Citation Nr: 21014469 Decision Date: 03/12/21 Archive Date: 03/12/21 DOCKET NO. 15-03 536 DATE: March 12, 2021 ORDER Entitlement to service connection for traumatic brain injury (TBI) is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. The competent evidence of record reflects that the Veteran does not have a current diagnosis of a traumatic brain injury. 2. The competent and persuasive evidence does not establish that the Veteran’s service-connected disabilities preclude him from substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for TBI have not been met. 38 U.S.C. §§ 1110, 1154(b), 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to a TDIU have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1995 to September 2011. He was awarded the Combat Action Ribbon. These matters come before the Board of Veterans' Appeals (Board) on appeal from a May 2013 and April 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that in a June 2019 correspondence, the Veteran through his attorney representative withdrew his hearing scheduled for July 10, 2019. Service Connection Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). In cases where a veteran asserts service connection for injuries or disease incurred or aggravated in combat, 38 U.S.C. § 1154(b) and its implementing regulation, 38 C.F.R. § 3.304(d), are applicable. This statute and regulation ease the evidentiary burden of a combat veteran by permitting the use, under certain circumstances, of lay evidence. If the veteran was engaged in combat with the enemy, as did the Veteran in this appeal, VA shall accept as sufficient proof of service connection satisfactory lay or other evidence of service incurrence, if the lay or other evidence is consistent with the circumstances, conditions, or hardships of such service. 38 U.S.C. § 1154(b); 38 C.F.R. § 3.304(d). Section 1154(b) of the United States Code establishes an event and injury during service does not end the matter. The provision does not mean that a grant of service connection is presumed for veterans who were injured in combat. Section 1154(b) can be used only to provide a factual basis upon which a determination could be made that a particular disease or injury was incurred or aggravated in service, not to link the claimed disability causally to the current disorder. Caluza v. Brown, 7 Vet. App. 498, 507 (1995); Libertine v. Brown, 9 Vet. App. 521, 523-24 (1996). 1. Entitlement to service connection for TBI is denied. The Veteran seeks service connection for TBI and asserts at a March 2016 VA examination that he experienced “several instances over the years of ‘bumping his head’ while driving in a vehicle.” He specifically asserts that in 1998, he was “in a crash while driving a Humvee,” bumped his head and “blacked out.” He further asserts that in 2008, while in Iraq, he was in a vehicle that was “going over a bumpy road” when he hit his head and “blacked out.” As an initial matter, the Board notes that service records indicate the Veteran was deployed to Iraq between November 2007 and November 2008. During this period, part of the Veteran’s duties required him to provided contingency construction and convoy security teams. The Veteran indicates that he did not seek medical treatment in-service for his head injuries and service treatment records reflect as much. Nevertheless, the Veteran’s asserted in-service injury of bumping his head and blacking out during a period of combat service is presumed to have occurred under U.S.C. § 1154(b); 38 C.F.R. § 3.304(d). However, despite having an in-service injury, the Board also notes that the threshold consideration for any service connection claim is the existence of a current disability. In the absence of proof of a present disability, there is no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223 (1992). Thus, the initial question for the Board is whether the Veteran has a current disability of TBI or residuals from bumping his head and blacking out. Based on the competent medical evidence discussed below, the Board concludes that the Veteran does not have a current diagnosis of TBI and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The February 2016 VA examiner evaluated the Veteran and determined that, although the Veteran reported a history of “bumping his head” and “blacking out” while in some type of vehicle during service, he did not have a diagnosis of TBI. A March 2016 addendum opinion found that the Veteran does not have TBI, no residuals, no functional limitations. The addendum opinion noted that there was insufficient evidence to warrant or confirm a diagnosis of a TBI or its residuals. An additional addendum opinion from the February 2016 VA examiner explained that the Veteran’s service treatment records (STRs) show reports of loss of consciousness; however, they were secondary to fainting episodes. The examiner further explained that during at least one of these episodes, it was noted that the Veteran may have hit his head while falling to the ground. The examiner indicated that in September 2010, after one of his reported episodes, the Veteran received a CT scan of his head as part of a syncope evaluation because he may have hit his head after fainting. The CT scan of his brain was normal. The examiner further reported that upon review of the Veteran’s STRs, no competent evidence of a current