Citation Nr: 21076990 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 17-31 559 DATE: December 28, 2021 ORDER 1. Entitlement to service connection for a cervical spine disability, to include cervical strain and retrolisthesis, is denied. 2. Entitlement to a total disability rating for compensation based on individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against a finding that the Veteran's cervical spine disability had its onset in service, was manifested within one year following service discharge, or is otherwise related to service. 2. The preponderance of the evidence is against a finding that the Veteran has been unable to secure or follow a substantially gainful occupation by reason of service-connected disabilities during the appeal period. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a cervical spine disability, to include cervical strain and retrolisthesis, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 2. The criteria for entitlement to a TDIU rating have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.3, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Army from September 2000 to November 2010. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a July 2015 rating decision. The Veteran testified at a Board hearing before the undersigned Veterans Law Judge in August 2021. A copy of the hearing transcript is included in the Veteran's claims file. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Additionally, where a veteran served 90 days or more of active service, and certain chronic diseases, such as arthritis, which is also known as degenerative joint disease and degenerative changes, become manifest to a degree of 10 percent or more within one year after the date of separation from such service, including arthritis, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1110, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). The Veteran has alleged that his current condition of neck strain relates to a May 2001 motor vehicle accident incurred during service, which was aggravated over the course of his active duty by wearing a helmet. He has stated that he did not receive treatment for this issue during service because seeking medical assistance was discouraged unless it was of a dire or imminent need. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the award of service connection. The reasons follow. On VA examination, the Veteran has been assessed with a cervical strain and retrolisthesis. Although this establishes that the Veteran has a current cervical spine disability, the preponderance of the evidence is against a finding of an in-service incurrence of this disability, or a causal relationship between the Veteran's current disability and his active duty service. Service treatment records in May 2001 show that the Veteran was treated for a head injury resulting from his reported motor vehicle accident. The Veteran was noted to be healing well, but there was no mention of complaints or injury to the Veteran's neck or cervical spine. He was able to eventually return to his regular activities and, although the Veteran would report back pain and a history of head injury during active duty, the record does not show contemporaneous findings or reports indicative of a neck injury. On a Post-Deployment Health Assessment from October 2005, the Veteran reported symptoms of back pain, but otherwise denied muscle aches and swollen, stiff, or painful joints. On a Pre-Deployment Health Assessment in February 2006, the Veteran denied having any medical problems. On an April 2006 Post-Deployment Health Assessment, the Veteran again reported back pain but denied muscle aches and swollen, still, or painful joints. He again denied any medical problems on a Pre-Deployment Health Assessment in August 2006. In an April 2009 Report of Medical History, the Veteran reported a positive history of head injury and stated that he had recurrent back pain resulting from the May 2001 car accident. He reported knee trouble and painful joints, which he explained as normal wear and tear of the joints from physical activities, further stating that his knees lock or give out every once in a while. He did not document any of his reported musculoskeletal issues as pertaining to his neck. On this report, the Veteran also reported a positive history of hernia and skin disease. The Veteran received a normal clinical evaluation of the neck and spine on physical examination later in the same month. The Veteran again received a normal clinical evaluation of the neck and spine on the July 2010 Report of Medical Examination that was performed at separation. Within the concurrent Report of Medical History, the Veteran reported a history of recurrent back pain, knee trouble, and hernia. He stated that his knees had been painful off and on for several years and that he wears a knee brace when pain is prominent. The Veteran did not report symptoms with his neck. Following the Veteran's service discharge, the record does not establish the onset of a cervical spine disability for multiple years. The Veteran recorded an unremarkable neck examination in March 2011. VA treatment records show that the Veteran reported neck problems beginning in October 2014. He was issued a neck pillow, heating pad, and TENS unit. The Veteran underwent an MRI of the thoracic and cervical spine in November 2014. The evaluating neurosurgeon