Citation Nr: 21063344 Decision Date: 10/14/21 Archive Date: 10/14/21 DOCKET NO. 17-31 606 DATE: October 14, 2021 ORDER Entitlement to an initial rating for gastroesophageal reflux disease (GERD) in excess of 10 percent from February 22, 2017 to July 15, 2017, and 30 percent, thereafter, is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) prior to January 5, 2017, is denied. FINDINGS OF FACT 1. The Veteran's GERD, prior to July 15, 2017, was not manifested by symptoms accompanied by substernal arm or shoulder pain, nor was there evidence that her GERD was productive of considerable impairment of health. 2. The Veteran's GERD, after July 15, 2017, was not manifested by symptoms of weight loss, hematemesis, or melena with moderate anemia, or other symptom combinations productive of severe impairment of health. 3. The record does not show that the Veteran is unable to secure or follow a substantially gainful occupation due solely to service-connected disabilities. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial rating for GERD in excess of 10 percent from February 22, 2017 to July 15, 2017, and 30 percent, thereafter, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.114, Diagnostic Code (DC) 7346. 2. The criteria for entitlement to a total disability rating based on individual unemployability (TDIU) prior to January 5, 2017, have not been met. 38 U.S.C. §§ 1155, 5103A, 5107; 38 C.F.R. §§ 3.159, 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 January 1995 to April 2001. These matters come before the Board of Veterans' Appeals (Board) on appeal from May 2013 and May 2017 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO). By way of background, the Veteran's TDIU claim stems from an increased rating claim for temporomandibular joint disorder (TMJ) which the Board previously found to be reasonably raised by the record in its November 2019 decision. Rice v. Shinseki, 22 Vet. App. 447 (2009). In the Board's November 2019 decision, the Board granted an increased rating of 40 percent for the Veteran's TMJ from May 20, 2011, to September 9, 2017 and a 50 percent rating thereafter. In the same decision, the Board raised entitlement to TDIU and remanded it, along with several other claims, for further development. A review of the claims file now shows that there has been substantial compliance with the Board's remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). Subsequent to the Board's remand, in a February 2021 rating decision, the RO granted service connection for sinusitis, vertigo and otitis media. This being a complete grant of the benefits sought, these claims are no longer before the Board. Grantham v. Brown, 114 F.3d 1156, 1158 (Fed. Cir. 1997). The Board notes, that the remaining claims on appeal now before the Board are entitlement to a TDIU and an increased rating for GERD. To that effect, in a November 2019 rating decision, the RO granted an increased rating for the Veteran's GERD to 30 percent effective July 15, 2017. The Board notes that the grant of an increased rating during the course of an appeal does not affect the pendency of that appeal. AB v. Brown, 6 Vet. App.35 (1993). As the Veteran is presumed to be seeking the maximum allowable benefit and the maximum benefit has not yet been awarded, the claim is still in controversy and on appeal. Id. Effective July 14, 2014, the Veteran is in receipt of a combined 100 percent schedular rating. The Board notes that the presence of a schedular 100 percent disability rating does not necessarily render the issue of TDIU moot. See Bradley v. Peake, 22 Vet. App. 280, 293-94 (2008) (holding that 100 percent evaluation does not render a TDIU claim moot where there is a possibility that TDIU will impact entitlement to special monthly compensation (SMC) based on receipt of service connection for a disability with a 100 percent rating and another with a separate 60 percent rating). In this case, however, the Veteran does not have a single disability that is 100 percent rated, nor, does the record indicate that any single disability rendered her unable to work. Rather, the claim for TDIU raise by the record pursuant to Rice, appears to be premised on the combined effect of her service-connected disabilities which potentially renders her unemployable and, therefore, under the facts of this case, her 100 percent schedular combined disability rating, from July 14, 2014, does render the TDIU claim moot, effective from that period. Thus, the issue has been appropriately recharacterized above. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). 