Citation Nr: 21007058 Decision Date: 02/08/21 Archive Date: 02/08/21 DOCKET NO. 16-30 942 DATE: February 8, 2021 ORDER Entitlement to an initial disability rating in excess of 50 percent prior to October 23, 2012 for major depressive disorder with anxiety associated with hypertension is denied. Entitlement to a disability rating in excess of 70 percent from October 23, 2012 for major depressive disorder with anxiety associated with hypertension is denied. Entitlement to an initial disability rating in excess of 40 percent for bilateral hypertensive retinopathy status post right central retinal venous occlusion is denied. Entitlement to total disability rating based on individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. Prior to October 23, 2012, the severity, frequency, and duration of the Veteran’s major depressive disorder with anxiety symptoms did not more closely approximate occupational and social impairment with deficiencies in most areas. 2. From October 23, 2012, the severity, frequency, and duration of the Veteran’s major depressive disorder with anxiety symptoms did not more closely approximate total occupational and social impairment. 3. Prior to August 2020, the Veteran’s corrected distance visual acuity is no worse than 20/200 in the right eye and 20/40 in the left eye. 4. Prior to August 2020, the Veteran’s impairment of the visual field is no worse than right eye contraction of 43.125 degrees and left eye contraction of 51.875 degrees. 5. From August 2020, the Veteran’s corrected distance visual acuity is no worse than 20/70 in his right eye and no worse than 20/40 in his left eye. 6. From August 2020, the Veteran’s impairment of visual field is no worse than 45 degrees. 7. The Veteran’s combined service-connected disabilities did not preclude him from securing or following a substantially gainful occupation. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 50 percent for major depressive disorder with anxiety associated with hypertension prior to October 23, 2012, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9434. 2. The criteria for a disability rating in excess of 70 percent for major depressive disorder with anxiety associated with hypertension from October 23, 2012, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9434. 3. The criteria for a disability rating in excess of 40 percent for bilateral hypertensive retinopathy status post right central retinal venous occlusion have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.76A, 4.79, Diagnostic Code 6080, Diagnostic Code 6006. 4. The criteria for entitlement to a TDIU have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.15, 4.16, 4.18, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from October 1972 until his honorable discharge in October 1974. These matters come before the Board of Veterans’ Appeals (Board) on appeal from the May 2011 and December 2012 rating decision by the Columbia, South Carolina Regional Office (RO) of the United States Department of Veterans Affairs (VA). In April 2019, the Board remanded the case to the RO for further development. Specifically, the Board directed the RO to obtain the Veteran’s VA treatment records from April 2016 to present; obtain complete Social Security Administration disability records; notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge regarding the nature, extent, and severity of his psychiatric, eye, hypertension, and headache disorder symptoms and the impact of the conditions on his ability to work; obtain a VA eye examination; and obtain a VA psychiatric examination. In response, in May 2019, the Veteran provided a Statement in Support of Claim (VA Form 21-4138) indicating that he does not receive SSA disability benefits and a lay statement that his headaches and dizziness come from mental confusion; in October 2019 and July 2020, the RO obtained the Veteran’s updated VA treatment records; in December 2019, the RO notified the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge regarding the nature, extent, and severity of his psychiatric, eye, hypertension, and headache disorder symptoms and the impact of the conditions on his ability to work; in February 2020, the RO obtained a response from SSA that they are unable to send medical records that were requested because there are no medical records; in July 2020, the RO obtained a psychiatric VA examination; and in September 2020, the RO obtained an eye VA examination. The Board finds that there has been substantial compliance with the Board’s previous remand directives regarding the issue(s) on appeal. Stegall v. West, 11 Vet. App. 268, 271 (1998). Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule), found in 38 C.F.R. Part 4. The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of any disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the Veteran’s medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31, 34 (1999). Where entitlement to compensation has been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where an appeal is based on an initial rating for a disability, however, evidence contemporaneous with the claim and the initial rating decision are most probative of the degree of disability existing when the initial rating was assigned and should be the evidence “used to decide whether an original rating on appeal was erroneous.” Fenderson v. West, 12 Vet. App. 119, 126 (1999). In either case, if later evidence indicates that the degree of disability increased or decreased following the assignment of the initial rating, staged ratings may be assigned for separate periods of time. Fenderson, 12 Vet. App. at 126; Hart v. Mansfield, 21 Vet. App. 505 (2007) (noting that staged ratings are appropriate whenever the factual findings show distinct time periods in which a disability exhibits symptoms that warrant different ratings). When adjudicating a claim for an increased initial evaluation, the relevant time period is from the date of the claim. Moore v. Nicholson, 21 Vet. App. 211, 215 (2007), rev’d in irrelevant part, Moore v. Shinseki, 555 F.3d 1369 (2009). When adjudicating an increased rating claim, the relevant time period for consideration is the time period one year before the claim was filed. Hart, 21 Vet. App. at 509. 1. Entitlement to an initial disability rating in excess of 50 percent prior to October 23, 2012 for major depressive disorder with anxiety associated with hypertension 2. Entitlement to a disability rating in excess of 70 percent from October 23, 2012 for major depressive disorder with anxiety associated with hypertension Due to the similar dispositions for the above claims on appeal, the Board will address them in a common discussion below. The Veteran asserts that he is entitled to a higher disability rating for his major depressive disorder with anxiety. Under the General Formula for Mental Disorders (General Formula), the Board must conduct a “holistic analysis” that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). The issue in this appeal is whether the Veteran’s associated symptoms caused the level of impairment required for a disability rating of 70 percent or higher. The Board concludes that the Veteran’s service-connected acquired psychiatric disability did not cause the level of impairment required for an initial disability rating of 70 percent or higher. The Veteran’s symptoms more closely approximated with a 50 percent rating, and resulted in a level of impairment that most closely approximated the level of impairment associated with a 50 percent rating. A noncompensable rating is assigned when a mental condition has been formally diagnosed, but symptoms are not severe enough to either require continuous medication, or to interfere with occupational and social functioning. A 10 percent rating is assigned when mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of occasional stress, or symptoms controlled by medication cause occupational and social impairment. A 30 percent rating is assigned when symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events), cause occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and normal conversation). A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; 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); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned for 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 minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name. Prior to October 23, 2012 VA treatment records, the May 2012 VA examination with an addendum opinion provided in August 2012, and the Veteran’s lay statements show that the Veteran’s major depressive disorder was manifested by symptoms associated with a 30 percent disability rating (depressed mood, anxiety, chronic sleep impairment); and symptoms associated with a 50 percent rating (disturbances in motivation and mood, difficulty in establishing and maintaining effective work and social relationships). The Veteran reported that he lives with his family in Columbia, South Carolina and was last employed in 2005 as a kitchen helper and stopped due to his non-service-connected knee disabilities. The Board finds the severity, frequency, and duration of the Veteran’s unlisted symptoms more closely approximate the symptoms contemplated by a 50 percent rating, which are less severe, less frequent, and shorter in duration than those contemplated by a 70 percent rating. See 38 C.F.R. § 4.126. The Veteran reported that these symptoms were not present daily, but would occur periodically. Further, poor appetite with reported weight loss, feelings of hopelessness, periods of cheerfulness and decreased interest in activities are similar to depressed mood, flattened affect, and disturbances of motivation and mood; which are contemplated by the assigned 50 percent rating or