Citation Nr: 21020812 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 11-10 034 DATE: April 8, 2021 ORDER A rating in excess of 10 percent from September 1, 2008 to October 17, 2016, in excess of 10 percent from March 1, 2017 to March 6, 2018, and in excess of 20 percent thereafter, for a low back disability, characterized as lumbar spine disc herniation and degenerative joint disease, is denied. An initial rating in excess of 20 percent for right lower extremity radiculopathy, secondary to a low back disability, is denied. An initial rating in excess of 10 percent for left lower extremity radiculopathy, secondary to a low back disability, is denied. An initial rating in excess of 10 percent for residuals of hepatitis B is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. During the periods of September 1, 2008 to October 17, 2016 and March 1, 2017 to March 6, 2018 the Veteran’s low back disability was manifested by painful limitation of motion; forward flexion of the thoracolumbar spine less than 60 degrees, a combined range of motion of the thoracolumbar spine of 120 degrees or less, or muscle spasm or guarding severe enough to result in abnormal gait or abnormal spinal contour such as scoliosis, revered lordosis, or abnormal kyphosis, and/or intervertebral disc syndrome have not been shown. 2. Since March 6, 2018 the Veteran’s low back disability has been manifested by pain and limitation of motion; forward flexion of the thoracolumbar spine less than 30 degrees, favorable ankylosis of the entire thoracolumbar spine, and/or intervertebral disc syndrome with for at least 6 weeks during the past 12 months, have not been shown. 3. Throughout the entire period on appeal, the Veteran’s right lower extremity radiculopathy disability were characterized by “moderate” incomplete paralysis of the sciatic nerve. 4. Throughout the entire period on appeal, the Veteran’s left lower extremity radiculopathy disability were characterized by “mild” incomplete paralysis of the sciatic nerve. 5. During the period on appeal, the Veteran’s Hepatitis B residuals were manifested by intermittent fatigue, malaise, and anorexia, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least one week, but less than two weeks, during the past 12-month period; incapacitating episodes more than two weeks during the past 12-month period were not shown. 6. Throughout the period on appeal, the Veteran’s service-connected disabilities did not prevent her from obtaining and retaining substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for a low back disability, characterized as lumbar spine disc herniation and degenerative joint disease, from September 1, 2008 to October 17, 2016 and March 1, 2017 to March 6, 2018, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.71, 4.71a, DC 5242. 2. The criteria for an initial rating in excess of 20 percent for a low back disability, characterized as lumbar spine disc herniation, from March 6, 2018, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.71, 4.71a, DC 5237. 3. The criteria for an initial rating in excess of 20 percent for a right lower extremity radiculopathy disability have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.6, 4.120, 4.123, 4.124, 4.124a, DC 8520. 4. The criteria for an initial rating in excess of 10 percent for a left lower extremity radiculopathy disability have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.6, 4.120, 4.123, 4.124, 4.124a, DC 8520. 5. 4. The criteria for entitlement to an initial rating in excess of 10 percent for hepatitis B residuals, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.114, Diagnostic Code 7345. 6. The criteria for Entitlement to a total disability rating based on unemployability (TDIU) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.3, 4.15, 4.16, 4.19, 4. 26. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1986 to October 1998, from July 1999 to August 1999, from December 2004 to November 2005, and from January 2006 to August 2008. In September 2017, the Veteran testified at before the undersigned Veterans Law Judge at a hearing held at the VA Central Office in Washington, DC. A transcript of that hearing is of record. These matters return to the Board of Veterans’ Appeals (Board) following February 2019 and October 2020 Board remand decisions which directed the Regional Office (RO) to complete additional development. Increased Ratings The Veteran is seeking increased ratings for her low back disability, bilateral lower extremity radiculopathy, and Hepatitis B residuals. Specifically, she alleges that these disabilities have worsened. Disability evaluations are determined by applying a schedule of ratings which is based on average impairment of earning capacity based on the specific diagnostic codes identifying the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two separate evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that particular rating. 38 C.F.R. § 4.7. For musculoskeletal disabilities, a higher rating based on greater limitation of motion due to pain on use, including during flare-ups. 38 C.F.R. §§ 4.10, 4.40, 4.45; see also DeLuca v. Brown, 8 Vet. App. 202 (1995). The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability, and therefore, actually painful, unstable, or malaligned joints, due to healed injury, are as entitled to at least the minimum compensable rating for the joint. See 38 C.F.R. § 4.59. 