1. Entitlement to an initial rating for gastroesophageal reflux disease (GERD) in excess of 10 percent from February 22, 2017 to July 15, 2017, and 30 percent, thereafter, is denied. The Veteran contends that her GERD and associated symptoms warrant a higher initial disability rating than 10 percent and greater than 30 percent after July 15, 2017. Specifically, she asserts that a higher rating is warranted due to symptoms of pain, vomiting and moderate anemia. See January 2021 VA Form 9. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The Rating Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. When 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 for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.3. Separate diagnostic codes identify the various disabilities. See 38 C.F.R. Part 4. GERD is not specifically listed in the rating schedule; therefore, it is rated analogous to a disability in which not only the functions affected, but anatomical localization and symptoms, are closely related, which in this case is "Hernia, hiatal." The criteria for evaluating diagnostic code (DC) 7346 for "Hernia, hiatal" (or GERD) shows as follows: A 60 percent rating is assigned if there are "Symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health." A 30 percent rating is assigned if there is "Persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health." A 10 percent rating is assigned "With two or more of the symptoms for the 30 percent evaluation of less severity." 38 C.F.R. § 4.114, DC 7346. In filing her claim, the Veteran states that her symptoms include substernal (chest) pain, severe heartburn, acid reflux, nausea episodes, regurgitation, and sleep disturbances caused by esophageal reflux and/or regurgitation. She has been prescribed medications including Prilosec and Zantac to treat GERD symptoms. A March 2017 private disability benefits questionnaire by Dr. N.D. confirmed the Veteran's diagnosis of GERD. During which time, the Veteran reported she began having hiccups and heartburn in 2005. Dr. N.D. noted the Veteran's symptoms of GERD to include persistently recurrent epigastric distress, dysphagia, pyrosis (heartburn) reflux, regurgitation, sleep disturbance, nausea and vomiting all occurring over four times a year lasting 10 days or more. The Veteran reported to Dr. N.D. that her symptoms, although severe, are under good control with dietary modifications and prescribed medications. It was reported by the Veteran and noted by Dr. N.D. that the Veteran has flexibility with her job which allows to work from home when her reflux is bad making it easier for her to manage her GERD symptoms. In October 2017, the Veteran submitted another private disability benefits questionnaire. The noted symptoms and functional impact were very similar to that noted above. The Veteran was also afforded a VA examination for her GERD in October 2017. Once more the Veteran's symptoms were noted to include persistent recurrent epigastric distress, pyrosis, reflux, regurgitation, nausea, and vomiting. However, the VA examiner also reported that her symptoms were "productive of severe impairment of health". Functionally, the examiner remarked that the Veteran's GERD had no impact. Based on the foregoing evidence, the Board concludes a rating greater than the already assigned is not warranted. Prior to July 15, 2017, the Veteran's GERD is mainly manifested by substernal pain, nausea, reported sleep disturbances, and regurgitation. While these symptoms occur four or more times per year, the Board does not deem this as "persistently recurrent" nor does the evidence suggest they produce "considerable impairment of health" warranting a 30 percent rating. Rather, the Veteran's GERD is largely controlled when she manages her diet and takes her prescribed medication. The 10 percent rating assigned already compensates the fact that her GERD results in at least two or more symptoms, which the Board finds more approximately reflects the Veteran's disability picture here. After July 15, 2017, the Veteran's GERD is mainly manifested by similar symptoms as noted above. However, it is clear that her GERD symptoms became severe enough for the October 2017 VA examiner to note that they would significantly impair her health. However, the record does not indicate that the Veteran experiences substernal arm or shoulder pain, anemia, weight loss, hematemesis, or melena. Also, the Veteran's private examiner from October 2017 did not note any real change in severity or any additional symptoms for the Veteran's GERD. The Board notes that dysphagia is defined as "difficulty swallowing," and pyrosis is defined as "heartburn." See "Dysphagia" and "Pyrosis" Merriam-Webster.com Dictionary, Merriam-Webster, https://www.merriam-webster.com/dictionary. Accessed 14 Sept. 2021. The Board expressly acknowledges credible lay evidence of record in adjudicating this claim, particularly, the Veteran's statements regarding symptoms analogous