Citation Nr: A21020104 Decision Date: 12/16/21 Archive Date: 12/16/21 DOCKET NO. 200205-60031 DATE: December 16, 2021 ORDER Entitlement to a total disability rating for compensation based on individual unemployability due to service-connected disabilities (TDIU) prior to February 10, 2020 is denied. FINDING OF FACT The preponderance of the evidence is against a finding that the Veteran was precluded from securing or following a substantially gainful occupation due to his service-connected disabilities prior to February 10, 2020. CONCLUSION OF LAW The criteria for entitlement to a TDIU rating were not met prior to February 10, 2020. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.25, 4.26. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from July 2009 to November 2017. In February 2020, the Veteran elected the modernized review system. 84 Fed. Reg. 138, 177 (Jan. 18, 2019) (to be codified at 38 C.F.R. § 19.2(d)). The rating decision on appeal was issued on April 30, 2019. The Veteran timely appealed this rating decision to the Board and requested a Direct Review of the evidence considered by the Regional Office (RO). In January 2021, the Board dismissed the Veteran's TDIU claim, based on an inaccurate calculation of the Veteran's combined total disability rating from November 2017 to February 2020. The Board determined that raising the Veteran's spinal disability rating to 40 percent would raise his combined total rating to 100 percent, effective November 23, 2017, which would render his TDIU claim moot. The Veteran appealed the January 2021 decision to the United States Court of Appeals for Veterans Claims (Court). In August 2021, the Veteran and the Secretary of VA (parties) entered into a Joint Motion for Partial Remand, relating only to the issue of TDIU, vacating and remanding the January 2021 Board decision. The parties agreed that the Board's reasoning for dismissal contained a mathematical error and directed the Board to provide new adequate reasons and bases with correction of this error. Accordingly, the matter is once again before the Board for reconsideration on the merits. 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). Since February 10, 2020, the Veteran has been in receipt of a 100 percent schedular rating. The Board notes that a grant of a 100 percent schedular rating does not necessarily render the issue of entitlement to a TDIU rating moot, as a TDIU rating could, in certain circumstances, render the Veteran eligible for special monthly compensation (SMC). SMC may be warranted if the Veteran has a 100 percent disabling rating for a single disability, and VA finds that a TDIU rating is warranted based solely on disabilities other than the disability that is rated at 100 percent. See Buie v. Shinseki, 24 Vet. App. 242 (2011); Bradley v. Peake, 22 Vet. App. 280 (2008). However, the Board notes that the Veteran does not have any individual disability that is rated as 100 percent disabling. Hence, the Board finds as fact that entitlement to a TDIU rating is moot for the period beginning on February 10, 2020. Prior to February 10, 2020, the Veteran was service connected for degenerative arthritis of the spine with a 40 percent disability rating from November 23, 2017; scars of the left anterior and right posterior chest (painful) with a 30 percent disability rating from November 23, 2017; posttraumatic stress disorder (PTSD) with a 30 percent disability rating from November 23, 2017; irritable bowel syndrome (IBS) with a 10 percent disability rating from September 23, 2018, and a 30 percent disability rating from February 19, 2019; left knee strain and degenerative meniscal changes with a 20 percent disability rating from November 23, 2017; sciatica of the right lower extremity with a 20 percent disability rating from November 23, 2017; sciatic of the left lower extremity with a 20 percent disability rating from November 23, 2017; tinnitus with a 10 percent disability rating from November 23, 2017; scars of the left anterior chest and right posterior chest (linear) with a 10 percent disability rating from November 23, 2017; bilateral pneumothorax with a noncompensable disability rating from November 23, 2017; and erectile dysfunction with a noncompensable disability rating from November, 23, 2017. As such, the Veteran had a combined total disability rating of 90 percent prior to February 10, 2020, qualifying for schedular TDIU consideration. "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 Court 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 disabilities render him unemployable. The Veteran has reported diffuse pain symptoms with difficulty engaging in prolonged physical activity, and being intolerant to temperature extremes and respiratory irritants. He has also reported a range of psychiatric symptoms associated with PTSD, including depression, anxiety, panic attacks, difficulty managing stress, interpersonal difficulties, social isolation, irritability, sleep difficulties, nightmares, and 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 was precluded from securing and following substantially gainful employment prior to February 