Citation Nr: 21012582 Decision Date: 03/04/21 Archive Date: 03/04/21 DOCKET NO. 13-22 126A DATE: March 4, 2021 ORDER A rating in excess of 30 percent for depression prior to October 7, 2019, is denied. A rating in excess of 70 percent for depression since October 7, 2019, is denied. A compensable rating for urticaria is denied. Service connection for migraines is denied. Service connection for a skin disorder is denied. A total disability rating based on individual unemployability (TDIU) due to service-connected disability is granted. FINDINGS OF FACT 1. The Veteran had active duty from December 1975 to May 1977. 2. Prior to October 7, 2019, a psychiatric disorder was manifested by subjective complaints of a depressed mood; objective findings reflected that the Veteran was alert and oriented, he exercised good insight and judgment, and his thoughts and speech were organized and goal oriented. 3. Since October 7, 2019, the psychiatric disorder has been manifested by subjective complaints of difficulty sleeping, anxiety, and depression; objective findings reflect that the Veteran was cooperative and oriented with good hygiene and grooming, judgment and insight were fair. 4. Urticaria did not manifest in recurrent episodes at least four times during the past 12-month period or chronic urticaria that requires first line treatment (antihistamines) for control. 5. Migraines were not shown in service and are not related to service. 6. A skin disorder, diagnosed as stucco keratosis and lichen simplex chronicus, is not related to service and was not caused by or permanently worsened in severity by a service-connected disability. 7. The Veteran’s service-connected disabilities preclude him from securing or following a substantially gainful occupation. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 30 percent for depression prior to October 7, 2019, have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.20, 4.59, 4.130, Diagnostic Code (DC) 9411 (2020). 2. The criteria for a rating in excess of 70 percent for depression since October 7, 2019, have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.20, 4.59, 4.130, DC 9411 (2020). 3. The criteria for a compensable rating for urticaria have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.118, DC 7825 (2020). 4. Migraines were not incurred in service. 38 U.S.C. §§ 1110, 1116, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.309 (2020). 5. A skin disorder was not incurred in service and not proximately due to, aggravated by, or the result of a service-connected disability. 38 U.S.C. §§ 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.309, 3.310 (2020). 6. The criteria for a TDIU has been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS In connection with this appeal, the Veteran testified at a May 2016 hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the claims file. In September 2017, the Board remanded the issues for further development. There has been substantial compliance with the remand directives, and there is no bar to proceeding with the appeal. Stegall v. West, 11 Vet. App. 268, 271. Increased Rating Claims Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Depression Acquired psychiatric disorders, including major depressive disorder and anxiety disorder, are evaluated under a General Rating Formula for Mental Disorders (“General Rating Formula”). Under the General Rating Formula, a 50 percent rating is warranted for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect, circumstantial, circumlocutory, or stereotyped speech, panic attacks occurring more than once a week, difficulty in understanding complex commands, impairment of short-term memory (i.e. retention of only highly learned material or forgetting to complete tasks), impaired judgment, impaired abstract thinking, disturbances of motivation and mood, and difficulty in establishing effective work and social relationships. A 70 percent rating is warranted for occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, or mood, due to such symptoms as: suicidal ideation, obsessional rituals which interfere with routine activities, speech intermittently illogical, obscure, or irrelevant, near continuous panic or depression affecting the ability to function independently, appropriately, and effectively, impaired impulse control (such as an unprovoked irritability with periods of violence), spatial disorientation, neglect of personal appearance and hygiene, difficulty in adapting to stressful circumstances (including work or a work-like setting), and an inability to establish and maintain effective relationships. The symptoms listed under the rating criteria are meant to be examples of symptoms that would warrant the rating, but they are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Prior to October 7, 2019. An August 2011 VA examination report reflected a diagnosis of history of bipolar disorder, depression and paranoid personality disorder. The examiner noted that 25 percent of the Veteran’s overall impairment was due to depression, 75 percent was due to a personality disorder, and there was no current evidence of bipolar disorder. The examiner opined that the Veteran’s psychiatric disorder caused 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, or; symptoms controlled by medication. Symptoms included a depressed mood. With respect to social relationships, the Veteran stated that he