disability related to a TBI was found. It was noted the Veteran was previously evaluated for TBI on or around October 2012; however, the Veteran was assessed with posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). It was also noted that the result of a March 2016 neuropsychological test was “not only inconsistent with mild head injury but also found to be invalid and suggestive of feigning of cognitive problems.” The addendum opinion concluded that all the Veteran’s subjective emotional and behavioral signs and symptoms are due to his psychiatric conditions and there was no competent evidence of a current disability related to TBI. Upon review of the Veteran’s treatment records, the Board finds there to be no credible diagnosis of TBI. STRs do not contain diagnosis of or treatment for TBI. A September 2009 treatment note shows a CT scan was ordered to rule out any pathology because of the Veteran’s symptoms of moderate dizziness. There was no evidence of hydrocephalus; hemorrhage or extra-axial fluid collections; or edema or masses. The visualized retrobulbar areas were unremarkable; TBI was not noted. A year later the Veteran was admitted to the ER for a seizure. Another CT scan of the brain was ordered and showed no acute findings. The Veteran’s in-service PTSD VA examination report from August 2011 found that a TBI diagnosis was not shown in the records reviewed and it later reiterated that there was no diagnosis of TBI. Likewise, his PTSD VA examinations from October 2012 and September 2014 also denied TBI diagnosis or finding. Although in November 2015, VA treatment notes reported that the Veteran tested positive for TBI screening, it also indicated that he was not diagnosed with having TBI during his military deployments. Though another November 2015 treatment note reported that the Veteran was diagnosed with TBI in October 2012, the medical tests proved otherwise. According to the Veteran’s March 2016 neuropsychological test, which was performed as part of his disability claim, the results indicated that the Veteran’s global cognitive status was mildly impaired. His psychomotor speed was severely impaired; executive functioning was moderately impaired; attention was moderately impaired; memory was mildly impaired; and language was low average. It was noted that there was evidence of suboptimal performance on a test used to assess whether an individual had valid cognitive impairment. The Veteran's scores on this test were lower than expected and would only reasonably be seen in a severely impaired individual at the level of dementia, which the Veteran did not have. It was further noted that the Veteran’s performance would not be obtained by a person suffering from a mild head injury and was suggestive of feigning of cognitive problems. As such, the results of this test were not considered valid and did not support a DSM-5 diagnosis of any cognitive or memory disorder secondary to possible TBI/Post Concussive Syndrome. Despite these findings and a normal CT scan, the Veteran continued to self-report a diagnosis of TBI as seen in a July 2017, August 2017, and December 2018 VA treatment note. These self-reports remain inconsistent with VA examiners’ findings, particularly his VA PTSD examination reports, which have all denied a diagnosis of TBI. Also, the Veteran’s treating psychologist reported that there was no diagnosis of TBI in the September 2012 DBQ. Moreover, a December 2018 treatment note indicates that a June 2018 MRI for the Veteran was within normal limits. Consequently, the Board gives more probative weight to the February 2016 VA examination report and its accompanying March 2016 addendum opinions. While the Veteran believes he has a current diagnosis of TBI, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). As such, the Board gives more probative weight to the competent medical evidence. Since the record presents no competent evidence to establish a present TBI disability during the appeal, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. Service connection for TBI is not warranted. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). 2. Entitlement to a TDIU is denied. On June 26, 2012, VA received the Veteran’s VA Form 21-8940. He asserts that his service-connected PTSD disability renders him unable to secure and follow substantially gainful employment; noting that he became too disabled to work in June 2011. According to an August 2019 correspondence, the Veteran believes he should be awarded a TDIU the day following his discharge from military service. A TDIU may be assigned where the schedular rating is less than total if it is found that the Veteran is unable to secure or follow a substantially gainful occupation as a result of 1) a single service-connected disability ratable at 60 percent or more, or 2) as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there are sufficient additional service-connected disabilities to bring the combined rating to 70 percent or more. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16(a). The term “substantially gainful occupation” is not defined in the rating schedule. Rather, the Court in Ray v. Wilkie, found the phrase has two components: an economic one and a noneconomic one. 31 Vet. App. 58 (2019). In assessing the Veteran’s ability to secure and follow a substantially gainful occupation, the Board is to consider the Veteran’s history, education, skill, and training as well as physical abilities and mental abilities required by the occupation at issue. Id. Such specific physical ability-factors include lifting, bending, sitting, standing, walking, climbing, grasping, typing, reaching, auditory, and visual. Id. Specific mental ability-factors include memory, concentration, ability to adapt to change, handle work-place stress, getting along with coworkers, and demonstrating reliability and productivity. Id. The central question is “whether the [V]eteran’s service-connected disabilities alone are of sufficient severity to produce unemployability,” not whether the Veteran could find employment. Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Consideration may be given to the Veteran’s level of education, special training, and previous work experience when arriving at this conclusion; factors such as age or impairment caused by non-service-connected disabilities are not to be considered. 38 C.F.R. §§ 3.341, 4.16, 4.19. Turning to the evidence of record, the Veteran is service-connected for: PTSD with MDD (rated at 50 percent from September 28, 2011; 100 percent from April 4, 2012; 50 percent from June 1, 2012; 100 percent from October 6, 2015; and 70 percent from December 1, 2015); sleep apnea (rated at 50 percent from September 28, 2011); gout (rated noncompensable from September 28, 2011; and 40 percent from August 22, 2012); diabetes mellitus type II (rated 20 percent from September 28, 2011); vertigo (rated 10 percent from September 28, 2011); and tinnitus (rated 10 percent from September 28, 2011). He is also service-connected for hypertension, erectile dysfunction, and cephalgia – all rated noncompensable. The Veteran has a combined disability rating of 80 percent from September 28, 2011; 90 percent from August 22, 2012; and 100 percent from December 1, 2015. Thus, he meets the schedular criteria for a TDIU. It is noted that from April 4, 2012 to May 31, 2012; and from October 6, 2015 to November 30, 2015; the Veteran was in receipt of a total schedular rating (100 percent) for PTSD as well as special monthly compensation under 38 U.S.C. § 1114. Hence, the issue of entitlement to a TDIU for those two periods is rendered moot. Although the Veteran has a combined disability rating of 100 percent from December 1, 2015; consideration of entitlement to TDIU is still required. The issue of entitlement to a TDIU may not be moot as VA’s duty to maximize a claimant’s benefits includes consideration of whether his disabilities establishes entitlement to SMC at the housebound rate under 38 U.S.C. § 1114(s), including whether the award of TDIU would provide entitlement to SMC. See AB v. Brown, 6 Vet. App. 35 (1993); Akles v. Derwinski, 1 Vet. App. 118, 121 (1991) (Entitlement to SMC is an “inferred issue” in the context of an increased rating claim); see Buie v. Shinseki, 24 Vet. App. 242, 250 (2011); Bradley v. Peake, 22 Vet. App. 280, 294 (2008). SMC may be warranted pursuant to 38 U.S.C. § 1114(s) if a veteran has a service-connected disability rated as 100 percent disabling and (1) has an additional service-connected disability or disabilities independently rated at 60 percent or more, or (2) by reason of such service-connected disability or disabilities is permanently housebound. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). The Veteran is not in receipt of SMC pursuant to 38 U.S.C. § 1114 (s) from December 1, 2015, and TDIU could, in theory, assist him in satisfying the criteria for SMC pursuant to 38 U.S.C. § 1114 (s). Analysis Upon evaluating the evidence, the Board finds that a TDIU is not warranted as the preponderance of the evidence does not show that the Veteran’s service-connected disabilities, either alone or collectively, rendered him unable to secure and follow a substantially gainful occupation. The Veteran’s VA Form 21-8940 reflects that he has four years of high school education. He reported that he had been employed full-time in the Navy from August 1995 to September 2012 as an equipment operator (EO). The Veteran did not provide any employment verification forms. The Veteran’s DD 214 shows his military specialty was construction mechanic. With regard to economic considerations, the record shows that the Veteran worked as a mechanic prior to enlisting in the military and has experience as a pool mechanic. During service he performed administrative work, trained others, was a heavy equipment operator, and worked in construction. According to the Veteran, his retirement in September 2012 was prompted by his PTSD. The question here is whether the Veteran was able to secure and follow substantially gainful employment prior to October 6, 2015, performing a job with earnings that were above the poverty threshold. Based on the overall evidence, the answer is, yes. With regard to non-economic consideration such as his physical disabilities, while the Veteran is service-connected for several disabilities listed above, he asserts that his service-connected PTSD renders him unable to secure and follow substantial gainful employment. However, the evidence of record indicates that none of the Veteran’s disabilities whether alone or in combination preclude him from obtaining and maintaining substantially gainful employment consistent with his work