Citation Nr: A21018145 Decision Date: 11/12/21 Archive Date: 11/12/21 DOCKET NO. 200121-62599 DATE: November 12, 2021 ORDER Entitlement to a rating in excess of 70 percent for posttraumatic stress disorder (PTSD) is denied. Entitlement to service connection for bruxism as secondary to the Veteran's service-connected PTSD is granted. Entitlement to a total disability rating for individual unemployability (TDIU) due to service-connected disabilities is denied. FINDINGS OF FACT 1. The Veteran's PTSD has been productive of occupational and social impairment with deficiencies in most areas, such as work, family relations, judgment, thinking, and mood; however, total occupational and social impairment has not been shown. 2. Resolving reasonable doubt in the Veteran's favor, the Veteran's bruxism is related to his service-connected PTSD. 3. The weight of the evidence does not establish that the Veteran was precluded from securing or maintaining substantially gainful employment solely due to his service-connected PTSD and diabetes mellitus disabilities. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of a 70 percent rating for PTSD have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.321, 4.1, 4.3, 4.10, 4.130, Diagnostic Code (DC) 9411(2020). 2. The criteria for entitlement to secondary service connection for bruxism have been met. 38 U.S.C. §§ 1110, 1131, 5107(2012); 38 C.F.R. §§ 3.102, 3.303 (2020). 3. The criteria for a TDIU have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16, 4.19 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1966 to January 1968. A rating decision was issued under the legacy system in February 2019 and the Veteran submitted a timely notice of disagreement (NOD). In December 2019, the agency of original jurisdiction (AOJ) issued a Statement of the Case (SOC). The Veteran opted the claims into the modernized review system, also known as the Appeals Modernization Act (AMA), by submitting a timely VA Form 10182, Decision Review Request: Board Appeal (NOD) identifying the December 2019 SOC; therefore, the December 2019 SOC is the decision on appeal. In the January 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) (NOD), the appellant elected the Evidence Submission option; therefore, the Board of Veterans' Appeals (Board) may only consider the evidence of record at the time of the AOJ decision on appeal, as well as any evidence submitted by the appellant or his or her representative with the VA Form 10182 or within 90 days of receipt of the VA Form 10182. 38 C.F.R. § 20.303. Thus, the Board may consider evidence submitted between January 27, 2020 and April 26, 2020. The Board notes no additional evidence was submitted during the evidence submission period. The Board notes that the Veteran revoked the power of attorney in favor of Agent D.P.W. in a written statement submitted in July 2021. See July 2021 VA Form 21-4138, Statement in Support of Claim. The Veteran also filed a VA Form 21-22 appointing the National Association of County Veterans Service Officers, Inc. Accordingly, the Board recognizes the National Association of County Veterans Service Officers, Inc. as the Veteran's representative. Additionally, the Board has taken jurisdiction of the issue of entitlement to service connection for bruxism, as the claim is reasonably raised in the record. "Once the Board has jurisdiction over a claim, however, it has the authority to address all issues related to that claim, even those not previously decided by the RO." See Jarrell v. Nicholson, 20 Vet. App. 326, 332 (2006); see also Chavis v. McDonough, 34 Vet. App. 1, 10 (2021). 1. Entitlement to a rating in excess of 70 percent for posttraumatic stress disorder (PTSD) The Veteran seeks a rating in excess of 70 percent for his service-connected PTSD. See January 2020 VA Form 10182. Legal criteria The Veteran's PTSD disability is currently rated under DC 9411, 38 C.F.R. § 4.130. VA regulations employ a "General Rating Formula for Mental Disorders" such as PTSD with compensable ratings of 10 percent, 30 percent, 50 percent, 70 percent, and 100 percent. 38 C.F.R. § 4.130. The criteria for 70 percent rating requires occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. See 38 C.F.R. § 4.130, DC 9400, General Rating Formula for Mental Disorders. A total schedular rating of 100 percent is warranted when the disorder results in total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of mental and personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. Assessing whether a particular rating is warranted "requires a two-part analysis." Emerson v. McDonald, 28 Vet. App. 200, 212 (2016). It requires an "initial assessment of the symptoms displayed by the veteran, and if they are of the kind enumerated in the regulation, [and] an assessment of [the extent] those symptoms result in occupational and social impairment []." Id. More generally, the rating analysis for psychiatric disorders is symptom driven. Golden v. Shulkin, 29 Vet. App. 221, 225 (2018); Vazquez-Claudio, Shinseki, 713 F.3d 112, 116 (Fed. Cir. 2013) ("The regulation's plain language highlights its symptom-driven nature."). The symptoms listed do not form an exhaustive list but rather