Citation Nr: 21067616 Decision Date: 11/04/21 Archive Date: 11/04/21 DOCKET NO. 07-05 982 DATE: November 4, 2021 ORDER Entitlement to a total disability rating based upon individual unemployability due to service-connected disabilities (TDIU) is denied. FINDINGS OF FACT 1. Service connection is currently in effect for posttraumatic stress disorder (PTSD), rated as 50 percent prior to July 30, 3008, 70 percent from July 30, 2008 to January 19, 2011, and 50 percent from January 19, 2011; supraventricular arrythmia, rated as 30 percent from January 28, 2016; tinnitus, rated as 10 percent from August 2003; hepatitis, rated as 10 percent from November 30, 2004; and bilateral hearing loss, onychomycosis, and hypertension, each rated as noncompensable throughout the period on appeal. 2. The evidence of record is not sufficient to show that the Veteran's service-connected disabilities, individually or in the aggregate, have prevented him from securing or maintaining substantially gainful employment consistent with his education and work experience at any time during the period on appeal. CONCLUSIONS OF LAW The schedular criteria for TDIU consideration are not met except for from July 30, 2008 to January 19, 2011 and since January 28, 2016; a schedular rating for TDIU is not warranted for any part of the rating period; and referral to VA's Director of Compensation and Pension Service for extraschedular consideration of a TDIU is not warranted. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.15, 4.16(a), (b), 4.18, 4.19, 4.25. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from March 1952 to March 1955. The Board remanded the appeal in February 2018 to obtain medical opinions from a Department of Veterans Affairs (VA) examiner regarding the Veteran's employability. The Board subsequently issued a decision denying the Veteran's TDIU claim in May 2020; however, that decision was vacated and the matter remanded to the Board in June 2021 by the Court of Appeals for Veterans Claims (CAVC) pursuant to the parties' Joint Motion for Remand (JMR), which concluded the Board had erred in failing to provide an adequate statement of reasons or bases by overly relying on VA examiners' conclusions about employability and occupational impairment. The Board was directed to make an independent judgment. The JMR also found that while the Board discussed the Veteran's physical ability to obtain substantially gainful employment, it did not analyze the Veteran's mental capacity to obtain substantially gainful employment. Entitlement to a total disability rating based upon individual unemployability due to service-connected disabilities (TDIU). The Veteran contends he is entitled to a total disability rating based on individual unemployability. He has contended that PTSD and his other service-connected disabilities render him unemployable. The Board, in its independent judgment, finds that the evidence is insufficient to establish that the Veteran has been unable to secure and follow substantially gainful employment at any time during the period on appeal. Legal Criteria A TDIU may be granted where the schedular rating is less than 100 percent if the Veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, and the Veteran is rated at 60 percent or more for a single service-connected disability, or rated at 70 percent for two or more service-connected disabilities and at least one disability is rated at least 40 percent. 38 C.F.R. §§ 3.340, 3.341, 4.16(a), 4.19. Furthermore, it is the policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disability shall be rated totally disabled. 38 C.F.R. § 4.16(b). Thus, if a Veteran fails to meet the applicable percentage standards enunciated in 38 C.F.R. § 4.16(a), an extraschedular rating is for consideration where the Veteran is unemployable due to service-connected disabilities. 38 C.F.R. § 4.16(b); see also Fanning v. Brown, 4 Vet. App. 225 (1993). Unlike the regular disability rating schedule, which is based on the average work-related impairment caused by a disability, "entitlement to a TDIU is based on an individual's particular circumstances." Rice v. Shinseki, 22 Vet. App. at 452 (2009). A veteran need not show complete unemployability in order to be entitled to a TDIU. Roberson v. Principi, 251 F.3d 1378, 1385 (Fed. Cir. 2001). In determining employability for VA purposes, consideration is given to the level of education, special training, and work experience, but not to age or non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16(a), 4.19; see also Faust v. West, 13 Vet. App. 342 (2000). For the Veteran to prevail on a claim for a TDIU, the sole fact that the Veteran is unemployed or has difficulty obtaining employment is not enough. The question is whether the Veteran is capable of performing the physical and mental acts required by employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993) (citing 38 C.F.R. §§ 4.1, 4.15, 4.16(a)). In Ray v. Wilkie, 31 Vet. App. 58 (2019), the Court noted that "substantially gainful employment" contains economic and noneconomic components; the economic component means "an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person," while the noneconomic component requires consideration of a veteran's ability to secure or follow that type of employment. The Court noted that attention must be given to the veteran's occupational history, education, skill and training, whether the veteran has the physical ability to perform occupational activities, and whether the veteran has the mental ability to perform occupational activities. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Evidence The Veteran's VA Form 21-8940 alleged unemployability since September 1, 2006 (the day after he retired from his federal service employment). At the time, the Veteran contended that PTSD, hepatitis, and tinnitus prevented him from securing or following a substantially gainful occupation. He also mentioned in the application that hearing loss and several nonservice-connected musculoskeletal conditions "affect[] optimal efficiency and productivity." Subsequent submissions by the Veteran and his attorney have emphasized his PTSD symptoms, but the Board will address all service-connected conditions, alone and in the aggregate, which the Veteran has contended impact his workplace functioning. The Board notes initially that the schedular percentage requirements for consideration of a TDIU under 38 C.F.R. § 4.16(a) are only met during the periods of July 30, 2008 to January 19, 2011 and from January 28, 2016 to present. Accordingly, a TDIU cannot be granted by the Board in the first instance under the schedular criteria of 38 C.F.R. § 4.16(a) for those periods when the initial schedular criteria for TDIU consideration are not met. The Board will therefore address whether referral for extraschedular consideration may be warranted based on evidence of unemployability. Furthermore, although the Veteran's TDIU claim alleges unemployability since September 1, 2006, the Board will discuss the Veteran's treatment history and records prior to this date in order to shed light on the Veteran's functionality leading up to his retirement and to compare his symptoms and functionality during his period of employment with his symptoms and functionality since his retirement. The evidence shows the Veteran has a Master of Science degree in education and worked on a full-time basis throughout his life. He retired on August 31, 2006, after working for the VA Regional Office for over ten years as a veterans' counselor. The day after his retirement, September 1, 2006, he submitted a claim for TDIU. The form alleged that he became too disabled to work full time on that day. The Veteran first sought mental health care in January 2003. At his initial social work consultation, he reported chronic sleep issues and frequent waking. He reported that he tried to stay constantly busy with work in order to keep his mind occupied and to buffer anxious and depressive feelings. He stated he found working with other veterans to be therapeutic and helped him to keep his focus off himself. He admitted to feeling depressed and stated he had experienced depressive states ever since he left Korea. At another January 2003 medical appointment, the Veteran noted he had problems initiating and maintaining sleep for years, noted that he was able to function at work, and expressed that he has low frustration tolerance. He was prescribed sertraline 50 mg. to treat depression, and temazepam 15 mg. to treat insomnia. At a March 2003 psychiatric intake appointment, it was noted the Veteran was able to function and concentrate at work, but comes home tired. He stated that working with veterans helped him get his thoughts and focus off himself. The Veteran reported that he has long had problems with anxiety, irritability, and low frustration tolerance. He reported he could get verbally abusive toward his wife and family. He reported continued sleep problems. He was prescribed 100 mg of trazodone for sleep. In May 2003, the Veteran began participating in group therapy sessions for veterans of the Korean War and WWII. These group therapy sessions initially occurred on a biweekly basis, and later switched to a monthly basis. The Veteran continued to attend these sessions throughout the period on appeal. Every session note reports that the Veteran was engaged and involved in the discussion. The Veteran's first VA examination for mental health/PTSD was in August 2003. It noted the Veteran experienced traumatic recollections daily, which had been going on ever since active duty. He stated there had been no remissions and that he had worked at his job, tolerating these symptoms since service. His current functional status was noted to be fairly good and that he has been able to function in his job for many years. The Veteran reported memory problems, but the examination showed his memory to be intact. Overall, the examiner found he exhibited moderate symptoms including a depressed mood, insomnia, and difficulty in occupational and social functioning and interpersonal relationships. A December 2003 medical treatment psychology note reflected the Veteran's chief complaint of poor sleep. He reported only sleeping 3-4 hours per night despite using 100 mg of trazodone. He rated his level of depression at a four out of ten, with ten being most severe on the perceived scale. His trazodone dosage was increased to 200 mg, and his sertraline dosage was increased to a "target dose" of 150 mg from 100 mg. A June 2004 VA PTSD examination noted that he continued to work full time as a veterans counselor and had been married to his wife for 23 years, whom he described as a stabilizing factor. He admitted to alcohol abuse as a type of self-medication for PTSD. He reported symptoms including nightmares 2-3 times per week, avoidance, emotional numbness, sleep deprivation, anger, irritability, and hypervigilance. The examiner noted his symptoms had not resulted in any missed work and that the "Veteran uses his work to defend against intrusive memories." The examiner noted the Veteran "reports no remission of symptoms but does not claim loss of work time related to such