10, 2020. The reasons follow. In November 2017, the Veteran was honorably discharged from the Army, where he worked as a combat engineer. The Veteran's Certificate of Release or Discharge From Active Duty states that the reason for separation was the completion of the Veteran's required active service. However, the Veteran has reported, and his military personnel record supports, that prior to the Veteran's discharge, he faced recurrent disciplinary issues, including an Article 15 and demotion, for being drunk at work on multiple occasions, as well as an incident where he was found unconscious and required hospitalization. However, the record further indicates that the Veteran entered an in-service rehabilitation program, has been sober since prior to his discharge from service, and the record does not show the Veteran to have had ongoing substance abuse issues during the relevant period. While the majority of the Veteran's service-connected disabilities were present at the time of discharge, the record does not show that physical disabilities prevented the Veteran from being able to fulfill his duties or job requirements prior to his service discharge. The Veteran is service connected for multiple musculoskeletal impairments relating to arthritis of the spine, radiculopathy/sciatica, and a knee strain. The Veteran underwent VA examinations of the spine and peripheral nerves in June 2018. The Veteran exhibited some decreased range of motion but recorded full muscle strength and normal sensation and reflexes. The examiner stated that the Veteran's condition causes difficulty with standing and walking long periods as well as driving long distances and/or sitting at desk for long periods due to pain, stiffness, and weakness in the lower back with numbness/tingling and paresthesias of both lower extremities, causing the Veteran to frequently reposition and shift his weight. The Veteran also underwent a VA examination of the knees and lower legs in June 2018. The Veteran recorded some slightly reduced strength in the left knee and was noted to regularly use a brace on the left knee. No other assistive device was noted. The Veteran had normal reflexes and no instability. The examiner stated that the Veteran's left knee disability causes difficulty with standing, walking for long periods as well as squatting, kneeling, climbing/descending stairs, and/or running/jumping due to pain, weakness, and stiffness of the knee. The record indicates generally stable functioning of the Veteran's musculoskeletal condition throughout the period on appeal without significant exacerbations requiring urgent or inpatient treatment, despite continued pain symptoms with reduced mobility and endurance. The Veteran began to report the use of a cane in 2018, although he stated in December 2018 that the use of a cane is necessary only when not using his knee brace. The Veteran was noted to exhibit excessive pain behavior on examination in December 2018 and he recorded full muscle strength. In 2019, examiners within a Social Security Administration (SSA) disability claim indicated the Veteran to be capable of work that involves lifting 50 pounds occasionally, 25 pounds frequently, and standing/walking up to six hours per day, with additional postural limitations. In March 2019, the Veteran underwent another VA examination for assessment of his lumbar spine disability. The Veteran reported the constant use of a cane, but recorded full muscle strength with normal sensation and reflexes. The functional impact of the Veteran's spine disability with bilateral lower extremity radiculopathy was stated as causing bilateral leg pain, tingling, numbness, back pain, stiffness, limited range of motion, and difficulty with heavy lifting, bending, prolonged walking, and climbing stairs. The Veteran underwent a VA examination of the knees and lower extremities in April 2019. The Veteran recorded some reduced strength. The examiner stated that knee pain and weakness caused the Veteran to have difficulty standing and walking as well as kneeling or climbing/descending stairs, causing him to be less efficient with decreased productivity levels. The examiner wrote that the Veteran has to use a cane for ambulation assistance, causing him to move slower. The examiner stated his disabilities would impact the Veteran's ability to perform an occupation that requires standing or walking greater than 15 minutes. Despite this finding, in March 2020, the Veteran reported that he walks "a couple miles" at a time to deal with psychiatric symptoms. The record shows that the Veteran intermittently uses a cane; however, the record contradicts the Veteran's report of constant cane use and recurrent physical examination findings during the relevant showed the Veteran to walk unaided with a normal gait in March 2019, May 2019, June 2019, August 2019, October 2019, November 2019, and January 2020. No use of a cane was noted on VA examination in 2018m, and the record does not show that the Veteran was prescribed the use of a cane. These findings show the Veteran's overall limitations are not as severe as those described by the March 2019 examiner. The