serve as examples of the type and degree of symptoms that would justify the associated rating. See Bankhead v. Shulkin, 29 Vet. App. 10, 1819 (2017). And the "'frequency, severity, and duration' of a veteran's symptoms must play an important role in determining his disability level." Vazquez-Claudio, 713 F.3d at 117. Factual Background By way of history the Veteran has been in receipt of service connection for PTSD rated as 70 percent disabling effective April 2012. See April 2013 Rating Decision. The Veteran's current increased rating claim arose in the context of his claim for individual unemployability. The Veteran filed a claim for TDIU on November 27, 2018. See November 2018 VA Form 21-9040. Therefore, the relevant temporal focus for PTSD is from one year prior to the date of receipt of the claim, which is from November 27, 2017 to December 23, 2019. 38 C.F.R. § 3.400(o)(2). In connection with his claim for TDIU, the Veteran underwent a VA examination for his PTSD. See December 2018 VA Review PTSD Disability Benefits Questionnaire (DBQ). The examiner found that the Veteran's PTSD resulted in occupational and social impairment with reduced reliability and productivity. When asked about his psychiatric treatment history, the Veteran reported he was seen by Dr. Florek until 2013 or 2014, and that his wife complained about his anger issues. Id. He stated his relationship with his children and grandchildren was okay, but denied being close to his four siblings. He noted he had friends at the golf course where he worked seasonally. He reported that he had a problem at work because he was verbally aggressive with one of the coaches. Id. He also endorsed other instances of verbal aggression including episodes of road rage. Id. The examiner found the Veteran's PTSD symptoms included: depressed mood; suspiciousness; chronic sleep impairment; mild memory loss; impaired judgment; difficulty in establishing and maintaining effective work and social relationships; and difficulty in adapting to stressful circumstances, including work and social relationships. On mental status examination (MSE), the examiner noted that the Veteran's teeth appeared damaged, and the Veteran "explained that he has ground them down from their original size." See December 2018 VA Review PTSD DBQ. The Veteran displayed normal speech and thought processes and no evidence of delusion was found. He denied auditory and visual hallucinations. Id. He described his mood as "not very happy often." The examiner noted that the Veteran appeared mildly depressed. Regarding suicide and homicidal ideations, the examiner noted the Veteran "convincingly denied" such. The Veteran endorsed sleep disturbance with frequent waking but noted he gets seven-and-one-half to eight (7.5-8) hours of sleep per night. The Veteran's affect was somewhat constricted. He also demonstrated short-term memory impairment and had fair insight and judgment. Id. The examiner concluded that the Veteran's occupational functioning was moderately impaired due to his PTSD. Id. According to the Veteran's VA treatment records, the Veteran did not receive any psychotropic medication or treatment for PTSD. For instance, prior to the December 2018 VA examination, the Veteran was seen for a telehealth primary care visit in October 2018. See October 2018 VA Tele-primary Care Note, in CAPRI received February 2019. PTSD was not listed as an active problem. The Veteran was noted to be alert and aware and no communication barriers were noted. Id. Additionally, the Veteran's depression and suicide screenings were negative for depression and suicide ideations. Id. During an August 2019 VA primary care visit, the Veteran appeared well-nourished and well groomed. See August 2019 VA Primary Care Note in CAPRI received December 2019. The Veteran reported experiencing events in the past 6 months that caused him stress or worry but declined to follow up. Id. Analysis Based on the foregoing evidence, the Board finds that the Veteran's PTSD symptoms most closely approximate those contemplated by a 70 percent rating, rather than a 100 percent rating. See 38 C.F.R. § 4.130, DC 9400. As noted previously, the Veteran was assigned a 70 percent rating for his service-connected PTSD. Regarding, the Veteran's occupational and social impairment, the December 2018 VA examiner opined that the Veteran had occupational and social impairment, with reduced reliability, which is consistent with a 50 percent rating. However, the Board will not disturb the currently assigned 70 percent disability rating. However, the Board finds that total occupational and social impairment has not be demonstrated such that a 100 percent rating is warranted. During the appeal period, the Veteran demonstrated the following PTSD symptoms: depressed mood; suspiciousness; chronic sleep impairment; mild memory loss; impaired judgment; difficulty in establishing and maintaining effective work and social relationships; and difficulty in adapting to stressful circumstances, including work and social relationships. See December 2018 VA Review PTSD DBQ. These symptoms are consistent with the rating criteria for 30, 50 and 70 percent disability ratings. Thus, the Veteran's