was married to his wife “who had a drug problem.” He indicated that his daughter added to his stress due to her choice of relationships. He denied any hobbies and reported spending most of his free time pursuing legal actions against those whom he believed have wronged him. With regard to occupation, he indicated that he had not worked in 10 years after being let go as a corrections officer following 21 years of service. VA treatment records from late 2012 to mid- 2013 reflect mental status examinations indicating that the Veteran had good hygiene and alert and oriented. Speech was normal rate and rhythm. His mood was euthymic and his affect was congruent. His thought process was productive and regular and his impulse control was good. He denied any suicidal ideation or homicidal ideation, delusions, paranoid ideation or audio or visual hallucinations. His recent and remote memory was intact. His judgement and insight were fair. An April 2013 VA examiner diagnosed a depressive disorder, NOS. The examiner opined that the Veteran’s psychiatric disorder caused 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, or; symptoms controlled by medication. Symptoms included a depressed mood. With respect to social relationships, the Veteran stated that he continued to live with his wife and described his marriage as stable. He indicated that he maintained contact with his sister but was unable to describe his hobbies or personal interests, with the exception of stating that he enjoyed his two dogs. The examiner noted that the Veteran did not appear to have any productive use of leisure time or productive hobbies. Regarding his occupation, he reported that he left his job working for the corrections department because he was offered a buyout. In support of his claim, the Veteran submitted three private evaluations dated April 2013, September 2014, and April 2016, from Dr. CB. The private evaluations provided multiple diagnoses, including major depression and posttraumatic stress disorder (PTSD), depression, and major depressive disorder without psychotic symptoms. In all three evaluations, the clinician noted that the Veteran experienced symptoms of deficiencies in family relations, obsessional rituals which interfere with routine activities, persistent irrational fear, intermittently illogical, obscure or irrelevant speech, deficiencies in work or school, depression affecting the ability to function independently, appropriately and effectively, neglect of personal appearance and hygiene, intermittent inability to perform activities of daily living, deficiens in mood, difficulty in adapting to stressful circumstances, intrusive recollections of a traumatic experience, unprovoked hostility and irritability, inability to establish and maintain effective relationships, and deficiencies in judgment. She also noted that the Veteran would be limited to multiple activities including maintain attention and concentration, perform activities on schedule, maintain regular attendance, to work with others, to set realistic goals or make plans independently, among others. In a June 2016 private evaluation dated by Dr. AE, the clinician noted a diagnosis of major depressive disorder without psychosis. The clinician noted that the Veteran experienced symptoms of persistent irrational fear, depression affecting the ability to function independently, appropriately and effectively, neglect of personal appearance and hygiene, deficiens in mood, difficulty in adapting to stressful circumstances, intrusive recollections of a traumatic experience and essentially listed the same limitations identified by Dr. CB. In a June 2016 VA Mental Disorder examination, the examiner opined that the Veteran’s psychiatric disorder caused 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. Symptoms included depressed mood, suspiciousness, flattened affect, disturbance of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. The Veteran reported that he had been married for over 30 years and retired from working as a corrections officer in 2000 and had not work since. On examination, the Veteran was neatly dressed and appropriated groomed, mood was irritable and sad and his affect was constricted. His thought process was organized, lucid and goal directed. Speech rate and volume were within normal limited. He denied any issues with obsessive compulsive thoughts or behaviors. He denied any suicidal ideation or homicidal ideation, delusions, paranoid ideation or audio or visual hallucinations. VA treatment records from 2016 to 2019 reflected mental status examinations indicating that the Veteran was groomed appropriately and alert and oriented. Speech was normal rate and rhythm. His mood was euthymic and his affect was congruent with mood. His thought process was normal and coherent and his impulse control was good. He denied any suicidal ideation or homicidal ideation, delusions, paranoid ideation or audio or visual hallucinations. His recent and remote memory was intact. His judgement and insight were fair. After a review of the record, the Veteran’s psychiatric disorder most nearly approximated a 30 percent rating prior to October 7, 2019, and a higher rating is not warranted for this time period. In this regard, despite symptoms such as depressed mood, suspiciousness, and flattened affect, the medical evidence reflects that the Veteran was generally functioning satisfactory. For