Citation Nr: 21014045 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 04-35 419 DATE: March 11, 2021 ORDER Entitlement to a total disability rating based on individual unemployability (TDIU) on an extra-schedular basis is denied. FINDING OF FACT The Veteran’s service-connected disabilities did not preclude him from securing or following substantially gainful employment consistent with his education and industrial background. CONCLUSION OF LAW The criteria for entitlement to a TDIU on an extra-schedular basis have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from February 1988 to June 1992. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2004 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This issue has a long procedural history, but in relevant part the Board found in a February 2014 Decision and Remand that entitlement to TDIU had been raised by the Veteran as part of his claim for entitlement to an increased rating for posttraumatic stress disorder (PTSD). See Rice v. Shinseki, 22 Vet. App. 447 (2009). The Board remanded the issue of entitlement to a TDIU in February 2014 and August 2017. The issue was additionally remanded in November 2018 for referral to the Director of VA Compensation Service (Director) for consideration of whether entitlement to an extra-schedular TDIU is warranted pursuant to 38 C.F.R. § 4.16(b). Duty to Notify and Assist VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.159, 3.326(a). These duties have been satisfied in this case. The RO associated the Veteran’s service records as well as VA and private outpatient treatment records with the claims file. All released or submitted private treatment records have been associated with the claims file. No other relevant records have been identified and are outstanding. Appropriate and necessary examinations were afforded the Veteran, and are adequate for evaluation, as they include needed findings to demonstrate current symptoms of service-connected disabilities and their effects. As such, VA has satisfied its duty to assist with the procurement of relevant records. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). The Veteran has not raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). Entitlement to a TDIU on an extra-schedular basis The Veteran contends that he is unemployable due to service-connected disabilities, particularly PTSD. During the period on appeal, the Veteran has been service connected for PTSD (10 percent effective February 8, 1992, then 50 percent, effective March 17, 2003); right chondromalacia patella (10 percent, effective March 17, 2003); tinnitus (10 percent, effective December 19, 2013); and left ear hearing loss (noncompensable from January 13, 2004). His combined evaluation for compensation is therefore, at most, 60 percent from March 17, 2003, under VA’s Combined Ratings Table. 38 C.F.R. § 4.25, Table I. The percentage criteria for TDIU are accordingly not satisfied at any time during the period because the Veteran does not have two or more service-connected disabilities with a combined rating of at least 70 percent with at least one rated as 40 percent disabling (or more), or a single disability rated 60 percent (or more). 38 C.F.R. § 4.16(a). Where the percentage requirements are not met but the veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disability, the case will be referred to the Director for extra-schedular consideration. 38 C.F.R. § 4.16(b). The central inquiry in a claim for TDIU 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). 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, 363 (1993). When “a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant.” 38 C.F.R. § 4.3; see also 38 C.F.R. § 3.102. Reasonable doubt refers to a doubt “which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim.” 38 C.F.R. § 3.102. A November 2020 advisory opinion from the Director recommended that an extra-schedular TDIU be denied. Although the Board is not bound by this recommendation, in this case the Board concurs with the Director’s opinion and finds that entitlement to a TDIU is not warranted based on the Veteran’s service-connected disabilities, including PTSD. As an initial matter, the Board acknowledges the holding of the United States Court of Appeals for Veterans Claims (Court) in Ray v. Wilkie that “the Board must . . . adequately explain[] its reasoning when a factual finding made at the referral stage comes out differently at the review stage.” 31 Vet. App. 58, 66–67 (2019); see also Smiddy v. Wilkie, 32 Vet. App. 350, 358 (2020). As the Court noted, “Some factors that may affect the Board’s ability to reach a different result . . . include, but are not limited to, the certainty or complexity of factfinding in the initial referral decision and to the extent to which the record has changed since the referral decision.” Ray, 31 Vet. App. at 67. In this case, the factfinding in the November 2018 referral decision was neither complex nor certain. The rationale for the referral decision was two paragraphs that cited only the evidence supporting entitlement to a TDIU based on PTSD without mentioning any evidence questioning such entitlement. Additionally, the referral decision did not find the Veteran unemployable but rather determined that referral to the Director was warranted for “consideration” of entitlement to an