Citation Nr: 21007155 Decision Date: 02/08/21 Archive Date: 02/08/21 DOCKET NO. 14-27 146 DATE: February 8, 2021 ORDER Entitlement to service connection for glaucoma, to include as due to herbicide exposure, is denied. Entitlement to service connection for a psychotic disorder, to include schizophrenia, is denied. Entitlement to a rating in excess of 10 percent for service-connected degenerative disc disease and degenerative osteoarthritis of the cervical spine disability is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. The Veteran’s glaucoma did not manifest in service or for many years thereafter and is not shown to be etiologically related to his service; glaucoma is not a disease listed as associated with exposure to herbicide agents. 2. The Veteran’s psychotic disorder, to include schizophrenia, did not manifest in service or for many years thereafter and is not shown to be etiologically related to his service. 3. For the appeal period, the Veteran’s service-connected cervical spine disability has manifested at worst as forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees without muscle spasm, guarding, or abnormal spine contour. 4. For the appeal period, the Veteran’s service-connected disabilities did not prevent him from obtaining or maintaining substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for glaucoma, to include as due to herbicide exposure, have not been met. 38 U.S.C. §§ 5103, 5103A, 5108; 38 C.F.R. § 3.156. 2. The criteria for entitlement to service connection for a psychotic disorder, to include schizophrenia, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for entitlement to a rating in excess of 10 percent for service-connected cervical spine disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242. 4. For the appeal period, the criteria for entitlement to TDIU have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16; Rice v. Shinseki, 22 Vet. App. 447. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from March 1965 to March 1969. A March 2019 Board decision remanded the issues on appeal for further development. That development has been accomplished, and the appeal has now been returned to the Board for further action. Stegall v. West, 11 Vet. App. 268 (1998). Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303 (a). To establish entitlement to service-connected compensation benefits, a Veteran must show (1) a present disability; (2) an 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. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Certain diseases may be presumed to have been incurred in service when manifest to a compensable degree within one year of discharge from active duty. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309. The option of establishing service connection through a demonstration of continuity of symptomatology is specifically limited to the chronic disabilities listed in 38 C.F.R. § 3.309 (a). See 38 C.F.R. § 3.303 (b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (rejecting the argument that continuity of symptomatology in § 3.303(b) has any role other than to afford an alternative route to service connection for specific chronic diseases). 1. Entitlement to service connection for glaucoma, to include as due to herbicide exposure. The Veteran asserts that his current glaucoma disability is related to his active service, to include exposure to herbicides during his service in Vietnam. He alternately asserts that his glaucoma is related to the chemical chloroquine he used in active service as an anti-malarial agent. Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). The Veteran has a current diagnosis of primary open angle glaucoma. VA recognizes glaucoma as an organic disease of the nervous system under 38 C.F.R. § 3.309 (a). If a veteran was exposed to an herbicide agent during active military, naval, or air service, certain diseases shall be service connected if the requirements of 38 C.F.R. § 3.307 (a)(6) are met, even if there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307 (d) are also satisfied. 38 C.F.R. § 3.309 (e). The Board notes that although the Veteran’s service in the Republic of Vietnam is established and his exposure to herbicides is presumed, glaucoma is not subject to presumptive service connection based on Agent Orange exposure. See 38 C.F.R. § 3.309 (e). VA’s Secretary has determined that a presumption of service connection based on exposure to herbicides used in the Republic of Vietnam during the Vietnam era is not warranted for any condition for which the Secretary has not specifically determined a presumption of service connection is warranted. See 68 Fed. Reg. 27,630 (May 20, 2003). However, the lack of unavailability of a presumption does not mean that the disability cannot be granted on a direct causation basis as discussed below. Stefl v. Nicholson, 21 Vet. App. 120 (2007). Service treatment records are silent concerning any treatment or diagnosis of glaucoma or any eye condition. Both a December 1996 and an August 1966 treatment record noted a normal eye examination. Post-service medical