example, all of the medical evidence reflected that he was alert and oriented, at times his mood was euthymic, he exercised good insight and judgment, and his thoughts and speech were organized and goal oriented. He lived with his wife of over 30 years and described his marriage as stable and maintained contact with a family member. Further, the Veteran consistently denied having suicidal or homicidal ideation, hallucinations or delusions, acts of violence, impaired abstract thinking, or circumstantial, circumlocutory or stereotyped speech. In sum, the medical evidence shows that any impairment due to psychiatric disorder is compensated for by the current 30 percent rating prior to October 7, 2019, and there are no symptoms like or similar to those for a higher rating have been shown during this period. Rating Period Since October 7, 2019. In an October 2019 VA examination, the opined that the Veteran’s psychiatric disorder caused occupational and social impairment with reduced reliability and productivity. Symptoms included depressed mood, anxiety, chronic sleep impairment, mild memory loss, and others. With respect to social relationships, the Veteran lived with his wife and had recently had a grandchild which he enjoyed. He noted that he spent his time working with a dog rescue and reading. Additionally, he reported working for 21 years as a corrections officer at a prison before he retired from the job. The examiner noted that “his career as a corrections officer seems to be somewhat contentious.” VA treatment records from late 2019 reflected that the Veteran was cooperative and oriented with good hygiene and grooming. Speech and though process were productive, regular rate, good rhythm, and volume. His mood was euthymic and his affect was congruent and appropriate. He denied any suicidal ideation or homicidal ideation, delusions, paranoid ideation or audio or visual hallucinations. His recent and remote memory was intact. His judgement and insight were fair. Based on the above, the evidence shows that a rating in excess of 70 percent is not warranted. Specifically, the evidence does not reflect total social impairment. In addition, the evidence does not record symptoms listed which are like or similar to those under the 100 percent rating criteria at any time during the appeal periods. In this regard, there is no gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting himself 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, his own occupation or his own name. This level of disability was not shown as the Veteran continued to pay attention to hygiene and self-care and was able to communicate logical and coherent thought with speech normal in flow and rate. As such, total occupational impairment is not shown. Further, he had been married for over 30 years and enjoyed his role of grandparent. As such, the level of social and occupational impairment shown by the evidence is adequately compensated by the 70 percent rating assigned during this time period. In sum, a rating in excess of 30 percent is not warranted prior to October 7, 2019, and a rating in excess of 70 percent is not warranted thereafter. At no time during the evaluation period prior to October 7, 2019, has the depression disability picture reflected occupational and social impairment with reduced reliability and productivity, and at no time during the appeal period beginning October 7, 2019, has total social and occupational impairment been shown. As such, higher ratings are not warranted and the appeals are denied. Urticaria Urticaria is rated noncompensable under DC 7825. The Board will consider all relevant diagnostic codes. During the appeal, effective August 13, 2018, VA revised the criteria for diagnosing and evaluating skin conditions including urticaria. VA will review the Veteran’s appeal under both the prior and current versions of the criteria under the circumstances. Prior to August 13, 2018, a 10 percent rating was warranted for episodes recurring at least four times during the past 12-month period that responded to treatment with antihistamines or sympathomimetics. Under the amended criteria, a 10 percent rating is warranted for chronic urticaria that requires first line treatment (antihistamines) for control. Turning to the evidence, at a January 2011 VA examination, the Veteran reported that he got flare-ups of a rash about twice a year that lasts for several days on the neck and trunk and he stated that it looked like boils and it itched also with involvement of the legs and hands. He was diagnosed with urticaria, but it was determined that there was currently no urticaria or eczema noted at this time. In a June 2016 VA examination, the examiner noted that the Veteran had a history of a rash in the right hand and both feet for many years associated with irritation and itching. He was diagnosed with contact dermatitis, but no urticaria was present. The examiner found that the Veteran treated the dermatitis with topical urea cream constant/near constant over the previous 12 months; however, he did not have any treatments or procedures other than the topical medications over the previous 12 months. The examiner observed that dermatitis did not cause scarring or disfigurement of his head, face, or neck, and that there were no benign or malignant skin neoplasms or systemic manifestations due to skin diseases and affected less than 5 percent of