extra-schedular TDIU. As outlined below, review of the complete record supports the Board’s determination that entitlement to an extra-schedular TDIU is not warranted. The evidence indicates that the Veteran has a four-year college degree in engineering electronics, obtained in 1995. He was in prison from 2000 to August 2005, and then worked for six years at a car dealership until September 2011. At a June 2011 VA examination for his left knee, the Veteran reported that during the last 12-month period he had lost “16 weeks” of work time but said “he has mostly lost time from work in the past one year for mental health issues.” In an April 2015 VA Form 21-8940 (Veteran’s Application for Increased Compensation Based on Unemployability), however, the Veteran reported September 2011 as the date on which his disability (PTSD) affected full-time employment; the date he last worked full time; and the date he became too disabled to work. He did not list his last employment or mention time lost from work. Because the Veteran worked full time until September 2011 and cites that as the date in which his PTSD affected his full-time employment and the date he became too disabled to work, the Board will focus most of its analysis on evidence from September 2011 to the present. To start its analysis, the Board will discuss the credibility of the Veteran’s statements regarding the type and severity of his symptoms. The Board notes that for each of his disabilities — psychological (PTSD), musculoskeletal (right knee), and audiological (left ear hearing loss and tinnitus) — the Veteran’s reports of symptoms and efforts to gauge his level of disability have been found not credible in at least one VA examination. As detailed below, an April 2015 VA examination for PTSD noted that the Veteran “performed [on a test] in a manner consistent with a conscious or unconscious attempt to feign memory difficulties”; the test results upon re-administration were “extremely unlikely and idiosyncratic. A March 2016 VA examination documented “Significant problems with the Veteran’s self-report of psychiatric symptoms.” An August 2017 VA examination stated that “the [V]eteran’s response style on the MMPI-2RF (a robust measure of psychological symptom validity) showed significant exaggeration at a level that invalidated his current self-report of psychological symptoms.” A February 2014 VA examination of the right knee did not list any range-of-motion results because “the Veteran put such little effort into knees ROM [range of motion], it is not appropriate to record the degrees of ROM [range of motion] here for rating purposes.” An April 2015 VA audiological examination similarly noted that the Veteran’s pure tone results were not valid because “Results were inconsistent,” noting a positive Stenger test as well as the Veteran’s “ability to answer interview questions presented at 45 dB AU.” Considering the lack of reliability in the Veteran’s statements over time and across his service-connected disabilities, the Board finds that his self-reports of symptoms are generally not credible, and diminished weight is given to his statements regarding severity of his symptoms. Because that the Veteran has cited his PTSD as the sole service-connected cause of his unemployability (see April 2015 VA Form 21-8940), the Board will first discuss this disability. The evidence is mixed regarding the impact of the Veteran’s PTSD on his ability to secure or follow any substantially gainful occupation. A November 2003 VA examination diagnosed the Veteran with “mild” PTSD and “Personality disorder, including sociopathy, in a very excitable and highly tense individual.” A July 2005 VA examination diagnosed the Veteran with “chronic, mild” PTSD and “Personality disorder, NOS, with antisocial and paranoid features.” The July 2005 VA examination noted that the Veteran “seems to be primarily disabled by his Axis II features [Personality disorder, NOS, with antisocial and paranoid features], but retains a mild degree of posttraumatic stress disorder, which itself is service connected.” October 2012 and January 2013 Social Security Administration (SSA) analyses noted that the Veteran had “Anxiety Disorders” and “Affective Disorders” but both with listed as “Non Severe.” These analyses also indicated that, at worst, the Veteran had “Moderate” “Difficulties in Maintaining Social Functioning” and “Mild” “Difficulties in Maintaining Concentration, Persistence, or Pace.” A January 2013 SSA Mental Residual Functional Capacity Assessment determined that the Veteran “can understand, retain, and carry out instructions . . . can perform routine tasks on a sustained basis, with normal supervision, and can [with] moderate limits [with] cooperate [with] co-workers in completing tasks and transactions. [The Veteran] can adjust to the mental demands of the work place.” A December 2012 VA examination diagnosed the Veteran with PTSD, personality disorder not otherwise specified, and a history of alcohol abuse and cannabis abuse. Although this VA examination stated that it could differentiate which symptoms are attributable to each diagnosis, it did not actually assign the various symptoms to each diagnosis. Overall, the VA examination determined that the Veteran’s level of occupational and social impairment considering to all of his mental diagnoses was “impairment with reduced reliability and productivity.” The VA examination indicated that The [V]eteran’s current symptoms of PTSD are considered to be mild to moderate and would result in occupational and social impairment with reduced reliability and productivity in a work[-]place setting. The [V]eteran’s Personality Disorder NOS would likely interfere with his capacity to form and maintain satisfactory interpersonal relationships. He is likely to have difficulty relating to coworkers, supervisors, or customers in an occupational setting. A November 2013 private vocational evaluation noted that from “2001-present” treatment records document “issues with anger/temper, sleep issues, social relationships, verbal outbursts in inappropriate settings, substance abuse as a means of self-medicating, emotional distancing, nightmares, mood swings and violent outbursts. He has demonstrated severe episodes of these symptoms at multiple times during his post-service adjustment.” The November 2013 private vocational evaluation stated that Most [VA medical center (VAMC) treatment records and VA examinations] opine his PTSD is only mildly limiting for this veteran. However, his history of poor decision-making, occupational instability, personal relationship issues with family, friends, and in a work setting, and his inability to refrain from verbal aggression/outbursts would indicate a more severe impact from PTSD. . . . . [The Veteran] is unable to sustain any form of employment based on the significance of the PTSD symptoms. He may have periods where he functions better than others. However, the records indicate when stressed or challenged, he responds poorly and makes extremely poor choices. He verbally becomes abusive, physically walks away from work settings, expresses his frustration on ‘targets’ such as his family, and socially withdraws from others. He is unable to sustain even simple work, as evidence by his poor work history. This private vocational evaluation did not explain why it discounted the VAMC records and VA examination findings of mild PTSD limitations. Additionally, it did not mention the multiple diagnoses of personality disorder or attempt to differentiate symptoms of PTSD versus personality disorder. Finally, the private vocational evaluation appeared to rely on the Veteran’s self-report of symptoms without discussing why it considered his reports credible. For these reasons, the Board has deemed this evaluation and its findings to be of lesser weight than the VA examinations, which discussed the complete evidence and explained why the Veteran’s self-reports were unreliable. An April 2015 VA examination diagnosed the Veteran with “Other Specified Personality Disorder” and PTSD. This VA examination found that it was not possible to differentiate which symptoms were attributable to personality disorder versus PTSD, although it indicated that the personality disorder was the Veteran’s “primary psychiatric difficulty” and that “The majority of veteran’s difficulties are most consistent with his personality disorder.” Overall, the VA examination determined that the Veteran’s level of occupational and social impairment, considering all mental diagnoses, was “impairment with reduced reliability and productivity.” The April 2015 VA examination additionally noted that on the Veteran’s memory and effort test the Veteran performed in a manner consistent with a conscious or unconscious attempt to feign memory difficulties. More significant in terms of indicating an inability to rely on veteran’s self-report of his symptoms, [the V]eteran performed even more poorly when the test was readministered after his description of PTSD trauma with the instructions, “we are looking at the effects of emotion on memory.” [The] Veteran’s performance actually deteriorated on the repeat administration, an extremely unlikely and idiosyncratic finding. Regarding effects on employment, the April 2015 VA examination stated that In relationship to his usual occupation and daily activities, [the V]eteran’s ability to understand and follow instructions is considered mildly impaired. His ability to retain instructions as well as sustain concentration to perform simple tasks is considered not impaired. His ability to sustain concentration to task persistence and pace is considered not impaired. His ability to respond appropriately to coworkers, supervisors, or the general public is considered not impaired. His ability to respond appropriately to changes in the work setting is considered not impaired. In a job, such as he had in 2011, which takes advantage of his mathematical abilities and interpersonal attributes, [the V]eteran is likely to do as well as he did for his 6 years of continuous employment. His greatest challenge would be dealing with interpersonal conflict such as caused him to lose the job in 2011. A March 2016 VA examination diagnosed the Veteran solely with antisocial personality disorder, further noting that Significant problems with the Veteran’s self-report of psychiatric symptoms preclude this examiner from making any diagnosis other than personality disorder; data from interview as well as from two standardized psychological measures (MMPI-2-RF and a measure of symptom validity) are strongly suggestive of non-credible self-report of psychiatric symptoms. This is not to say that the