history, training, education, and skills. The Veteran underwent several VA examinations for his service-connected disabilities during the course of the appeal. While in-service, the Veteran was afforded a VA examination in August 2011 for mental disorders and was diagnosed with PTSD and MDD. The examination report reflects that the Veteran’s mental disorder symptoms were not severe enough to interfere with occupational and social functioning. The Veteran’s reported symptoms included anxiety, suspiciousness, chronic sleep impairment, and mild memory loss. He had occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily. An opinion was not provided regarding the Veteran’s employability. In September 2012, the Veteran’s treating psychologist completed a disability benefits questionnaire (DBQ) to discuss the Veteran’s employability as it pertains to his PTSD. The psychologist noted that the Veteran entered an advanced, intensive, residential program at the Biloxi VAMC as a follow-up course of care and successfully completed the treatment program in May 2012. The psychologist also noted that the Veteran began receiving outpatient treatment for his PTSD in March 2012. In addition to the symptoms the Veteran previously endorsed at his August 2011 VA examination, he now endorsed depressed mood; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; flattened affect; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances, including work or a worklike setting; inability to establish and maintain effective relationships; suicidal ideation; neglect of personal appearance and hygiene; and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. The psychologist found that the Veteran had occupational and social impairment with deficiencies in most areas. The psychologist concluded that the Veteran’s PTSD symptoms rendered him unemployable because he would most likely experience occupational impairment that would represent a prohibitive challenge to his successful pursuits. In October 2012, the Veteran underwent a new VA examination for PTSD. The examiner noted that the Veteran had not been employed since he was discharged from service in 2011 for reason of temporary disability that was determined to be combat related. The Veteran reported that he had some problems with panic attacks that have lessened since treatment and that he now experienced them "maybe once a week.” He also reported continued problems with mood swings; irritability – snaps at little things. The Veteran further reported that his symptoms were persistent since his military service and without any significant periods of remission. Apart from suicidal ideation and a few others, the Veteran endorsed most of the same symptoms as his September 2012 DBQ. However, this examiner found that the Veteran had occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily. The examiner indicated that the Veteran’s PTSD symptoms alone did not preclude him from securing or maintaining gainful employment. The examiner explained that the Veteran’s PTSD symptoms did not impact his ability to engage in physical and/or light-duty work if he so chooses. The examiner furthered that based on his current level of functioning, the Veteran appeared capable of flexibly scheduled employment with limited stress/responsibility; and limited/minimal interaction with staff and/or customers, if applicable. As a result of the stark contrast between the two VA examination reports regarding the Veteran’s occupational and social impairment versus the Veteran’s DBQ from his treating psychologist, along with conflicting opinions on employability, a clarification opinion was requested. Pursuant to this request, a clarifying opinion was provided in May 2013. Based on a review of the Veteran’s file and treatment records, this VA examiner determined that the Veteran’s PTSD symptoms alone did not preclude him from securing or maintaining substantially gainful employment. The examiner’s reasoning was that the Veteran appeared capable of light-duty, flexibly scheduled employment with limited stress/responsibility; and limited/minimal interaction with staff and/or customers, if applicable. The examiner noted that the opinion was based solely on the Veteran’s mental health related functioning. In September 2014, a VA examiner found that the Veteran had occupational and social impairment with reduced reliability and productivity due to his PTSD. The Veteran reported that he stopped participating in group care a year earlier to care for his father. Though he tried to return in March 2014, he felt more agitated and avoided leaving his home to prevent him from losing his temper in public. The Veteran also reported having more panic attacks associated with leaving his home and receiving calls from unknown numbers. He reported similar symptoms as the September 2012 DBQ and October 2012 VA exam. The examiner opined that that the Veteran’s symptoms of PTSD and depression did not impact his ability to engage in physical and/or light-duty work, if he so chooses. The examiner explained that there was no evidence to suggest that the Veteran’s PTSD symptoms alone would preclude him from securing or maintaining substantially gainful employment. The examiner affirmed the other VA examiners’ findings that the Veteran appeared capable of light-duty work, flexibly scheduled employment with limited