did not indicate any type of cervical spine disability and stated that there was no significant neural compression. The Veteran reported intermittent pain and discomfort symptoms in the neck thereafter. In January 2017, the Veteran underwent a VA examination for assessment of his cervical spine disability. He reported experiencing intermittent neck pain when moving his neck from side to side since his 2001 car accident. The Veteran was diagnosed with a cervical strain and retrolisthesis. After a review of the record, the examiner opined that it is less likely than not that the Veteran's cervical spine disability was caused by or related to active service. The examiner stated that the record does not show any neck complains in the immediate aftermath of the Veteran's May 2001 car accident or in the years thereafter, including on separation examination in 2010. The examiner noted that the Veteran did not have a documented neck complaint with a corresponding diagnosis until 2015. The examiner found the prolonged period between the Veteran's alleged injury and his report of symptoms and/or diagnosis to weigh against service connection. As to the Veteran's assertion that he did not report or seek treatment for his cervical spine disability during service because he was discouraged from seeking treatment except for urgent or dire medical problems, the Board does not find this statement to be persuasive or fully supported by the longitudinal record. Even if the Veteran were discouraged from seeking treatment for anything but the most serious medical problems during active duty, he could still report his symptomology on Reports of Medical History, including at the time of separation. On multiple occasions, the Veteran reported his medical history of head injury, skin disease, and hernia, despite not requiring concurrent medical treatment for these issues. He consistently reported the symptoms he experienced in his back and knees. In the July 2010 Report of Medical History, the Veteran documented multiple injuries from the May 2001 car accident, which included recurrent back pain, two lacerations to the back of his head, and a concussion and loss of consciousness. Not included in this list was neck or cervical spine pain. The Board finds that had the Veteran experienced symptoms involving his neck/cervical spine during service, including as a result of the May 2001 car accident, he would have documented such symptoms, as he documented multiple other medical symptoms he experienced during service and from that car accident. Additionally, the service treatment records show that the Veteran sought treatment at separate times for a range of issues, such as ankle sprains and stomach cramps. These findings show that the Veteran was capable of, and did, report or seek treatment for the medical symptoms he was experiencing during active duty. The Veteran was detailed in providing his medical history at the time of the July 2010 Report of Medical History, and the lack of documentation of neck pain, while reporting wearing glasses, undergoing laser treatment to correct his vision, having painful knees, experiencing a hernia during basic training, sustaining two lacerations to the back of his head from the May 2001 car accident, experiencing a concussion from the May 2001 car accident, and having recurrent back pain, is evidence against the Veteran having experienced neck pain or a neck disease or injury during service; otherwise, he would have documented such pain. At the March 2011 VA examination, approximately four months following service discharge, the Veteran reported low back pain, bilateral knee pain, and bilateral ankle painall musculoskeletal painbut he did not report neck pain at that time. Thus, to the extent that the Veteran has alleged in-service neck pain, the Board finds such allegation not credible. As a result, the preponderance of the evidence is against a disease or injury involving the neck/cervical spine during service, and the in-service disease or injury element is not met. Alternatively, the Veteran could have sought treatment for a cervical spine disability, or reported symptoms in his neck, in the first three years following his discharge from active duty. However, the Veteran did not report problems in his neck for multiple years, even though the record shows that the Veteran underwent a physical evaluation of his neck/cervical spine in the year after his discharge from service, without noted diagnosis or complaint. Additionally, the preponderance of the evidence is against a nexus between the current cervical spine disability and service. The 2017 VA examiner's opinion is probative, as it was based on a concurrent in-person medical examination and review of the record with a rationale supported by the evidence. The examiner had noted there was a lack of evidence of neck complaints within the service treatment records, which aligns with the Board's finding. The examiner also stated that the prolonged period of no neck complaints in the years following service discharge was a basis for why the examiner concluded it was less likely than not related to service, which is also a fact with which the Board agrees. However, the examiner wrote, "It was not until 2015" that the Veteran documented a neck complaint. Based on the Board's review of the record, the Veteran filed a claim for service connection for an "upper back