because he is philosophically 'work-oriented.'" The Veteran reported golfing regularly with a group of friends. He denied any suicidal or homicidal ideation or hallucinatory experiences. There was no evidence of delusional thinking. Thought processes were logical and goal directed. Insight and judgment appeared to be intact. Memory in all spheres was intact and overall intellectual functioning was in the average to high average range. The Veteran received a diagnosis of moderate PTSD and alcohol abuse. A March 2005 VA PTSD examination report reflects that the Veteran reported that he continued to work full time, explaining that "if he does not keep himself busy his symptoms get worse." The examiner noted the Veteran had not missed any work in the past 12 months due to PTSD symptoms. The Veteran reported that he was getting older and wanted to retire, but worried he would get very depressed and would not know what to do with himself if he did not work. The Veteran reported he used work to cope with his symptoms, that his symptoms were better when he was at work, and referred to himself as a workaholic, noting he had worked two jobs at a time and went to full-time school. The Veteran was noted to be attending group therapy and taking medications including 200 mg of trazodone to promote sleep, as well as 150 mg of sertraline. He reported not drinking anymore because he could not mix it with his medication. He reported difficulty in getting close with his children but indicated his relationships with his wife and grandchildren were good. The examiner observed him to be tense and anxious during the interview, but he was oriented to person, place, and time. His memory was intact for both short-term and long-term memory. The Veteran denied panic attacks but reported nightmares and feeling guilty and severely depressed and moderately anxious. The Veteran reported irritability but noted he did not have impulse control problems. He reported that he spent "all day long" answering telephone calls at his workplace. An August 2005 medical treatment note included a depression screen where the Veteran indicated feeling depressed most of the day, nearly every day, for the past two weeks, and indicated diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day, for the past two weeks. A March 2006 medical treatment note reflects that the Veteran reported continued poor sleep and mild symptoms of depression. It was noted that "he continues to work full time at the Waco VARO and reported that his job was not stressful to him." His medications were changed due to concern that trazodone was no longer effective for sleep. Two weeks later, the Veteran reported the new medication was not making him drowsy at all and trazodone was restarted. In April 2006 he reported that he joined a gym. The evidence reflects that the Veteran retired from his employment on August 31, 2006, and filed his claim for TDIU on September 1, 2006. His TDIU claim listed PTSD, hepatitis, and tinnitus as preventing him from securing or following a substantially gainful occupation. In an October 2006 statement, the Veteran indicated he had retired as a result of physical disabilities; he stated due to hearing impairment, it had become increasingly difficult to hear phone conversations with individuals who had soft or low speech volume, and that sitting for long periods of time affected his left hip, lower back, and knees which interfered with his work efficiency. He stated that he had felt he was no longer serving veterans to the best of his abilities. An October 2007 medical treatment note indicates the Veteran denied depression and stated with the help of his Korean War support group his PTSD was under fair control. He continued to report chronic sleep problems and noted that trazodone was not totally effective. The Veteran was afforded another VA PTSD examination in July 2008. He reported frequent crying spells, depressed, mood, sleep problems, and irritability. The Veteran reported he had retired because "work wasn't fun anymore." He stated that he had been very successful at work, and developed programs to improve efficiency. He reported that he became irritated and less patient with changes he perceived as inefficient and thus decided to retire. He reported social impairments including frequent arguments with his wife and an episode involving a near-altercation with a motorist who cut him off in traffic. The Veteran expressed concern about overreacting. He reported panic attacks 4-5 times per year. He reported checking the locks on his doors 2-3 times per night and noted he had engaged in this behavior since his discharge from the military. The behavior did not interfere with routine activities. In December 2008, the Veteran's was noted to have mild depression and anxiety and complained of ongoing sleep problems. The Veteran was prescribed citalopram 60 mg. Trazodone was continued at 200 mg for sleep. In July 2009, the citalopram was reduced to 20 mg. A March 2010 medical treatment note reflects the Veteran was continued on 200 mg of trazodone for sleep. The Veteran stated he had not taken his antidepressant citalopram "for some time and really doesn't see that he needs it." He voiced no problems during the visit and reported he was doing "ok." In August 2010, the Veteran underwent a VA PTSD examination. The examiner noted the Veteran had retired based on being "eligible by age or duration of work." The Veteran was noted to still be attending his Korean War support group twice a month. The Veteran reported being a "loner" and only seeing friends for weekly golfing. He reported