Citation Nr: 21021370 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 16-43 034 DATE: April 12, 2021 ORDER Entitlement to a disability rating in excess of 50 percent prior to May 19, 2018, and in excess of 70 percent thereafter, for service-connected major depressive disorder with unspecified trauma and stress-related disorder (hereinafter “MDD”) is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) is denied. FINDINGS OF FACT 1. Prior to May 19, 2018, the severity, frequency, and duration of the Veteran’s MDD did not more nearly approximate occupational and social impairment with deficiencies in most areas. 2. From May 19, 2018, the severity, frequency, and duration of the Veteran’s MDD have not more nearly approximated total occupational and social impairment. 3. The Veteran’s service-connected disabilities do not preclude him from obtaining or maintaining gainful employment. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 50 percent prior to May 19, 2018, and in excess of 70 percent thereafter, for service-connected MDD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.130, Diagnostic Code 9434. 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 October 1956 to October 1959. This matter comes before the Board of Veterans’ Appeals (Board) from an August 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). By way of background, the Veteran was granted service connection for MDD in November 2010, and was assigned a 30 percent disability rating. He filed a claim for an increased rating in May 2014, which was denied in August 2014. The Veteran appealed to the Board, where his claim was denied in September 2017. He then appealed to the United States Court of Appeals for Veterans Claims (Court) and, in a September 2018 Order, the Court granted a Joint Motion for Remand (JMR) in which the parties agreed to vacate the September 2017 decision and remand the matter to the Board. The JMR directed the Board to consider evidence regarding both passive and active suicidal ideation and whether staged ratings are warranted. In October 2019, the Board remanded the claim for a supplemental statement of the case (SSOC) to consider additional VA treatment records, which addressed the Veteran’s mental health and noted his reported suicidal ideation. In November 2019, the Agency of Original Jurisdiction (AOJ) issued a decision granting higher evaluations for MDD with unspecified trauma and stress-related disorder effective from August 9, 2006, assigning a 100 percent rating from August 9, 2006, a 50 percent rating from July 31, 2014, and a 70 percent rating from May 19, 2018. While the AOJ appeared to have been under the misunderstanding that it was granting service connection for the disability and assigning initial staged ratings, it nevertheless assigned these higher, staged ratings. Where there is no clearly expressed intent to limit the appeal to entitlement to a specified disability rating, the AOJ and Board are required to consider entitlement to all available ratings for that condition. AB v. Brown, 6 Vet. App. 35, 39 (1993). Accordingly, the issues were subsequently characterized as described above. In March 2020, the Board again remanded the claim for an addendum opinion to address the impact of his service-connected psychiatric disability on his capacity to obtain and retain employment, as a January 2020 VA examination failed to address impact on work capacity simply because the Veteran was retired. The Board instructed that the examiner was to provide a statement about the impacts of his service-connected MDD with unspecified trauma and stress-related disorder on the Veteran’s capacity to tolerate and function adequately in activities, interactions, and situations which may occur when obtaining and retaining work. The examiner’s opinions were to address symptoms of disability present during the entire claim period, and not merely those symptoms present at the time of examination. This was of particular relevance for questions of the impacts of the Veteran’s reports of suicidal ideation on his capacity to obtain or retain work, since consideration of such was required by the JMR. While a VA examination addendum was obtained in June 2020, regrettably, the examiner failed to address impacts of suicidal ideation, and in fact failed to even note suicidal ideation. The prior VA psychiatric examination for compensation purposes in January 2020 noted that the Veteran had “flatly denied current suicidal or homicidal ideation, plan, or intent.” However, the Veteran had reported that approximately three months earlier he had experienced suicidal thoughts “during a bout of physiological (sic) anxiety symptomatology.” The Veteran had then expressed his belief that his suicidal thoughts had reduced under current medication. The examiner noted that based on the absence of current ideation he “is not a candidate for civil commitment at this time.” However, this did not speak to the impact of the Veteran’s suicidal ideation on work capacity, as the JMR required to be addressed. Accordingly, the Board remanded the claim again in September 2020 for an examiner to specifically address the nature and extent of any impacts on capacity to obtain or retain employment of the Veteran’s suicidal ideation over the course of claim. The Board finds that there has been substantial