symptoms are not the symptoms contemplated by the 100 percent rating, and were not of the severity, frequency, or duration required by the 100 percent rating criteria as discussed in more detail below. The Board notes that the Veteran barely exhibited the symptoms for a 70 percent rating. The evidence of record did not demonstrate that the Veteran had near continuous panic or depression affecting ability to function independently, appropriately, and effectively, impaired impulse control, spatial disorientation, or speech intermittently illogical, obscure or irrelevant. Additionally, despite noting he had ground his teeth during the December 2018 VA examination, there was no evidence that the Veteran's PSTD resulted in neglect of personal appearance and hygiene. Indeed, the Veteran was noted to be well groomed in August 2019. See August 2019 VA Primary Care Note in CAPRI received December 2019. Additionally, the Veteran denied suicidal ideations during the December 2018 VA examination and during the October 2018 VA tele-primary care visit. See October 2018 VA Tele-primary Care Note, in CAPRI received February 2019. Nevertheless, the Board finds that the Veteran's functional impairment due to his PTSD most nearly approximates the criteria for a 50 percent rating. See Mauerhan v. Principi, 16 Vet. App. 436 (2002) (symptoms recited in the rating schedule for mental disorders are to serve as examples of the type and degree of the symptoms and not an exhaustive list). The Board considered whether a higher rating was warranted for his service-connected PTSD. However, the Veteran has not established any of the symptoms, such as those associated with a 100 percent rating, including: gross impairment in thought process or communication, disorientation to time or place, persistent danger of hurting self or others, persistent delusions or hallucinations, inability to perform activities of daily living, memory loss of names of close relatives, current or former occupation, or own name. Id. The U.S. Court of Appeals for the Federal Circuit has explained that evaluation under § 4.130 is "symptom driven," meaning that "symptom[s] should be the fact finder's primary focus when deciding entitlement to a given disability rating" under that regulation. "[A] veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. "To qualify for a particular disability rating, § 4.130 requires "not only the presence of certain symptoms[,] but also that those symptoms have caused occupational and social impairment in most of the referenced areas." For instance, the December 2018 VA examiner found the Veteran had normal speech and thought processes, whereas to be consistent with a 100 percent rating, it would require gross impairment in communication and thought processes. Additionally, during an October 2018 the Veteran was noted to be alert and aware and no communication barriers were noted. See October 2018 VA Tele-primary Care Note, in CAPRI received February 2019. Additionally, the Veteran denied persistent hallucinations and homicidal or suicidal ideations in his December 2018 VA examination and during his VA treatment, whereas to be consistent with a 100 percent rating it would require persistent hallucinations and persistent danger of hurting one-self and others. Moreover, the evidence does not demonstrate that the Veteran has had any delusions or hallucinations that are persistent, behavior that has been grossly inappropriate, or had here is an inability to perform activities of daily living, or that he has memory loss that reaches a level where he does not remember his own name. Additionally, there is no evidence that the Veteran was disoriented to time or place, because his VA treatment records, and VA examination reflect that he was alert and oriented. See i.e., October 2018 VA Tele-primary Care Note, in CAPRI received February 2019. Additionally, the December 2018 VA examiner did not list disorientation to or place as one of the Veteran's PTSD symptoms. See December 2018 VA Review PTSD DBQ. Thus, for the reasons discussed above, the Board finds that the preponderance of the evidence is against a finding that the Veteran's overall level of social and occupational impairment due to his PTSD more nearly approximates the level contemplated by a 100 percent rating. Notably, the Veteran's symptoms have been consistent throughout the appeal period. See Fenderson v. West, 12 Vet. App. 119, 126 (1999) (finding that at the time of an initial rating "separate ratings can be assigned for separate periods of time based on facts found", a practice known as "staged" rating). Here, however, the evidence warrants a uniform 70 rating. In deciding the claim, the Board considered the lay statements from the Veteran, and finds that his statements are competent and credible evidence of the Veteran's PTSD which he experienced or observed. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005); see also Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, these statements are not competent evidence as to a specific level of disability according to the appropriate diagnostic codes. See Robinson v. Shinseki, 557 F.3d 1355 (2009). Evidence concerning the nature and extent of the Veteran's PTSD has been provided by the medical personnel who have examined him at various times during the current appeal and who have rendered pertinent opinions in conjunction with the physical evaluations. The medical findings as provided in the examination reports directly address the criteria under which this type of disability is evaluated. The Board, therefore, finds the medical findings to be of a greater probative value as to the current severity of the Veteran's PTSD than his statements. Therefore, the Board finds that the preponderance of the evidence supports a finding that the rating in excess of 70 percent is not warranted. Hence the benefit-of-the-doubt doctrine does not apply. Gilbert v. Derwinski, 1 Vet. App. 49 (1991); 38 U.S.C. § § 5107(b); 38 C.F.R. §§ 4.3, 4.7. Accordingly, the claim for a rating in excess of 70 percent for PTSD is denied. 2. Service Connection The issue of entitlement to service connection for bruxism was raised as part of the Veteran's increased rating claim for PTSD pursuant to a recent precedential decision in Bailey v. Wilkie, 33 Vet. App. 188 (2021). Legal Criteria In Bailey, the United States Court of Appeals for Veterans Claims (Court) held that pursuant to 38 C.F.R. § 3.155(d)(2), it is not necessary for a claimant to file a formal secondary service connection claim for additional complications related to a service-connected disability when such residual complications are reasonably raised by the record during the rating period for the primary disability, explaining VA's duty to maximize benefits requires it to exhaust all schedular alternatives, including entitlement to secondary service connection, when evaluating a disability. 33 Vet. App. 188 (2021). In order to prevail under a theory of secondary service connection, there must be: (1) evidence of a current disorder; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disorder. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Analysis The Board observes that the December 2018 VA examination report noted that the Veteran's teeth were visibly damaged. See December 2018 VA Review PTSD Disability Benefits Questionnaire (DBQ). During the December 2018 VA examination, the Veteran "explained that he has ground them down from their original size." Id. The examiner made no additional remarks regarding the Veteran's teeth, and the remaining medical evidence is silent on this issue. "Bruxism" is the "involuntary, nonfunctional, rhymic or spasmodic gnashing, grinding, and clenching of teeth,... usually during sleep... [and] [c]auses may be related to repressed aggression, emotional tension, anger, fear, and frustration." Dorland's Illustrated Medical Dictionary 257 (32d ed. 2012). Resolving all reasonable doubt in the Veteran's favor, the Board finds that the Veteran has a current disability of bruxism, which was identified during the December 2018 VA examination report, when the examiner observed the Veteran's teeth were visibly damaged. Additionally, the Veteran reported that he ground his teeth from their original size. As such, the first element of secondary service connection has been met. Second, the Veteran is service-connected for PTSD. As such, the second element of service connection has been met. Lastly, with resolution of the reasonable doubt in his favor, the Board finds a nexus between the Veteran's bruxism and PTSD has been demonstrated, as the definition of bruxism seems to suggest psychiatric or mental cause. Accordingly, after resolving all doubt in the Veteran's favor, the Board finds that service connection for bruxism is warranted as secondary to PTSD. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 3. Entitlement to a TDIU due to service-connected is denied. The Veteran contends that he is unable to secure or follow substantiality gainful employment as a result of his service-connected PTSD and diabetes mellitus (DM) disabilities. See November 2018 VA Form 21-8940, Veteran's Application for Increased Compensation Based on Employability. Legal Criteria TDIU will be awarded when a veteran is unable to secure or follow a substantially gainful occupation because of a service-connected disability or disabilities. 38 C.F.R. § 4.16(a). To qualify for a TDIU on a schedular basis, the evidence must show (1) a single disability rated as 100 percent disabling; or (2) that the disabled person is unable to secure or follow a substantially gainful occupation because of her or her service-connected disabilities, with one disability ratable at 60 percent or more, or, for more than one disability, at least one disability ratable at 40 percent or more and a combined disability rating of 70 percent or more. Id. For the purpose of determining entitlement to a schedular TDIU, disabilities of one or both upper extremities or of one or both lower extremities, including the bilateral factor, are considered as one disability. 38 C.F.R. § 4.16(a). The United States Court of Appeals for the Federal Circuit stated that the ultimate question of whether a Veteran is capable of substantial gainful employment is not a medical one; that determination is for the adjudicator. Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013); Floore v. Shinseki, 26 Vet. App. 376, 381 (2013). As such, the focus of the findings obtained on examination is not on whether the Veteran is unemployable due to his service-connected disabilities, but rather the functional impairment caused solely by his service-connected disabilities in concert. The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. A disability rating in itself is recognition that the impairment makes it difficult to obtain or keep employment, but the ultimate question is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether he can find employment. Van Hoose v. Brown, 4 Vet. App. 361 (1993). In Ray v. Wilkie, the United States Court of Appeals for Veterans Claims (Court) explained 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. Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). The noneconomic factors include the Veteran's: work history, education, skill, and training; the Veteran's physical ability to perform work activities; and the Veteran's mental ability to perform work activities required by the Veteran's occupation. Relevant Facts and Analysis The Veteran submitted a TDIU claim in November 2018. See November 2018 VA Form 21-9040. Therefore, the relevant temporal focus for TDIU is the date of receipt of the claim, which is from November 27, 2017. 38 C.F.R. § 3.400. The Veteran is in receipt of service connection for PTSD rated as 70 percent disabling effective April 2012, and DM rated as 20 percent disabling effective November 2018. See February 2019 Rating Decision Codesheet. His total combined disability rating is 80 percent effective November 27, 2018. Thus, he meets the schedular requirements for a TDIU. 38 C.F.R. § 4.16. The remaining question is whether the Veteran's service-connected disabilities render him unemployable during this period. In his October 2018 TDIU application, the Veteran indicated that he last worked full time in January 2003 at the Post Office since 1968. See October 2018 VA Form 21-9040, Veteran's Application for Increased Compensation Based on Unemployability. He has a high school diploma. He asserted that PTSD and DMI prevent him securing or following any substantially gainful occupation. Id. The Veteran also noted that he worked at a Post Office as a letter carrier and Vehicle Operations Maintenance. He further stated "[d]uring my employment there, my [] PTSD and [DM], prevent me from maintaining gainful employment, both sedentary and labor intensive." He further asserted that he was unable to maintain other employment for the same reasons. Turning to the medical evidence, the Veteran was provided a VA examination for his DM condition. See December 2018 VA Diabetes Mellitus DBQ. The examiner found that the Veteran's DM was managed by restricted diet and that he was prescribed oral hypoglycemic agent however, the Veteran did not require regulation of activities as part of medical management of DM. The Veteran did not have progressive unintentional weight loss or loss of strength attributable to DM, nor did he have any complications of DM. Regarding the functional impact of the Veteran's DM, the examiner opined that the "[V]eteran's diabetes does not impact on physical or sedentary activities." Id. As discussed above, the Veteran also underwent a VA examination for his service-connected PTSD in December 2018 in connection with his TDIU claim. See December 2018 VA Review PTSD DBQ. During the examination, the Veteran reported that he worked on a seasonal basis at the golf course and was planning to resign "this year because his vision is blurry, which is a problem when he tries to drive." Id. The examiner opined that the Veteran's PTSD resulted in moderate cognitive difficulty such as impaired concentration and short-term memory, which may impede completion of tasks in a timely and efficient manner, moderate social impairment, due to irritability and isolative behavior, affecting his ability to interact with his supervisors and coworkers appropriately, and that his sleep disturbance may affect his attendance. She concluded that overall, his PTSD symptoms resulted in moderate impairment of occupational functioning. Based on the above-cited evidence, the Board finds that the weight of the evidence fails to establish that the Veteran's service-connected disabilities preclude him from obtaining or maintaining substantially gainful employment. While the Veteran's service-connected PTSD and DM disabilities cause some functional impairment including physical and psychiatric symptoms, the evidence of record does not demonstrate they have risen to the level that he is unable to secure or follow any substantially gainful employment in light of his education and occupational experience. The Board reiterates the Court defined the phrase "unable to secure and follow a substantially gainful occupation" to have two components: an economic component (an occupation earning more than marginal income); and a noneconomic component that considers such factors as the Veteran's history, education, skill, training, physical ability, and mental ability. See Ray v. Wilkie, 31 Vet. App.at 73). Economic Factor Turning to the economic factor, the Board is unable to ascertain whether the Veteran has earned more