lower. The Board also finds the level of impairment caused by the Veteran’s symptoms more closely approximates the level associated with a 50 percent rating. The Veteran experienced occupational and social impairment with reduced reliability and productivity. Mental status examinations in VA and private treatment records and the May 2012 VA examination indicate that the Veteran had occupational and social impairment with reduced reliability and productivity. During the May 2012 VA examination, the Veteran reported that he feels limited due to his health, has difficulty with his sleep pattern, difficulty initiating and maintaining sleep, low energy level, decreased appetite with a reported weight loss of a few pounds in the last month, feeling of hopelessness, anxiety, and periods of tearfulness and decreased interest in activities with a history of polysubstance dependence of alcohol and crack cocaine (currently in sustained remission for the past 4 years). The Board notes that the Veteran’s June 2012 VA treatment records reflect that the Veteran’s Zoloft was discontinued because the Veteran reported that he did not need it anymore. The issue in this appeal is whether the Veteran’s associated symptoms caused the level of impairment required for a disability rating of 70 percent or higher. The Board concludes that the Veteran’s symptoms did not cause the level of impairment required for a disability rating of 70 percent or higher. The Veteran’s symptoms more closely approximated the symptoms associated with a 50 percent disability rating, and resulted in a level of impairment that most closely approximated the level of impairment associated with a 50 percent rating. The Board notes that the Veteran expressed suicidal ideation, which is similar to persistent danger of self-harm, which is contemplated by the 70 percent and 100 percent criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017). However, the severity, frequency, and duration of the Veteran’s suicidal ideation has not risen to the level contemplated by the 70 percent nor 100 percent disability ratings. The Veteran regularly denied thoughts, intent, or a plan involving self-harm in existing treatment records, and during the May 2012 VA examination. While the Veteran did experience a single symptom contemplated by a 70 percent disability rating (suicidal ideation) the evidence overall does not demonstrate the level of impairment associated with a 70 percent disability rating. As noted above, the Veteran’s other remaining symptoms were either contemplated by or more consistent with a 50 percent disability rating or lower. Further, while the May 2011 and March 2012 VA treatment records show the Veteran reported two incidents of prior suicidal ideations (10-months apart), they also reflect that the Veteran did not currently have suicidal ideation. In fact, during the May 2012 VA examination, the Veteran denied suicidal ideation. From October 23, 2012 The October 2012 with an addendum issued in December 2012 VA examination, VA Treatment records, and the Veteran’s lay statements show that the Veteran’s major depressive disorder with anxiety was manifested by symptoms associated with a 30 percent rating (depressed mood, anxiety, chronic sleep impairment, mild memory loss (such as forgetting names, directions, or recent events); symptoms associated with a 50 percent rating (flattened affect; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships); and symptoms associated with a 70 percent rating (suicidal ideation; and difficulty in adapting to stressful circumstances (including work or a worklike setting). The April 2016 VA examination, VA Treatment records, and the Veteran’s lay statements show that the Veteran’s major depressive disorder with anxiety was manifested by symptoms associated with a 30 percent rating (depressed mood; symptoms associated with a 50 percent rating (disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships); and a single symptom associated with a 70 percent rating (difficulty in adapting to stressful circumstances (including work or a worklike setting). The July 2020 VA examination, VA Treatment records, and the Veteran’s lay statements show that the Veteran’s major depressive disorder with anxiety was manifested by symptoms associated with a 30 percent rating (depressed mood, anxiety, chronic sleep impairment, and mild memory loss (such as forgetting names, directions, or recent events). The July 2020 VA examination did not find any symptoms associated with the 50 percent disability rating, the 70 percent disability rating, nor the 100 percent disability rating. The Board notes that the Veteran expressed prior suicidal ideation, which is similar to persistent danger of self-harm, which is contemplated by the 70 percent and 100 percent criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017). However, the severity, frequency, and duration of the