the total body area. The examiner found that the Veteran did not have any debilitating episode or non-debilitating episodes of urticaria, primary cutaneous vasculitis, erythema multiforme, or toxic epidermal necrolysis over the 12 months prior to examination. On an October 2019 VA examination, the Veteran reported that he did not recalled when his current skin lesions began. He complained of a “skin condition” affecting his right palm and his right and left heels, and the lesions were not painful but itchy, especially the right palm lesion. The examiner diagnosed stucco keratosis and lichen simplex chronicus. He noted that the Veteran did not have any of the specific skin conditions listed on examination, including chronic urticaria. Further, the examiner found that the Veteran’s current skin disorders, stucco keratosis and lichen simplex chronicus, were separate conditions from his service-connected urticaria. The examiner noted that both conditions were a result of excessive drying of the skin, were common in individuals over 50 years of age and were common in those individuals who did not use skin moisturizing cream on a daily basis to treat the dryness. The examiner indicated that the Veteran had all these risk factors. He opined that these skin conditions were less likely than not due to the Veteran’s service-connected urticaria. The examiner found that the Veteran treated lichen simplex chronicus with topical Fluocinonide over the previous 12 months for a period of less than 6 weeks, treated stucco keratosis with topical ammonium lactate over the previous 12 months for a period of less than 6 weeks; however, the Veteran did not have any treatments or procedures other than the topical medications over the previous 12 months. Based on the foregoing, a compensable rating for urticaria is not warranted. Specifically, the evidence does not show a diagnosis of urticaria and as such, a higher rating is not warranted. Further, the Veteran has not been prescribed any medication for treatment of urticaria. In addition, although he was diagnosed with stucco keratosis and lichen simplex chronicus, those were determined to not be related to service-connected urticaria. The Board also has considered whether a compensable rating is warranted under another diagnostic code. Specifically, the Veteran has reported multiple symptoms that are not specifically contemplated in DC 7825 which he contends are related to urticaria; however, the medical examination reports of record considered the Veteran’s contentions and concluded that there were no findings or residuals attributable to urticaria. Moreover, the October 2019 examiner found that the Veteran’s current skin disorders, stucco keratosis and lichen simplex chronicus, were separate conditions from his service-connected urticaria. The examiner noted that both conditions were a result of excessive drying of the skin, were common in individuals over 50 years of age and were common in those individuals who do not use skin moisturizing cream on a daily basis to treat the dryness. The examiner indicated that the Veteran had all these risk factors. He opined that these skin conditions were less likely than not due to the Veteran’s service-connected urticaria. For these reasons, a compensable rating is not warranted under another diagnostic code. Accordingly, the medical evidence does not support a compensable rating for urticaria. Service Connection Claims Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).   Migraines Turning to the evidence, as to a current disorder, an October 2019 VA examiner noted that the Veteran had been diagnosed with migraines. Therefore, a current diagnosis is shown. As to an in-service incurrence, the Veteran does not contend, nor do the service treatment records (STRs) show, that migraines began during service; rather, he claims that migraines were the result of the swine flu vaccine he received during service. A review of the vaccination records reflect that he received a bivalent influenza vaccination, recorded as “flu BIV” in December 1975. Therefore, the second element of service connection is met. As to a medical nexus, an October 2019 VA examiner diagnosed the Veteran with migraine including migraine variants. The examiner opined that the Veteran’s migraines were less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner indicated that the STRs noted a few episodic headaches not described as migraine headaches and there was no treatment for migraine headaches. Further, the examiner noted that there was no definite STR report that the Veteran had migraine headaches following vaccination in service. In support of his claim, the Veteran submitted an April 2017 narrative from Dr. CB that noted that the Veteran’s headaches were the result of an in-service vaccination; however, the clinician offered no explanation or underlying rationale, nor any indication of how she reached her conclusion. Therefore, the April 2017 private medical opinion is of lesser probative value. The Board has the responsibility of weighing conflicting medical opinions and may place greater weight on one medical opinion over another depending upon factors such as reasoning employed by the clinician and the extent to which they reviewed prior clinical records and other evidence. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 30004 (2008); Prejean v. West, 13 Vet. App. 444, 44849 (2000) (stating that factors for assessing the probative value of a medical opinion include the thoroughness and detail of the opinion). In this case, the Board affords the VA examination and opinion more probative weight than the private opinion. The VA examiner reviewed the claims file, to include the STRs, and provided detailed rationale for the opinion rendered. On the other hand, the private clinician offered a bare conclusion without any support. There is no indication that the clinician reviewed the claims file and it appears that she only considered the Veteran’s statements in reaching the conclusion. Therefore, the weight of the medical evidence does not support the claim on a direct basis. Skin Disorder The Veteran contends that his skin disability, other than his service connected urticaria, was incurred during or as a result of service. Alternatively, he argues that his skin disorder is secondary to his service-connected disabilities. Turning to the evidence, as to a current disorder, an October 2019 VA examiner diagnosed the Veteran with stucco keratosis and lichen simplex chronicus; therefore, a current diagnosis is shown. As to an in-service incurrence, the Veteran asserts that he began experiencing a skin disability as a result of a swine flu shot vaccine administered during service. As noted above, he received a bivalent influenza vaccination in December 1975. A December 1976 STR reflected that he developed and was treated for viral exanthema, a skin condition, for five days, and released to active duty with no sequelae. Therefore, the second element of service connection is met. As to a medical nexus, the evidence fails to support a finding that the Veteran’s current skin disorder, other than urticaria, is etiologically related to service. In September 1980, the Veteran underwent a VA examination to determine whether he had a current skin disability related to his period of service. He claimed that he developed large welts and a rash, after he received a flu shot. He was noted to have a brown hyperpigmented muscular area on the right lower leg. He was diagnosed with urticaria and granted service connection. In December 2002, he was reported to have pruritus of the hands and feet for multiple months. In April 2009, the Veteran complained of having a rash on and off for many years since he received a vaccine in service. The rash was described as pruritic and on the upper back and chest. In a January 2011 VA examination, he described the rash but there was no diagnosis made at that time. In August 2015, he reported that he believed that the rash in his hands and sole of his feet was due to a vaccination received in service. In an October 2019 VA examination, after a thorough review of the record, articles submitted by the Veteran and a physical examination, the examiner found that the Veteran’s skin condition, diagnosed as stucco keratosis and lichen simplex chronicus, was less likely as not incurred in or caused by the swine flu vaccination during service. The examiner reasoned that the STRs reflected that the Veteran was inoculated in December 1975 with a bivalent influenza vaccine. The examiner explained that the influenza or “flu” vaccine at this time consisted of two general strains or types of influenza, Influenza A and Influenza B. He referenced historical documents from the Center for Disease Control (CDC) that noted, “in 1976, two recruits at Ft. Dix, NJ, had an influenza-like virus” which was later identified as strain “A/New Jersey/76” or “Hsw1N1.” However, the examiner noted that this influenza strain, Hsw1N1, was new and therefore, it could not have been included in the influenza vaccine that the Veteran received during service in December 1975. He indicated that in the spring, emergency legislation for the “National Swine Flu Immunization Program,” was passed and production of a new “swine flu vaccine” was begun in August 1976 with nationwide immunizations beginning in October 1976, and by December 1976, the swine flu vaccination program was suspended because of the growing risk of developing the neurological disease, Guillain-Barre syndrome (GBS) The examiner concluded that the Veteran did not receive the “swine flu vaccine” in December 1975 because it had not been manufactured yet. But rather, in December 1975, he received the influenza vaccination, consisting of the strains of Influenza A and B. He noted that there was no evidence in the Veteran’s STRs, that he received any further influenza vaccinations after his last one, noted in December 1975. Regarding vaccination with the “Bird flu vaccine” or the swine flu vaccine, the examiner indicated that the vaccine would not have caused any permanent skin disorder. The examiner noted that the most common and important adverse effect from the vaccination program with swine flu was the increased risk of developing the neurological disorder, GBS. He indicated that there was no evidence, in the medical literature, that swine flu, caused the skin condition, observed on the Veteran’s right hand and both heels on examination. This evidence weighs against the claim on a direct basis. As to secondary service-connection, the Veteran has claimed that his skin disability is secondary to a service-connected urticaria or to depression. As noted above, he has a current diagnosis of stucco keratosis and lichen simplex chronicus and is service connected for urticaria and depression. Therefore, the