treatment records first detail the Veteran’s complaint, treatment, and diagnosis of glaucoma in September 2010. An October 2016 VA examination report opined that it was less likely than not that the Veteran’s glaucoma was related to exposure to herbicides and/or chloroquine. As rationale, the examiner stated that there was no association between open angle glaucoma and herbicides or chloroquine. A January 2017 VA addendum opinion from the October 2016 examiner stated that the Veteran did not have a diagnosis of neovascular glaucoma which is associated with diabetes and indirectly associated with herbicide exposure. Instead, the Veteran’s glaucoma is an open angle glaucoma. The examiner reasoned that there are no studies in medical literature which supported association between herbicides and chloroquine to primary open angle glaucoma. The examiner again opined that it was less likely than not that the Veteran’s open angle glaucoma was related to his active military service, exposure to herbicides, or chloroquine. It is not in dispute that the Veteran has glaucoma as treatment records clearly show diagnosis of the disease. However, evidence does not show that his glaucoma manifested in service. The Veteran’s service treatment records are silent for complaints, treatment, findings, or diagnoses related to glaucoma. Likewise, his glaucoma is not shown to have been manifested within a year following the Veteran’s separation from service, nor is post-service continuity of manifestations of the disease shown. Indeed, evidence of record reflects that glaucoma was initially diagnosed in 2010, over forty years after the Veteran’s separation from service. Accordingly, service connection for glaucoma on the basis that it became manifest in service and persisted, on a presumptive basis (as a chronic disease under 38 U.S.C. § 1112 or based on continuity under 38 C.F.R. § 3.303 (b)), is not warranted. The analysis turns to whether service connection for glaucoma may be granted based on an affirmative showing of a nexus to service. After review of the evidence, the Board finds that service connection for glaucoma on a direct basis is also not warranted. There is no probative objective medical evidence of record which provides a positive nexus between the disability and active service. The VA examiner of record has provided a negative etiologic opinion, and there are no probative contrary medical opinions of record. The only evidence that relates the Veteran’s claimed glaucoma to his service is in his own lay statements. While the Veteran is competent to describe observable symptoms, it is not argued or shown that the Veteran is qualified through specialized education, training, or experience to offer an opinion on questions that require scientific or medical expertise. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In summary, there is no competent evidence that the Veteran’s glaucoma may be etiologically related to his service or manifested in service and persisted on a presumptive basis. Considering the foregoing, the preponderance of the evidence is against the claim, and the appeal must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to service connection for a psychotic disorder. The Veteran also contends that he is entitled to service connection for a psychotic disorder, to include schizophrenia. In correspondence of record, the Veteran detailed several instances of hostile military activity which he contends caused his current psychotic disorder, to include schizophrenia. As noted above, certain chronic diseases, including psychoses, are subject to presumptive service connection if manifest to a compensable degree within one year from separation from service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307 (a)(3), 3.309(a). Service treatment records are silent concerning treatment or diagnosis of a psychotic disorder, to include schizophrenia. A March 1969 service discharge examination reflects the Veteran did not suffer from any psychosis. Post-service medical treatment records reflect treatment for and diagnosis of schizophrenia. Records reflect a June 2003 initial evaluation for correct diagnosis of psychiatric symptoms, to include schizophrenia. An August 2011 VA examination report opined that it was less likely than not that the Veteran’s psychotic symptoms were related to his military service. As rationale, the examiner noted the Veteran’s medical file indicated initial suspicion of schizophrenia in 1980, or 11 years after service discharge. A September 2016 VA examination report opined that it was less likely than not that the Veteran’s psychotic disorder, to include schizophrenia, was related to his active military service. As rationale, the examiner stated that the Veteran’s psychotic symptoms appeared 11 years after military discharge, and there was no evidence of onset of mental health symptoms during his military service. Further, the examiner noted that schizophrenia is a chronic mental illness and clinical literature did not support a single incident to cause schizophrenia. As such, the examiner found