Veteran’s suicidal ideation has not risen to the level contemplated by the 100 percent disability ratings. The Veteran regularly denied thoughts, intent, or a plan involving self-harm in existing treatment records and during the May 2012 VA examination. The Board also finds the level of impairment caused by the Veteran’s symptoms more closely approximates the level associated with a 70 percent rating or less. The Veteran experienced occupational and social impairment with reduced reliability and productivity with deficiencies in most areas during the October 2012 VA examination; and demonstrated improvement showing occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation during the April 2016 and July 2020 VA examinations. Mental status examinations in VA treatment records are consistent with the above findings. While the Veteran did experience a single symptom contemplated by a 70 percent and 100 percent rating (suicidal ideation) the evidence overall does not demonstrate the level of impairment associated with a 100 percent rating. As noted above, the Veteran’s other remaining symptoms were either contemplated by or more consistent with a 70 percent rating or less. Additionally, although the Veteran is not currently employed, he does report that he has been married and divorced twice, he is currently single, has one child and one grandchild, is currently living alone but cited some reliable family support and that he is moderately socially integrated with regular interpersonal interactions and activities with his family, but can be isolated and avoidant at times. In short, the preponderance of the evidence weighs against finding that the severity, frequency, and duration of the Veteran’s symptoms resulted in the level of impairment required for a 100 percent disability rating, specifically the Veteran’s symptoms do not result in total occupational and social impairment. The criteria for a 100 percent or higher rating are not met and the appeal must be denied. 3. Entitlement to an initial disability rating in excess of 40 percent for bilateral hypertensive retinopathy status post right central retinal venous occlusion The Veteran asserts that he is entitled to a higher disability rating for bilateral hypertensive retinopathy status post right central retinal venous occlusion. Unless otherwise directed, evaluate diseases of the eye under the General Rating Formula for Diseases of the Eye. 38 C.F.R. § 4.79, Diagnostic Codes 6000 through 6009. Impairment of Visual Acuity is rated under Diagnostic Codes 6061 through 6066. Impairment of Visual Fields is rated under Diagnostic Codes 6080 through 6081. The Veteran is rated under Diagnostic Code 6006. The criteria under Diagnostic Codes 6000 through 6009 instructs to evaluate on the basis of either visual impairment due to the particular condition or on incapacitating episodes, whichever results in a higher evaluation. 38 C.F.R. § 4.79. Where incapacitating episodes have a total duration of at least 1 week, but less than 2 weeks, during the past 12 months, a 10 percent disability rating is warranted. Where incapacitating episodes have a total duration of at least 2 weeks, but less than 4 weeks, during the past 12 months, a 20 percent disability rating is warranted. Where incapacitating episodes have a total duration of at least 4 weeks, but less than 6 weeks, during the past 12 months, a 40 percent disability rating is warranted. Where incapacitating episodes have a total duration of at least 6 weeks during the past 12 months, a 60 percent disability rating is warranted. A Note following the General Rating Formula indicates that, for VA purposes, an incapacitating episode is a period of acute symptoms severe enough to require prescribed bed rest and treatment by a physician or other healthcare provider. Id. Evaluations of defective vision from noncompensable to 100 percent based on organic impairment of visual acuity (excluding developmental errors of refraction), visual field, and muscle function. 38 C.F.R. §§ 4.76(a), 4.79. The examination for visual impairment must be conducted by a licensed optometrist or by a licensed ophthalmologist and the examiner must identify the disease, injury, or any other pathologic found. 38 C.F.R. § 4.76(b). Examination of visual fields or muscle function will be conducted only when there is a medical indication of disease or injury that may be associated with visual field defect or impaired muscle function. Id. Unless medically contraindicated, the fundus must be examined with the Veteran’s pupils dilated. Id. Examinations of visual acuity must include the central uncorrected and corrected visual acuity for distance and near vision using Snellen’s test type or its equivalent. 38 C.F.R. § 4.76(a). Evaluation of central visual acuity on the basis of corrected distance vision with central fixation, even if a central scotoma is present. 