1. A rating in excess of 10 percent from September 1, 2008 to October 17, 2016, in excess of 10 percent from March 1, 2017 to March 6, 2018, and in excess of 20 percent thereafter, for a low back disability, characterized as lumbar spine disc herniation degenerative joint disease 2. An initial rating in excess of 20 percent for right lower extremity radiculopathy, secondary to a low back disability 3. An initial rating in excess of 10 percent for left lower extremity radiculopathy, secondary to a low back disability Low Back Disability The Veteran’s low back disability is rated under Diagnostic Code (DC) 5237, which addresses strain of the lumbar or cervical portions of the spine. She has a 10 percent rating for the periods from September 1, 2008 to October 17, 2016 and from March 1, 2017 to March 6, 2018. Since March 6, 2018, this disability has been rated at 20 percent. The Veteran was assigned a temporary total disability rating for her low back disability from October 17, 2016 to March 1, 2017 following surgery; this period will not be discussed below as the Veteran was in receipt of a maximum schedular rating. Under DC 5237 a rating in excess of 10 percent is warranted for a thoracolumbar spine disability when the evidence shows: • Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees (20 percent); • A combined range of motion of the thoracolumbar spine not greater than 120 degrees (20 percent); • Muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis (20 percent); or, • Intervertebral disc syndrome (IVDS) with incapacitating episodes have a total duration of at least 2 weeks but less than 4 weeks during the past 12 months (20 percent). 38 C.F.R. § 4.71a. A rating in excess of 20 percent is warranted when the evidence shows: • Forward flexion of the thoracolumbar spine to 30 degrees or less (40 percent); • Favorable ankylosis of the entire thoracolumbar spine (40 percent); or, • Intervertebral disc syndrome (IVDS) with incapacitating episodes have a total duration of at least 4 weeks during the past 12 months (40 percent). 38 C.F.R. § 4.71a. From September 1, 2008 to October 17, 2016 and March 1, 2017 to March 6, 2018 Based on the evidence of record, ratings in excess of 10 percent for the periods from September 1, 2008 to October 17, 2016 and March 1, 2017 to March 6, 2018 are not warranted. There was no evidence in the Veteran's treatment records to support a rating in excess of 10 percent for the periods from September 1, 2008 to October 17, 2016 and from March 1, 2017 to March 6, 2018. Of note, while the Veteran's medical treatment records, including from April 2009, June 2011, and October 2013 reflect painful motion and some limitation of function, there was no evidence to warrant a higher rating for this disability. Specifically, the range of motion testing documented on April 2009, June 2011, and October 2013 do not show frontal flexion at less than 70 degrees, and combined range of motion not less than 140 degrees. As such, a rating in excess of 10 percent is not for application for the periods from September 1, 2008 to October 17, 2016 and from March 1, 2017 to March 6, 2018. From March 6, 2018 Based on the evidence of record, the Board determines that a rating in excess of 20 percent is not warranted for the period since March 6, 2018. Specifically, at a March 2018 VA examination, the Veteran reported that she experiences constant back pain and flare-ups which she indicated prevent her from prolonged standing or sitting and interfere with motions such as bending or twisting and climbing up and down stairs. On examination, the Veteran displayed forward flexion to 50 degrees and 115 degrees of total combined range of motion. The Veteran was able to perform repetitive testing with no additional functional loss. The examiner noted that the examination was not performed in a consistent manner with a flare-up and indicated that they were not able to opine to the Veteran’s functional loss during a flare-up without resorting to mere speculation. While the examiner observed guarding, they indicated that it did not result in abnormal gait or spinal contour. The examiner did not find ankylosis but noted that the Veteran experiences IVDS not resulting in any episodes of bed rest prescribed by a physician in the previous 12 months. The examiner endorsed diagnoses of left and right lower extremity radiculopathy but did not any other neurologic abnormalities related to the Veteran’s low back disability. The Veteran was afforded a further examination in October 2019. The Veteran reported pain and daily flare-ups described as mild to moderate and lasting between 15 minutes to 10 hours, brought on by slight movements in the wrong way. The Veteran stated that she treats her flare-ups with medication and rest. The Veteran reported right side weakness, leg and arm spasms, with loss of grip in her hand. Upon examination, the Veteran displayed forward flexion to 70 degrees, and combined flexion to 150 degrees. The examiner noted that the Veteran’s examination coincided with a flare-up, the Veteran’s measured range of motion was noted by the examiner to reflect her limitation during a flare-up. Following repetitive use, her forward flexion was measured at 55 degrees and 125 degrees combined. The examiner found no muscle spasm or guarding during their examination, and did not endorse any other factors which would contribute to the Veteran’s disability such as ankylosis or instability. The Veteran was found to have normal muscle strength in her thighs, knees, lower legs, ankles, and feet/toes. The examiner noted that the Veteran suffers from radiculopathy in both legs