Veteran has been diagnosed with bilateral pneumothorax relating to a collapsed lung incurred in service. The Veteran has reported symptoms of shortness of breath, fatigue, and dizziness during physical exercise. The Veteran has been able to sustain a smoking habit, despite efforts to quit. The Veteran underwent a VA respiratory examination in June 2018. The examiner stated that the Veteran's condition makes him unable to work in his field of education due to possible asbestos exposure from automobiles, metal shavings, smoke, and intolerance of fumes and chemicals and temperature extremes that cause increased shortness of breath, cough, exercise tolerance and fatigue. He underwent outpatient pulmonary treatment in August 2019, reporting shortness of breath, trouble breathing, periodic wheezing, and dyspnea with exertion. The Veteran was assessed with dyspnea. However, respiratory examinations during the relevant period predominantly did not show acute findings. The record shows only routine, conservative treatment relating to the Veteran's scars, without exacerbations requiring urgent or inpatient care. The Veteran underwent a VA examination for assessment of his service-connected scars in June 2018. As to functional impact, the examination report stated that the Veteran reported extreme sensitivity and discomfort to all trunk scars with light palpation and friction from rubbing of clothing, especially restriction and/or heavy clothing from the waist up. As to the Veteran's psychiatric disorder, he underwent a VA psychiatric examination in June 2018. The Veteran reported experiencing panic attacks occurring twice month, nightmares approximately four times per month, as well as sleep disturbances, occasional flashbacks, heightened startle response, and anxiety. The Veteran reported that he visits family on occasion and that he plays bass guitar when visiting family. He stated that he had no employment since his military discharge. The Veteran was diagnosed with PTSD. The examiner described the severity of the Veteran's condition as occupational and social impairment due to mild or transient symptoms that decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medication. The Veteran has engaged in individual, group, and couples therapy through VA over the course of the relevant period. He has reported increasing symptoms of depression, anxiety, panic attacks, social isolation, sleep problems, and memory and concentration deficits. At times, the Veteran has also reported improved functioning with the use of medication. However, treatment records generally show the Veteran to be fully alert, oriented, friendly, and cooperative, with a logical, organized, and goal-directed thought process, appropriate appearance, adequate grooming, good insight and judgment, and intact memory and attention span. Such findings were recorded on examinations in October 2018, December 2018, January 2019, March 2019, May 2019, June 2019, August 2019, October 2019, November 2019, January 2020, March 2020, May 2020, and July 2020. The Veteran denied suicidal ideation on these occasions, although he has reported passive suicidal ideation at times without plan or intent. Suicidal ideation does not appear to cause the Veteran significant functional limitations, as he has not required inpatient or urgent treatment during the relevant period relating thereto and has consistently exhibited intact cognition, good insight and judgment, and appropriate behavior. Group therapy records show the Veteran to be attentive and to actively and appropriately engage with group discussion. In November 2018, the Veteran underwent a psychological evaluation relating to his SSA disability claim. The Veteran was found capable of understanding and following through on simple and moderately complicated verbal instructions and single-step directions, and likely able to understand multi-step directions. It was stated that the Veteran may have some difficulty following through on multi-step directions due to inconsistent attention and concentration, and may be likely to have at least moderate difficulty handling job stress due to significant depression and panic attacks. Also, the Veteran was found to have mild to moderate difficulty getting along with bosses and co-workers and acting appropriately on a consistent basis. The Veteran reported difficulty with most areas of self-care, but stated that he is able to cook meals and that he showers daily. A March 2019 SSA evaluation stated that the Veteran is somewhat limited by psychological symptoms, but the impact of his symptoms does not wholly compromise the Veteran's ability to function independently, appropriately, or effectively on a sustained basis. The Veteran's functional limitations were described as less than marked, and the alleged severity and limiting effects of the Veteran's impairments were found not to be wholly supported. In January 2019, the Veteran reported ongoing psychiatric symptomology, but stated that panic attacks were reduced some with increased medication. He also reported attempting to reduce symptoms by playing guitar and working on his motorcycle. The following