to pyrosis, regurgitation, substernal pain, nausea, and sleep disturbances. The Veteran is competent to report symptoms and experiences observable by her senses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). However, while her GERD manifestations are no doubt painful and impact her quality of life when they occur, the evidence as a whole does not suggest they have resulted in a severe impairment of her health. As such, the already assigned 30 percent rating from July 15, 2017 is found to fully compensate the Veteran for her GERD symptoms, which the Board finds more approximately reflects the Veteran's current disability picture. The Board finds that the evidence of record is insufficient to establish that the Veteran should be awarded a higher disability rating for GERD. Thereby, the criteria for an increased rating in excess of 10 percent prior to July 15, 2017 and 30 percent afterwards, for GERD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.114, DC 7346. 2. Entitlement to a total disability rating based on individual unemployability (TDIU) prior to January 5, 2017, is denied. Generally, total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). If there is only one such disability, it must be rated at 60 percent or more, and if there are two or more disabilities, there shall be at least one disability rated at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent. 38 C.F.R. § 4.16(a). The Veteran's claim for TDIU stems from her increased rating claim for TMJ from May 2013. Specifically, there were indications from the record that raised the allegation of unemployability due to her service-connected disabilities and a suggestion that the Veteran may only have marginal employment, as opposed to substantially gainful employment. See April 2012 Statement in Support of Claim and April 2015 Third Party Correspondence. As noted above, effective July 14, 2014, the Veteran is in receipt of a combined 100 percent schedular rating that renders any claim for TDIU moot after this time period. Therefore, the Veteran's claim for TDIU is limited to the appeal period prior to July 14, 2014. Prior to July 14, 2014, the Veteran was in receipt of a combined disability rating of 90 percent from May 20, 2011 therefore, the Veteran does meet the schedular criteria for a TDIU per 38 C.F.R. § 4.16(a). At which time the Veteran was service connected for adjustment disorder with depressed mood rated at 30 percent; migraine headaches rated at 50 percent; TMJ rated at 40 percent; sinusitis rated at 30 percent; uterine fibroids rated at 30 percent; bilateral knee patellofemoral syndrome with arthritis at 10 percent each; benign paroxysmal positional vertigo at 10 percent; tinnitus at 10 percent; bilateral leg varicose veins rated noncompensable; and bilateral chronic otitis media with otalgia (earaches, middle ear infection) rated noncompensable. The term "substantially gainful occupation" is not defined in the rating schedule. Rather, the Court in Ray v. Wilkie, found the phrase has two components: an economic one and a noneconomic one. 31 Vet. App. 58 (2019). In assessing the Veteran's ability to secure and follow a substantially gainful occupation, the Board is to consider the Veteran's history, education, skill, and training as well as physical abilities and mental abilities required by the occupation at issue. Id. Such specific physical ability-factors include lifting, bending, sitting, standing, walking, climbing, grasping, typing, reaching, auditory, and visual. Id. Specific mental ability-factors include memory, concentration, ability to adapt to change, handle work-place stress, getting along with coworkers, and demonstrating reliability and productivity. Id. The central question is "whether the [V]eteran's service-connected disabilities alone are of sufficient severity to produce unemployability," not whether the Veteran could find employment. Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). In determining whether a Veteran is unemployable for VA purposes, consideration may be given to the Veteran's level of education, special training, and previous work experience, but not to age or any impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19 (2016); Hersey v. Derwinski, 2 Vet. App. 91 (1992); Faust v. West, 13 Vet. App. 342 (2000). A Veteran need not show 100 percent unemployability in order to be entitled to a TDIU. Roberson v. Principi, 251 F.3d 1378 (Fed. Cir. 2001). As noted earlier, the Board previously remanded the issue in November 2019 for the RO to initially develop the newly raised claim for TDIU. This development was to include providing the Veteran with notice of the requirements for entitlement to a TDIU including VA Form 21-8940 (Veterans Application for Increased Compensation Based on Unemployability), invite her to submit additional evidence in support of the claim, and to ask the Veteran to provide IRS tax returns for the years she has not been able to obtain and maintain substantially gainful employment due to her service-connected disabilities. The Board notes, that VA has a duty to assist the Veteran in obtaining information, and the Veteran has a duty on his part to cooperate with VA in developing a claim. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) (noting that "[t]he duty to assist is not always a one-way street"). VA's duty must be understood as a duty to assist the Veteran in developing his claim, rather than a duty on the part of VA to develop the entire claim with the Veteran performing a passive role. Turk v. Peake, 21 Vet. App. 565, 568 (2008). In this instance, the Veteran must aid in the development of her claim by providing necessary information as requested. If the Veteran fails to do so, her claim will be decided based on the evidence of record. See 38 C.F.R. § 3.655. A review of the record indicates VA sent the required notice and requested employment information from the Veteran in a letter dated January 9, 2020. Unfortunately, there has been no response by the Veteran or her representative. As such, the Veteran's claim must be decided on the evidence of record. In rendering a close examination of the evidence, the Board finds the evidence does not support a grant of TDIU prior to July 14, 2014. Rather the evidence shows although the Veteran has physical as well as mental limitations, her service-connected disabilities alone would not preclude employment, in fact she has remained gainfully employed throughout the period on appeal. The Veteran's educational history includes a high school diploma as well as two master's degrees. Her military occupational specialty was yeoman. Post service, the Veteran worked as a clerk/typist and as a paralegal in 2002. Afterwards she was unemployed and sought vocational rehabilitation to obtain additional education which was granted. In November 2005 it was determined that the Veteran had completed rehabilitation to the point of employability. Currently she works as a mental health counselor. Social Security Administration (SSA) records indicate the Veteran has not applied for SSA benefits, to include disability benefits. Nonetheless, the Board notes that any findings or reports from the SSA are not dispositive or binding on VA. See Collier v. Derwinski, 1 Vet. App. 413, 417 (1991). The Veteran's medical records document a lengthy history of medical issues resulting in several VA and private examinations for her service-connected disabilities effective prior to July 14, 2014. In May 2013 the Veteran was afforded a VA sinusitis examination. At which time the examiner found no symptomology to warrant a diagnosis and no functional impact was reported. The Veteran was also afforded, in May 2013, a VA mental disorders examination. The examiner diagnosed the Veteran with adjustment disorder with depressed mood and summarized her occupational and social impairment to be due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress. The examiner noted symptoms of depressed mood and anxiety with other symptoms of difficulty sleeping, socially withdrawn and quick to become irritable. The Veteran was found to be competent to manage her own finances and the examiner concluded "the Veteran remains capable to work on a full-time basis from a mental health point of view". The Veteran, again in May 2013, was afforded a VA hearing loss and tinnitus examination. She was diagnosed with tinnitus however, it was noted by the examiner that her tinnitus did not impact ordinary conditions of daily life, including her ability to work. In May 2014, a private disability benefits questionnaire for the Veteran's migraines was submitted. The private examiner noted that the Veteran could not work when she experienced her migraines. It was reported that she experienced headache pain on both sides of her head that worsened upon physical activity. Nausea, vomiting, and sensitivity to light and sound with changes in vision and dizziness were also noted. The examiner noted that the Veteran experienced prostrating attacks less than once every two months with no very frequent prostrating and prolonged attacks of migraine pain. Private examiner, Dr. E.H. provided a private TMJ disability benefits questionnaire in May 2014. At which time the Veteran reported that she had a lengthy history of jaw trouble to include surgery. She further reported that her TMJ makes it hard to eat and that speaking at length is difficult. Functionally, Dr. E.H. noted that the Veteran's episodes of TMJ pain limits her ability to open her mouth and her pain adversely affected her