he did not socialize with anyone and was often short-tempered with his wife. He reported enjoying gardening. He reported experiencing a panic attack once a month. The Veteran brought up the altercation with the motorist he had previously reported at the July 2008 examination, noting that he had challenged the other driver to fight, but "soon calmed down" after the driver sped away. The examiner noted it was doubtful the Veteran would ever be symptom-free, that his PTSD symptoms would continue to impact his functioning, and "prognosis appears to be poor." In January 2011, the Veteran underwent another VA PTSD examination. He reported that he had quit taking his antidepressant as he felt it was not needed. He endorsed no depressive symptoms aside from irritability. He reported being satisfied with the Korean War support group. He reported experiencing crying spells when triggered by reminders of his military experience. He reported a supportive relationship with his wife. He stated he had been a "loner" ever since returning from Korea and noted that he did not socialize with his coworkers throughout his career. He reported continuing to golf weekly with a consistent group of friends. He stated he enjoyed daily gardening. He again brought up the near-altercation with a motorist that he had discussed in his July 2008 VA examination, reflecting that he was "too old" to be getting into fights with other drivers. He stated he was able to consider consequences before acting. The examiner found his recent and immediate memory to be mildly impaired, with remote memory normal. In July 2016, the Veteran began individual (rather than group) mental health treatment. At his initial consult, he was noted to have mood instability and poor sleep, and reported he was mildly depressed and moderately anxious. He described poor sleep hygiene and nightmares. His memory, cognitive function, insight and judgment were noted to be "fair." In October 2016, a mental health treatment note reflects the Veteran's reported stressors including acute abdominal pain for which he was encouraged to see primary care as a walk-in that same day. He reported depressed at a five out of ten and anxiety at a three out of ten. He reported anger, irritability, and mood swings. It was noted the Veteran was not taking the proper dosage of his trazadone to aid in sleep his prescription was now at 300 mg. and he was continuing to take 200 mg. He was encouraged to take the correct amount. His next psychotherapy session was scheduled for three months out. In January 2017, the Veteran was afforded a VA PTSD examination. The Veteran reported no panic attacks, mild anxiety, and moderate depressive symptoms. The Veteran reported mild memory loss, problems with concentration, and sleep disturbances. The VA psychiatric examiner noted no issues with memory or recall, and indicated the Veteran was alert and oriented. The examiner concluded the Veteran experienced occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. In an August 2017 addendum, the examiner added that the Veteran's mental health symptoms would not prevent him from obtaining and maintaining substantially gainful employment. In December 2017, at a routine psychotherapy appointment, the Veteran reported his mood was good and denied depression. He reported his sleep was adequate and that the combination of mirtazapine and trazadone helped. He denied experiencing nightmares. He reported pain levels at a zero out of ten on the pain scale. The Veteran was noted to be cooperative, ambulating independently, and participating fully during the session. No psychomotor agitation or retardation was noted. His attention and concentration were demonstrated to conversational content. His mood was euthymic. His thought processes were noted to be coherent, logical, and goal directed, and he was noted to be alert and oriented. The mental health provider indicated his mood was stable. His medications were unchanged. In February 2018, it was noted that the Veteran was active in his Korean War support group discussion, and had shared the sad news of his daughter having terminal cancer. The provider noted the Veteran had attended all appointments regularly and was active in the group, and further stated the Veteran was emotionally supportive of the other members and shared openly about his own personal issues. VA examination reports from July 2018 indicate that the Veteran has no restrictions due to his liver condition or onychomycosis, and that he is able to do light work despite his heart condition and hypertension. Hearing loss was noted not to affect his ability to function in the majority of employment situations. Tinnitus was noted to have no impact on his ability to function in any employment situation. A VA examiner also opined in a July 2018 medical opinion that the Veteran would have "no job related difficulties secondary to service connected mental health issues," and commented that in the examiner's opinion, "employment was cathartic for the veteran, rather than problematic due to PTSD symptoms." A January 2019 routine psychotherapy note reflects continued reports of poor sleep and frequent wakening during the night. The Veteran reported his sleep had been that way since the military. He denied having depression, but stated he was prone to crying, adding, "I don't mind crying, it's a release for me. It's not depression, it's a reaction. I'm okay with that." He denied having nightmares. He reported walking at Walmart for two hours every Monday for exercise. He reported his mood was okay if he was busy, because he doesn't