Citation Nr: 21009168 Decision Date: 02/19/21 Archive Date: 02/19/21 DOCKET NO. 15-45 617 DATE: February 19, 2021 ORDER Entitlement to a total disability rating based on individual unemployability (TDIU), to include on an extraschedular basis, is denied. FINDING OF FACT 1. The average impairment in earning capacity due to the Veteran’s service-connected disability symptoms are adequately compensated and accounted for in the Veteran’s schedular ratings. CONCLUSION OF LAW The requirements for entitlement to a TDIU have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the U.S. Army National Guard from January 2008 to January 2009, to include service in Operation Iraqi Freedom from March 2008 to December 2008. From March 2010 to September 2010, the Veteran completed Title 32 Full-Time National Guard Duty. Additionally, the Veteran completed active duty for training (ACDUTRA) in the Army National Guard from October 2000 to April 2001. See DD-214, Certificates of Release or Discharge from Active Duty. This matter comes before the board as the result of a reasonable question of a total rating based on unemployability. If a Veteran or the Veteran’s record raises the issue of substantially gainful employment due to the disability for which an increased rating is sought, then part and parcel to the claim is whether a TDIU is warranted. See Rice v. Shinseki, 22 Vet. App. 447 (2009). The Veteran filed claims in November 2013 and October 2017 for an increased evaluation of post-traumatic stress disorder (PTSD) greater than 10 percent. See November 2013 and October 2017 VA Forms 21-526EZ, Application for Disability Compensation. December 2017 VA correspondence indicated that the Veteran was having difficulty maintaining employment. See December 2017 VA Patient Information Letter. In April 2019, VA correspondence stated that prescribed medications prevented him from work as a truck driver. See April 2019 VA Vocational Rehabilitation and Employment decision letter. This matter was remanded by the Board of Veterans’ Appeals (Board) in June 2017, April 2018, November 2018, September 2019 and August 2020 for further development and adjudication by the Department of Veterans Affairs (VA) Regional Office (RO) in the first instance. This case has been advanced on the docket pursuant to 38 U.S.C. § 7107(b) and 38 C.F.R. § 20.902(c). The matter has been returned to the Board for further action. 1. Entitlement to a total disability rating based on individual unemployability (TDIU). The Veteran’s record raises the possibility that his service-connected disabilities preclude him from obtaining and maintaining substantially gainful employment. See December 2017 VA Patient Information and April 2019 VA Vocational Rehabilitation and Employment decision letters. VA will grant a TDIU when the evidence shows that a veteran is precluded, by reason of his service-connected disabilities, from securing and following “substantially gainful employment” consistent with his education and occupational experience. 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). In determining unemployability for VA purposes, consideration may be given to a veteran’s level of education, special training, and previous work experience but not to age or any impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19; Hersey v. Derwinski, 2 Vet. App. 91, 94 (1992); Faust v. West, 13 Vet. App. 342 (2000). The sole fact that a veteran is unemployed or has difficulty obtaining employment is not enough, as a high rating in itself is a recognition that the impairment makes it difficult to obtain and keep employment. The 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 v. Brown, 4 Vet. App. 361, 363 (1993) (citing 38 C.F.R. §§ 4.1, 4.15, 4.16(a)). Medical evaluations are probative to understanding the level of functional impairment; however, the ultimate determination of unemployability is a legal question, not a medical one. See Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013). Recently, in Ray v. Wilkie, 31 Vet. App. 58 (2019), the Court defined the term “unable to secure and follow a substantially gainful occupation” in § 4.16(b) to include two components: one economic and one noneconomic. The economic component means an occupation earning more than marginal income (outside of a protected environment) as determined by the United States Department of Commerce as the poverty threshold for one person. The non-economic component includes consideration of: the Veteran’s history, education, skill, and training; whether the veteran has the physical ability to perform the type of activities required by the occupation at issue; and whether the veteran has the mental ability to perform the activities required by the occupation at issue. The Board