Veteran does not have another genuine psychological disorder, or disorders. However, due to the heavy reliance of self-report of symptoms on the process of accurate diagnosis of psychological disorder, no additional diagnosis can be rendered for purposes of this Claims exam. The March 2016 VA examination listed the impact of the Veteran’s antisocial personality disorder on occupation as “impairment with reduced reliability and productivity.” An April 2017 examination by a private psychologist diagnosed the Veteran with PTSD only, making no reference to prior VA diagnoses of personality disorder. An April 2017 evaluation by the same private psychologist listed the diagnoses of personality disorder in its Supportive Medical Documentation section but did not address the diagnoses in any other section. The April 2017 private evaluation determined that the Veteran “cannot sustain the stress from a competitive work environment or be expected to engage in gainful activity due to his PTSD.” To support this, the private evaluation relied on the Veteran’s reports: [The Veteran] describes not getting enough restful sleep and feeling fatigued nearly every day which would be a safety issue in the workplace. He reports difficulty remembering events, requests and occasionally forgetting details or sequencing that would affect his employment. He has difficulty maintaining and sustaining steady mood . . . [which] leads to problems in his social and work life . . . He remarks that he feels nervous and worried and struggles with ongoing anxiety issues; this sort of anxiety is a safety hazard on the job. With poor interpersonal skills and workplace trust issues, the Veteran would have an increase in paranoia and would struggle with appropriate work interaction. The April 2017 private evaluation also listed the Veteran’s PTSD symptoms, as reported in buddy statements, such as “com[ing] home from work and drink[ing] until passing out; nightmares; mood swings; excessively strident and incautious; possess[ing] some sort of rage; depressed; neglects his personal hygiene and his struggle to continue to the present.” The Board notes that the private examination and evaluation relied primarily on the Veteran’s statements regarding the effects of his PTSD on his ability to work. The private evaluation did not administer any validity tests or address the two prior VA examinations which found the Veteran’s test results were “consistent with a conscious or unconscious attempt to feign memory difficulties” (April 2015 VA examination) and “strongly suggestive of non-credible self-report of psychiatric symptoms” (March 2016 VA examination). Additionally, the private evaluation, while noting diagnoses of personality disorder, did not attempt to differentiate PTSD symptoms from personality disorder symptoms. For these reasons, the Board has assigned less weight to the findings of the private psychologist than it has to the VA examinations, which discussed the complete evidence and explained why the Veteran’s self-reports were unreliable. In an April 2017 Residual Functional Capacity Evaluation, the same private psychologist determined that the Veteran would miss “3 or more” days of work per month “due to mental problems.” The private psychologist also indicated that the Veteran would need to leave early from the workplace “3 or more” days per month “because of mental problems” and noted that “More than 3 days per month [the Veteran] would not stay focused for at least 7 hours of 8 hour workday.” Finally, the private psychologist determined that “More than once per month the [V]eteran would react in a violent manner” if he “were subjected to the normal pressures and constructive criticisms of a job.” The private psychologist did not provide rationale for these findings, did not indicate what evidence was relied on, and did not differentiate between the effects of the various diagnosed mental conditions. Accordingly, this document is given less weight in the Board’s analysis than the VA examination evidence, which discussed the complete evidence and explained why the Veteran’s self-reports were unreliable. An August 2017 VA examination noted that Unfortunately, the [V]eteran’s response style on the MMPI-2RF (a robust measure of psychological symptom validity) showed significant exaggeration at a level that invalidated his current self-report of psychological symptoms. Because of this, the measure’s clinical profile could not be used to aid in diagnostic clarification. Also because of this, self-report information throughout this report should not be accepted at face value. This VA examination diagnosed only antisocial personality disorder, explaining after an in-depth review of the record that This is not to say that the diagnosis [of PTSD] never existed, it would be speculative to say that . . . The only evidence in favor of a trauma-based disorder is the Veteran’s self-report to periodic examiners and to a mental health prescriber during brief and infrequent visits. The Veteran’s self-report has been found to be invalid for diagnostic or rating purposes. Therefore, this leaves no evidence in the support of a trauma-based disorder. The August 2017 VA examination determined that the Veteran’s level of occupational and social impairment from his mental diagnosis was “impairment with reduced reliability and