compliance with the prior Board remand directives. Stegall v. West, 11 Vet. App. 268 (1998). The matter now returns for further adjudication. INCREASED RATINGS FOR MDD Disability ratings are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. See 38 C.F.R. § 4.3. To evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran’s condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). As in the instant case, where an increase in the level of a disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55 (1994). Moreover, separate ratings can be assigned for separate periods of time based on the facts found, a practice known as “staged” ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). The evidentiary record does not reasonably raise the prospect that the Veteran’s disability is not and cannot be adequately rated under the Rating Schedule. The Veteran’s MDD is evaluated under Diagnostic Code 9434, which assigns ratings based upon the General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130. A 50 percent rating is warranted when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory such as, retention of only highly learned material, forgetting to complete tasks; impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent rating is warranted when there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to suicidal ideation; obsessional rituals which interfere with routine activities, speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, or effectively; impaired impulse control, such as unprovoked irritability with periods of violence; spatial disorientation, neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances, including work or a work-like setting; and the inability to establish and maintain effective relationships. Id. A maximum 100 percent rating is warranted when there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene; disorientation to time and place; memory loss for names of close relatives, own occupation, or own name. Id. The symptoms listed in the General Rating Formula for Mental Disorders are not intended to constitute an exhaustive list. Rather, the symptoms serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436 (2002).   A rating in excess of 50 percent prior to May 19, 2018. As noted above, the Veteran filed a claim for an increased rating for his MDD in May 2014, and a VA examination was afforded the following July 2014. While his original diagnosis of MDD was confirmed, the examiner also diagnosed an unspecified trauma- and stressor-related disorder. The examiner opined that his symptoms were more nearly approximated by occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, due to symptoms such as depressed mood and anxiety. The Veteran also described sleep impairment and disturbances of motivation and mood. The examiner noted that it was difficult to distinguish the Veteran’s report of depressed mood, decreased interest in activities, and feelings of hopelessness from symptoms consistent with a depressive episode or reflection of the Change of Affect cluster in the symptoms criteria for posttraumatic stress disorder (PTSD). However, the chronicity and severity of the Veteran’s nightmares and anxiety symptoms were attributable solely to the newly-diagnosed stressor-related disorder. Behavioral observations note the Veteran as appropriately dressed and groomed. Speech, orientation, and memory were normal, and insight, judgment, and impulse control were fair. There was no evidence of psychosis or homicidal ideation; however, the Veteran did endorse suicidal ideation with no plan or intent. Despite the additional diagnosis, the examiner explained that, based on clinical interview and review of the medical record, there was no support for an increase in the severity level of his disability, noting that the Veteran’s symptom presentation was chronic and well-document in a previous VA examination for the purposes of his initial service connection claim in 2010. The Veteran described his symptoms as manageable with medication and attributed any worsening of his mood to an increase in pain related to nonservice-connected hip and leg problems. An additional VA examination was afforded in July 2016, where the Veteran again reported that his nonservice-connected musculoskeletal pain exacerbated his depression. The examiner opined that his symptoms were more nearly approximated by occupational and social impairment with due to mild or transient symptoms of depressed mood, anxiety, chronic sleep impairment, and flattened affect. While it was also noted that the Veteran had difficulty with memory at times, there no thought disorders, abnormal speech, or abnormal orientation. There are no medical treatment records that are in significant conflict with the findings upon VA examination during this period on appeal. While January 2016 VA treatment records note the Veteran undergoing counseling at his local VA Medical Center for increased depression due to weather changes and physical limitations, as well as “vague” suicidal ideation, he denied any plan or intent. He declined voluntary hospitalization and did not meet the criteria for involuntary hospitalization. Mental status examinations during this period were consistent with the VA examinations, with normal grooming, attention and concentration, orientation, speech, memory, insight, and