recognizes the Court’s findings in Cantrell v. Shulkin, 28 Vet. App. 382 (2000) concerning the meaning of the term “in a protected environment” under 38 C.F.R. § 4.16(a). In Cantrell, the Court held that the meaning of “employment in a protected environment” is not clear from the regulation’s plain language and noted that the list of examples in the regulation “suggests that VA may have intended employment ‘in a protected environment’ to be a term of art that differs from the ordinary, accommodation-based dictionary definition proffered by the [V]eteran.” Id. The Board takes note of the examples of “protected environment” used in the text of 38 C.F.R. § 4.16(a), “family business or sheltered workshop.” In the case of a family business, it is common for an employer to hire a relative to fill a position, not because the relative is necessarily the most capable or efficient prospective employee, but for reasons of affection or obligation. The term “sheltered workshop” is not defined in Title 38 of the Code of Federal Regulations. Several state codes across the U.S. define “sheltered work shop” in the following ways: “a facility designed to provide gainful employment for individuals with severe disabilities who cannot be absorbed into the competitive labor market or to provide interim employment for such individuals when employment opportunities for them in the competitive labor market do not exist” (Louisiana); “a facility, or any portion thereof, operated by a nonprofit organization, corporation, partnership, limited liability company or association whose purpose is to provide meaningful work or training activities to individuals with developmental disabilities” (Oklahoma); “an occupation-oriented facility operated by a not-for-profit corporation, which, except for its staff, employs only persons with disabilities” (Missouri); “an occupation-oriented facility operated by a nonprofit agency, public or private, which except for its staff, employs only handicapped persons” (New Jersey). La. R.S. § 39:1604.4 ; 63 Okl. St. § 1-865.2 ; § 178.900 R.S.Mo.; N.J. Stat. § 34:16-40. Title 20 of the Code of Federal Regulations, 20 C.F.R. § 404.1574 (a)(3), which the Code describes as an evaluation guide for (Social Security Administration) employees for determining whether a worker is involved in substantially gainful activity, states: “If you are working in a sheltered workshop, you may or may not be earning the amounts you are being paid. The fact that the sheltered workshop or similar facility is operating at a loss or is receiving some charitable contributions or government aid does not establish that you are not earning all you are being paid.” The Board recognizes that the Secretary, as of this decision, has not defined “protected environment.” Therefore, said determinations must be made on a case-by-case basis, evaluating the information and evidence in the record. TDIU may be assigned where the schedular rating is less than total and it is found that the Veteran is unable to secure or follow a substantially gainful occupation as a result of either (1) a single service-connected disability ratable at 60 percent or more, or (2) two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 3.341, 4.16(a). If the Veteran does not meet the required percentage standards set forth in 38 C.F.R. § 4.16(a), he still may receive a TDIU on an extraschedular basis if it is determined that he is unable to secure or follow a substantially gainful occupation by reason of his service-connected disabilities. 38 C.F.R. § 4.16(b). In cases where extraschedular consideration is warranted, referral to the Director of Compensation Service is necessary prior to a determination on eligibility. In Thun v. Peake, 22 Vet. App. 111 (2008), the Court held that the determination of whether a claimant is entitled to an extraschedular rating under 38 C.F.R. § 3.321(b) is a three-step inquiry. First, there must be a finding that the evidence of record presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. Id. This first element is a threshold element and requires the Board to compare the severity and symptomatology of the claimant’s service-connected disability with the rating-schedule for that disability. See Id. If the rating criteria reasonably describe the claimant’s disability level and symptomatology, the assigned schedular evaluation is adequate and no referral is required. Id. Second, if the schedular criteria are found to be inadequate to evaluate the claimant’s disability, the Board must determine whether the exceptional disability exhibits other related factors such as marked interference with employment or frequent periods of hospitalization. Id. If so, then under the third step of the inquiry