month, the Veteran reported that from April 2018 to August 2018, he had attempted to obtain work in multiple different positions as a maintenance worker, security guard, and prison guard. In March 2019, the Veteran engaged with vocational rehabilitation through VA. A related narrative report stated that the Veteran should not work in a setting where there is a large crowd of people, loud noises, physical demands, or some place where conflict is likely to arise. Examples of jobs that the Veteran should avoid were listed as police officer, mechanic, and nurse. The Veteran presented to the emergency department in May 2019. Although he was noted to be anxious, the Veteran's reason for treatment was dizziness, which was attributed to dehydration, with no apparent association with the Veteran's service connected physical disabilities. The Veteran stated that he is always anxious when visiting medical providers. The following month, the Veteran described this incident as an "anxiety attack," although this is not supported by the concurrent treatment records, which the Veteran attributed to a medication increase. The record does not otherwise show the Veteran required urgent or inpatient psychiatric treatment during the relevant period, despite his reports of increased panic attacks. The Veteran submitted a private psychological assessment by Erik Levy, PsyD, after the relevant period in March 2020. Dr. Levy stated that the Veteran was totally socially and occupationally impaired based solely on his psychiatric disability from the time of his separation from service. The examiner stated that the Veteran experiences constant depression and panic attacks, and that his need to self-isolate and his volatility, including property destruction and violent outburst, would prevent employment. The Board notes that Dr. Levy's interview with the Veteran occurred after the relevant period and, therefore, although he was able to review the evidence of record, Dr.'s Levy's assessment of the Veteran's functioning during the relevant period was highly reliable on the Veteran's self-reporting of symptoms. While the Veteran is competent to report his observed symptoms, Dr. Levy's report includes multiple statements from the Veteran that are not reflective of the Veteran's functioning during the relevant period and are contradicted by the contemporaneous evidence of record, which reduces the probative value of Dr. Levy's opinion. For instance, Dr. Levy noted the Veteran to report that he cannot play music anymore because he is unable to use his hands, so he does not "really enjoy anything anymore." However, in 2018 and 2019, the Veteran reported that he plays bass guitar when visiting family and that he plays the guitar to attempt to reduce his psychiatric symptoms. The record does not demonstrate significantly decreased function in the Veteran's hands during the appeal period to support the allegation that he was unable to use them. Rather, physical examination findings from November 2019, just four months prior to the Veteran's interview with Dr. Levy showed the Veteran to have full motor strength and intact sensation bilaterally in his upper extremities. The Veteran also reported the ability to work on motorcycles during the relevant period, which would require the effective use of his hands. While not directly associated with Dr. Levy's opinion on the Veteran's psychiatric functioning, the Board notes that the Veteran was not service connected for radiculopathy of the upper extremities prior to February 2020. Dr. Levy's report contains a number of additional inconsistent statements that contradict the evidence of record, which serves to undermine the Veteran's credibility and reduce the probative value of Dr. Levy's opinion. For example, the Veteran reported that he has "no contact with my family whatsoever." This is also not supported by the evidence of record. The Veteran reported in 2018 that he sometimes visits family in Houston. In 2019, the Veteran specifically stated that his father was relocating from North Carolina in order to live closer to the Veteran. The Veteran reported that his wife does all of the household cooking, shopping, and cleaning, and that his memory has gotten to the point "where I can't remember that I am even cooking something." He added that he takes a shower "every other day if I can remember," and that he brushes his teeth only when he remembers. However, the Veteran reported in November 2018 that he showers daily and is able to cook meals. In December 2018, he stated that he married a younger woman "who does not help much with household chores nor with the children," indicating that he bore the primary responsibilities in this area. Records from 2019 document that the Veteran is able to take care of his activities of daily living. Again, the record does not establish exacerbations of the Veteran's condition to support the alleged worsened condition reported by the Veteran. Routine examination findings both before and after the time of Dr. Levy's assessment consistently show the Veteran to have grossly intact memory and attention span, including in October 2018, December 