judgment. At times it was noted that his mood was “good,” and that his medications were helping with his symptoms. For the period prior to May 19, 2018, the Board finds that the severity of the Veteran’s MDD more closely approximated occupational and social impairment with reduced reliability and productivity, warranting no more than the currently-assigned 50 percent disability rating. The evidence of record is absent any indication that the Veteran’s disability during this particular appeal period has more closely approximated occupational and social impairment with deficiencies in most areas (the criteria for the next higher, 70 percent evaluation), due to symptoms such as: obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control; spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances; and an inability to establish and maintain effective relationships. 38 C.F.R. § 4.130, Diagnostic Code 9434. The Board acknowledges that the Veteran reported thoughts of suicidal ideation during this period. The Board finds these thoughts to be no more than passive suicidal ideation. Both passive and active suicidal ideation are comprised of thoughts: passive suicidal ideation entails thoughts such as wishing that you were dead, while active suicidal ideation entails thoughts of self-directed violence and death. Bankhead v. Shulkin, 29 Vet. App. 10, 20 (2017). When evaluating psychiatric disabilities, the Board considers the frequency, severity, and duration of suicidal ideations and the impact on the Veteran’s life, rather than limiting consideration to the intention to act. No caregiver or VA examiner has determined that he has had plans or committed any overt acts, and he specifically denied thoughts to harm himself or others to the VA examiner. Importantly, they have not found this symptom has inhibited his ability to function. Instead, he had suicidal ideation described as without plan or intent, with no reports of suicidal ideation at all upon VA examination in 2016. The evidence does not show the Veteran’s suicidal thoughts or ideation affected his functioning; that is, interfering with job performance, activities of daily living, routine activities, etc. In sum, while the Veteran’s symptoms during this period may have included occasional passive suicidal thoughts, this symptom has not affected his ability to function independently or created a deficiency in most areas of the Veteran’s life for the purposes of the next higher, 70 percent rating under the General Rating Formula for Mental Disorders. Moreover, even if the suicidal thoughts do represent suicidal ideation, the VA examiners considered these thoughts along with all the other symptomatology and still found that overall the disability was productive of no more than occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. Not only did this opinion include consideration of the Veteran’s reports of passive suicidal ideation, but this particular level of occupational and social impairment is contemplated by a lower, 30 percent rating under the rating criteria, and no medical professional has described a level of impairment greater than that found by the VA examiners during this period. The Board also acknowledges that VA treatment records during this period note relationship difficulties, particularly with the Veteran’s spouse. The Board does not find, however, that his reports indicate an inability to establish and maintain effective relationships for the purposes of a 70 percent rating. Of note, records reflect the Veteran attempting to reconcile with his wife, and he did not report poor relationships with his children. He consistently reported an active social life that was diminished by physical impairments. Thus, while he may nevertheless have difficulty in establishing and maintaining effective work and social relationships, this is already contemplated for in the currently assigned 50 percent rating. A rating in excess of 70 percent from May 19, 2018. The Board also finds that a rating in excess of the 70 percent that is currently assigned for the period on appeal beginning May 2018 is not warranted. Additional examinations have been afforded to the Veteran for his increased rating claim in May 2018, January 2020, and December 2020. Upon interview and examination, each examiner opined that the Veteran’s approximated occupational and social impairment with reduced reliability and productivity, due to symptoms that included depressed mood, anxiety, irritability, suspiciousness, panic attacks that occur weekly or less often, impairment of short and long-term memory, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and difficulty in adapting to stressful circumstances. The Veteran denied suicidal or homicidal ideation during these examinations, as well as any delusions or hallucinations. Other than memory difficulties at times and diminished hearing due to service-connected hearing loss and tinnitus disabilities, there were no noteworthy abnormal behavioral observations at any of these examinations. The Board also notes that the December 2020 examiner specifically noted that research demonstrated significant overlap between major depressive disorder and PTSD and subthreshold trauma disorders. As a result, it was difficult to distinguish Veteran’s report of depressed mood, decreased interest in