the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service for a determination of whether the claimant’s disability picture requires the assignment of an extra-schedular rating. Id. When there is an approximate balance in the evidence regarding the merits of an issue material to the determination of the matter, the benefit of doubt shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Duty to Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2016). Proper VCAA notice must inform the claimant of any information and evidence not of record: (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b)(1). In Dingess-Hartman v. Nicholson, 19 Vet. App. 473 (2006), the United States Court of Appeals for Veterans Claims held that the VCAA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim: 1) veteran status; 2) existence of a disability; 3) a connection between the veteran’s service and the disability; 4) degree of disability; and 5) effective date of the disability. With respect to the Veteran’s claim, no notice or duty to assist deficiencies have been alleged by the Veteran. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”) Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Nevertheless, VA has satisfied its duties to inform and assist the Veteran in this case. See 38 U.S.C. §§ 5103, 5103A; 38 C.F.R. § 21.1032(a). Further development or assistance by VA is not warranted. The RO provided a custom 38 U.S.C. § 5103A Notice in October 2017 informing the Veteran of the legal requirements needed to substantiate the claim and how VA would obtain any evidence needed to support the claim. See October 2017 Custom 5103 Notice. Further efforts to inform and assist the Veteran include VA examinations in March 2014, November 2017, December 2017, May 2019, July 2019, and November 2019, a June 2014 Decision Review Officer Process Explanation Letter, a November 2015 Statement of the Case, Board remands in June 2017, April 2018, November 2018, September 2019, and August 2020, Supplemental Statements of the Case in February 2018, May 2018, August 2019, June 2020, and December 2020. A remand for further development of this claim would serve no useful purpose. Further, the RO’s efforts have substantially complied with the instructions contained in the June 2017, April 2018, November 2018, September 2019, and August 2020 Board remands. See Stegall v. West, 11 Vet. App. 268 (1998). In-service and post -service medical, Social Security Administration (SSA), and Internal Revenue Service (IRS) records have been obtained, medical examinations have been performed, and the Veteran was afforded multiple opportunities to provide employer information, work history, specific periods of unemployment, and clarification regarding unemployability. See September 2019 and August 2020 Board remands, October 2019 VA Form 21-4138, August 2020 VA Correspondence, September 2020 VA Form 21-8940, September 2020 VA Form 21-0820, September 2020 VA Form 21-4192, October 2020 VA Subsequent Development Letter, November 2020 VA Form 21-0820. VA’s duty to assist is not unlimited. Subsection (d) of 38 C.F.R. § 3.159 provides an important limitation on the provision of assistance: “VA will refrain from providing assistance in obtaining evidence for a claim if the substantially complete application for benefits indicates that there is no reasonable possibility that any assistance VA would provide to the claimant would substantiate the claim.” See Sullivan v. McDonald, 815 F.3d 786 (Fed. Cir. 2016). Factual Background Service-connected conditions for the Veteran include: 1) PTSD, to include symptoms of anxiety and night sweats (the latter also claimed as sleep disorder) [rated as 10 percent disabling from May 9, 2011, 30 percent disabling from December 15, 2017, 50 percent disabling from September 9, 2010, and 70 percent from September 9, 2010]; 2) migraines (rated as 50 percent disabling from November 14, 2013); 3) irritable bowel syndrome and diarrhea (IBS) [rated as 30 percent disabling from August 6, 2019]; 4) erectile dysfunction (ED) [rated as 0 percent disabling from August 6, 2019]; and 5) sinusitis (rated as 0 percent disabling from August 6, 2019). See April 2020 VA Rating Decision Codesheet. Combined overall ratings for the Veteran, including consideration of the bilateral factor, excluding periods of temporary total ratings and special monthly compensation, are: 1) 70 percent from September 9, 2010; and 2) 90 percent from November 14, 2013. See April 2020 VA Rating Decision Codesheet. The Veteran graduated from high school and attended one year of college at the University of Arkansas – Little Rock before his National Guard unit deployed to Iraq in 2008. See March 2016 SSA Mental Diagnostic Evaluation. In addition, the Veteran was enrolled at South University – Savannah in August 2017. See April 2019 VA Vocational Rehabilitation and Employment (VRE) Correspondence. Army National Guard records indicate that the Veteran was trained as a Track Vehicle Mechanic, Motor Transport Operator, and as a Horizontal Construction Engineer. See DD-214, Certificates of Release or Discharge from Active Duty. The Veteran also holds a Commercial Driver License (CDL) to operate large, heavy, and hazardous material vehicles in the United States. See March 2016 SSA Mental Diagnostic Evaluation. According to SSA records, the Veteran can operate a forklift. See November 2017 SSA Form 3368, Disability Report – Adult. As indicated previously, the Veteran has not claimed TDIU per se. Pursuant to the September 2019 Board remand, the Veteran was asked to complete VA Form 21-8940, Veteran’s Application for Increased Compensation Based on Unemployability. See September 2019 Board remand. In his January 2020 Application, the Veteran indicated that “PTSD, Migraines, IBS, Sinusitis” prevents him from securing or following any substantially gainful employment. When requested to “List all of your employment including self-employment for the last five years you worked,” the Veteran listed “Dept of the Army.” When asked “Date your disability affected full-time employment” and “Date you last worked full-time,” the Veteran indicated “12-01-2017.” For “What is the most you ever earned in one year,” the Veteran listed “$3,200.00” as a “Soldier.” See January 2020 VA Form 21-8940, Application for Increased Compensation Based on Unemployability. The Veteran indicated in his VA Forms 21-8940 that he became unable to work “12-01-2017.” See January and September VA Forms 21-8940, Application for Increased Compensation Based on Unemployability. In his January 2016 SSA disability application, the Veteran alleged an inability to work as of “12/17/14.” While the Veteran responded “No” to the question, “Is the individual working,” he also indicated, “Currently working as a truck driver.” See March 2016 SSA Disability Determination Explanation. In the August 2019 SSA disability application, the Veteran alleged the inability to work as of “10/27/2017.” The Veteran responded “No” to the questions, “Since you last told us about your medical conditions, has there been any CHANGE in your physical or mental condition, Since you last told us about your medical conditions, do you have any NEW physical or mental conditions, Has the individual worked since last completing a disability report, Has the individual performed work after the alleged onset date?” See January 2020 SSA Disability Determination Explanation. The Veteran stated during his July 2019 VA examination that he “worked most recently in February (2019) as a truck driver.” See July 2019 VA Compensation and Pension Examination Note. IRS records indicate that the Veteran worked for and received W-2 Wage and Tax Statements from MVT Services, Rent A Center, US Xpress, Inc., Celadon Trucking Services, Inc., Tipton Enterprise, Quality Drivers Logistic, Inc., CRST Expedited, Superior Protection Services, Inc., LL Glenn Plaza Loop, LLC, EDS Service Solutions, LLC, JB Hunt Transport, Inc., Gary Carpenter Construction, USA Truck, Inc., Swift Transportation Services, RMR Driver Services, FirstStaff, Inc., Department of the Army, Tyson Sales and Distribution, Inc., and Arkansas Highway and Transportation. See October 2019 IRS Wage and Income Transcript. The Veteran reported in a telephone call that he did not file taxes for the 2019 calendar year. See VA Form 27-0820, Report of General Information. For the 2012 tax year, reported income for the Veteran was $90,419.00, including Thompson Transportation, Inc., $66,500.00, TruGreen Limited Partnership, $9,591.00, USA Truck, Inc., $11,483.00, and JB Hunt Transport, Inc., $2,845.00. See October 2019 IRS Wage and Income Transcript. During a July 2019 VA appointment, the Veteran stated that he worked as recently as February 2019 “as a truck driver.” See July 2019 VA Compensation and Pension Examination Note. The Veteran was asked to complete an additional VA Form 21-8940 Application pursuant to the August 2020 Board remand. The returned document was a facsimile of the January 2020 submission. See January and September 2020 VA Forms 21-8940, Application for Increased Compensation Based on Unemployability. The August 2020 Board remand also requested clarification from the Veteran for, “[T]he nature, hours, and income relating to any employment during the claims period (September 2010 to present)…address the report of employment in February 2019…complete (VA Form 21-4192, Request for Employment Information in Connection with Claim for Disability Benefits).” See August 2020 Board remand. The 21-4192 Form was returned