no evidence that the Veteran’s psychotic disorder, including schizophrenia, was due to or caused by a disease or injury during active service. The Board has closely reviewed the medical and lay evidence in the Veteran’s claims file and finds no evidence that may serve as a medical nexus between the Veteran’s assertion of an etiological link between active service and his current psychotic disorder, to include schizophrenia. There is simply no evidence that a psychotic disorder, to include schizophrenia, was manifest in service, that a psychosis is shown to have been manifest within one year of active service, and/or that a present psychotic disorder, including schizophrenia, is etiologically related to active service. Here, there is competent evidence of the diagnosis and treatment for schizophrenia, but other than the Veteran’s unsupported contentions, there is no objective medical evidence that this disability may be associated with service. The post service treatment records indicate that he did not receive a diagnosis or treatment for schizophrenia until 1980, which is eleven years after his discharge from active service. The Board also finds that the Veteran’s service entrance and service separation examinations are highly probative that symptoms of an acquired psychiatric disorder were not present upon service entrance or during active service. The service examiners specifically noted the Veteran was not depressed and did not display symptoms of psychosis during both examinations. Further, there is no medical opinion of record linking the Veteran’s current psychotic disorder, to include schizophrenia, to his active service. As to the Veteran’s other diagnosed psychiatric disabilities, the Board notes that he is currently service-connected for other specified depressive disorder with nightmare disorder. To the extent that the Veteran advances his own interpretation of his medical condition indicating that his current psychotic disorder, to include schizophrenia, is related to service, the Board acknowledges that lay witnesses may, in some circumstances, opine on questions of diagnosis and etiology. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) In any event, the probative value of the Veteran’s general assertions in this regard are outweighed by the probative value of the evidence outlined above, to include the reasoned opinion of the VA examiners of record. As the evidence does not establish the claimed psychotic disorder, to include schizophrenia, occurred during active service, is etiologically related to active service, or that treatment for the psychotic disorder, to include schizophrenia, occurred within the one-year presumptive period, service connection is not warranted. 38 C.F.R. § 3.384. The Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable in the instant appeal. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Increased Rating Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C. § 1155 ; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. 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 required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. Evaluations are based upon lack of usefulness of the part or system affected, especially in self-support. 38 C.F.R. § 4.10. In evaluating musculoskeletal disabilities, consideration is given to additional functional limitation due to factors such as pain, weakness, fatigability, and incoordination. 38 C.F.R. §§ 4.40 and 4.45; DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). Diagnostic codes predicated on limitation of motion do not prohibit consideration of a higher rating based on functional loss due to pain on use or due to flare-ups under 38 C.F.R. §§ 4.40, 4.45, and 4.59. Johnson v. Brown, 9 Vet. App. 7 (1996). However, in Mitchell v. Shinseki, 25 Vet. App. 32 (2011), the Court clarified that there is a difference between joint motion pain as opposed to pain that places further limitation of the particular range of motion. Disability of the musculoskeletal system is the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. The examination upon which ratings are based must adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. Pain must affect the ability to perform normal working movements with normal excursion, strength, speed, coordination, or endurance in order to constitute functional loss. Id. The provisions 38 C.F.R. §§ 4.40, 4.45, 4.59 should only be considered in conjunction with the Diagnostic Codes predicated on limitation of motion. Johnson v. Brown, 9 Vet. App. 7 (1996). Under 38 C.F.R. § 4.40, functional loss may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant on motion. Disability of the musculoskeletal system is the inability to perform normal working movement with normal excursion, strength, speed, coordination, and endurance, and that weakness is as important as limitation of motion, and that a part that becomes disabled on use must be regarded as seriously disabled. A little used part of the musculoskeletal system may be expected to show evidence of disuse, through atrophy, for example. 