38 C.F.R. § 4.76(b). However, when the lens required to correct distance vision in the poorer eye differs by more than three diopters from the lens required to correct distance vision in the better eye (and the difference is not due to congenital or developmental refractive error), and either the poorer eye or both eyes are service connected, evaluate the visual acuity of the poorer eye using either its uncorrected or corrected visual acuity, whichever results in better combined visual acuity. Id. For evaluations of restrictions in visual field(s), the examiner must use either Goldmann kinetic perimetry or automated perimetry using Humphrey Model 750, Octopus Model 101, or later versions of these perimetric devices with simulated kinetic Goldmann testing capability. 38 C.F.R. § 4.77. Determination of the average concentric contraction of the visual field of each eye by measuring the remaining visual field (in degrees) at each of the eight principal meridians 45 degrees apart, adding them, and dividing the sum by eight. 38 C.F.R. § 4.77(b). To determine the evaluation for visual impairment when both decreased visual acuity and visual field defect are present in one or both eyes and are service connected, separately evaluate the visual acuity and visual field defect (expressed as a level of visual acuity), and combine them under the provisions of 38 C.F.R. § 4.25. As a preliminary matter, the record reflects that the Veteran does not have a history of incapacitating episodes during the period on appeal. A May 2012 VA examination reveals that the Veteran had the following visual defects. 05.30.2012 Uncorrected Distance Corrected Distance Uncorrected Near Corrected Near RIGHT 20/200 20/200 20/400 20/200 LEFT 20/70 20/20 20/400 20/20 The May 2012 VA examination also revealed that the Veteran has a documented mild visual field defect of the right eye. Normal Right Left Up 45 25 35 Up Temporally 55 55 40 Temporally 85 55 70 Down Temporally 85 50 70 Down 65 40 55 Down Nasally 50 30 45 Nasally 60 45 55 Up Nasally 55 45 45 The Veteran’s average concentric contraction of the visual field of each eye results in a right eye contraction of 43.125 degrees and left eye contraction of 51.875 degrees. Based on the evidence above, a disability rating in excess of 40 percent for the Veteran’s loss of visual acuity and visual field is not warranted. The Veteran’s visual acuity of 20/200 corrected distance in the right eye and 20/20 corrected distance in the left eye warrants a 20 percent disability rating. Additionally, the Veteran’s average contraction of the visual field of 43.125 degrees of the right eye and 51.875 degrees of the left eye warrants a 20 percent disability rating combined. Combining the Veteran’s results for visual acuity disability rating of 20 percent disabling and contraction of visual field disability rating of 20 percent results in a combined disability rating of 40 percent disabling. An April 2016 VA examination reveals that the Veteran had the following visual defects. 04.07.2016 Uncorrected Distance Corrected Distance Uncorrected Near Corrected Near RIGHT 10/200 20/200 10/200 20/200 LEFT 20/100 20/40 20/200 20/40 The April 2016 VA examination also revealed that the Veteran has a documented visual field defect of loss of the inferior half of the visual field in the left eye and loss of superior half of the right eye. Based on the evidence above, a disability rating in excess of 40 percent for the Veteran’s loss of visual acuity and visual field is not warranted. The Veteran’s visual acuity of 20/200 corrected distance in the right eye and 20/40 corrected distance in the left eye warrants a 20 percent disability rating. Additionally, the Veteran’s visual field defect of loss of the inferior half of the visual field in the left eye warrants a 10 percent disability rating and loss of superior half of the right eye warrants a 10 percent disability rating. Combining the Veteran’s results for visual acuity disability rating of 20 percent disabling and contraction of visual field disability rating of 20 percent (10 percent for each eye) results in a combined disability rating of 40 percent disabling. An August 2020 VA examination reveals that the Veteran had the following visual impairment(s). 