condition" in August 2014 and neck pain was documented within an October 2014 VA treatment record. This slight discrepancy does not alter the probative value of the 2017 opinion, as August 2014 and October 2014 are in close proximity to 2015, which is not a significant amount of time, considering that the Veteran was discharged in 2010. There is no competent evidence to weigh against this medical opinion. While the Veteran is competent to report his observed symptoms, his reports are not supported by contemporaneous medical findings, including his own statements during his period of active duty, and he is not competent to make a medical diagnosis of any cervical spine disability. The record does not demonstrate reports or findings of a neck problems or a cervical spine disability until multiple years after service discharge. The Veteran had a normal clinical evaluation of his neck and spine during his discharge examination in July 2010 and VA examination in March 2011. Additionally, the record does not establish the presence of any arthritic or degenerative cervical condition within one year of the Veteran's separation from service to warrant an award of service connection on a presumptive basis for a chronic disease. As stated, service treatment records show that the Veteran received normal clinical evaluations of the neck and spine on separation examination and the Veteran did not report symptoms involving his neck. An evaluation of the cervical spine in 2011 did not indicate any degenerative or arthritic condition. The Veteran's retrolisthesis was not assessed until 2017, seven years following his discharge from active duty. As such, service connection for a cervical spine disability is not warranted on a presumptive basis. For all the reasons stated herein, the weight of the evidence is against an award of service connection for a cervical spine disability, to include cervical strain and retrolisthesis. As the preponderance of the evidence is against the claim for service connection, the benefit of the doubt doctrine is not for application, and the Veteran's claim is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. TDIU Total disability will be considered to exist where there is present any impairment of mind and body that is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is unable to secure or follow a substantially gainful occupation because of service-connected disabilities, provided that the Veteran meets the schedular requirements. Specifically, if there is only one such disability, the disability shall be ratable at 60 percent or more; if there are two or more disabilities, there shall be at least one disability that is ratable at 40 percent or more and enough additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). The Veteran is service connected for posttraumatic stress disorder (PTSD) with a 50 percent disability rating from August 5, 2014; radiculopathy of the left lower extremity with a 20 percent disability rating from August 5, 2014; radiculopathy of the right lower extremity with a 20 percent disability rating from August 5, 2014; lumbar strain with degenerative disc disease with a 10 percent disability rating from November 9, 2010, a 40 percent disability rating from August 5, 2015, and a 20 percent disability rating from February 26, 2020; bilateral ankle strains with a 10 percent disability rating in each ankle from November 9, 2010; and patellofemoral syndrome in the bilateral knees with a 10 percent disability rating in each knee from November 9, 2010. Based upon the above, the Veteran's combined disability rating during the relevant appeal period was 90 percent from August 5, 2014. As such, the Veteran's service-connected disabilities have met the schedular criteria for a TDIU rating for the period on appeal. "Substantially gainful employment" is that employment "which is ordinarily followed by the nondisabled to earn their livelihood with earnings common to the particular occupation in the community where the veteran resides." Moore v. Derwinski, 1 Vet. App. 356, 358 (1991). "Marginal employment shall not be considered substantially gainful employment." 38 C.F.R. § 4.16. In determining whether a veteran can secure and follow a substantially gainful occupation, the U.S. Court of Appeals for Veterans Claims in Ray v. Wilkie directed the Board to consider the following factors: (1) the veteran's history, education, skill, and training; (2) whether the veteran has the physical ability (both exertional and non-exertional) to perform the type of activities required by the occupation at issue; and (3) whether the veteran has the mental ability to perform the activities required by the occupation at issue. 31 Vet. App. 58, 73 (2019). In determining whether unemployability exists, consideration may be given to the Veteran's level of education, special training, and previous work experience, but not to his age or to any impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. The responsibility for making the ultimate TDIU determination is placed on the adjudicator and not a medical examiner. See Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013). A medical examiner's role is limited to describing the effects of disability upon the person's ordinary activity. See Floore v. Shinseki, 26 Vet. App. 376, 381 (2013). The Veteran is competent to testify as to facts he personally observed or described; this includes recalling what he personally felt, saw, smelled, heard, or tasted. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Veteran has alleged that his combined service-connected impairments render him unemployable since May 2015 when he stopped working at Sam's Club. He has reported that he experiences chronic pain symptoms and reduced mobility. At his hearing, the Veteran testified that his combined impairments make it difficult for him to sleep, although he included a discussion of his sleep apnea, for which he is not service connected. He has also reported a range of psychiatric symptoms, including depression, anxiety, social withdrawal, reduced interest, irritability, hypervigilance, cognitive deficits, and a history of suicidal ideation. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against a finding that the Veteran is unable to secure or follow substantially gainful employment due to the service-connected disabilities. The reasons follow. The Veteran reported that he last worked at Sam's Club in May 2015 as a floor associate. He indicated he would straighten up the aisles and would be responsible for moving pallets of goods, using a hand truck and weighing up to 400 pounds, which would put strain on his back. The Veteran stated that he was not physically capable of continuing this employment and that his bosses referred to him as a liability. In his May 2015 TDIU application, the Veteran stated that his PTSD caused frequent episodes of unfocused attention at work. He stated that his knee problems were exacerbated due to constant demand of weight-bearing movement during the work shift, and his back was worsened due to constant pushing, pulling, lifting and twisting in his job duties. He reported that his back would regularly give out and his knees would lock up at inopportune times. He reported constant pain, stiffness, and difficulty of movement. As noted, the Veteran's physical disabilities relate to multiple musculoskeletal impairments of the spine and lower extremities, including the knees and ankles. The Veteran underwent a VA examination of the knees and lower legs in June 2015. The Veteran was noted to have no surgery, steroid injections, or drainage to the knees. He reported constant pain, but the Veteran recorded full strength and exhibited no instability. The Veteran reported the constant use of a cane for his back and knee conditions. The examiner stated that the impact of the Veteran's knee/lower leg disabilities resulted in functional limitation with work and the Veteran's activities of daily living. The examiner stated that the Veteran was unable to lift more than 10 pounds, unable to walk more than 3/4 mile, unable to stand more than 30 minutes, and unable to sit more than 60 minutes. However, the Board notes that the extent of limitations reported by the Veteran and assessed by the examiner during this examination is not consistent with his functioning over the course of the relevant period. While the Veteran has intermittently appeared for treatment using a cane, the record does not reflect the constant use of a cane. Just one month prior, the Veteran was employed at Sam's Club doing work that he reported required constant pushing, pulling, lifting, and twisting, while maneuvering pallets that weighed up to 400 pounds. While the Veteran had difficulty completing these tasks, the record does not establish that the Veteran used a cane when performing this work. Additionally, treatment records from December 2016, June 2017, August 2017, April 2018, January 2019, and August 2019 showed the Veteran to ambulate without difficulty or to have a normal gait with no abnormalities, and without mention of an assistive device. During hospital treatment in February 2016, the Veteran was noted not to use any assistive device for ambulation. The Veteran also was found not to require any assistive device on VA examination in January 2017, and he reported only occasional cane use in February 2020. Furthermore, the assessed limitations, and the Veteran's reported constant use of a cane, are not consistent with the Veteran's reported activity levels throughout the relevant period, as discussed further below. This includes recurrent reports of maintaining an exercise regimen, going on long walks with his neighbor, walking his dogs, biking, swimming, doing yardwork, and painting his house. The Veteran's reports of such activities were noted in February 2016, May 2017, July 2017, May 2018, June 2018, August 2018, and January 2020. At his August 2021 Board hearing, the Veteran reported that he is able to drive for two hours at a time before needing to stop to stretch. As such, the Board finds this examination report is not fully reflective of the Veteran's functioning over the relevant period. The Veteran underwent surgery for a nonservice-connected hernia in 2018. Despite the Veteran's pain symptoms and reduced mobility, the record reflects relatively stable functioning over the course of the relevant period, with generally conservative treatment and without significant exacerbations of his service-connected physical disabilities requiring urgent or inpatient treatment. In 2018, the Veteran reported performing yardwork on multiple occasions, exercising daily by walking with a neighbor, riding a bicycle, going to a waterpark, doing projects around the house, and taking a vacation to Universal Studios. He