first two elements of secondary service have been met. As to the third element of a medical nexus, an October 2019 VA examiner opined that it was less likely than not that stucco keratosis and lichen simplex chronicus were due to his service-connected disabilities. The examiner reasoned that both conditions were a result of excessive drying of the skin, were common in individuals over 50 years of age and were common in those individuals who did not use skin moisturizing cream on a daily basis to treat the dryness. The examiner indicated that the Veteran had all these risk factors. Accordingly, as no medical nexus has been shown between a skin disability other than urticaria and any service-connected disability, the medical evidence does not support the claims on a secondary basis. The Board has considered the Veteran’s lay statements and testimony that his service-connected disabilities are worse and that his nonservice-connected disorders began in service. While he is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to offer etiologies of his nonservice-connected disorders or to identify specific levels of disability of his service-connected disabilities according to the appropriate diagnostic codes. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claims for service connection and there is no doubt to be otherwise resolved. As such, the appeals are denied. TDIU It is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated as totally disabled. 38 C.F.R. § 4.16. Substantially gainful employment is that employment that is ordinarily followed by the nondisabled to earn their livelihoods with earnings common to the particular occupation in the community where the veteran resides. Moore v. Derwinski, 1 Vet. App. 356 (1991). Marginal employment will not be considered substantially gainful employment. 38 C.F.R. § 4.16 (a). A TDIU may be assigned, if the scheduler rating is less than total, when the disabled person is, in the judgment of the rating agency, 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 it is ratable at 60 percent or more, and that if there are two or more such disabilities at least one is ratable at 40 percent or more and the combined rating is 70 percent or more. 38 C.F.R. § 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 (1993). Neither nonservice-connected disabilities nor advancing age may be considered in the determination. 38 C.F.R. §§ 3.341, 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). A claim for TDIU is because of subjective factors that the objective rating does not consider. Vittese v. Brown, 7 Vet. App. 31 (1994). The Veteran’s service-connected disabilities include depression at 70 percent, degenerative arthritis of the lumbar spine at 20 percent, left lower extremity sciatica at 10 percent, and urticaria at 0 percent. The combined rating is 80 percent from October 7, 2019. Thus, he meets the requirements for a TDIU on a schedular basis under 38 C.F.R. § 4.16(a). Even so, to grant TDIU it must be found that he is unable to secure or follow a substantially gainful occupation as a result of his service-connected disabilities. In the March 2017 VA Form 21-8940, the Veteran indicated that he was unemployable due to all service-connected disabilities. He reported two years of a college education, no additional education or training, and previous employment as a corrections officer at a state prison until 2000 when he retired from the job. There are several medical opinions of record concerning the impact of the Veteran’s service-connected disabilities on employment. In support of his claim, the Veteran submitted three private evaluations in April 2013, September 2014, and April 2016, Dr. CB and a June 2016 evaluation from Dr. AE. These reports were outlined in more detail above. In essence, all the private evaluations concluded that the Veteran would not be capable of performing gainful employment with the symptoms and limitations from his psychological impairment. Further, in a March 2017 letter, a private clinician noted that the Veteran was unable to work because of his numerous physical and psychological issues. An October 2019 VA Mental Disorders examination, the examiner concluded that the Veteran was able to stay at his job for 21 years before retirement. In February 2019 and March 2020 VA back examinations, he reported that his back disability impacted his ability to work in terms of bending and lifting objects as required by his occupation. Additionally, the March 2020 examiner indicated that the Veteran previously worked as a corrections officer before retiring and during his employment he reported 1-2 weeks’ time lost in last 12 months. In a March 2020 Peripheral Nerves examination, he reported that left lower extremity sciatica significantly impacted his ability to bend or lift objects as required by his occupation. Based on the above, the evidence supports a finding that the Veteran is unable to perform physical labor due to his degenerative arthritis of the lumbar spine and left lower extremity sciatica. Additionally, because of his variously described psychiatric symptoms, he is unable to perform sedentary work. As such, he is not substantially and gainfully employable due to his service-connected disabilities. Therefore, a TDIU is granted. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Grzeczkowicz 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.