without any of the requested employer input. See September 2020 VA Form 21-4192. SSA records reflect the following Veteran work history: 1) Assembly Line Worker, Chicken Factory, July 2017 to October 2017 ($29.10 per hour); 2) Delivery Specialist, Delivery Company, January 2010 to June 2017 ($25,000.00 per year); 3) Security Guard, January 2006 to December 2009 ($23,000.00 per year); and 4) Food Service Worker, January 2004 to January 2005 ($10,000 per year). See August 2019 SSA Form 3368, Disability Report – Adult, SSA Form 3369, Work History Report, and January 2020 SSA Assessment of Vocational Factors. With the exception of the 2018 tax year, IRS records for the Veteran reflect income levels above the poverty threshold from the years 2010 to 2018, which includes time that he spent voluntarily unemployed. See October 2019 IRS Wage and Income Transcript. The Board notes that the Veteran’s VA disability income is not “taxable” for IRS purposes. See U.S. Department of the Treasury. Internal Revenue Service. (2020). Publication 525: Taxable and Nontaxable Income (Cat. 15047D). Washington, DC: U.S. Government Publishing Office. The Board also notes that the Veteran reported work during the 2019 tax year but did not file an IRS tax return. See July 2019 Compensation and Pension Examination Note and November 2020 VA Form 27-0820, Report of General Information. Regarding his ability to handle finances, the Veteran stated, “I don’t have much [sic] and it’s gone before bills can get fully paid.” See August 2019 SSA Form 3373-BK, Function Report – Adult. On more than one occasion, the Veteran verbalized “financial stress (with child support).” See November 2013 VA Mental Health Initial Evaluation Note. See also October 2017 VA Telephone Encounter Addendum and Mental Health Medication Management Notes (“stressed due to having a high child support payment and his current living situation…working for 30 hours a week for the State (Highway) Department but only being left with $37 after all of the child support payments.”) At his SSA mental evaluation, the Veteran reported, “[H]e’s is scared being so unstable…He is not making enough money…The bills and his job are on his mind [sic] and when he is on the road he can be too angry…his financial state effects everyone in his family…stressed about his finances.” See March 2016 SSA Mental Diagnostic Evaluation. While the Veteran reports, “he cannot keep a job since 2009 more than three months,” the Veteran admitted, “[H]e will just quit a job.” Regarding his work as a security guard, the Veteran stated, “I come here for $7.00 an hour, and there is money all over this place. The thoughts were too scary to keep the job.” Describing his various jobs as a truck driver, the Veteran reflected, “[W]orking over the road hauls. He gets lonesome and misses his family. He will tell himself that he can go back home and be fine. He will quit his trucking job and then find a job.” See March 2016 SSA Mental Diagnostic Evaluation. As one psychologist summed up the Veteran’s work ethic, “Gets frustrated and quits jobs.” See March 2016 SSA Allegation of Impairments.   Period from September 9, 2010 As of November 14, 2013, the Veteran was service connected for migraines with an evaluation of 50 percent disabling. See June 2019 VA Rating Decision Narrative. Beginning December 15, 2017, the Veteran was service connected for PTSD, with anxiety and night sweats, with an evaluation of 30 percent disabling. See February 2018 VA Rating Decision Narrative. The Veteran was granted service connection for IBS and diarrhea from August 6, 2019. See November 2019 VA Rating Decision Narrative. In January 2020, the Veteran was granted service connection for ED and sinusitis, both evaluated at 0 percent disabling. See January 2020 VA Rating Decision Narrative. Eventually, service connection for PTSD was increased to 70 percent disabling, with an effective date of September 9, 2010. See April 2020 VA Rating Decision Narrative. The Board finds that the Veteran meets the rating requirements for consideration of a schedular TDIU from September 9, 2010. However, there is no evidence from the Veteran or the record that he is or became unemployable at any point during the appeal period. While VA Vocational Rehabilitation and Education (VRE) determined, “You are no longer able to work as a truck driver due to medications you have been previously prescribed,” the Veteran was dismissed from the program for failure to provide documentation that he was unemployable. See April 2019 VA VRE Correspondence and August 2019 VR-13, Discontinuance Letter. While the Veteran contends, “I have lost employment due to blackouts and being sick [sic] not able to function (See December 2015 VA Form 9 Correspondence),” he has