speech. A follow up letter by Dr. E.H. further noted speaking was painful for the Veteran due to her TMJ condition. So much so, that she needed a "narrator" at work in order to complete an oral presentation. A July 2014 VA knee and lower leg examination resulted in the confirmation that the Veteran has a diagnosis of bilateral knee patellofemoral syndrome with arthritis. The Veteran reported aches and swelling with painful motion. The examiner noted painful motion upon range of motion testing. It was further noted that no assistive devices were used and that her condition limits the Veteran's ability to bend, stoop, and stand for prolonged periods. An April 2017 private migraine examination by Dr. N.D. noted that the Veteran's migraines are debilitating to the point she cannot work. Dr. N.D. further noted that the Veteran had accommodations, so she is able to work from home however, when she has headaches, she is not able to do any activities. The Veteran submitted a private disability benefits questionnaire for her vertigo in July 2017 by Dr. D.L. The private examiner noted that the Veteran's vertigo episodes last up to one week and that the Veteran makes several visits to urgent care with severe symptoms a year. Dr. D.L. reported that the Veteran has reasonable accommodations for work due to flare ups of symptoms which occur more than twice per month. In November 2017, the Veteran was afforded a gynecological VA examination. At which time the Veteran's uterine fibroids conditions was confirmed and lengthy medical history involving surgeries was reviewed. Ultimately, the examiner opined that her uterine fibroids condition had no functional impact. The Veteran was first afforded a VA examination for her vertigo in December 2020. At which time, the examiner confirmed the Veteran's diagnosis of vertigo. Functionally, the examiner opined "occupations involving ladders and/or heights [along with] operating machinery is hindered during vertigo episodes". The Veteran's sinusitis was first examined in December 2020 as well. During the examination, the Veteran's diagnosis of chronic sinusitis was confirmed. Specifically, it was noted that she has frontal and ethmoid sinuses affected with pain and tenderness. It was noted that "due to sinus congestion there is limitation with activities such as climbing stairs over one flight, walking over 50 to 75 yards, and exercise is limited". The Veteran's service-connected bilateral varicose veins and chronic otitis media with otalgia have been assigned a noncompensable rating. The medical record indicates these conditions do not negatively impact the Veteran's functional ability and therefore a detailed discussion of the medical evidence associated with these conditions will not be further addressed. After thorough review of the claims file, the Board finds the evidence does not support TDIU. The preponderance of the evidence supports that the Veteran has been employed full time as a mental health counselor, is able to engage in sedentary employment with appropriate education and work history despite the functional limitations of her service-connected disabilities. In Withers v. Wilkie, the Court noted that VA has not explicitly defined the meaning of "sedentary employment." Withers v. Wilkie, 30 Vet. App. 139 (2018). Until VA provides such a definition, "the meaning and relevance of the term will have to be discerned on a case-by-case basis from the medical and lay evidence presented and in light of each veteran's education, training, and work history." Id. at 149-150. See also Rouse v. McDonough, No. 19-5699 (2021), which confirmed the holding in Withers and declined to compel VA to adopt the definition of "sedentary work" or "sedentary employment" used by the Social Security Administration. Here, the Veteran's education, training, and work history demonstrate that she has the capacity to engage in sedentary occupations such as paralegal, mental health counselor, and clerk; performing clerical work including typing; and using a telephone. The Board considered the physical ability-factors noted in Ray, to include lifting, bending, sitting, standing, walking, climbing, grasping, typing, reaching, auditory, and visual. See Ray, 31 Vet. App. 58. Although the medical evidence of record indicates a limited ability to engage in physical activities, these limitations would not preclude occupations which are primarily sedentary. She has never reported that the amount of time she can sit in one sitting is limited. Additionally, no VA or private examiner found the Veteran's physical limitations precluded her ability to work based solely on service-connected disabilities nor that she was incapable of sedentary employment. The Board also considered the mental ability factors noted in