continued to predominantly record normal muscle strength on examination. The Veteran underwent a VA examination of his spine in February 2020. He recorded some reduced range of motion and was found to have mild radiculopathy in the lower extremities, but he recorded full muscle strength and normal reflexes. The examiner stated that the functional impact of the Veteran's condition resulted in limited bending, walking, standing, and sitting. The Board finds this examiner's assessment to be probative, as it is more consistent with the Veteran's reported activity levels discussed above. As to the Veteran's psychiatric disorder, at a VA examination in 2014, prior to the relevant period, the Veteran was found to meet the criteria for PTSD, and expressed concern with his increased irritability, lowered frustration tolerance, and hypervigilance. He stated that work was going very well, but he was having some difficulty in school with concentration problems. The Veteran's symptoms were noted to have a mild to moderate impact on occupational and social functioning. Notably, the Veteran has had one voluntary inpatient admission for psychiatric treatment for three days in February 2006 for suicidal ideation. The Veteran's wife reported that she found the Veteran in a darkened room with a gun on his lap. The Veteran reported that he was alarmed that his mood had deteriorated to the point that he was having thoughts of self-harm. However, by the time of discharge, both the Veteran and his wife reported significant improvement in the Veteran's condition. On follow-up the following month, the Veteran recorded normal findings on mental status examination and denied suicidal ideation. The Veteran was alert, oriented, calm, and cooperative and exhibited a linear, logical, and goal-directed thought process, fair insight and judgment, and normal cognition. Despite continued symptomology, the record reflects generally stable functioning thereafter without the need for additional inpatient or urgent care. The above normal findings on mental status examination were repeated throughout the relevant period, including in April 2016, May 2016, June 2016, September 2016, December 2016, January 2017, June 2017, July 2017, August 2017, September 2017, and January 2018. In May 2017, the Veteran reported that he was spending time reading, exercising, and going to the library. He reported doing well overall and coping with stress effectively. In July 2017, the Veteran reported activities such as playing video games, watching comedies, staying active, crocheting, playing "Brain Games," coloring, painting his house, doing home projects, and taking care of his pets. In September 2017, the Veteran reported that medication helped his anxiety. In January 2018, the Veteran reported that he had not experienced suicidal ideation in 23 months and stated that his medication was "doing its job." In 2018, the Veteran and his wife took a vacation to Universal Studios, reported daily walking with a neighbor, and frequented a waterpark. While the Veteran has reported sleep difficulties at times, the Veteran has predominantly reported getting six to eight hours of sleep per night, including in February 2016, July 2017, September 2017, December 2017, August 2018, June 2019, August 2019, and January 2020. He has routinely been found to be fully alert and oriented and to exhibit appropriate behavior. The weight of the evidence is against a finding that the Veteran is unemployable due to his service-connected disabilities. The longitudinal evidence shows the Veteran to exhibit a high level of functional abilities, despite limitations associated with his physical and mental impairments. Despite the Veteran's pain and limited mobility, he has reported the ability to regularly exercise, ride a bicycle, go on walks, drive for multiple hours, paint his house, go swimming, and do household projects and yardwork. Treatment has been conservative, and he has not required inpatient or urgent medical care for his physical conditions. While the Veteran has had some ongoing psychiatric symptoms, he has reported improvement with the use of medication since his brief inpatient admission in February 2016. He has routinely recorded normal findings on mental status examination and exhibited appropriate behavior while participating in a wide array of activities, as noted above. Regarding the Veteran's education, training, skills, and work history, the Veteran reported that he completed three years of college. The Veteran worked as a computer technician in the military, maintaining local computer systems. He most recently worked at Sam's Club between 2014 and 2015. Overall, the Veteran's work history and his education demonstrate a capacity for learning, training, and adaptability that would not be hindered by his service-connected disabilities. These attributes would facilitate the Veteran's return to employment in an occupation that he is capable of performing. As to the Veteran's physical ability to perform substantially gainful employment, the Board acknowledges that the Veteran experiences chronic pain in his back and lower extremities and has difficulty with prolonged exertional activities. However, treatment records predominantly reflect that treatment has been conservative and the Veteran has full muscle strength and can ambulate independently. He has demonstrated independence in his