think. He denied pain. He was noted to be alert and oriented, polite and cooperative, with normal speech and intact judgment and insight. His only psychotropic medication remained trazodone, for sleep. In July 2019, the Veteran presented for routine psychotherapy appointment. It was noted he had last seen the provider in January 2019. The Veteran reported he had "a day or two of low mood in a month, but it is fleeting." He reported improved sleep with two trazodone (200 mg total) and the addition of melatonin. He reported feeling rested in the morning. He was noted to be pleasant and cooperative, and endorsed a stable mood. The provider observed that his PTSD symptoms were minimized with medication, and his mood and PTSD "are stable at this time." Routine follow up was suggested in six months' time. In January 2020, it was noted the Veteran had missed several Korean War support group meetings due to travel, "as he is actively involved in reunions." His recent stressors included his daughter's death from terminal illness. He reported continuing to regularly play golf and spending time working in his yard. The provider observed the Veteran "consistently is active in group, initiating and facilitating discussion." He reported benefits from "being able to be with others that went through the same thing I did." His psychiatry treatment plan medical note, also in January 2020, reflects the Veteran's reported strengths and abilities, which include, "I am a good communicator," "I am able to get along with people," "I have an education," "I trust my judgment," and "I work well with others," among other attributes identified. In February 2020, the Veteran's representative submitted VA Form 646, which asserted the Veteran was seeking TDIU solely due to his PTSD. Analysis The ultimate question of whether a Veteran is capable of substantially gainful employment is not a medical one, but rather a determination for the adjudicator considering the totality of the circumstances. See 38 C.F.R. § 4.16(a); Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013). The Veteran was able to work without significant impairment by his PTSD until he chose to retire in August 2006. Although the Veteran reports irritability, anger problems, crying spells, and hypervigilance, the Veteran has consistently reported these symptoms and has stated he has experienced these symptoms, without remission, since he returned from Korea. The Veteran has also had longstanding sleep issues, including for the duration of the time he was employed; indeed, his sleep troubles are consistently the focus of his psychiatric treatment. The Veteran's medical records reflect he has often reported anxiety, irritability, and low frustration tolerance. These symptoms were also present during the time he was fully employed; by the Veteran's own admissions, and as his medical records reflect, his social functioning and family relationships often suffered at the expense of him becoming engrossed in, successful at, and fulfilled by his work. As his 2003 medical notes reflect, he reported he could get verbally abusive toward his wife and family, but reported being able to function and succeed at work. He repeatedly stated that work was therapeutic for him and that he enjoyed staying busy and focusing on others, rather than himself. Although the Veteran's July 2008 C&P examination reported worsening symptoms and a report of a near-altercation with a motorist, his complaints were focused mainly on issues with his wife and social impairments. He expressed regret about how he had behaved toward the other driver. The examiner specifically annotated that his symptoms interfered with social functioning, rather than occupational. The Veteran also stated in this examination that he retired because work was no longer fun, and reported that "he had been quite successful in his work and had been involved in the development of several programs to improve work efficiency," but found himself becoming "more easily irritated and less patient with changes he perceived as inefficient and thus decided to retire." A December 2008 medical note, just a few months later, noted only mild depression and anxiety. By all accounts, the Veteran's work was satisfying to him, while his PTSD symptoms unfortunately impacted his personal life. The Veteran managed to have a long and successful career as a civil servant despite his PTSD symptoms and despite his years of poor sleep. The Veteran, through his representative, argues that he retired due to PTSD symptoms, i.e., an inability to cope with changes in the workplace, and that this indicates the Veteran was and remains unemployable. The Board disagrees. By the Veteran's own reports, his work was the best coping mechanism he had. He routinely reported to VA examiners and medical providers alike that work was therapeutic and beneficial for him, that it helped him not to ruminate or think about his traumatic experiences, and that he placed great value and prestige in his work and his expertise. He expressed a desire to retire in 2005, but was concerned about what he would do when he no longer had the focus and distraction of his work. The Veteran did report that he decided to retire due to changes in the workplace, but by his report these were changes that he believed resulted in inefficiencies, an area of particular concern to him. The evidence does not indicate that the Veteran could not mentally cope with changes; rather, the Veteran appears to have simply been ready to move on. As he stated to the July 2008 VA examiner, "work wasn't fun anymore." Contrary to an individual