productivity.” The VA examination listed three symptoms of his mental diagnosis: (1) difficulty in establishing and maintaining effective work and social relationships; (2) difficulty in adapting to stressful circumstances, including work or a worklike setting; and (3) impaired impulse control, such as unprovoked irritability with periods of violence. After considering this evidence, the Board gives greater weight to the VA examinations, particularly the April 2015, March 2016, and August 2017 VA examinations that included validity tests. As noted above, the two private opinion providers who supported a TDIU based on PTSD relied on the Veteran’s statements for their findings. Moreover, these opinion providers did not address the VAMC and VA examination findings of personality disorder and did not discuss how they determined that the Veteran’s reports were credible. This is particularly telling for the April 2017 private evaluation and examination, which had access to the April 2015 and March 2016 VA examinations that flagged the Veteran’s self-reports as unreliable. The Board acknowledges the various buddy statements documenting symptoms such as irritation, mood swings, depression, anger, nightmares, and hypervigilance. To be clear, the Board has not found that the Veteran does not experience PTSD symptoms, but rather that the symptoms do not render him incapable of securing or following substantially gainful employment. VAMC records similarly document PTSD symptoms, although the credibility of the Veteran’s self-reports are in question, as documented by the VA examinations. For example, a January 2013 VAMC record noted sleep paralysis and nightmares. A February 2014 VAMC record stated that the Veteran “has had traumatic experiences affect[] his mood, sleep and life. depressed, anger and irritability, not trusting, nightmares, flash backs ect [sic].” A September 2018 VAMC record related that the Veteran “wants to stay away from people . . . . Traumatic memories and flashbacks come back to him about people burning and screaming.” Additionally, the Board notes the April 2015 VA examination that found it could not separate the symptoms of PTSD and personality disorder. In cases where the effects of a service-connected condition cannot be separated from those of nonservice-connected conditions, VA must resolve reasonable doubt in the Veteran’s favor and attribute such signs and symptoms to the service-connected disability. Mittleider v. West, 11 Vet. App. 181 (1998). Even following Mittleider and attributing all of the Veteran’s psychological symptoms to his service-connected PTSD, the Board cannot find that these symptoms render him unable to secure and follow substantially gainful employment. The April 2015 VA examination, which stated it could not differentiate between the symptoms of the Veteran’s personality disorder and PTSD, determined that the Veteran was not totally impaired by his psychiatric conditions but rather had “impairment with reduced reliability and productivity.” This is in keeping with the December 2012, March 2016, and August 2017 VA examinations, which also listed the Veteran’s level of impairment as “Occupational and social impairment with reduced reliability and productivity” based on his diagnosed mental disabilities. Because these VA examinations considered the Veteran’s complete psychological symptoms from all diagnoses and consistently described it as “impairment with reduced reliability and productivity,” the Board finds that even applying Mittleider and considering the effects from his additional diagnoses, unemployability is not shown. The Board has also considered the articles submitted by the private psychologist who provided the April 2017 private evaluation, private examination, and Residual Functional Capacity Evaluation. The Board notes that these articles support the idea that PTSD (and other psychiatric diagnoses) can impact veterans’ work performance and ability to maintain employment. A prior Board decision as well as this decision have already considered the effects of the Veteran’s PTSD on his ability to work, however. After analyzing the specific effects of the Veteran’s disability, the Board has found that his symptoms do not render him unable to secure or follow a substantially gainful occupation. Thus, while PTSD can cause a veteran to be unemployable, that is not the situation in this case. The Board finds that the Veteran’s PTSD and other psychological conditions lead to “Occupational and social impairment with reduced reliability and productivity.” He is capable of performing work in which his interactions with other people are limited. Turning to the Veteran’s other service-connected disabilities, a July 2005 VA examination noted that the Veteran’s report of “constant knee pain as well as cracking, grinding, weakness, swelling, and give way.” The Veteran described his knee pain as a seven on a scale from one to 10, with 10 being the worst, and stated that “his knees hurt bad” when he “ben[t] to clean cars” for work. An August 2010 VA examination noted that precipitating factors for flare ups were “certain movements like twisting, ‘bumping into things,’ weather changes, running, walking to much.” The VA examination listed the Veteran’s standing limitation as “2-3 hours” and stated that his right knee disability “Prevents” chores and