38 C.F.R. § 4.40. The provisions of 38 C.F.R. §§ 4.45 and 4.59 also contemplate inquiry into whether there is limitation of motion, weakness, excess fatigability, incoordination, and impaired ability to execute skilled movements smoothly, and pain on movement, swelling, deformity, or atrophy of disuse. Instability of station, disturbance of locomotion, and interference with sitting, standing, and weight-bearing are also related considerations. The Court has held that diagnostic codes predicated on limitation of motion require consideration of a higher rating based on functional loss due to pain on use or due to flare-ups. 38 C.F.R. §§ 4.40, 4.45, 4.59; Johnson v. Brown, 9 Vet. App. 7 (1997); DeLuca v. Brown, 8 Vet. App. 202, 206 (1995). The provisions of 38 C.F.R. § 4.59, which relate to painful motion, are not limited to arthritis and must be considered when raised by the claimant or when reasonably raised by the record. Burton v. Shinseki, 25 Vet. App. 1 (2011). In general, when an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where entitlement to compensation has already been established and an increase in the disability rating is at issue as is the case for sinusitis, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Staged ratings are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). 3. Entitlement to a rating in excess of 10 percent for service-connected degenerative disc disease and degenerative osteoarthritis of the cervical spine disability. Finally, the Veteran asserts that his service-connected cervical spine disability is more severe than his current disability rating reflects. His service-connected spine disability is currently rated under Diagnostic Code 5242. Under the General Rating Formula For Diseases and Injuries of the Spine, a 10 percent rating is assigned for forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees, or a combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees, or muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour, or vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is assigned for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees, or the combined range of motion of the cervical spine not greater than 170 degrees, or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 30 percent rating is assigned for forward flexion of the cervical spine 15 degrees or less or favorable ankylosis of the entire cervical spine. A 40 percent rating is assigned for unfavorable ankylosis of the entire cervical spine, or forward flexion of the thoracolumbar spine 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A maximum 100 percent rating is assigned for unfavorable ankylosis of the entire spine. Note (1): Evaluate any associated objective neurologic abnormalities, including but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. Id. Note (2): For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Id. Note (4): Round each range of motion measurement to the nearest five degrees. Id. Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Id. Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. 38 C.F.R. § 4.71a , Diagnostic Codes 5235 to 5242. Diagnostic Code 5243 provides that intervertebral disc syndrome (preoperatively or postoperatively) be rated either under the General Rating Formula for Disease and Injuries of the Spine, or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under 38 C.F.R. § 4.25. 38 C.F.R. § 4.71a, Diagnostic Code 5243. Under Diagnostic Code 5243, a 40 percent rating is warranted where there are incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. Id. Diagnostic Code 5243 defines an incapacitating episode as a period of acute signs and symptoms that requires bed rest prescribed by a physician and treatment by a physician. Id. There is a large amount of evidence in this case, consisting of mainly medical evidence. The Board notes that it has reviewed the evidence in its entirety but will not be discussing all of it with specificity. See Newhouse v. Nicholson, 497 F.3d 1298, 1302 (Fed. Cir. 2007) (The Board is presumed to have considered all evidence presented in the record and is therefore not required to specifically discuss every piece of evidence.). The Board will address that evidence which is pertinent to the appeal. A May 2014 VA examination report recorded cervical forward flexion measured 45 degrees or greater without objective evidence of painful motion. Functional loss was noted as less movement than normal and pain on movement. The examiner noted no localized tenderness, muscle spasm, guarding, or abnormal gait. Further, no muscle atrophy, ankylosis, or IVDS was noted. An October 2016 VA examination measured cervical forward flexion at 40 degrees. While the Veteran did describe some functional loss, the examiner detailed there was no weakened movement, subjective complaints of fatiguability, incoordination, pain in movement, swelling, deformity, atrophy, spasm, guarding, or abnormal gait. A February 2018 VA examination report measured forward flexion as 45 degrees. The examiner noted a diagnosis of IVDS without prescribed bed rest. Functional