and fully descriptive medical examinations are required, with emphasis upon the limitation of activity imposed by the disabling condition. Over a period of many years, a veteran's disability claim may require re-ratings in accordance with changes in laws, medical knowledge and his or her physical or mental condition. It is essential, both in the examination and in the evaluation of disability, that each disability be viewed in relation to its history. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. It is the responsibility of the rating specialist to interpret reports of examination in the light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2. Consideration of factors wholly outside the rating criteria constitutes error as a matter of law. Massey v. Brown, 7 Vet. App. 204, 207-08 (1994). Claims that include symptoms and effects not contemplated by an applicable diagnostic code should be adjudicated for any applicable separate schedular rating prior to consideration of an extra-schedular rating under 38 C.F.R. § 3.321(b)(1). See Morgan v. Wilkie, 31 Vet. App. 162, 167 (2019). "VA is obligated to develop and adjudicate claims for secondary service connection that are reasonably raised during the processing of a properly initiated claim as to the primary service-connected disability's evaluation level." Bailey v. Wilkie, 33 Vet. App. 188, 201 (2021). Evaluation of disabilities based upon manifestations not resulting from service-connected disease or injury and the pyramiding of ratings for the same disability under various diagnoses is prohibited. 38 C.F.R. § 4.14. VA regulations generally provide for separate ratings based on separate disabilities, not separate symptoms. See Cullen v. Shinseki, 24 Vet. App. 74, 81-82 (2010). The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Under the General Formula, including for major depressive disorder (Diagnostic Code 9434), a 30 percent rating is assigned when symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events), cause occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and normal conversation). A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned when symptoms such as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name cause total occupational and social impairment. When rating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and a veteran's capacity for adjustment during periods of remission. The rating agency shall assign a rating based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. When rating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment but shall not assign a rating solely on the basis of social impairment. 38 C.F.R. § 4.126. The rating adjudicator must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). VA regulations provide that ratings on account of diseases subject to temporary or episodic improvement (such as manic depressive or other psychotic reaction and psychoneurotic reaction) will not be reduced on any one examination, except in those instances where all the evidence of record clearly warrants the conclusion that sustained improvement has been demonstrated. Moreover, though material improvement in the physical or mental condition is clearly reflected the rating agency will consider whether the evidence makes it reasonably certain that the improvement will be maintained under the ordinary conditions of life. 38 C.F.R. § 3.344(a). A total rating for compensation may be assigned where the schedular rating is less than total when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). It is the policy of VA to administer the law under a broad interpretation, consistent with the facts in each case with all reasonable doubt to be resolved in favor of the claimant. However, the reasonable doubt rule is not a means for reconciling actual conflict or a contradiction in the evidence. 38 C.F.R. § 4.3. VA examination in April 2014 included a diagnosis of major depressive disorder. The examiner found that the Veteran's level of occupational and social impairment was best summarized as an impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medication. Depressed mood was the only symptom noted to apply to the diagnosis. It was noted the Veteran reported a history including complaints of sleep disturbance, low energy and fatigue, periodic irritability, decreased short-term memory, distressing dreams, and periodic triggered memories of Vietnam. The examiner noted that he had denied any aggression toward others, that there was no suggestion of a memory-related impairment, that his distressing dreams were not consistent with traumatic nightmares, and that his reported triggers were not consistent with clinically significant reactivity. Provided remarks noted it was unclear to what extent the Veteran's mood would improve if he used his psychotropic medications as prescribed. His impairment appeared to be predominantly within the realm of social functioning. A May 2016 VA examination included a diagnosis of major depressive disorder with additional relevant medical diagnoses of sleep apnea and knee/back pain. The examiner found that the Veteran's level of occupational and social impairment was best summarized as an impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medication. The symptoms noted to apply to the diagnosis included depressed mood, chronic sleep impairment, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. It was noted that the Veteran continued to experience symptoms of depression causing some mild impairment in functioning and that his use of antidepressant medication had been beneficial. VA treatment records note diagnoses and treatment including for depression, obstructive sleep apnea, and difficulty sleeping. A March 2019 report noted the Veteran demonstrated diagnostic criteria including nightmares, avoidance of