2018, March 2019, May 2019, June 2019, August 2019, October 2019, January 2020, March 2020, May 2020, July 2020, October 2020, and December 2020. Additionally, treatment records from July 2019 document that the Veteran did not keep a physical food journal, despite a treating provider's recommendation, because "I keep it all in my head." These findings do not demonstrate the level of cognitive dysfunction described by the Veteran. Finally, the Veteran reported that he is "always mad and irritable" and that he yells at family members, throws things, and destroys property. The examiner indicated that such symptoms would prevent the Veteran from obtaining and sustaining employment. However, in late 2018, the Veteran denied a history of violence. VA treatment records have consistently described the Veteran's behavior as cooperative and reasonable, and he was described as friendly and pleasant on multiple occasions. Records further document the Veteran's ability to engage actively and appropriately in a group setting. These inconsistencies, inadvertent or otherwise, serve to undermine the Veteran's credibility, and significantly reduce the probative value of Dr. Levy's conclusions, as well as the findings of any other examination dependent on the Veteran's self-reporting for its findings and conclusions. The Veteran has not alleged, and the record does not support, that tinnitus, erectile dysfunction, or IBS cause vocational limitations for the Veteran. VA examinations conducted in June 2018 stated that the Veteran's tinnitus and erectile dysfunction do not impact the Veteran's ability to work. Similarly, a February 2019 VA examination found the Veteran's IBS to have no impact on the Veteran's ability to work. These conditions did not require regular treatment during the period on appeal. The preponderance of the evidence is against a finding that the Veteran's service connected disabilities precluded him from securing or following substantially gainful employment prior to February 10, 2020. As stated, the Veteran's primary issue impacting his ability to work at the time of service discharge related to his history of alcohol abuse, from which he maintained sobriety during the relevant period. The Veteran's service-connected disabilities have required conservative treatment only without urgent or inpatient care. He has maintained independence in his activities of daily living with the ability to ambulate independently without muscle atrophy and with intact sensation and reflexes. Despite his psychiatric symptoms, the Veteran has routinely been found to have intact cognitive functioning and to exhibit appropriate behavior. The Veteran reported that he attempted to obtain work in multiple, different occupations during the relevant period, which demonstrates that the Veteran believes he is capable of working. The weight of the evidence supports that the Veteran was capable of substantially gainful employment during the relevant period. Regarding the Veteran's education, training, skills, and work history, the Veteran has reported that he has a high school degree and earned certification as a mechanic and machinist. The Veteran worked as a machinist and mechanic prior to his period of active duty for approximately 15 years, and was a combat engineer while in service, a job he performed for approximately eight years. He reported that in 2018, he attempted to become employed in the security and maintenance fields. The Veteran's work history and skilled certification demonstrate a capacity for learning and training that were not demonstrated to be hindered by his service-connected disabilities during the relevant period. These attributes would have facilitated the Veteran's return to substantially gainful employment in a line of work that the Veteran could perform, which will be described in more detail below. As to the Veteran's physical ability to perform substantially gainful employment, the Board acknowledges that the Veteran experiences pain symptoms with reduced mobility and difficulty with sustained exertional activity. The Veteran is also sensitive to temperature extremes and respiratory irritants. The Veteran has reported the ability to ambulate independently with the use of a knee brace, as well as the ability to walk multiple miles at a time. He has maintained independence in his activities of daily living and indicated the ability to work on motorcycles, play guitar, and contribute to household chores and child-rearing during the relevant period. The Veteran reported attempting to find work as a security guard and maintenance worker during the relevant period, indicating that he believed he was capable of such employment. As such, the Veteran's limitations can be appropriately accommodated by restricting the Veteran to occupations at least at the "light" exertional level, in a temperature controlled environment, without exposure to pulmonary irritants. The Department of Labor's Dictionary of Occupational Titles (DOT) defines light work as exerting up to 20 pounds of force occasionally (i.e., up to one-third of the time), and/or 10 pounds of force frequently (i.e., from one-third