loss was noted as less movement than normal and pain on movement. The examiner also noted the bilateral paracervical muscles were tender to palpation. No muscle spasm, guarding, ankylosis, or abnormal gait was noted. Medical treatment records reflect the Veteran’s complaints of cervical pain, but the records contain no range of motion measurements or any other criteria used for rating purposes. After review, the Board finds that the preponderance of the evidence of record weighs against the assignment of a rating in excess of 10 percent for the service-connected cervical spine disability. While the Veteran has reported pain of his cervical spine, motion limited to greater than 15 degrees but not greater than 30 degrees or spasms or guarding resulting in abnormal gait or abnormal spinal contour have not been shown at any time. Further, throughout the period of appeal there are no records indicating IVDS with prescribed incapacitating episodes, and there is no objective evidence of other related neurological abnormalities. The Board notes that the Veteran has asserted that his cervical back disorder warrants a greater disability rating. However, objective findings in the record do not support this. The Veteran is competent to report certain obvious symptoms of his cervical spine disability but not to identify a specific level of disability. Barr v. Nicholson, 21 Vet. App. 303 (2007). Competent evidence concerning the nature and extent of the Veteran’s service-connected disability has been provided by the VA medical professionals who examined him. The medical findings adequately address the criteria under which this disability is evaluated. The Board accords the objective medical findings greater weight than subjective complaints of increased symptomatology. Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991). The Board additionally considered whether there are any other Diagnostic Codes which could apply to the Veteran’s current cervical spine disability. Diagnostic Code 5242 allows for a rating under Diagnostic Code 5003 for arthritis. Diagnostic Code 5003 provides for a compensable rating only if one is not available under the general formula; thus, it is not applicable to this case. The Board therefore finds that there are no other potentially applicable Diagnostic Codes by which a higher rating can be assigned. The Board further finds that a separate disability rating is not warranted because the evidence does not demonstrate that the Veteran suffers from a separate neurological disability distinct from his already service-connected lumbar spine disability. See Bierman v. Brown, 6 Vet. App. 125, at 129-32 (1994). Separate disability ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one disorder was not “duplicative of or overlapping with the symptomatology” of the other disorder. See Esteban v. Brown, 6 Vet. App. 259, 262 (1994). The Board has also considered the provisions of 38 C.F.R. §§ 4.40, 4.45, 4.59, and the holdings in DeLuca. However, an evaluation in excess of 10 percent for the Veteran’s cervical spine disability is not warranted on the basis of functional loss due to pain or weakness in this case, as his symptoms are supported by pathology consistent with the assigned 10 percent rating. In this regard, the Board observes that the Veteran has continually complained of cervical pain during the appeal period. However, the effect of the pain in the Veteran’s back is contemplated in the currently assigned disability evaluations. The Veteran’s complaints do not, when viewed in conjunction with the medical evidence, tend to establish weakened movement, excess fatigability, or incoordination to the degree that would warrant an increased evaluation. Thus, the Board finds that the weight of the evidence is against the claim for a rating in excess of 10 percent for service-connected degenerative disc disease and degenerative osteoarthritis of the cervical spine. The preponderance of the evidence is against this issue, and the benefit of the doubt doctrine does not apply. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102 ; Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). 4. Entitlement to a total disability rating based on individual unemployability (TDIU) Pursuant to 38 C.F.R. § 4.16 (a), a total disability rating 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 as a result of service connected disabilities, provided that, if there is only one such disability, this disability shall be ratable at 60 percent or more, or if there are two or more 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). When considering whether the Veteran’s disabilities meet this requirement, disabilities affecting a single body system will be considered as one disability. Id. In his November 2017 application for a TDIU, the Veteran stated that he is unemployed partly because of his service-connected degenerative disc disease of the cervical spine. As an increased rating claim for such disability is currently on appeal, the current claim for a TDIU rating based on the Veteran’s service-connected disabilities is also on