Ray, to include memory, concentration, ability to adapt to change, handle workplace stress, getting along with coworkers, and demonstrating reliability and productivity. See Ray, 31 Vet. App. 58. Although the medical evidence of record indicates occupational and social impairment due to her service-connected adjustment disorder with depressed mood condition, such impairment is limited to at worst resulting in reduced reliability and productivity. Furthermore, the Veteran herself seems to indicate that the primary cause of her need for accomodation at work are due to her physical conditions such as TMJ, migraines, and tinnitus. See April 2012 and April 2015 Statements in Support of Claim. As noted earlier, the Veteran has been employed throughout the period on appeal. However, the Veteran has been in receipt of reasonable accommodations through her employer since August 2014. These accommodations include a flexible work schedule, to include ability to work from home, assistance with 40-hour training with a reduction in the amount of time speaking and providing backup for on-call hotline duties. See April 2015 Third Party Correspondence, see also July 2015 Letter from the Director of the War Fighter Support Program. These accommodations indicate a potential that even though employed, the Veteran's employment might be marginal in nature. As such, the Board has considered whether this would be tantamount to a protected work environment. Generally, marginal employment shall be deemed to exist when a Veteran's earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. 38 C.F.R. § 4.16(a); Faust v. West, 13 Vet. App. 342, 355-56 (2000) ("substantially gainful employment" for TDIU purposes is met where the annual earned income exceeds the poverty threshold for "one person," irrespective of the number of hours or days actually worked and without regard to any prior income history). Where, however, a veteran's disabilities do not result in lost income or where legally required accommodations permit a veteran to maintain gainful employment, an award of TDIU does not serve its intended purpose. Cantrell v. Shulkin, 28 Vet. App. 382 (2017) (Lance, J., concurring) ("Where a claimant's employer is required by law to provide reasonable accommodations pursuant to the ADA and those accommodations allow the claimant to engage in a substantially gainful occupation, a TDIU award would, in effect, constitute a second paycheck on the back of the taxpayer."). Marginal employment may also be held to exist on a facts-found basis, including when employment resulting in earned annual income exceeding the poverty threshold for one person was performed in a "protected environment such as a family business or sheltered workshop." 38 C.F.R. § 4.16(a). In the instant case, the Board finds that the Veteran's need for reasonable accommodations due to her service-connected disabilities does not result in a protected work environment as contemplated by VA regulations. In this regard, the needed accommodations of a flexible work schedule, assistance with speaking engagements and providing a back-up for on call duties, as legally required accommodations would not diminish the core job duties and responsibilities or impair the Veteran's ability to perform successfully in such a position. The Board does not doubt that the Veteran's service-connected disabilities cause impairing symptomatology. This impairment of function is recognized by the ratings assigned to each of her service-connected disabilities. Consideration may not be given to a veteran's age or to the impairment caused by nonservice-connected disabilities when determining entitlement to TDIU. Additionally, as previously noted, the Veteran did not respond to VA's request for additional information concerning her TDIU claim which could have assisted the Board in its adjudication. Since the duty to assist is not a one-way street, the Board was forced to decide the claim based on the evidence of record. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). As such, the evidence does not support that the Veteran's service-connected disabilities, prior to July 14, 2014, precluded substantially gainful employment, specifically to include sedentary employment as outlined above. In light of the Veteran's past work history, training, and skills and in light of the medical evidence in this case, the Board finds the Veteran has been substantially and gainfully employed throughout the period on appeal. For these reasons, the Board finds that an award for TDIU prior to July 14, 2014, is not warranted and, therefore, this claim must be denied. SHEREEN M. MARCUS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. F. Minnitte, Attorney Advisor 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.