and did not endorse diagnoses of any additional neurological disabilities due or related to her low back disability. The examiner noted that the Veteran had not have any episodes of acute signs and symptoms due to IVDS requiring bed rest at any point in the prior 12 months. There was also no evidence in the Veteran's treatment records during this period, to support a rating in excess of 20 percent based upon limitation of motion or incapacitating episodes of IVDS. Therefore, a rating in excess of 20 percent is not for application. Bilateral Lower Extremity Radiculopathy The Veteran is currently in receipt of a 20 percent rating for right lower extremity radiculopathy, and a 10 percent rating for left lower extremity radiculopathy. Both disabilities are rated by 38 C.F.R. § 4.124a, DC 8520 which provides ratings for disability of the sciatic nerve, neuritis, or neuralgia. A rating in excess of 10 percent under DC 8520 is warranted when the evidence shows: • Moderate incomplete paralysis of the sciatic nerve (20 percent); or • Moderately severe incomplete paralysis of the sciatic nerve (40 percent). 38 C.F.R. § 4.124a, DC 8520 The term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to a varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. Initially, the Board cannot find that higher ratings for either disability are warranted at this time. The Veteran was afforded examinations in March 2018 and October 2019 to evaluate her low back disability, at the same time the examiners performed testing to evaluate the severity of her bilateral lower extremity radiculopathy. The Veteran was first diagnosed with bilateral lower extremity radiculopathy at the March 2018 examination. The examiner found that the right lower extremity radiculopathy was characterized by moderate incomplete paralysis, and the left by mild incomplete paralysis. No other signs or symptoms were documented. Similarly, at the October 2019 VA examination the examiner noted the Veteran’s bilateral lower extremity radiculopathy and following testing indicated that overall severity of both was mild. There were no other symptoms noted. The Veteran’s medical records for this period are silent in regard to any further symptoms or treatment for the Veteran’s peripheral neuropathy. The Board finds that a disability rating greater than the assigned 20 and 10 percent disability ratings for the Veteran’s right and left lower extremities respectfully is not warranted. The findings set forth above show that the severity of the Veteran’s right lower extremity radiculopathy is manifested by no more than moderate incomplete paralysis, and the left by no more than mild incomplete paralysis. The Veteran did not have more significant symptoms such as atrophy, muscle wasting, tremor or indication of moderate or moderately severe symptoms so as to warrant disability ratings higher than those currently assigned. For the foregoing reasons, the Board finds that the Veteran’s service-connected peripheral neuropathy of the right and left lower extremities do not meet the criteria for disability ratings higher than 20 and 10 percent respectfully. The preponderance of the evidence being against each claim, the appeal must be denied. Other Considerations When considering these ratings, the Board has considered the impact of functional loss in the Veteran's back due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 206 -07 (1995). In this case, the Veteran has complained that she is limited in performing activities of daily living due to pain and weakness. However, while the Veteran experiences the aforementioned symptoms, overall, it does not appear that these symptoms result in additional and significant functional loss, and her complaints are adequately contemplated in the ratings she currently receives. See Sharp v. Shinseki, 29 Vet. App. 26 (2017); Mitchell v. Shinseki, 25 Vet. App. 32, 37-43 (2011) (pain must affect some aspect of the normal working movements of the body such as strength, speed, coordination or endurance). Here, while the Veteran has alleged that she is functionally limited due to her lumbar disability, her medical records and both VA examinations are silent for any discussion of her being limited to the extent that would indicate that a higher rating is warranted. Next, when evaluating the extent of the Veteran's low back disability, the Board is required to consider whether a separate evaluation is warranted for any associated neurological abnormality including, but not limited to, bowel or bladder impairment, neurological impairment in the extremities or other such disorders, which are to be evaluated under the appropriate diagnostic code. See 38 C.F.R. § 4.71 (a). In this case, the medical evidence indicates diagnoses for bilateral lower extremity radiculopathy, which is discussed above; the Veteran does not have any other diagnosed associated neurological disabilities related to her low back disability. The Board acknowledges the Veteran's assertions and belief that her low back disability and bilateral lower extremity radiculopathy have progressed beyond their original diagnosis and thus her ratings should be increased. Nevertheless, while she is competent to report the observable physical symptoms of these disorders, such as pain and weakness, she is not competent to determine that they have progressed. These issues are medically complex and require specialized medical education and knowledge of the interaction between multiple systems in the body as well as the ability to interpret complicated diagnostic medical testing. See Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007), See 38 U.S.C. § 1110. On the other hand, such competent evidence concerning the nature and extent of the Veteran's low back disability and bilateral lower extremity radiculopathy have been provided by the medical personnel who have examined her during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports) directly address the criteria under which these disabilities are evaluated. Competency of evidence differs from weight and credibility. While the Veteran is competent to report symptoms because this requires only personal knowledge as it comes to her through her senses, she is not competent to identify a specific level of disability of her back disability according to the appropriate diagnostic codes. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). Accordingly, based on the evidence of record, higher ratings for the Veteran’s low back disability and bilateral lower extremity radiculopathy are not warranted for any period on appeal. The Veteran's appeal is denied. 4. An initial rating in excess of 10 percent for residuals of hepatitis B The Veteran currently receives a 10 percent for hepatitis B residuals under 38 C.F.R. § 4.114, DC 7345. Under DC 7345 a 20 percent rating requires daily fatigue, malaise, and anorexia (without weight loss or hepatomegaly), requiring dietary restriction or continuous medication, or incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least two weeks, but less than four weeks, during the past 12-month period. 38 C.F.R. § 4.114, DC 7345. After a review of the evidence of record, the Board has determined that a rating in excess of 10 percent for the Veteran’s hepatitis B residuals is not warranted. The Veteran was afforded VA examinations in March 2018 and October 2019, an addendum opinion was sought by the RO in April 2020 to evaluate the nature and severity of her hepatitis B residuals. At the March 2018 examination the Veteran reported symptoms of fatigue about 4 times each week, lasting for between 2 and 3 hours. The examiner noted that the Veteran experienced fatigue and nausea; symptoms of anorexia, arthralgia, right upper quadrant pain, and incapacitating episodes were not endorsed. The record is noteworthy for statements the Veteran made at her October 2019 examination, where she endorsed near constant symptoms of fatigue, daily right upper quadrant pain, and intermittent symptoms of anorexia. She also indicated that she had incapacitating episodes due to her symptoms for a duration of 6 weeks or more in the previous 12 months. The examiner did not provide any opinion or analysis regarding the reported increase in the severity of the Veteran’s symptoms. However, an April 2020 addendum opinion author indicated that a review of the Veteran’s medical records indicates a consistent level of severity of her hepatitis B residuals. Furthermore, they note a January 2018 medical visit where the Veteran’s hepatitis B is referred to as asymptomatic and suppressed without medication. An October 2019 lab shows normal liver function. In reviewing the Veteran’s October 2019 VA examination, the author notes that there is no medical evidence to support an increase in the severity of the Veteran’s symptoms and that her reported symptoms are more likely due to comorbid conditions than due to her hepatitis B residuals. The author cited the Veteran’s medical records where she expressed that she was “doing well” in addition to the lack of a documented increase in severity of her symptoms in the clinical evidence. Moreover, the Veteran’s medical records for the period on appeal are silent for her reported increase in severity. A September 2020 medical note does show the Veteran complaining that she is very fatigued but does not indicate any incapacitating episodes in the previous 12 months, in fact, at this visit the Veteran reports that she is doing well. The Board is affording more probative value to what observed at her treatment evaluations, over the what she stated at to VA examiner in October 2019, as the Veteran is more likely to be candid with her own treating physicians than she is with a VA examiner who is evaluating her in the context of a claim for additional benefits. In considering the appropriate disability ratings, the Board has also considered the Veteran’s statements that her disability is worse than the rating she currently receives. In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). The Board acknowledges the Veteran’s assertions and belief that her hepatitis B residuals have progressed beyond its original diagnosis and thus her rating should be increased. Nevertheless, while she is competent to report the observable physical symptoms of this disorder, such as pain and fatigue in general, she is not competent to determine that it has progressed. This issue are medically complex and require specialized medical education and knowledge of the interaction between multiple systems in the body as well as the ability to interpret complicated diagnostic medical testing. See Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007), See 38 U.S.C. § 1110. On the other hand, such competent evidence concerning the nature and extent of the Veteran’s low back disability and bilateral lower extremity radiculopathy have been provided by the medical personnel who have examined her during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports) directly address the criteria under which these disabilities are evaluated. Competency of evidence differs from weight and credibility. While the Veteran is competent to report symptoms because this requires only personal knowledge as it comes to her through her senses, she is not competent to identify a specific level of disability of her hepatitis b residuals according to the appropriate diagnostic codes. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (“although interest may affect the credibility of testimony, it does not affect competency to testify”). Additionally, she is not competent to attribute such symptoms to a specific disability. In sum, the preponderance of the evidence of record does not support a rating in excess of 10 percent for hepatitis B residuals. Therefore, the Board finds that a rating in excess of 10 percent for the Veteran’s hepatitis B disability is not warranted. The appeal is denied. TDIU A TDIU may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. See 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16. This is so provided the unemployability is the result of a single service-connected disability ratable at 60 percent or more, or the result of two or more service-connected disabilities, where at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16 (a). A total disability rating may also be assigned on an extra-schedular basis, pursuant to the procedures set forth in 38 C.F.R. § 4.16 (b), for Veterans who are unemployable by reason of service-connected disabilities, but who fail to meet the percentage standards set forth in section 4.16(a). The veteran’s service-connected disabilities, alone, must be sufficiently severe to produce unemployability. Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). In determining whether unemployability exists, consideration may be given to the veteran’s level of education, special training, and previous work experience, but not to age or to any impairment caused by non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. Additionally, the Board acknowledges that the phrase “unable to secure and follow a substantially gainful occupation” in § 4.16(b) contains both economic and noneconomic components. The economic component requires a determination as to whether a Veteran’s income exceeds the poverty threshold. The noneconomic component requires a determination as to a Veteran’s ability to secure and follow such employment. The U.S. Court of Appeals for Veterans’ Claims (CAVC) put forth certain factors that may be appropriate in making such a determination. First, the CAVC noted that attention should be given to the Veteran’s history, education, skill, and training. Next, the CAVC found that consideration of the Veteran’s physical ability is necessary, with possible relevant factors including the Veteran’s limitations as to lifting, bending, sitting, standing, walking, climbing, grasping, typing, and reaching, as well as audio and visual limitations. Finally, considerations should be given to the Veteran’s mental ability, including his/her limitations as to memory, concentration, ability to adapt to change, handle workplace stress, get along with coworkers, and demonstrate reliability and productivity. See Ray v. Wilkie, Vet. App. (2019) (2019 U.S. App. Vet. Claims LEXIS 386). 5. Entitlement to a total disability rating based on individual unemployability (TDIU) The Veteran asserts that she is unable to work because of her service-connected disabilities, and therefore seeks TDIU. The Veteran reported that she last worked in 2008. After a review of the evidence of record, the Board determines that TDIU is not warranted. As an initial matter, the Board notes that the Veteran has not at any time during the period on appeal met the schedular requirements for TDIU. During the period on appeal, the Veteran’s service-connected disabilities consist of a low back disability rated at 20 percent disabling, right lower extremity radiculopathy rated at 20 percent, left lower extremity radiculopathy rated at 10 percent, hepatitis B residuals rated at 10 percent, and non-compensable ratings for residuals of a right wrist fracture, hypertension, scaring due to bilateral fibroadenoma of the breasts, and surgical scar associated with her low back disability. Thus, the Veteran’s highest combined rating during the period on appeal is 50 percent. Thus, she does not meet the schedular criteria for TDIU under 38 C.F.R. § 4.16 (a). Moreover, TDIU is also not warranted based on the evidence of record, because any inability of the Veteran to secure or follow a substantially gainful occupation has not been shown. See 38 C.F.R. § 4.16 (b). With respect to the medical evidence, the Veteran’s VA medical treatment records indicate that while her disabilities contribute to some functional limitations, she is not necessarily precluded from working. Specifically, the Veteran was afforded VA examinations in March 2018, and October 2019. In March 2018 the Veteran received examinations for her low back disability, cardiac disability, and hepatitis B residuals. At these examinations, the Veteran reported experiencing fatigue and nausea due to her hepatitis b residuals, she also reported experiencing constant back pain and flare-ups which she indicated prevent her from prolonged standing or sitting and interfere with motions such as bending or twisting and climbing up and down stairs. She did not endorse any functional limitations resulting from her cardiac disability. The examiners opined that the Veteran’s hepatitis b residual symptoms did not impact her ability to