provided no employment history, employer information, or documentation regarding periods of unemployability. See September 2019 and August 2020 Board remands, October 2019 VA Form 21-4138, August 2020 VA Correspondence, September 2020 VA Form 21-8940, September 2020 VA Form 21-0820, September 2020 VA Form 21-4192, October 2020 VA Subsequent Development Letter, November 2020 VA Form 21-0820. The Board is left with evidence in VA treatment, SSA, and IRS records for clues to the Veteran’s work history. Prior to his February 2013 grant of service connection for PTSD, the Veteran was afforded VA PTSD treatment in a December 2011 rating decision. See December 2011 and February 2013 VA Rating Decision Codesheets. At May 2012 treatment, the records note, “(Veteran) has had about 8 jobs since 2009…quit because he was not making enough money…always looking for something better.” See May 2012 VA Mental Health Diagnostic Assessment. An October 2012 VA examination recorded, “Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress.” See October 2012 VA examination report. At a November 2013 VA mental health appointment, it was noted, “(Veteran’s) imminent risk for self or other harm is deemed to be low and can be managed on an outpatient basis…steady employment contracted at FedEx.” The Veteran added, “It’s a job…don’t make enough money.” See November 2013 VA Mental Health Initial Evaluation Note. November 2013 PTSD screens were negative (score = 1) and positive (score = 4). See November 2013 VA Primary Care and Preventative Medicine Notes. During November 2013 treatment, “When asked about lack of follow through with mental health and PTSD program [sic] he reported that he had been unable to take off work…Reports he cannot take too much time off for appointments…discussed referral back to (mental health) / PTSD as he did not follow through last year due to long distance (truck) driving…does not want to take too much time off from work for appointments.” See November 2013 VA Mental Health Initial Evaluation Note. At his March 2014 VA examination, the examiner concluded, “A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication.” See March 2014 VA examination report. In his January 2016 application for SSA disability, the Veteran indicated that “PTSD, migraines, (high blood pressure), anxiety, and depression” prevented him from working. See March 2016 SSA Disability Determination Explanation. The Veteran is not currently service-connected for hypertension or depression, and his current PTSD evaluation includes “symptoms of anxiety,” although he has never been diagnosed with an anxiety disorder. See November 2017 Mental Disorders VA examination and April 2020 VA Rating Decision Codesheet. The March 2016 SSA examiner determined “Difficulties in Maintaining Social Functioning: Mild” for the Veteran. During the examination, the Veteran stated that he could “cope on Xanax.” Regarding migraines, the Veteran reported “weekly” occurrences, with a prescription for “Depakote…but seldom takes it.” The Veteran indicated that he was not phonophobic. The examiner concluded, “The objective medical evidence alone does not reasonably substantiate the claimant’s allegations about the intensity, persistence and functionality limiting effects of the symptoms.” See March 2016 SSA Disability Determination Explanation. A May 2016 treatment note included, “history of PTSD otherwise no significant medical illnesses. He denies any medicines today.” See May 2016 VA Physician Emergency Department Note. An October 2017 treatment note quoted the Veteran as saying, “I get treatment / start doing better and then I stop…I am all over the place. (My) family tells me I have ADHD.” See October 2017 VA Primary Care Telephone Encounter Note. Another October 2017 treatment note documented, “financial concerns that have caused him increasing anxiety and depression.” See October 2017 VA Admission Evaluation Note. In November 2017, a Mental Disorders (Other than PTSD) examination concluded, “No mental disorder diagnosis.” See November 2017 VA examination report. A December 2017 National Guard evaluation included, “(Veteran) was diagnosed with PTSD as early as May 2012…[H]is condition does not disqualify him from retention.” See December 2017 Arkansas National Guard Report of Mental Status Evaluation. Also, in December 2017, the Veteran completed a VA examination for PTSD which determined, “Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress.” See December 2017 VA examination report. The Veteran completed an VA examination for headaches in December 2017. Regarding functional impact, the Veteran stated that, “He has (headaches) for weeks at a time.” See December 2017 VA examination report. At VA treatment in April 2018, the examiner