stress/responsibility; and limited/minimal interaction with staff and/or customers. The examiner also noted that this opinion was based solely on the Veteran’s mental health related functioning and did not account for any physical difficulties he may be experiencing. Regarding his other disabilities, at his September 2012 VA examination for tinnitus, the Veteran reported that it impacted his ordinary conditions of daily life, including his ability to work because “tinnitus is annoying, frustrating and distracting.” Based on her evaluation of the Veteran’s disability, the audiologist explained that tinnitus was not a disability that would interfere with the Veteran’s ability to engage in physical or light-duty work. At another VA examination for his service-connected disabilities, also in September 2012, the Veteran reported that he was unemployed and described a typical day which involved helping his children get ready for school, performing minor chores around the house, and watching television and/or playing video games. He reported having one prostrating migraine attack a month and a weekly headache that lasted anywhere between 30 minutes to three hours. He also endorsed pain in his bilateral feet/toes, and left ankle. The Veteran indicated that his sleep apnea, gout, type II diabetes, hypertension, erectile dysfunction, and headaches did not impact his ability to work. The examiner concluded that the Veteran could do light-duty work. The examiner reasoned that the Veteran was able to do his activities of daily living; was able to drive locally; perform minor household chores; and use a telephone and computer. In March 2013, the Veteran underwent a VA examination for his service-connected vertigo. He reported that he continued to have very short bursts of lightheadedness, lasting seconds to less than a minute, and that they had not worsened over time. He denied any impact on his ability to work due to vertigo. The VA examiner noted that the Veteran was advised that his medication – Ambien and benzoates would cause some lightheadedness and contribute to the primary reason for his symptoms. That same month, a clarification opinion was obtained regarding the Veteran’s September 2012 VA examination report for his type II diabetes and headaches. The examiner again indicated that the Veteran’s diabetes and headaches did not cause restrictions in employment. As a reminder, the question before the Board is whether the Veteran’s service-connected disabilities, either alone or in combination, were of sufficient severity to produce unemployability. The answer is no, they were not. The Board has considered the physical ability-factors noted in Ray, to include lifting, bending, sitting, standing, walking, climbing, grasping, typing, reaching, auditory, and visual. See Ray, 31 Vet. App. 58. The Veteran has not reported physical credible limitations that would preclude him from gainful employment nor have the VA examiners reported such. To the extent that he would raise physical impairments, the Board notes that the record demonstrates that the Veteran reports assisting his wife in preparing their children for school and he performs chores around his house. It is presumed that these activities would involve bending, sitting, standing, walking, climbing, grasping, and reaching. As discussed above, the Veteran’s tinnitus has not been noted as impacting his ability to work. The Board also considered the mental ability-factors noted in Ray, to include memory, concentration, ability to adapt to change, handle work-place stress, getting along with coworkers, and demonstrating reliability and productivity. See Ray, 31 Vet. App. 58. However, the competent and contemporaneous evidence of record does not demonstrate that the Veteran suffers with memory loss or concentration difficulties so severe that would preclude him from working particularly in his field of experience such as an auto mechanic or construction worker. Indeed, an August 2012 VA treatment note indicates that the Veteran self-reported poor memory. However, a September 2012 VA treatment note indicates that the Veteran was evaluated by a speech pathologist and was found to have overall mild cognitive deficits in the area of recall/memory. Regarding his getting along with others and demonstrating reliability and productivity, the Board turns to the Veteran’s VA therapy notes which show that he was an engaging participant at his group therapy sessions. The Board acknowledges arguments presented by the Veteran’s representative in February 2017 and August 2019 correspondences. The representative noted that the Veteran was granted Social Security Disability benefits, and that those records contain a Mental Residual Functional Capacity (MRFC) evaluation from April 2012 which found the Veteran to have the following occupational limitations: "cannot maintain attention and concentration for two hour periods, cannot work in coordination or proximity to others without being unduly distracted by them, and cannot complete a normal workday or workweek without interruptions from psychologically based symptoms.” The representative also reported that the Veteran was unable to care for himself, and was hospitalized three times for PTSD exacerbations. The Board notes that the April 2012 Social Security Notice of Reconsideration for the Veteran’s disability insurance