work, while her low back disability would. Specifically, the examiner wrote that employment with prolonged standing or walking would not be recommended, however, they also indicated that employment with restrictions would still be possible. In October 2019 the Veteran’s low back disability and hepatitis B residuals were evaluated to determine their severity. At these examinations the Veteran reported pain, weakness, and flare-ups due to her low back disability, and near constant symptoms of fatigue, daily right upper quadrant pain, and intermittent symptoms of anorexia. She also indicated that she had incapacitating episodes due to her symptoms for a duration of 6 weeks or more in the previous 12 months due to her hepatitis b residuals. The Veteran denied any incapacitating episodes of her low back disability, and upon examination she exhibited full muscle strength. The examiner opined that her low back disability would cause difficulty bending over to lift heavy objects, but they did not state that the Veteran would be precluded from employment due to her low back disability entirely. The hepatitis b examiner noted that the Veteran’s fatigue could be classified as moderate to severe and may affect employment. The RO obtained an addendum opinion in April 2020 to elaborate on the findings of the Veteran’s October 2019 hepatitis b examination. The author of the opinion indicated that the Veteran’s reported increase in the severity of her symptoms was likely due to comorbid conditions rather than her hepatitis b, especially given the Veteran’s own statements in her medical records indicating that she was doing well. The Veteran’s medical records are silent for any additional notations of functional loss caused by the Veteran’s service-connected disabilities. There are no further limitations documented in the available clinical evidence. The Board has also considered the Veteran’s level of education and previous work experience. See 38 C.F.R. §§ 4.16. In this case, the Veteran reported that she last worked at a full-time level in 2008 after several tours of duty in the military where she received training and worked as an administrative specialist. She is also a high school and college graduate. The Veteran has reported issues related to ambulation and in relation to standing and sitting for a prolonged period of time, there is no indication in the clinical evidence that these issues would preclude sedentary employment in accordance with her past education and training. The Board notes that while the applicable statues and regulations do not define “sedentary work.” However, the Social Security Administration has stated that “Sedentary work involves lifting no more than 10 pounds at a time and occasionally lifting or carrying articles like docket files, ledgers, and small tools. Although a sedentary job is defined as one which involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required occasionally and other sedentary criteria are met.” 20 CFR 404.1567 (a). The Board finds that this definition is adequate for adjudication purposes here. Here, the Veteran’s occupational background and level of education confirms that she was qualified for sedentary occupations during the period on appeal. Thus, the VA medical opinions indicating that her specific disabilities do not preclude sedentary work, as defined above, weighs against the instant TDIU claim because the Veteran’s background indicates she is well qualified for sedentary work, such as work in an administrate capacity at a desk. Id. at 148 (before the Board can rely on an examiner’s finding that a veteran is capable of sedentary work to deny TDIU, it must also ensure that the finding is consistent with the medical evidence as a whole). The Board recognizes statements from the Veteran and her representative regarding her TDIU claim. Namely, that her pain, and functional impairment resulting from her disabilities prevent her from working. Neither the Veteran nor her representative have suggested that her flare-ups are of a severity which would prevent her from obtaining or retaining gainful employment. However, the Board finds her statements less probative as that the medical evidence, as discussed, indicated that she could work in a sedentary position with some accommodations. The above-discussed opinions from the VA examiners do not indicate that the Veteran’s service-connected disabilities would preclude employment of a sedentary nature. Moreover, the limitations described within them are remarkably similar given that they span several years. Additionally, the Veteran has not submitted any evidence, including private opinions or examinations, which support her claim for TDIU. The Board finds that the clinical evidence is sufficient for the Board to make its own conclusions. Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013) (applicable regulations place responsibility for the ultimate TDIU determination on the VA, not a medical examiner). As such, the Board concludes that the Veteran’s service-connected disabilities do not prevent her from obtaining and retaining substantial gainful employment. Accordingly, the weight of the evidence is against the Veteran’s claim for entitlement to TDIU. The benefit of the doubt rule is inapplicable as evidence is not in equipoise. As such, the Veteran’s claim is denied. See Owens v. Brown, 7 Vet. App. 429, 433 (1995).   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. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Q. Hernan, Attorney Advisor