reported, “(Veteran) requesting more clonazepam which I told him I would not do. He was offered a referral for PTSD psychotherapy and (a trial of paroxetine or) prazosin as well but declined. He then missed his next appointment. He scheduled today’s appointment and came in…(to) explain why he needs to be prescribed clonazepam or alprazolam…indicating he didn’t want medications that were effective for PTSD but for anxiety and irritability…he was not interested in either another referral to the PTSD program or pharmacotherapy…question about how honest he was being with me.” See April 2018 VA Administrative Note Addendum. In May 2019, a healthcare provider noted, “Veteran is not engaged in (mental health) treatment…Veteran was accepted into PTSD domiciliary in 2017 but did not show for enrollment…healthcare team recommends engagement in PTSD treatment…Veteran agreed that he needed treatment but did not commit.” See May 2019 VA Caregiver Program Support Note. The Veteran was a “No Show” for his May 2019 VA examination for PTSD. See May 2019 VA examination report. The May 2019 VA examination for headaches noted that the Veteran, “[M]ay lose consciousness due to pain…has to be in a quiet and dark room.” See May 2019 VA examination report. The Veteran reported “blacking out” in a May 2011 treatment appointment. The sister of the Veteran clarified the Veteran’s remarks by stating that the Veteran meant “going to sleep when he gets comfortable while having a headache.” See May 2101 VA Neurology Consult Result. A July 2019 VA examination for PTSD concluded, “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... (Veteran) worked most recently in February as a truck driver.” See July 2019 VA Compensation and Pension Examination Note. In August 2019, the Veteran completed a treatment appointment that reflected, “No constipation or diarrhea. No problems with GERD…PTSD symptoms several medications did not use these for extended period of time.” See August 2019 VA Primary Care Note. Included in his August 2019 application for reconsideration of SSA disability, the Veteran listed “PTSD, anxiety, anger issues” as disabilities that prevented him from working. In his January 2020 psychological evaluation for SSA, the examiner noted, “(Veteran) is now 50 percent service-connected for PTSD…does not receive a level of collateral support or mental health treatment that is usually associated with chronic or debilitating mental illness…demonstrates an ability to independently give and receive information, and manage healthcare relationships to obtain beneficial outcomes…appears to…conduct himself in an appropriate manner…capacity for work where interpersonal contact is incidental to work performed.” See January 2020 SSA Disability Determination Explanation. In the SSA Residual Functional Capacity assessment, the examiner determined, “[T]he (Veteran’s) statements about the intensity, persistence, and functionally limiting effects of the symptoms was not substantiated by the objective medical evidence.” The examiner went on to state that, while the Veteran may be “moderately limited” in some areas, he had the ability to: work in coordination with or in proximity to others, including getting along with coworkers, complete a normal workday and workweek without interruptions from psychologically based symptoms, and accept instructions and respond appropriately to criticism from supervisors. See January 2020 SSA Disability Determination Explanation. Although not determinative in and of itself, the Veteran’s application for SSA disability and application for reconsideration of SSA disability were denied with a determination of “Not Disabled.” See March 2016 and January 2020 SSA Disability Determination Explanations. November 2019 VA examinations reported, “May require time off (from work) for severe headaches…Veteran’s male reproductive system condition does not impact his ability to work…frequent restroom breaks when having episodes of diarrhea.” See November 2015 Sinusitis, Male Reproductive Organ Conditions, and Intestinal Conditions VA examination reports. A November 2019 Gulf War Conditions examination documented no functional impact on the Veteran’s ability to work. See November 2019 Gulf War Conditions VA examination report. In January 2020, the Veteran reported, “[S]light worsening headache the past week. He denies any nausea, vomiting, fevers, chills, or any focal weakness.” See January 2020 VA Emergency Room Note. A September 2020 treatment note lists, “Past Medical History: anxiety, PTSD, migraines, tinnitus, ED.” There was no mention of IBS, diarrhea, or sinusitis. See September 2020 VA Primary Care Telephone Addendum. To consider entitlement to individual unemployability, the law requires the Veteran to provide a