to two-thirds of the time), and/or a negligible amount of force constantly to lift, carry, push, pull, or otherwise move objects. According to the DOT's definition, when walking or standing are involved to a significant degree, the job is classified as light even when the weight lifted is negligible. A job is also classified as light when it involves sitting most of the time with a degree of pushing and pulling of arm and/or leg controls, or when the job requires working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible. The Board finds no prejudice to the Veteran in considering the definition for purposes of deciding this claim and the definition is the same used in relation to his SSA disability claim. The treatment record does not show the Veteran's physical disabilities limited him beyond the restrictions of light work, with additional environmental restrictions, prior to February 2020 as evidenced by his reported activity levels during the relevant period. Accordingly, the weight of the evidence shows that the Veteran was physically capable of performing substantially gainful employment prior to February 10, 2020. As to the Veteran's mental ability to perform substantially gainful employment, the Board acknowledges that the Veteran experiences a range of psychiatric symptoms, as discussed above, including sleep disturbances, mood fluctuations with anxiety, depression, irritability, panic attacks, social isolation, and suicidal ideation. However, the record generally does not show these symptoms cause significant functional limitations that would preclude substantially gainful employment. The Veteran has maintained sobriety and did not require inpatient psychiatric care during the relevant period. The Veteran required only routine, recurrent mental health treatment, and he has responded well to medication and counseling. Findings on mental status examination generally indicate the Veteran to be alert, oriented, friendly, and cooperative, with a logical, organized, and goal-directed thought process, appropriate appearance, adequate grooming, good insight and judgment, and intact memory and attention span. The Veteran has routinely demonstrated his ability to socialize appropriately during medical appointments and group counseling sessions. In light of the Veteran's symptoms, he could be accommodated by restricting him from positions that involve managerial or supervisory duties, or executive decision-making. Additionally, the Veteran should not work in crowds or in positions that require commercial driving or routine, face-to-face interaction with the public. Such restrictions would help to avoid stress and exacerbations relating to the Veteran's symptoms, include anxiety and social limitations. These restrictions would not preclude the Veteran from all forms of substantially gainful employment and, thus, the Veteran was capable of performing the mental requirements of substantially gainful employment prior to February 10, 2020. 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 was capable of work that would result in income at the level of substantially gainful employment. For example, the Veteran could perform jobs such as a telemarketer, where the employee makes or takes calls and primarily reads from a script, which does not require extensive training or experience, could be performed while seated and would not be impacted by the Veteran's use of a cane. He could also perform the job of a customer service agent. A customer service agent interacts with customers to handle complaints, process orders, and answer questions. These positions can be performed in a controlled environment, oftentimes from home, which would avoid exacerbations of the Veteran's psychiatric symptoms, and would require little exertional effort. Furthermore, the Veteran would be capable of performing certain assembly line or manufacturing positions, jobs that would not exceed the limitations of light work, primarily requiring the use of the upper extremities (to reiterate, the Veteran was not service connected for disabilities involving the upper extremities prior to February 2020), in a controlled environment. Such positions would require little social interaction, and would be routine and repetitive in nature. The occupations described above would not require supervisory duties or executive decision-making. 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 was precluded from all forms of substantially gainful employment during the relevant period. For all the reasons described above, the Board finds that the preponderance of the evidence is against a finding that the Veteran was precluded from all forms of substantially gainful employment and, therefore, is not entitled to a TDIU rating prior to February 10, 2020. The Board has considered the applicability of the benefit-of-the-doubt doctrine. However, it is not applicable where, as here, there is not an approximate balance of positive and negative evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Accordingly, entitlement to a TDIU rating prior to February 10, 2020 is denied. 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.