activities, and feelings of hopelessness from symptoms consistent with a depressive episode or reflections of the change in affect cluster in the PTSD symptom criteria. However, the chronicity and severity of the Veteran’s nightmares, hypervigilance, being easily startled, and physiological symptoms of anxiety can be attributed solely to his diagnosis of unspecified trauma- and stressor-related disorder. As the symptoms that comprise each disorder are similar and overlap significantly, the examiner opined that the diagnoses are not independent of each other and resulted from the same etiology. The Veteran’s VA mental health treatment records, including behavioral observations, are not in significant conflict with the above findings during the remaining period on appeal, with these records reflecting his participation in individual counseling sessions for depression, anxiety, irritability, and sleep impairment. Based on the above, the Board finds that the evidence does not demonstrate symptoms indicative of a higher, 100 percent rating, such as gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene, disorientation to time and place, or memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130, Diagnostic Code 9434. The Board again acknowledges that the record reflects a history of suicidal thought. Suicidal ideation is recognized as being supportive of a 70 percent disability rating, although if it is persistent might be supportive of a 100 percent rating, which contemplates peristent danger of hurting self. Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017). However, the Board does not find the severity, frequency, and duration of any suicidal ideation has risen to the level contemplated by the 100 percent rating. The Veteran has consistently denied any attempt or planning of self-harm, and VA treatment providers have not found him to be at a high risk of suicide. Similarly, while the Veteran has expressed increased irritability, no treatment provider has indicated that he has expressed actual homicidal thinking, and has consistently denied active homicidal ideation. Thus, the Board does not find that the Veteran’s thought processes amount to a persistent danger to himself or others. The Board also notes that, while the Veteran has also endorsed panic attacks during this period on appeal to treatment providers, these are also contemplated by the 70 percent rating. Moreover, no examiner during this period has found the Veteran’s occupational and social impairment to manifest more than reduced reliability and productivity, which is the criteria for a lower, 50 percent rating under the General Rating Formula for Mental Disorders. Conclusion As to both periods on appeal, the Board is sympathetic to the Veteran’s lay statements that his disability is worse than it has evaluated, and those statements have been considered. The Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. Layno v. Brown, 6 Vet. App. 465 (1994). He is not, however, competent to identify a specific level of disability according to the appropriate diagnostic codes. Such competent evidence concerning the nature and extent of the Veteran’s disability have been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and the clinical records) directly address the criteria under which the disability is evaluated. The medical and lay evidence has been assessed by the Board in determining the overall disability ratings. In conclusion, the preponderance of the evidence is against entitlement to a disability rating in excess of 50 percent prior to May 19, 2018, and in excess of 70 percent thereafter, for service-connected MDD. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is inapplicable. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). TDIU The Veteran asserts that he is unable to secure and follow a substantially gainful occupation as a result of his service-connected disabilities. VA will grant a total rating for compensation purposes based on unemployability when the evidence shows a veteran is precluded from obtaining or maintaining any gainful employment consistent with his education and occupational experience, by reason of his service-connected disabilities. 38 C.F.R. §§ 3.340, 3.341, 4.16. In reaching such a determination, the central inquiry is “whether the Veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability.” Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). In arriving at a conclusion, consideration may be given to the veteran’s level of education, special training, and previous work experience, but not to his age or the impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. The United States Court of Appeals for Veterans Claims (Court) has held that the term “unable to secure and follow a substantially gainful occupation” in 38 C.F.R. § 4.16 has two components. First, there is an economic component which essentially contemplates an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. Second, there is a non-economic component dealing with the individual veteran’s ability to “follow and secure” employment. For the second component, attention must be given to: (a) the veteran’s history, education, skill and training, (b) the veteran’s physical ability (both exertional and non-exertional) to perform the type of activities (e.g., sedentary, light, medium, heavy or very heavy) required by the occupation at issue, with relevant factors such as lifting, bending, sitting, standing, walking, climbing, grasping, typing, reaching, auditory and visual, and (c) whether the Veteran has the mental ability to perform the type of activities required by the occupation at issue, with relevant factors such as memory, concentration, and ability to adapt to change, handle work place stress, get along with coworkers and demonstrate reliability and productivity. Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). As “sedentary” is defined as “[r]equiring or marked by much sitting ” the Board finds that sedentary employment is a job where the worker primarily sits down. WEBSTER’S II NEW COLLEGE DICTIONARY 999 (1999). If there is only one service-connected disability, it must be rated at least 60 percent disabling to qualify for TDIU benefits; if there are two or more such disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). Here, the Veteran meets the threshold schedular disability percentage requirement for TDIU consideration as a result of his service-connected MDD, hearing loss, and tinnitus from May 19, 2018. 38 C.F.R. § 4.16(a). While he does not meet the schedular threshold for the period prior to May 19, 2018, an extraschedular TDIU is available for a Veteran who does not meet the above requirements if the Veteran is unable to secure and follow a substantially gainful occupation due to service-connected disabilities; however, this decision must first be referred to the VA’s Director of Compensation Service. 38 C.F.R. § 4.16(b). In this case, however, the Board finds that a TDIU, including referral for any extraschedular consideration, is not warranted. Military personnel records reflect the Veteran’s military occupation specialty (MOS)/rating was that of a general warehouse clerk; however his records reflect that he also performed security when stationed in Korea. On his December 2019 application for unemployability he reported that his service-connected MDD and hearing loss/tinnitus disabilities prevent him from following a substantially gainful occupation. The Veteran reported completing high school, and that he last worked full-time in 1997 as a maintenance worker. During VA examinations, the Veteran reported that he was employed for 40 years in maintenance, first by Superior Tape Company for nearly 20 years, then by Willard Home Products. After retiring from Willard, he did part-time work until the late 2000s. The Veteran presented for VA audiological examinations in October 2015, March 2019, and January 2020 to assess the current severity of his service-connected hearing loss and tinnitus, where he was interviewed each time by an examiner who also reviewed the pertinent medical history and performed an examination. The Veteran reported difficulty understanding speech and difficulty falling asleep due to the ringing caused by his tinnitus. Importantly, however the Board notes that the Veterans specifically stated to the January 2020 examiner that, as he still attends meetings and goes to the movies, his activities of daily living are not impeded by hearing loss or tinnitus. He also reported that, when he was employed, his hearing loss and tinnitus did not affect his ability to work, and that no ear condition impacted his decision to retire. As to his service connected MDD, the Veteran presented for several VA examinations to assess the current severity of his disability, at which time he was interviewed by each examiner who also reviewed the pertinent medical history and performed an examination. During clinical interviews, the Veteran reported working in maintenance and manufacturing for decades. He endorsed depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, chronic sleep impairment, mild memory loss, 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. As noted in the Board’s denial of his increased rating claim above, the examiners reported the Veteran’s MDD resulted in a level of occupational and social impairment manifesting no more than reduced reliability and productivity, and for reasons previously stated the Board has determined that the severity of his disability did not amount to total occupational and social impairment. The Board also recognizes that the Veteran reported in January 2020 that, while he was able to carry out his job duties at his last employer, he retired due to a desire to no longer work with his coworkers due to irritability and being “on edge.” When asked to describe why he feels his MDD renders him unemployable, he referenced his “condition of sudden noises,” and that he does not want to “get involved in that” in a workplace setting as it would lead to panic attacks. He stated he’d rather be alone at home to do his own thing, and also reported a lack of energy and concentration. He denied having been reprimanded or being disciplined at work, however, and he denied that his irritability led to outbursts in the workplace. Additionally, and notably, the Veteran also stated that his two hip replacements (which are not service-connected) affect his ability to work “most of all.” As previously noted, the June 2020 examiner stated that she was unable to determine the impact of the Veteran’s mental health symptoms on his capacity for employment without resorting to mere speculation. The examiner noted