substantially complete application. As noted previously, the Board remanded the matter in September 2019 and August 2020 to provide the Veteran with opportunities to substantiate the claim. The August 2020 Board remand requested that the Veteran “clarify the nature, hours, and income relating to any employment during the claims period (September 2010 to present). You should specifically address the report of employment in February 2019 as noted in the July 2019 VA PTSD examination (as a truck driver).” See August 2020 Board remand. The Veteran was also requested to “provide employer information for any part of the appeal period (beginning September 2010) for which you seek TDIU.” See August 2020 Board remand. While the Veteran confirmed that these items were completed (See September 2020 VA Form 21-0820, Report of General Information, and VA Form 21-4138, Statement in Support of Claim), employer and income information, as it relates to the Veteran’s employability, was not provided. See September 2020 VA Forms 21-8940 and 21-4192. The Board cannot verify the Veteran’s work status or employability. The Veteran was discharged from the VA Vocational Rehabilitation and Education program for “lack of cooperation” regarding documentation of the same. See August 2019 VR-13, Discontinuance Letter. Based on the available evidence in the record, the Veteran cannot be found unable to secure or follow a substantially gainful occupation as a result of service- connected disabilities. There is no evidence from the Veteran or in the record that the Veteran requires or is otherwise employed in a protected work environment or is physically or mentally unable to perform his duties as a truck or delivery driver, construction worker, security guard, factory worker, food service employee, or at any of the previously unmentioned jobs for which the Veteran possesses the education, training, and experience to perform. There is no evidence from the Veteran or in the record that any of the Veteran’s employers made accommodations to protect or shelter the Veteran in consideration of his service-connected disabilities. Referral for extraschedular consideration is not warranted for the Veteran’s service-connected PTSD, migraine, IBS, ED, or sinusitis symptoms. The symptoms do not show “such an exceptional or unusual disability picture... as to render impractical the application of the regular schedular standards.” 38 C.F.R. § 3.321(b) (2016). The Veteran has alleged no uncompensated symptoms associated with his service-connected disabilities. The average impairment in earning capacity due to the Veteran’s service-connected disability symptoms are adequately compensated and accounted for in the Veteran’s schedular rating. See Thun v. Peake, 22 Vet. App. at 115. Conclusion As previously noted, the standard in awarding a TDIU 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 v. Brown, 4 Vet. App. 361, 363 (1993) (citing 38 C.F.R. §§ 4.1, 4.15, 4.16(a)). 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). In summary, the Board concludes that the Veteran’s service-connected conditions do not prevent him from securing or following a substantially gainful occupation, consistent with his history, education, skill, and training. While the Veteran’s service-connected conditions have the potential to functionally impact his employment, as suggested by his current 70 percent PTSD evaluation, the standard under 38 C.F.R. § 4.16(a) is whether the disabled person is unable to secure or follow a substantially gainful occupation. The record reflects that, when the Veteran chooses to work, he is not only able to do so, but he has a high-income ceiling. The Board finds that the Veteran’s employment cannot be considered marginal. According to the record, the Veteran has never had legal issues, been disciplined, nor has he experienced interpersonal problems during his work history. There is no evidence that his service-connected conditions limited his work to the degree required for a TDIU, including that the Veteran was employed in a sheltered or protected work environment during the appeal period. A referral to the Director, Compensation Service, for extra-schedular consideration under 38 C.F.R. § 4.16(b) is not warranted. The Board finds that the current evaluation ratings accurately reflect the elements of the Veteran’s disability picture. Therefore, a preponderance of the evidence is against a finding that the Veteran’s service-connected conditions preclude all forms of substantially gainful employment, considering history, education, skill, and training. Accordingly, the Veteran’s claim for a TDIU is denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Small, Attorney Advisor 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.