than marginal income and meets the economic component of being unable to secure and follow a substantially gainful occupation. Although the Veteran indicated that he stopped working full time in January 2003, the evidence of record indicated he worked part-time on a seasonal basis at a golf course. See November 2012 VA Initial PTSD DBQ; December 2018 VA Review PTSD DBQ. Thus, as the Veteran's work was seasonal and part-time, the Board resolves reasonable doubt in his favor and finds he has not earned more than marginal income and meets the economic component of being unable to secure and follow a substantially gainful occupation. Non-economic factors As noted above, the noneconomic factors include the Veteran's: work history, education, skill, and training; the Veteran's physical ability to perform work activities; and the Veteran's mental ability to perform work activities required by the Veteran's occupation. The Veteran's post-service work history includes working at the postal service for 37 years and working part-time at a golf course. His education includes a high school diploma. Regarding, the physical limitations caused by his service-connected DM, the December 2018 VA examiner noted that Veteran did not have progressive unintentional weight loss, loss of strength, or any complications attributable to DM. See December 2018 VA Diabetes Mellitus DBQ. Regarding the functional impact of the Veteran's DM, the examiner opined that the "[V]eteran's diabetes does not impact on physical or sedentary activities." Id. As such, the December 2018 VA examination report reflects that the Veteran's service-connected DM did not result in functional limitations that would render him unemployable. Regarding the mental limitations caused by the Veteran's service-connected PTSD, the December 2018 VA examiner opined the Veteran's PTSD resulted in moderate cognitive difficulty such as impaired concentration and short-term memory, which may impede completion of tasks in a timely and efficient manner, moderate social impairment, due to irritability and isolative behavior, affecting his ability to interact with his supervisors and coworkers appropriately, and that his sleep disturbance may affect his attendance. See December 2018 VA Review PTSD DBQ. She further concluded that overall, his PTSD symptoms resulted in moderate impairment of occupational functioning. Thus, the December 2018 PSTD VA examination fails to demonstrate that the Veteran's was precluded from obtaining and maintaining substantially gainful employment as a result of his PTSD. The Board considered the Veteran's lay statements and finds that he is competent and credible regarding the symptoms of his service-connected disabilities. However, although a layperson is competent to report observable symptoms he experiences, as a layperson he is not competent to provide a medical opinion concerning whether he is unable to work due to his service-connected disabilities. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Importantly, there is no evidence of record that the Veteran has the medical expertise sufficient to render such a determination. As such, the Veteran's lay statements regarding his employability are not probative. Instead, the Board accords significant probative weight to the VA examiners' opinions which are based on the review of the pertinent evidence and examination of the Veteran. Based on the above-cited evidence, the Board finds that the weight of the evidence does not establish that the Veteran's service-connected disabilities preclude him from obtaining or maintaining substantially gainful employment. While the Veteran's service-connected PTSD and DM disabilities cause some functional impairment, which is reflected by the combined 80 percent combined rating, the evidence of record does not demonstrate they have risen to the level that he is unable to secure or follow any substantially gainful employment in light of his education and occupational experience. In fact, no medical professional has opined that the Veteran's service-connected disabilities resulted in significant impairment which precluded gainful employment. Instead, the evidence demonstrates that the Veteran retired from the Post Office after 37 years, and was planning on resigning from his part-time employment at golf course due to blurry vision, a non-service-connected disability. However, non-service-connected disabilities nor advancing age may be considered for a TDIU. 38C.F.R. §4.19. In sum, the evidence deemed most probative by the Board establishes that the Veteran's service-connected disabilities have not rendered him unable to secure and follow a substantially gainful occupation at any time during the appeal period. The Board is grateful to the Veteran for his service, and regrets that it cannot render a favorable decision in this matter. Therefore, as the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt doctrine does not apply and the Veteran's claim for entitlement to TDIU must be denied. See 38U.S.C. §5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). YVETTE R. WHITE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Lilly, 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.