suffering from occupational impairments due to mental health symptoms, the evidence paints a picture of a longstanding, competent employee, who placed a great deal of value in his work, who performed his work with excellence, and for whom work was a substantial stabilizing factor in his life. Far from being unable to do his job, the evidence indicates the Veteran made a personal choice to retire after weighing the pros and cons. While he may have felt he could no longer do his job as well as he expected or demanded of himself, the evidence does not reflect that he would have been unable to secure or follow substantially gainful employment post-retirement. Further, the evidence does not reflect that his PTSD symptoms became worse after his retirement or rendered him unemployable in subsequent years; to the contrary, many of his symptoms appeared to improve. The Veteran stopped taking antidepressant medication sometime in 2010 as he felt he didn't need it. The Veteran began individual psychotherapy treatment in 2016 and appears to have benefited from it; in December 2017 he denied even having depression and reported his sleep was adequate. He also denied experiencing nightmares, which had previously been a consistent complaint in his treatment records. He similarly denied experiencing nightmares in January 2019. The Veteran added melatonin to his sleep medication regimen in 2019 and reported improved sleep. In July 2019, his PTSD symptoms were noted to be minimal. He has continued to be deeply involved and participatory in his Korean War support group and in reunions. His psychotherapy appointments, previously at three-month intervals, were most recently (per available records) scheduled at six-month intervals, indicating a reduced need for mental health supportive intervention. The Veteran, through his representative, argued that his memory loss would also render him unemployable, but the records do not reflect significant memory loss. At the August 2010 VA examination, his recent memory was noted to be moderately impaired, and he commented that he sometimes forgot tasks his wife asked him to do. His remote memory was noted to be mildly impaired. The January 2011 VA examination found his recent and immediate memory to be only mildly impaired, with remote memory normal. At the January 2017 VA examination, the Veteran noted mild memory loss, but the VA examiner indicated no problems with memory or recall. Moreover, considering the Veteran's years of experience and education levels, any minor memory issues could likely be addressed with workplace accommodations such as electronic calendar or task reminders, writing things down, or other administrative housekeeping. The preponderance of the evidence is against a finding that the Veteran's memory loss, alone or in combination with his other PTSD symptoms, are so severe as to prevent him from obtaining or maintaining gainful employment, considering his experience, skill, and education levels. The opinion of the July 2018 VA examiner, indicating no work restrictions due to PTSD symptoms, is also highly probative. While the Board does not rely on it alone, nor on the other VA examiners' conclusions as to the levels of occupational impairment over the years, the overall evidence of record supports a conclusion that the Veteran has consistently had the mental ability to secure and maintain gainful employment. As to his physical limitations, the Veteran argued in his October 2006 statement that he retired because the combined effect of his conditions made it too difficult for him to perform his job and provide the level of service he felt veterans deserved. He expressed frustration with being unable to clearly hear his clients on the phone. Although the Veteran may very well have had difficulty hearing soft or low speaking voices due to his hearing impairment and/or tinnitus, this does not indicate he would be unable to secure or maintain gainful employment that would enable sufficient accommodation for his disabilities. Indeed, the Veteran has an advanced degree and decades of specialized experience, and has previously considered himself an expert who developed new training programs. The Veteran's work history and his substantial capabilities do not indicate that he would be limited to an entry-level job answering phones at a call-center or something similar, or otherwise be limited by his hearing impairment. Further, the Veteran's medical records reflect that he has worn hearing aids since 2004 (prior to his retirement), received new hearing aids in January 2009, and reported during a March 2009 medical appointment that he wears his new hearing aids full time and his ability to understand conversation is improved. Finally, his hearing loss is and always has been rated as noncompensable, which indicates it does not interfere with his earning capacity. As to tinnitus, the Veteran complained to VA medical providers about tinnitus in July and August 2004 and December 2005, when he was employed, rating it as subjectively severe and bothersome. The Veteran was able to work despite the tinnitus. The medical records do not reflect specific complaints of tinnitus since that time. His November 2005 and December 2005 VA examinations reflect his report that tinnitus was irritating to him in quiet environments. The July 2018 VA medical opinions, mentioned previously, concluded that hearing loss and tinnitus have no impact on the Veteran's ability to function in any employment situation. Specifically, the VA examiner noted that his hearing thresholds were noted to be normal through 2 KHZ, "which