benefits claim indicated that their “previous determination denying [his] claim was proper under the law.” The notice further explained that the Veteran’s condition was not severe enough to keep him from working and that he could adjust to other work. As for the MRFC, the evaluator also reported that the Veteran “can understand and remember simple instructions” and “has the ability to relate appropriately to peers and supervisors.” The Board finds that, while the Veteran may be unable to work a desk job that requires a high level of interfacing with others, he could work as a janitor during an evening shift. This would limit his interactions with others, require a lower level of concentration, and allow for flexibility with work hours – he would still be home during the day to help with his children. Regarding the Veteran’s inability to care for himself, his treatment records report otherwise. Particularly, the Veteran has stated that he helps his wife with getting their children ready for school in the mornings and he does chores around the house. Indeed, the records show the Veteran was hospitalized; however, the record also suggest that at least one was associated with his discontinuance of his prescribed medication. The November 2014 VA discharge note indicates that the Veteran was admitted to the inpatient behavioral health unit and medications previously prescribed for his PTSD were resumed. The Veteran acknowledged a desire to re-engage in outpatient individual and group psychotherapy following discharge. After a period of brief observation, the Veteran requested discharge. Additionally, the discharge note from his other mental health treatment post military service, indicates that the Veteran enrolled in the PTSD Residential Rehabilitation Treatment Program (PRRTP) to “continue to get better and take care of my family.” In the August 2019 correspondence, the Veteran’s representative referenced the Veteran’s treating VA psychologist and his September 2012 DBQ as support for a TDIU effective the date after his discharge from military service. Regarding the September 2012 DBQ, the Board finds that the report does not align with the overall VA treatment records. Rather, the October 2012 VA examination report appears to be more consistent with the Veteran’s various treatment records. Indeed, the issue of suicidal ideation was raised by the representative and the DBQ identified it as a symptom; however, while the Veteran admitted to passive suicidal thoughts, he more often than not explained that he would not act on these thoughts because he could not do that to his wife who has been by his side and supported him, and their three young children. The record suggests that during the period in question, the Veteran appeared more interested in improving his mental health symptoms by seeking treatment and did not endorse an active desire or express plans resulting from his suicidal thoughts. Regarding the Veterans temporary assignment of a total rating, the Board notes that the assignment was not due to the Veteran’s inability to obtain or secure gainful employment but rather because he was ‘hospitalized’. See 38 C.F.R. § 4.29. Based on the review of the various assessments regarding the Veteran’s occupational impairment provided by the VA examiners, the Board finds that the Veteran’s service-connected disabilities have not totally preclude his ability to secure and follow substantially gainful employment. Although the Veteran’s PTSD may have caused some level of occupational impairment, it did not totally preclude his ability to secure and follow substantially gainful employment. Moreover, his other service-connected disabilities are also not shown by persuasive evidence to have significantly impacted his ability to work. The Board finds that even considering the combined impact of his service-connected disabilities would not reasonably preclude him from securing and maintaining gainful employment. With respect to PTSD specifically, the VA examiners have offered competent and persuasive opinions and reported that the Veteran’s overall level of occupational and social impairment in August 2011 and October 2012, due to his PTSD with MDD, was an occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. As discussed earlier, these VA examination reports along with the September 2014 examination findings appear more consistent with the Veteran’s overall contemporaneous treatment records than what was reported by his treating psychologist’s DBQ in September 2012, who indicated that the Veteran’s PTSD symptoms rendered him unemployable. Due to the vague reasoning provided, which appears to be based on supposition, the Board maintains that the September 2012 treating psychologist’s medical opinion is less probative. There is not compelling evidence that the Veteran’s service-connected disabilities rendered him unable to secure and follow a substantially gainful occupation. The Board has considered the applicability of the benefit of the doubt doctrine; however, the preponderance of the evidence is against the claim. As such, that doctrine is not applicable. For this reason, entitlement to TDIU is denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert at 55-57 (1990). D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Telamour, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.