08.20.2020 Uncorrected Distance Corrected Distance Uncorrected Near Corrected Near RIGHT 10/200 20/70 20/200 20/70 LEFT 20/50 20/40 20/70 20/40 The August 2020 VA examination also revealed that the Veteran has a documented visual field defect. Normal Right Left Up 45 32 23 Up Temporally 55 33 45 Temporally 85 40 67 Down Temporally 85 45 63 Down 65 32 42 Down Nasally 50 40 31 Nasally 60 31 27 Up Nasally 55 36 23 The Veteran’s average concentric contraction of the visual field of each eye results in a right eye contraction of 36.125 degrees and left eye contraction of 40.125 degrees. Based on the evidence above, a disability rating in excess of 40 percent for the Veteran’s loss of visual acuity and visual field is not warranted. The Veteran’s visual acuity of 20/70 corrected distance of the right eye and 20/40 corrected distance of the left eye warrants a 10 percent disability rating. Additionally, the Veteran’s average contraction of the visual field of 36.125 degrees of the right eye and 40.125 degrees of the left eye warrants a 30 percent disability rating. Combining the Veteran’s results for visual acuity disability rating of 10 percent disabling and contraction of visual field disability rating of 30 percent results in a combined disability rating of 40 percent disabling. The Board notes that the August 2020 VA examiner noted that the contraction of visual field in the left eye is of unknown etiology as there are on findings which would be expected to cause visual field contraction of the left eye. However, as noted above, even if that contraction of the visual field was considered service connected, it would result in no higher than the current 40 percent disabling. If the contraction of the visual field of the left eye was not determined to be service connected, it would result in a combined 10 percent disabling rather than the 40 percent. Accordingly, the preponderance of the most probative evidence is against the claim of entitlement to a disability rating in excess of 40 percent for a loss of visual acuity and impairment of visual field. Although the basis for the Veteran’s 40 percent disability rating has changed over time, specifically with improvement in visual acuity and a decrease in visual fields, the resulting 40 percent disability rating has remained the same. In reaching the conclusion above, the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran’s claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 4. Entitlement to TDIU VA will grant TDIU when the evidence shows that a veteran is precluded, by reason of service-connected disabilities, from obtaining and maintaining any form of gainful employment consistent with his education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. TDIU is granted only when it is established that the service-connected disabilities are so severe, standing alone, as to prevent the retaining of gainful employment. If there is only one such disability, it must be rated at least 60 percent disabling to qualify for benefits based on individual unemployability. 38 C.F.R. § 4.16(a). If there are two or more such disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). Entitlement to a total rating must be based solely on the impact of service-connected disabilities on the ability to keep and maintain substantially gainful employment. 38 C.F.R. §§ 3.340, 3.341, 4.16. The central inquiry is “whether the veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability.” Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). The Court recently defined “substantially gainful employment,” holding that there is both an economic and a noneconomic component; 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 (2019). The Court set forth a number of factors to consider in making the latter determination, including the following: the veteran’s history, education, skill, and training; his or her physical abilities, including any audio or visual limitations, as well as limitations in lifting, bending, sitting, standing, walking, climbing, grasping, typing, reaching; and his or her mental ability, include ing limitations in memory, concentration, ability to adapt to change, handle workplace stress, get along with coworkers, and demonstrate reliability and productivity. Id. Where these percentage requirements are not met, entitlement to benefits on an extraschedular basis may be considered when a veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities, and consideration is given to the veteran’s background including his employment and educational history. 38 C.F.R. §§ 3.321(b), 4.16(b). The Board does not have the authority to assign an extraschedular TDIU rating in the first instance. Bowling v. Principi, 15 Vet. App. 1 (2001). Rather, the issue must be referred to the Director of Compensation Service for such assessment in the first instance. Kuppamala v. McDonald, 27 Vet. App. 447, 457 (2015). Thereafter, the Board has jurisdiction to review the entirety of the Director’s decision denying or granting an extraschedular rating and is authorized to assign an extraschedular rating when appropriate. Kuppamala, 27 Vet. App. at 457. For VA purposes, the term unemployability is synonymous with inability to secure and follow a substantially gainful occupation. VAOPGPREC 75-91, 57 Fed. Reg. 2,317 (Jan. 21, 1992). Consideration may be given to the veteran’s education, special training, and previous work experience, but not to his or her age or to the impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). A high 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 or she can find employment. Van Hoose, 4 Vet. App. at 363. The ability to work sporadically or obtain marginal employment is not substantially gainful employment. 