would only affect [the] Veteran in difficult listening situations... The hearing loss in the high frequencies would not impact ability to function in most employment situations." Although irritating to the Veteran at times, no restrictions for job activities were warranted on account of either hearing loss or tinnitus. Considered in combination, the job-related impacts of his hearing impairment and tinnitus would be minimal. While the Veteran may have been bothered by his difficulty in hearing soft-speaking individuals on the telephone, and was irritated by tinnitus, this does not support a finding that the Veteran's hearing impairment and tinnitus would preclude him from other substantially gainful employment consistent with his level of education and experience. Regarding his other physical limitations, the Veteran's medical records have always noted him to be ambulatory and self-sufficient. His liver condition and onychomycosis do not warrant any work restrictions. His other service-connected physical disabilities (hypertension and heart condition) limit him only insofar as they limit him to sedentary or light work. This is not a far-fetched recommendation; the Veteran has been employed in non-physically demanding, office-based occupations for the entirety of his post-military career. The Board finds that the Veteran has the physical ability to secure and maintain employment, and could perform light duty or sedentary work. The definition of sedentary work utilized by the Social Security Administration states that sedentary work requires the ability to sit for six hours out of an eight-hour workday and stand and/or walk for at least two hours in an eight-hour work day. The Veteran does not have any standing, sitting, or walking restrictions due to service-connected physical disabilities that would prevent him from meeting these requirements. The Board finds that the Veteran has the physical ability to perform occupational activities, and that his background, experience, and education levels would enable him to work in a sedentary, light-duty or office setting, where he would be able to obtain any reasonable accommodations necessary. Although the Veteran, through his representative, argues that the Board should consider the Veteran's other physical issues such as back, hip, and knee problems, as well, these are nonservice-connected conditions that the Board may not consider in evaluation of a TDIU. The Veteran, through his representative, also suggested his physical conditions exacerbate his PTSD. The September 2021 submission argued the Board should consider how physical impairments such as tinnitus and hearing loss plus hip, back, and knee problems (nonservice-connected issues) "have exacerbated the mental impact of his PTSD." The Veteran's psychiatric records do not support this contention. The Veteran's psychiatric records persistently focus on his major complaint throughout his life: sleep. The Veteran has reported significant sleep troubles since returning from Korea, has trialed different medications and dosages over the years to attempt to address his sleep troubles, and has thrived in his professional career in spite of those sleep troubles. The Veteran has complained of his hearing loss and tinnitus, but at no time did he articulate, nor have his mental health providers indicated, that these physical conditions were exacerbating his PTSD at allmuch less to such a degree that he would be unable to secure or maintain gainful employment. The Board notes that the Veteran's service-connected disabilities have undoubtedly affected his ability to work and his work performance, as reflected by his fairly high disability ratings and combined ratings over the years. See Van Hoose v. Brown, 4 Vet. App. 361 (1993) (a high rating in itself is recognition that impairment makes it difficult to obtain or keep employment). However, for a TDIU to be granted, the Veteran must show that his service-connected disabilities preclude him from securing and maintaining all forms of substantially gainful employment consistent with his advanced education and many years of past work experience. This is not shown. In sum, having carefully considered the Veteran's contentions, his education and employment background, and all the limitations imposed on him as a consequence of his service-connected disabilities, both mental and physical, the Board finds that the criteria for entitlement to a TDIU have not been met for any portion of the period on appeal during which schedular consideration of a TDIU is appropriate, as the evidence is against a finding that the Veteran was unable to secure or follow substantially gainful employment. Additionally, the Board declines to refer the matter of extraschedular consideration to the Director of VA's Compensation and Pension Service for the time periods where the schedular criteria are not met, as the evidence is against a finding that the Veteran was unable to secure or follow a substantially gainful occupation due to service-connected disabilities during those time periods, as well. Instead, the evidence shows, through the entire period on appeal, that the Veteran's service-connected disabilities did not preclude him from securing or following a substantially gainful occupation. As the preponderance of the evidence is against the Veteran's claim, the benefit-of-the-doubt rule does not apply, and entitlement to a TDIU is denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). JENNIFER HWA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Medley, 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.