recreation, although it noted that he “Still exercises, but not able to do running- uses eliptical [sic].” A February 2014 VA examination noted the Veteran’s report that “when he was working [as a finance manager for a car shop/dealership] ‘the pain was insane . . . sometimes I couldn’t go to work my knee hurt so much’. He also says the pain meds made him feel funny which effected [sic] work.” The examination continued, however, that “Based on MRI & x-ray findings, his right knee condition would cause moderately [sic] limits to physical employment, no limits to sedentary employment.” The February 2014 VA examination then explained that the Veteran’s range of motion measurements could not be recorded because the Veteran guarded his knee as “he sa[id] he [was] in so much pain.” The VA examiner found this “unlikely considering his imaging findings” and “the fact that he is on narcotic pain medication.” Furthermore, the VA examination noted that the Veteran resisted flexion yet his chondromalacia patella “should have little if any limiting impact to knee flexion.” The VA examiner stated that the Veteran’s “Limits are more likely an attempt at secondary gain (a higher VA disability rating), than truely [sic] the result of his disability diagnosis of chondromalacia patella.” An April 2015 VA medical opinion stated that “Based on objective clinical evidence and review of records, the Veteran’s [service-connected] Chondromalacia Patella (right knee) would cause mild to moderate limits to physical labor that involved prolonged walking/standing/stairs/ladders etc, due to knee pain. There would be no limitations to sedentary labor.” As discussed previously, the Board has determined that the Veteran’s statements regarding his symptoms and their severity are of decreased credibility. This was again seen with the February 2014 VA examination, which found the Veteran was misrepresenting his knee limitations. Based on this evidence, the Board finds that the Veteran’s right knee would limit prolonged walking, standing, and other physical movements but would not prohibit work that allowed the Veteran to remain seated or walk only for short periods. As for the Veteran’s service-connected left-ear hearing loss and tinnitus, a December 2013 VA audiological examination noted the Veteran’s report that his hearing loss affected his ability to work because “he can’t understand people sometimes.” For tinnitus, the Veteran stated at that same VA examination that it impaired his ability to work because “it can give him a headache and put him in a bad mood.” He stated that his tinnitus “occurs once a day to once a week and lasts 30 minutes to hours.” An April 2015 VA examination determined that the Veteran’s pure tone test results were not valid because “Results were inconsistent and cannot be used for rating decisions. Positive Stenger found at 4000 Hz. SRTs inconsistant [sic] with pure tone results and his ability to answer interview questions presented at 45 dB AU.” The Veteran reported that his hearing loss impacts his ability to work in that “he can’t hear too good” and his tinnitus affected his ability to work because “it drives him insane.” The April 2015 VA examination stated that the Veteran’s “hearing loss and tinnitus should not impact his ability to perform all types of physical or sedentary jobs to the degree as to render him unemployable.” The Board again notes the Veteran’s recorded attempt to misrepresent his symptoms at the April 2015 VA examination. Because of this and the Veteran’s documented history of misrepresenting the severity of his other disabilities, the Board finds the Veteran’s statements regarding his hearing loss and tinnitus to be of limited credibility. The Board accordingly relies on the VA examination determination of his limitation and finds that the Veteran’s hearing loss and tinnitus would not render him unable to work a physical or sedentary (non-physical) job. The Board had not only considered the impact of each service-connected disability on employment but also ascertained their combined effects on his ability to secure or follow a substantially gainful occupation. Taking into account all of the Veteran’s service-connected disabilities, the Board finds that the Veteran is able to perform non-physical work in which the Veteran remains seated, walks only for short periods, and had limited interactions with other people. This is in keeping with the findings of a June 2014 SSA Decision, which considered the service-connected disabilities as well as disabilities not associated with service. That SSA Decision determined that the Veteran has the residual functional capacity to perform light work “except he should have a sit/stand option in 30-minute intervals” and that he “should not climb ladders, ropes, or scaffolds. He should avoid exposure to hazards and vibrations. His work should be task-oriented with brief interaction with co-workers and supervisors, and no contact with the public. He should not do high-production quota work.” In sum, the Board concludes that the Veteran’s service-connected PTSD, right chondromalacia patella, left ear hearing loss, and tinnitus do not render him unable to secure and follow a substantially gainful occupation. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board W. Ripplinger, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.