appeal. See Rice, 22 Vet. App. at 447. For the appeal period, the Veteran has only been service connected for depressive disorder with nightmares, rated as noncompensable effective September 14, 2010 and rated as 50 percent disabling effective June 16, 2017; radiculopathy of the right upper extremity rated as 20 percent disabling effective February 5, 2018; and degenerative disc disease of the cervical spine rated as 10 percent disabling effective January 31, 2003. The Veteran’s combined disability evaluation was 10 percent from January 13, 2003 to June 15, 2017 and 60 percent from June 16, 2017. As such, the Veteran did not meet the minimum scheduler criteria for TDIU under 38 C.F.R. § 4.16 (a) for the appeal period. Even so, the Board may consider an extra-schedular TDIU if the Veteran’s service-connected disability, while not reaching the threshold criteria, nonetheless rendered him unemployable. In determining employability for VA purposes, consideration is given to the level of education, special training, and work experience. 38 C.F.R. § 3.341, 4.16(a), 4.19; Faust v. West, 13 Vet. App. 342 (2000). The question is whether the Veteran is capable of performing the physical and mental acts required by employment. Van Hoose v. Brown, 4 Vet. App. 361 (1993); 38 C.F.R. § 4.1, 4.15, 4.16(a). The Court has provided guidance as to the meaning of the phrase ability to “secure and follow” such employment. In determining whether a veteran can secure and follow a substantially gainful occupation, attention must be given to the veteran’s history, education, skill, and training; whether the veteran has the physical ability (both exertional and nonexertional) to perform the type of activities (e.g., sedentary, light, medium, heavy, or very heavy) required by the occupation at issue, to include factors relating to the veteran’s limitations, if any, concerning lifting, bending, sitting, standing, walking, climbing, grasping, typing, and reaching, as well as auditory and visual limitations; and whether the veteran has the mental ability to perform the activities required by the occupation at issue, to include factors relating to the veteran’s limitations, if any, concerning memory, concentration, ability to adapt to change, handle work place stress, get along with coworkers, and demonstrate reliability and productivity. Ray v. Wilkie, No. 17-0781, slip op. at 16 (U.S. Vet. App. Mar. 14, 2019). Under the facts of this case, the Board finds extraschedular referral is inappropriate. When considering entitlement to TDIU, the record must demonstrate some factor that takes the Veteran’s situation outside the norm since the VA Rating Schedule already is designed to take into consideration impairment that renders it difficult to obtain and keep employment. Van Hoose, 4 Vet. App. 361. Here, the evidence preponderates against finding that the Veteran’s service-connected disabilities produced total unemployability. Specifically, the evidence of record reflects that while his service-connected disabilities may have interfered with his job duties, it did not impact his employability as supported by the June 2018 VA examiner’s report and his November 2017 application for a TDIU. The June 2018 VA examination report for service-connected depression detailed that the Veteran’s depressive disorder did not interfere with his employment as the examiner rated “employment” as a “0” to denote less frequent symptom or difficulty. The February 2018 VA examination for service-connected cervical disability noted the only employment interference would be unrestricted heavy lifting and carrying. Further, in his application for a TDIU, the Veteran stated that he was unable to secure employment because of several non-service connected disabilities in addition to his service-connected depression and cervical back disability. There is no other evidence to the contrary of record. The Board has given consideration to contentions in the record regarding the Veteran’s symptomology, however; finds it is not productive of total unemployability. The Board emphasizes that the rating schedule is 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. To the extent the service-connected disabilities affect the Veteran’s employment, the assigned schedular ratings for the disabilities compensate the Veteran for such impairment. For the forgoing reasons, the Board finds that competent, probative evidence simply does not support a finding that the Veteran’s service-connected disabilities rendered him unemployable at any time during the appeal period. In sum, based on the occupational and disability picture presented by the evidence of record, the Board finds that the evidence does not reveal factors outside the norm resulting in unemployability due to the Veteran’s service-connected disabilities, and the appeal will not be referred for further extraschedular consideration. As such, the appeal must be denied. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. Kelli A. Kordich Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Peden 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.