that employment duties and settings are not homogeneous, and as such, simply knowing the Veteran’s current mental health symptoms does not provide enough information to opine as to whether he would have the “capacity” to be employed in general. Despite not providing a definitive opinion, however, the examiner did also note that there were a number of variables which have a bearing upon the Veteran’s capacity to work, of which his mental health symptoms are only one, such as physical health concerns. As noted, the Veteran has nonservice-connected musculoskeletal ailments that limit his ability to work in a physical environment. The record also reflects obstructive sleep apnea, diabetes, hypertension, and obesity. In December 2020, and pursuant to a September 2020 Board remand, an additional examination and opinion were obtained, as the June 2020 examiner did not specifically address the nature and extent of any impacts of the Veteran’s suicidal ideation on his capacity to obtain or maintain employment over the course of claim. The examiner opined, after review of the Veteran’s mental health records during the appeal where he consistently denied suicidal plan or intent, there were no concerns regarding the Veteran’s status in that regard. The examiner also noted that, while the Veteran has hearing difficulties, is “edgy” around people, and has difficulties with his memory, he appeared to be able to follow on repetitive tasks which do not require high levels of cognitive functioning. Treatment records are not in significant conflict with findings during VA examination. Taken as a whole, the Veteran’s symptoms do not suggest he was unable to obtain and maintain employment. Given the Veteran’s education and work history, symptoms reported by the Veteran, and the level of functional impairment as reported by VA examiners and treatment providers the Board does not consider his level of impairment as one that would preclude employment. The Board has considered the Veteran’s lay statements that his service-connected disabilities make it difficult to work, and the Board acknowledges the limitations of these disabilities. The Veteran’s functional limitations involving his hearing loss and tinnitus would not preclude employment that did not involve significant safety hazards requiring good hearing, and the Veteran has no other service-connected physical disabilities, such as a musculoskeletal disability. While the Veteran reported bilateral hip problems that would affect his mobility in a physical work environment, nonservice-connected disabilities cannot be considered in determining entitlement to a TDIU, nor can the Veteran’s advanced age. While he only obtained a high school diploma, he was able to maintain a decades-long career in manufacturing and maintenance, which was not impacted by any mental health or hearing loss disability. Rather, the Veteran retired due to age and physical ailments unrelated to any service-connected disability. While he reported irritability at work, this did not affect previous employment. To the extent his symptoms may currently be more severe than they were during his previous employment, the Board does not find that any other service-connected disability would prevent him from working in a setting where he had limited personal interactions. This type of work would also produce income above the poverty threshold. Moreover, the rating schedule already contemplates industrial impairment. Stated another way, evidence of occupational limitations is present in every case in which an evaluation has been assigned for a service-connected disability. See 38 C.F.R. § 4.1 (explaining that disability evaluation percentages “represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and their residual conditions in civil occupations” and “degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability”); see also Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). (“A high rating in itself is a recognition that the impairment makes it difficult to obtain and keep employment.”). If the Board were to accept the argument that evidence of occupational limitations due to service-connected disabilities necessarily constitutes evidence of unemployability, then entitlement to TDIU would be reasonably raised and warranted in every case where a Veteran challenged the assigned evaluation. Instead, for a Veteran to prevail on a claim for a TDIU the record must reflect some factor which takes the case outside the norm. The sole fact that the Veteran is unemployed or has shown evidence of a difficulty in obtaining employment is not enough. The question is whether this Veteran is capable of performing the physical and mental acts required by employment, not whether he can find employment. See 38 C.F.R. § 4.16(a). Van Hoose, 4 Vet. App. at 361. Accordingly, the Board finds that the preponderance of the evidence is against a finding that the Veteran is unable to secure and follow a substantially gainful occupation due to his service-connected MDD, hearing loss, and tinnitus, and the claim for entitlement to a TDIU is denied. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is inapplicable. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). J.N. MOATS Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Scarduzio, 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.