38 C.F.R. § 4.16(a); Moore v. Derwinski, 1 Vet. App. 356, 358 (1991). Marginal employment, i.e., earned annual income that does not exceed the poverty threshold for one person, is not considered substantially gainful employment. 38 C.F.R. § 4.16(a). Service connection is in effect for the following disabilities: major depressive disorder (rated at 50 to 70 percent disabling during the period on appeal), bilateral hypertensive retinopathy status post right central retinal venous occlusion (rated at 40 percent disabling), hypertension (rated at 10 to 20 percent disabling during the period on appeal), and tension headaches (rated at a non-compensable disability rating). For the time period on appeal, the Veteran’s combined disability evaluation has ranged from 80 to 90 percent during the period on appeal. Thus, the percentage requirements for a TDIU are met because the Veteran has at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). The Veteran also suffers from several non-service-connected conditions, including the following: erectile dysfunction, arthritis, left knee replacement (due to degenerative arthritis), lower back pain, right foot disability (big toe, hammer toe and degenerative joints), left elbow disability, and dizziness. The evidence of record does not demonstrate that the Veteran’s service-connected disabilities alone resulted in unemployability. In contrast, the Veteran has reported that his employment ended due to his non-service-connected knee disability and that he works when he feels like working. In short, the evidence of record overwhelmingly shows that the Veteran’s inability to obtain and maintain employment is due to the Veteran’s nonservice-connected knee disability or due to his desire not to work (as noted below, that the Veteran indicated that he works when he feels like working). There is no probative evidence that the Veteran’s service-connected disabilities, on their own, results in such impairment as to render the Veteran unable to work. As such, there is simply no evidence of unusual or exceptional circumstances to warrant referral for extraschedular consideration of a total disability rating based on the Veteran’s service-connected disability. Given the above, the preponderance of the evidence does not support the Veteran’s assertion that his service-connected disabilities are of such severity as to preclude his participation in any form of substantially gainful employment. Accordingly, the Board concludes that referral of this claim for consideration of TDIU on an extraschedular basis is not warranted. The Board notes that during the period on appeal, the Veteran has provided varying information concerning his employment. For example, during the October 2012 VA examination, the Veteran reported that his last job was at Fort Jackson working in the kitchen but was unable to continue due to a knee replacement. During the April 2016 VA examination, the Veteran reported that he worked for 10-11 years at the United States Post Office and has been doing pick up work for the past 20 to 30 years and that he works 20 hours per week when work is available and that he works when he feels like working. Finally, during the July 2020 VA examination, the Veteran reported that he last worked six years prior at Fort Jackson working in the kitchen but stopped due to difficulties with attention and memory. The Veteran’s inconsistent statements included within the Veteran’s VA examinations compel the Board to find that the Veteran’s more recent statement as to the reason he is not employed are not credible. See Caluza v. Brown, 7 Vet. App. 498, 510-11 (1995) (Board must evaluate credibility of all evidence; lay statements may be evaluated based on, inter alia, inconsistent statements, facial plausibility, and consistency with other evidence of record); see also Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). To be clear, the Board is not questioning the Veteran’s honesty or moral character. The Veteran is attempting to recollect events that transpired a long time ago, and the passage of time, along with the inconsistencies noted above, compels a conclusion that the Veteran is not an accurate historian as to these particular statements. See Caluza, 7 Vet. App. at 510-11. Therefore, the Board cannot assign them probative weight. Id. The evidence in this case is not so evenly balanced so as to allow for application of the benefit of the doubt rule as required by law and VA regulations. See 38 U.S.C. § 5107 (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1991). Therefore, the Veteran’s claim for entitlement to a TDIU is denied. M. Tenner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Deemer, 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.