activities of daily living and has reported the ability to walk for exercise, ride a bike, swim, paint his house, travel, drive for multiple hours, and perform yardwork and household projects. The totality of the evidence shows that the Veteran is capable of performing work at least at the sedentary exertional level with the ability to change positions to avoid prolonged sitting. The Department of Labor's Dictionary of Occupational Titles (DOT) defines sedentary work as exerting up to 10 pounds of force occasionally (i.e., up to one third of the time), and/or a negligible amount of force frequently (i.e., from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body. According to the DOT's definition, sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met. The Board finds no prejudice to the Veteran in considering the definition for purposes of deciding this claim. The longitudinal record indicates that the Veteran is at least capable of sedentary work with the ability to periodically switch positions for comfort, as his reported activity levels have consistently exceeded the limitations of sedentary work. Accordingly, the weight of the evidence shows that the Veteran is physically capable of performing substantially gainful employment. As to the Veteran's mental ability to perform substantially gainful employment, the Veteran experiences a range of psychiatric symptoms associated with PTSD. However, these symptoms have generally not resulted in significant functional limitations that would preclude employment. The Veteran has repeatedly been documented to be calm, cooperative, and pleasant, and mental status examinations generally reflect the Veteran to be fully alert and oriented with intact insight, judgment, cognition, and memory, and a linear, logical, and goal-oriented thought process. The Veteran does not demonstrate communication deficits and has consistently demonstrated appropriate behavior, including the ability to function in public spaces, such as amusement and water parks. The Veteran is able to drive for extended periods and enjoy activities such as video games, crocheting, Brain Games, reading, and going to the library. Accordingly, the preponderance of the evidence suggests that the Veteran is capable of occupations that do not require work in crowds or routine face-to-face interaction with the general public, so as to avoid potential symptom exacerbations. As the Veteran's service-connected disabilities do not cause the Veteran vocational limitations, the weight of the evidence shows that the Veteran is mentally capable of performing substantially gainful employment. Based on the above assessment of the Veteran's physical and mental abilities with consideration of his education, training, skills, and work history, the Board finds that the Veteran is capable of work that would result in income at the level of substantially gainful employment. For example, the preponderance of the evidence is against a finding that the Veteran's service-connected disabilities would preclude him from jobs that rely on the Veteran's experience as a computer technician, such as an IT support specialist, which occupation helps to resolve technical issues for users, remotely over the phone or computer. This is an area in which the Veteran is knowledgeable and would require little exertional effort with the ability to periodically stand, as needed. Many such occupations can be performed from home and would not require face-to-face interaction with the public. Additionally, the Veteran could perform jobs that involve data entry. With data entry, the Veteran is primarily responsible for entering data into a system. These jobs can usually be done from home without significant training or experience. These occupations require very little exertional effort and would allow the Veteran to change positions as needed. Based on the Veteran's education and work history, he possesses the basic computer skills needed for such a position. Alternatively, there are jobs that can be performed at home, such as a telemarketer, where the employee makes calls and reads a script, which does not require extensive training or experience, would require minimal exertional activity, and would allow the Veteran to change positions as needed. Similarly, a customer service agent interacts with customers to handle complaints, process orders, and answer questions. These positions can often be performed from home, while seated, and would allow the Veteran to adjust positions for comfort. These examples are not exhaustive but are merely illustrative of potential occupations that the Veteran could perform. This is evidence against a finding that the Veteran is precluded from all forms of substantially gainful employment due to his service-connected disabilities during the relevant period. For all these reasons, the Board finds the preponderance of the evidence is against a finding that the Veteran is precluded from securing or following all forms of substantially gainful occupation due to his service-connected disabilities. As the probative evidence of record weighs against the Veteran's claim, there is no reasonable doubt to be resolved, and the claim of entitlement to a TDIU rating is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. A. P. SIMPSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Wonderling, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.