crowds, and negative alterations in cognition. The examiner also noted his medication regime was discussed and found that his current symptoms were likely related to a break in medication use and an adjustment to recent surgery. It was noted he was not gravely disabled. An August 2019 report noted he complained of an inability to sleep, flashbacks or Vietnam, and occasional nervousness. It was noted that he had retired from his employment as a carpenter and that he had completed two years of college education in safety engineering. The examiner noted he reported numerous symptoms of depression including marked diminished interest or pleasure in all or almost all activities; significant weight loss or weight gain, or decreased or increased appetite; insomnia or hypersomnia; psychomotor agitation or retardation; fatigue or loss of energy; and diminished ability to think or concentrate. The symptoms, however, did not cause significant distress or impairment in important areas of functioning. The examiner found it was unclear whether these symptoms were a result of the lack of sleep due to insomnia. The diagnosis included insomnia and rule out mild recurrent major depressive disorder. A February 2020 VA treatment report noted the Veteran had stopped taking Mirtazapine. He stated he did not need it because he was sleeping much better and his mood was improved. VA examination in August 2021 included a diagnosis of major depressive disorder, in full remission. The examiner commented that the disorder appeared to be well controlled at the present time. The Veteran's level of occupational and social impairment was best summarized as an impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medication. Flattened affect was the only symptom noted to apply to the diagnosis. The examiner observed that the Veteran was casually attired and that he moved and talked slowly, but that rapport was easily established and maintained. His affect was somewhat blunted. His thought processes appeared fairly well organized, with thoughts characterized by some poverty of ideational content. His insight and judgment appeared fair. He denied suicidal ideation. There was no evidence of psychotic symptomatology. The examiner found the Veteran had no job-related difficulties secondary to service-connected mental health issues. Based upon the evidence of record, the Board finds that the Veteran's service-connected major depressive disorder is manifested by no more than occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. The overall evidence of record as to the matter is persuasive that the disability has neither improved materially nor increased in severity for any identifiable period during the appeal. Although the May 2016 VA examiner noted symptoms indicative of a higher 50 percent rating (disturbances of motivation and mood and difficulty in establishing and maintaining effective work and social relationships), it was specifically noted that the Veteran's symptoms of depression caused only some mild impairment in functioning. Therefore, a schedular rating in excess of 30 percent is denied. The Board notes that VA regulations under 38 C.F.R. § 3.344(a) and 38 C.F.R. § 4.1 address the stabilization of ratings, flare-ups must be of such length as to establish that the overall impairment is more severe than currently evaluated, rather than a brief snapshot in time. The Board finds the degrees of disability specified in this case are adequate to compensate for any loss of working time from exacerbations or illness proportionate to the severity of the several grades of disability. There are no reports of exacerbation or flare-ups that are quantifiable nor of sufficient duration to warrant a change in evaluation without violating the provisions of 38 C.F.R. § 4.1 and 38 C.F.R. § 3.344(a) regarding stabilization of ratings. VA records show service connection is established for prostate cancer residuals, major depressive disorder, and erectile dysfunction and residual scars associated with prostate cancer. The Veteran's combined service-connected disability rating is 70 percent effective May 1, 2021. As he is shown to have met the schedular criteria for TDIU eligibility under 38 C.F.R. § 4.16(a), the pertinent issue for consideration is whether he is unable to secure or follow a substantially gainful occupation as a result of service-connected disability. Although the Veteran asserted that he had experienced employment difficulties in 2018, the overall evidence does not demonstrate that he unable to secure or follow a substantially gainful occupation as a result of service-connected disability. The August 2021 VA examiner found he had no job-related difficulties secondary to service-connected mental health issues. It is additionally significant to note that a December 2020 VA examination found his residuals of prostate cancer had no impact on his ability to work. The Board acknowledges that the Veteran is competent to report observable symptoms. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). He is not, however, competent to identify a specific level of disability. Competent evidence concerning the nature and extent of the Veteran's service-connected disability has been provided by VA medical professionals who have examined him. The medical findings adequately address the criteria under which the disability is evaluated and clearly demonstrate that the degree of impairment over the period at issue. The Board accords these findings greater weight than the Veteran's complaints as to any increased symptomatology. See Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991). The preponderance of the evidence in this case is against the claim for an increased rating. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Douglas 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.